Oral desensitization to 5-aminosalicylic acid medications.

BACKGROUND: Although hypersensitive subjects have been desensitized to oral sulfasalazine, the feasibility of oral desensitization to the drug's active moiety, 5-aminosalicylic acid has been questioned and never been reported. METHODS: We devised a 5-aminosalicylic acid desensitization protocol and administered the drug to two hypersensitive subjects on three occasions. RESULTS: Both 5-aminosalicylic acid hypersensitive subjects were successfully desensitized without complications and were able to tolerate therapeutic doses. CONCLUSION: Despite changing the drug's properties by crushing it for incrementally increasing administration, we successfully desensitized two patients on three occasions with 5-aminosalicylic acid.

Mite allergen control with acaricide fails.

BACKGROUND: We compared the effects of an acaricide, benzyl benzoate, with the effects of baking soda control applied to bedroom and living room carpets on house dust mite allergen levels, lung function, and medication use in 12 adult patients with asthma for 12 months. METHODS: This was a randomized, double-blind, placebo-controlled study. Patients were enrolled from the allergy clinic of a large tertiary care center in a metropolitan area. All patients had positive dust mite puncture test results. Six patients used benzyl benzoate, and six used baking soda. Other aggressive mite control measures were implemented uniformly in each group. Subjects were to make two carpet applications, at baseline and at 6 months according to the manufacturer's recommendations. Dust samples were collected in bedroom and living room carpets at 0, 3, 6, 9, and 12 months; and quantities of Der p I and Der f I allergens were determined. Spirometry was done every 3 months, and peak flow rates were recorded for 10 days after each dust sampling. RESULTS: There were no significant differences in mean allergen levels between the two groups over time at either site. There were no significant changes in lung function or medication use for either group. CONCLUSIONS: Benzyl benzoate powder applications may not be effective when done according to manufacturer's instructions. Further studies are necessary to test effectiveness when applied more frequently and for longer periods.

Effective education of adults with asthma who are allergic to dust mites.

The effects of supplementary computer instruction in house dust mite-avoidance measures on adherence to implementing measures, on home dust mite-allergen levels, and on symptomatology were investigated in 52 adult patients with mite-associated asthma. Twenty-six patients received conventional instruction (counseling and written instruction) and the other 26 patients received conventional plus 22 minutes of interactive computer-assisted instruction. Instructions were aimed at mite-avoidance measures. Pre- and postinstruction dust samples were collected, and adherence was monitored. All patients kept symptom diaries twice a day. Patients' progress was followed for 12 weeks, and all patients completed the study. Adherence, number of observed and self-reported mite-avoidance measures implemented after visit, was higher for the computer group (p = 0.023). The computer-instructed group achieved significantly lower levels of mite allergen in bedroom carpets (p = 0.004) with mean levels of mite allergen declining from 6.5 +/- 7.6 to 2.2 +/- 4.3 micrograms/gm of dust (two-site monoclonal antibody assays), whereas levels for the conventional-instructed group did not change. Moreover, by study weeks 9 and 10, the computer-instructed group was significantly less symptomatic (p = 0.033). Mean symptom scores for this group decreased from 12.4 to 7.7, compared with 16.4 to 14.3. Conventional instruction supplemented with computer instruction is suggested in mite education.

Acute dosing with methylprednisolone in normal subjects does not affect theophylline clearance.

This investigation was prompted by earlier studies that suggested that short-term corticosteroids alter the clearance of theophylline. We evaluated the kinetics of theophylline administered with and without doses of oral methylprednisolone in six normal subjects. One milligram per kilogram of methylprednisolone or placebo was administered eight hours and again one hour prior to an infusion of 6 mg/kg of aminophylline. Serum levels were monitored at 15 minutes, 30 minutes, 11/2 hours, 2, 4, 6, 8, and 12-14 hours. Clearance after administration of steroids in the former was 43 +/- 7 mL/kg/h (SD) and after placebo 42 +/- 10, mL/kg/h. These data indicate that at this dose and duration methylprednisolone seems to have no statistical or clinically significant impact upon the clearance of theophylline in normal subjects.

Corticosteroids and theophylline clearance.

