The effect of chlorpheniramine on asthma.

Patients with stable asthma can tolerate antihistamines without any significant deleterious effects both on a short- and a long-term basis. In addition, patients with steroid-dependent asthma appear to tolerate antihistamines without any significant deleterious effects. Therefore, oral chlorpheniramine does not appear to have ill effects on patients with asthma. Warning labels required by the FDA for antihistamine use in asthmatics are unnecessary.

High frequency of atopic asthma in a pulmonary clinic population.

Seventy-two consecutive adult asthmatic patients seen in the Pulmonary Clinic at Rhode Island Hospital were tested for atopy by prick test with 14 standard aeroallergens and by in vitro total and specific IgE determinations (FAST). A total of 58.3 percent of patients were found to be atopic by these tests. There was a significant difference between the mean total serum IgE in atopic and nonatopic asthma and in atopic asthma and control subjects. The age onset was lower in atopic asthmatic patients, and they were more likely to have a history of chronic rhinitis than nonatopic subjects. Family history of rhinitis or asthma and severity of asthma was not different between the two groups. Since our outpatient facility has a large allergy clinic in proximity to the pulmonary clinic, which was the source of our patient population, this investigation has a negative bias toward allergy. Nevertheless, this study reveals that atopy is common in adult asthmatic patients, and a battery of allergy tests (skin tests or in vitro tests) together with total serum IgE is able to differentiate between atopic and nonatopic asthma.

Anaphylaxis to peanuts: clinical correlation to skin tests.

To determine the prevalence of peanut sensitivity in a group of patients referred for routine allergy evaluation, we skin tested 365 consecutive patients with a battery of extracts that included pollens, danders, mold, dust and peanuts. These patients were seen either in private practice or in the Allergy Clinic (Rhode Island Hospital). Of these 365 patients, 248 were found to be atopic. Eight patients had a positive scratch test to peanut extract, and four of these had a positive history of peanut sensitivity. One asymptomatic patient to peanut by history reacted to open challenge with 2 oz of peanut on two occasions. We, therefore, found that 3.2% (8 of 248) of our atopic patients had a positive skin test to peanuts and of these at least 62.5% (5 of 8) had clinical sensitivity to peanuts. No nonatopic patient reacted to peanut skin testing.

Eastern pine sensitivity in New England.

The purpose of this study is to assess the frequency of clinical sensitivity to Eastern White Pine Pollen, 100 consecutive patients with the seasonal (SAR) or perennial (PAR) allergic rhinitis seen in the allergy clinic were prick tested with pine pollen extract, 8-tree mixture, histamine and negative control. Positive skin test (ST) was defined as a wheal greater than 3 mm larger than control, plus flare. Patients with a positive ST were then asked to stop antihistamine and other related drug, for 48 hours and challenged in a double blind manner with increasing concentrations of intranasal pine extract, starting at 1/100,000 w/v, followed by 1/10,000, 1/1000 and 1/100 at 20 minute intervals. The dose given was 0.15 cc by metered dose spray; one nostril received pine extract diluted in saline, the other received plain saline,. Rhinometric measurements were obtained before and 20 minutes after each challenge. Positive challenges were defined as 1) subjective feeling of increased stuffiness or rhinorrhea and 2) greater than 25% decrease in nasal airflow. Six patients (6%) had a positive ST to pine pollen extract and two of four patients with positive pine skin test had a positive FAST. Four of these were challenged intranasally, 2 had a positive challenge. All six patients had a history of spring SAR and positive reaction to 8-tree mix. Out of the 100 patients skin tested, 61 had spring SAR; therefore, the incidence of positive ST to pine in patients with spring SAR was 6/61 (10%). We conclude that pine pollen can be a cause of spring SAR in the New England area.

Osteonecrosis as a complication of steroid dependent asthma: a case report and review.

Corticosteroid associated osteonecrosis is a complex disease requiring high physician suspicion to make an early diagnosis. Although the exact cause is not completely known, it appears that systemic illness, anatomic location and elevated interosseous pressures interact to produce this lesion. Plain film and technetium bone scan are most commonly used for diagnosis, but occasionally, invasive procedures are required. Surgical treatment, ranging from decompression to total hip replacement, is most commonly, but not always recommended.

Rechallenge of patients who developed oral candidiasis or hoarseness with beclomethasone dipropionate.

Of 158 asthmatic patients who were placed on inhaled beclomethasone, 15 (9.5%) developed either hoarseness (8), oral thrush (6), or both (1). When their adverse reactions subsided, seven of these 15 patients were rechallenged with inhaled beclomethasone. These included five cases who developed hoarseness and three who developed Candidiasis. One patient had both. Oral thrush did not recur, but 60% (3/5) of patients with hoarseness had recurrence. We conclude that patients may be restarted on inhaled beclomethasone when clinically indicated; however, because of the high recurrence rate, patients who develop hoarseness should not be re-challenged. Concomitant use of oral prednisone and topical beclomethasone may increase the risk of developing hoarseness or candidiasis.