A model of viral wheeze in nonasthmatic adults: symptoms and physiology.
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Episodic wheezing associated with viral infections of the upper respiratory tract (URT) is a common problem in young children but also occurs in adults. It is hypothesized that an experimental infection with human coronavirus (HCoV), the second most prevalent common cold virus, would cause lower respiratory tract (LRT) changes in adults with a history of viral wheeze. Twenty-four viral wheezers (15 atopic) and 19 controls (seven atopic) were inoculated with HCoV 229E and monitored for the development of symptoms, changes in airway physiology and provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (FEV1) (PC20). At baseline, viral wheezers were similar to controls in PC20 (mean+/-SD log2PC20: 5.1+/-1.9 and 5.8+/-1.4 g x L(-1), respectively) but had a lower FEV1 than controls (mean+/-SD 85.8+/-11.4 and 95.6+/-13.2% predicted, respectively p < 0.05). Nineteen viral wheezers and 11 controls developed colds. Viral wheezers with colds reported significantly more URT symptoms than controls (median scores (interquartile range): 24 (10-37) and 6 (4-15), respectively p = 0.014). Sixteen viral wheezers and no controls reported LRT symptoms (wheeze, chest tightness and shortness of breath). The viral wheezers with colds had small (3-4%) reductions in FEV1 and peak expiratory flow on days with LRT symptoms (days 3-6), but a progressive reduction in PC20 from baseline on days 2, 4 and 17 after inoculation (by 0.82, 1.35 and 1.82 doubling concentrations, respectively). The fall in PC20 affected both atopic and nonatopic subjects equally. There were no changes in FEV1 or PC20 in controls. An adult model of viral wheeze that is independent of atopy and therefore, of classical atopic asthma was established. (+info)
Painless thyroiditis induced by the cessation of betamethasone.
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We describe the first reported case of painless thyroiditis induced by an abrupt cessation of betamethasone. A 53-year-old woman experienced transient thyrotoxicosis after the abrupt cessation of celestamine, a mixture of betamethasone and chlorpheniramine. Since neither TSH receptor- nor thyroid stimulating-antibodies were negative, and thyroid scintigram did not show the thyroid gland, she was diagnosed as having painless thyroiditis. Fourteen months after the onset of thyrotoxicosis, serum TSH was detectable without hypothyroidism. We speculate that reduction in betamethasone may be one of the triggers of painless thyroiditis. (+info)
Regulatory roles of IL-12, IL-4 and IFN-gamma on IgE synthesis in atopic patients.
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OBJECTIVE: To investigate the mechanism of cytokine regulation in atopy by analyzing the effects of three major cytokines, IL-4, IL-12 and IFN-gamma on in vitro IgE synthesis of human peripheral blood mononuclear cell (PBMC) from normal individuals and atopic patients. METHODS: We investigated 5 normal individuals and 22 atopic patients including 12 allergic asthma, 8 allergic rhinitis and 2 atopic dermatitis. Human PBMCs were separated and incubated in 96-wells culture plates with different cytokines. Cultured for 7 days, the supernatant was collected and the contents of IgE synthesized in vitro were detected. RESULTS: There was no IgE synthesis in vitro of PBMC from all the normal individuals and 7 patients, however, other 15 patients' PBMC could produce IgE in vitro. We found that rhIL-4 could induce in vitro IgE synthesis of PBMC from all the normal individuals and 22 patients. rhIL-12 could inhibit IgE synthesis induced by rhIL-4. Further investigation of cytokine effects on IgE synthesis was conducted in 15 patients whose PBMCs did produce IgE in vitro (average level was 714 +/- 1105 ng/L). The following effects were observed: (1) 10 micrograms/L rhIL-4 could augment in vitro IgE synthesis from 714 +/- 1105 ng/L to higher level of 1483 +/- 1396 ng/L; (2) 20 micrograms/L rhIL-12 could inhibit in vitro IgE synthesis from 714 +/- 1105 ng/L to lower level of 452 +/- 969 ng/L; (3) rhIL-12 could block IgE synthesis induced by rhIL-4 to the level of 583 +/- 1084 ng/L; (4) 50 micrograms/L IFN-gamma could inhibit in vitro IgE synthesis from 714 +/- 1105 ng/L to the level of 461 +/- 1063 ng/L. CONCLUSIONS: rhIL-4 could induce in vitro IgE synthesis, rhIFN-gamma could inhibit the in vitro IgE synthesis and rhIL-12 could antagonize rhIL-4 effect on in vitro IgE synthesis of PBMC from atopic patients. (+info)
The costs of nonsedating antihistamine therapy for allergic rhinitis in managed care: an updated analysis.