Whether the administration of corticosteroids affects the disposition of theophylline remains unclear. Increased clearance, decreased clearance, and no change in clearance are all reported with steroid doses that are used in the treatment of asthma. This study found that theophylline kinetics among two normal subjects did not change after corticosteroids, while in one normal adult, clearance was significantly higher after corticosteroids. Additional study will be needed to ascertain if oral corticosteroids given over a short period may affect theophylline disposition in some patients.

Assessment of IgE-mediated sensitivity during immunotherapy: comparison of the RAST with and without adsorption of IgG to titrated prick skin tests.

The effect of specific IgG induced by allergy immunotherapy on specific IgE binding in the RAST was assessed by removal of the IgG with staphylococcus protein A bound to Sepharose. In sera from those patients with the highest titers of specific IgG, RAST binding was increased 8% following adsorption of the post-immunotherapy sera while in sera obtained from the same patients before immunotherapy adsorption increased binding only 3%. The effect of allergy immunotherapy on the titrated prick skin test was compared to the effect on the RAST to the same allergen. In nine patients who received the highest dose of grass extract, the area of the titrated prick skin tests was reduced following immunotherapy by 75%. Staphylococcus protein-A adsorption of sera from these patients drawn before immunotherapy resulted in an increase in RAST binding of 2.7% compared to an increase of 6% in sera obtained after immunotherapy, suggesting suppression of RAST binding of only 3% by specific IgG. It is concluded that RAST levels are affected less than prick skin tests by the immunologic response to allergy immunotherapy. Some interference in RAST binding is produced by specific IgG antibody in high titers, but for many critical purposes the degree of interference is not significant.

Cromolyn sodium in seasonal allergic conjunctivitis.

A formulation of 2% cromolyn sodium (CS) ophthalmic solution without the preservative, 2-phenylethanol, was compared with placebo in 58 patients with seasonal allergic conjunctivitis. Selection was based on history and positive skin tests. Neither immunotherapy nor use of antihistamines was allowed. This study was double-blinded and stratified by RAST scores to assure comparable groups. Either CS or placebo was used six times daily. Patients were observed weekly for 5 weeks during the peak of the fall weed-pollen exposure. Nasal symptoms were treated as required with beclomethasone nasal spray, and uncontrolled ocular symptoms were treated with boric acid and ephedrine solution. Nasal and ocular symptoms were recorded. There was a significant suppression of eye symptoms in the group receiving CS ophthalmic solution (p less than 0.02) during weeks 2, 4, and 5. There was a trend for nasal symptoms and the requirement for nasal beclomethasone to be less in patients receiving CS.

Criteria for the discontinuation of antibiotic therapy during presumptive treatment of suspected neonatal infection.

Unstable newborns are often subjected to multiple diagnostic tests and then treated presumptively for bacterial infection. Inconclusive test results may perpetuate unnecessary therapy. One hundred twenty-three neonates were prospectively evaluated for infection. Complete physical examinations and chest radiographs were performed. Of ten screening tests only the white blood cell count, absolute band count, absolute band/neutrophil ratio and C-reactive protein showed statistical differences (P less than 0.05) among 32 patients with positive "nonpermissive" (blood, cerebrospinal fluid, suprapubic or catheter urine, needle aspirate, tracheal aspirate) cultures and 50 with negative cultures who had antibiotic therapy discontinued within 72 hours. Forty-one additional patients were continued on therapy despite negative cultures. Incomplete bacteriologic evaluation resulted in unconfirmed "pneumonia" in 16 of these children. No statistical differences between the culture negative groups existed regardless of treatment status, suggesting that patients in the latter group may not have required continued treatment. A definitive, bacteriologic evaluation emphasizing "nonpermissive" cultures should be completed in newborns suspected of infection which, when negative, should allow discontinuation of antibiotics. In equivocal cases, a negative C-reactive protein best supports cessation of therapy. This approach can reduce the total duration of newborn exposure to antibiotics in a high risk nursery by 20%. A prospective, definitive, diagnostic evaluation (emphasizing non-permissive cultures) avoids uninterpretable but frequently used tests and reduces cost while adding confidence in the termination of therapy.