Cockroach allergy and allergen-specific immunotherapy in asthma: potential and pitfalls.

PURPOSE OF REVIEW: To provide a summary and discussion of cockroach allergy and clinical trials of cockroach allergen immunotherapy. RECENT FINDINGS: Cockroach allergen exposure among sensitized children is increasingly recognized as a key factor contributing to asthma morbidity. Recent trials suggest that cockroach immunotherapy holds promise as a treatment strategy with studies demonstrating immunomodulatory and clinical effects. However, a few obstacles need to be overcome to realize the full potential of this treatment modality as cockroach-allergic patients often exhibit complex sensitization patterns to multiple cockroach-associated proteins, and an immunodominant allergen has not been identified. These factors have made it difficult to produce standardized cockroach allergen extracts that are potent and provide the broad allergen profiles needed for optimal treatment. There have been important advances in the identification and cloning of cockroach allergens, and several strategies are being developed to provide therapeutic cockroach allergen products with enhanced clinical efficacy. SUMMARY: Allergen immunotherapy has the capability of modulating the immune response to cockroach allergen and has potential as a valuable treatment modality. Further studies of the clinical efficacy, along with the development of improved therapeutic products, are needed to advance our knowledge and realize the full potential of this promising therapy.

The use of hospice care in end-stage psychiatric patients.

Hospice care is rarely used in end-stage psychiatric patients, yet situations exist where psychiatric intervention is futile and comfort care is the best option. Delusional disorder is rare, typically begins later in life, and has a chronic course that responds poorly to treatment. The prognosis is affected by factors such as chronicity and insight. A case of a chronic and intractable delusional disorder that affected eating behavior and subsequently caused serious medical complications. Due to the severity of the case and the unique ethical issues it presented, the prognosis was determined to be poor and the patient was discharged home with hospice care. The case presented a rare opportunity to assess hospice care provided to an end-stage psychiatric patient.