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OBJECTIVE: To update a prior study evaluating the use and costs of new-generation antihistamines for the treatment of allergic rhinitis in a managed care population. STUDY DESIGN: A retrospective database review of rhinitis-related medical and pharmacy-related claims during a treatment period of 12 months. METHODS: Patients who had been diagnosed as having allergic rhinitis and had at least 1 prescription claim were identified from a database containing patient-level medical and pharmaceutical claims. The treatment patterns for patients meeting study criteria were documented for a 12-month period to describe how nonsedating antihistamines are being used in allergic rhinitis, and to assess the associated costs of various medications. Subanalyses of patients categorized by comorbidity status were also performed. RESULTS: A total of 105,696 patients were included in this updated analysis, covering calendar year 1999. Nonsedating antihistamines were used by 68% of the sample, with loratadine and fexofenadine being the most commonly prescribed agents. The mean annual rhinitis-specific charge for fexofenadine-treated patients was $409 (standard deviation [SD] 727), which was significantly lower compared with charges for loratadine-treated patients, $424 (SD 740), P = .0144, or cetirizine-treated patients, $444 (SD 625), P < .0001. This trend was also observed in comparisons of patient subgroups. CONCLUSIONS: Consistent with our prior study, loratadine and cetirizine were generally associated with significantly higher treatment charges than fexofenadine. This result was observed across different stratifications of patients, including those with comorbid respiratory illness, concomitant use of nasal steroids, and asthma and/or sinusitis. These results provide further useful insights into the differential costs associated with the use of nonsedating antihistamines for allergic rhinitis treatment. (+info)
Identification of missense mutation in the IL12B gene: lack of association between IL12B polymorphisms and asthma and allergic rhinitis in the Japanese population.
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Interleukin-12 (IL-12) is a macrophage-derived cytokine that modulates T lymphocyte responses and can suppress allergic inflammation. In a genome-wide screen, we found strong evidence for linkage of atopic asthma with marker D5S1352, located close to IL12B, with a maximum lod score of 4.34. We screened for mutation in IL12B and found three novel (-4475-4insG, Glu186Asp and Ser226Asn) variants and one previously reported (1188A>C) variant in IL12B, and conducted transmission disequilibrium tests in families identified through children with atopic asthma or allergic rhinitis. Frequencies of the Asn226 and 1188C alleles in the parents were 0.04 and 0.5, respectively. Preferential transmission of either the Ser226/Asn226 or 1188A/C allele to asthma-affected or rhinitis-affected children was not observed (P > 0.1) and was not associated significantly with total serum IgE level (P > 0.1). Our results indicate that polymorphisms in IL12B are not likely to be associated with the development of atopy-related phenotypes. (+info)
Wood stove heating, asthma and allergies.
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In two German studies household wood or coal stove use was negatively associated with atopic sensitization and allergic rhinitis in childhood. Wood stove heating is strongly related to 'traditional lifestyle and therefore subjected to confounding factors possibly yet not known. The study was conducted to study these factors and the independent impact of early exposure to wood stove heating on subsequent asthma and atopic disease. In a questionnaire survey among 10667 Finnish university students aged 18-25 years, we investigated the association between wood stove heating at age 0-6 years and asthma and allergies up to young adulthood. Adjustment was made for factors related to the heating system and atopic disorders by using multivariate regression. Unadjusted lifetime prevalence rates for physician-diagnosed asthma, allergic rhinoconjunctivitis, atopic dermatitis and self-reported wheezing were lower among subjects with wood stove heating compared to other heating systems. There was a significant negative association between childhood wood stove heating and allergic rhinitis or conjunctivitis in the univariate model (OR 0.61, 95% CI 0.61-0.91), but not for the other diseases. The significant association disappeared in the multivariate analysis after adjusting for various family indoor and outdoor (adjusted OR 0.96, 95% CI 0.77-1.20) factors. The association between wood stove heating and allergic rhinoconjunctivitis was mainly confounded by childhood residential environment, especially the farm environment. Farm environment was found to be the main confounding factor related to association between wood stove heating and asthma, and atopic diseases. (+info)
Multicenter study on the prevalence of perennial allergic rhinitis and allergy-associated disorders.
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Multicenter Study on the Prevalence of Perennial Allergic Rhinitis and Allergy-Associated Disorders This study was aimed to determine the prevalence of perennial allergic rhinitis (PAR) using the skin test, radioallergosorbent test (RAST), or multiple allergosorbent test (MAST) and to clarify the clinical aspects of the patients diagnosed as having PAR by the questionnaire survey and rhinologic examination. The 71,120 subjects who had visited the 23 otolaryngology clinics at the randomly selected tertiary referral hospitals in Korea between November 1, 1999 and April 30, 2000 were studied. PAR was diagnosed when subjects complained of two or more associated symptoms and the skin test, RAST, or MAST using perennial inhalant allergens was positive. The questionnaire survey and rhinologic examination were performed in subjects with PAR. The prevalence of PAR was 3.93%. We could find no significant difference in the prevalence of PAR between the two sexes. However, there was a significant difference in the prevalence of PAR between the child and adult groups. The chief complaints were, in order of decreasing frequency, nasal obstruction, watery rhinorrhea, and sneezing. There was a family history of PAR in 40.2% of the subjects. The 39.6% of the subjects had associated allergic diseases, being atopic dermatitis most common. In conclusion, the prevalence of PAR in tertiary referral hospitals in Korea is 3.93%. Many subjects with PAR have family history and appear to be associated with other allergic diseases. (+info)
A double-blind, placebo-controlled, and randomized study of loratadine (Clarityne) syrup for the treatment of allergic rhinitis in children aged 3 to 12 years.
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Allergic rhinitis is a common disease in children, and antihistamines are the key medication. However, traditional tablets are not convenient and lead to low compliance in young children. The aim of this double-blind, placebo-controlled, parallel, randomized study was to evaluate the effectiveness and safety of loratadine syrup for the treatment of children aged 3 to 12 years with allergic rhinitis. Sixty children with allergic rhinitis due to dust mites were enrolled. They were randomized into 2 parallel groups: one group received loratadine syrup 5 mg or 10 mg daily for 3 weeks, and the other group received placebo. The patients returned to special clinics for symptoms evaluation at day 7 and day 21, and the parents were requested to record disease severity daily. Both evaluations, physician's and parents', were recorded with a 4-point scale for 5 symptoms: sneezing, rhinorrhea, nasal congestion, nasal itching and ocular symptoms. Forty-six patients completed the study, 22 in the loratadine group and 24 in the placebo group. At the initial visit, the total symptom score (TSS) in both groups was not significantly different (p = 0.39). The TSS of the loratadine syrup group at day 7 and day 21 was lower than those of the placebo group (p = 0.003, p = 0.06). The daily card scores in the experimental group were also significantly lower than those of the placebo group (week 1, p = 0.014; week 2, p = 0.029; week 3, p = 0.014). No adverse reactions were recorded in both groups. This study revealed that loratadine syrup 5 mg or 10 mg once a day improved symptom scores of children with allergic rhinitis effectively and safely. (+info)