Exhaled breath condensate pH in the evaluation of asthma.

As a marker of inflammation, exhaled breath condensate (EBC) pH may be a useful screening tool in the evaluation of asthma, especially in a military recruit population. To evaluate the utility of EBC pH in the diagnosis of asthma, EBC pH levels were determined in basic military trainees prior to an evaluation for asthma that included a history, physical exam, baseline spirometry, and a methacholine or exercise challenge. Of 86 basic trainees who had symptoms suggestive of asthma and underwent methacholine or exercise challenges, 51 (59.3%) had a positive methacholine or exercise challenge and were diagnosed with asthma. The mean EBC pH of the trainees who were diagnosed with asthma (6.39, range 5.91-6.82), was significantly (p < 0.001) lower than those trainees without asthma (6.64, range 6.34-7.18). There was, however, some overlap of the EBC pH values between the two groups. The measurement of EBC pH did show a significant mean difference between asthmatic and nonasthmatic patients in a military recruit population.

Prevalence of positive skin test responses to 53 allergens in patients with rhinitis symptoms.

Prior studies looking at allergic sensitization have focused on narrow age ranges or small numbers of allergens. This study is the first to examine the prevalence of positive skin test responses in a symptomatic military population with a wide age range of patients and large number of allergens. This study was a retrospective analysis of our skin test database. We included 1137 patients aged 4-79 years old who underwent our standard skin-prick testing panel of 53 aeroallergens and 2 controls using the Quintest device (Hollister-Stier, Spokane, WA). Results indicated that 81.6% of patients had at least one positive skin test. Rates of atopy were similar between male and female patients; 9.2% of patients were monosensitized. The average number of positive skin tests peaked in the 10- to 19-year age group at 13.1 and declined in older age groups. The prevalence of atopy peaked in the 30- to 39-year age group at 85.5% and decreased in older age groups. The most common allergens were grasses, mountain cedar, and dust mites. Sensitization rates for many underreported allergens, including mouse and rat, are presented. This study shows that 81.6% of patients in a symptomatic military population were atopic. These rates are high, even when compared with other allergic populations. Atopy peaked in young adulthood and declined in older age groups. Grasses, mountain cedar, and dust mites were the most common allergens. Although performed in a military population, these results should be applicable to many allergy practices.

Delay of chemotherapy to prevent progressive vaccinia.

OBJECTIVE: The goal was to discuss the potential risk of progressive vaccinia in the setting of smallpox vaccination with immunosuppression and to present strategies to avoid progressive vaccinia. METHODS: A case report and literature review are presented. RESULTS: A 21-year-old, male, military member received smallpox vaccination and was coincidentally diagnosed as having osteosarcoma approximately 2 weeks later. His recent vaccination was recognized, and chemotherapy was subsequently delayed until separation of the scab at the vaccination site. The patient received neoadjuvant chemotherapy and fared well, without any evidence of progressive vaccinia or other smallpox vaccine complications. CONCLUSIONS: Smallpox vaccine should be withheld from immunocompromised patients because of the risk of progressive vaccinia. Conversely, immunosuppressive therapies should be delayed for recently vaccinated patients. There are no controlled trials in this area, but withholding immunosuppressive therapy until separation of the scab is a rational approach. This patient was exposed to chemotherapy after scab separation and did not develop progressive vaccinia.

Physical urticaria.

Physical urticarias are a unique subgroup of chronic urticaria in which patients develop urticaria secondary to environmental stimuli. Common triggers include exercise, temperature changes, cold, heat, pressure, sunlight, vibration, and water. Systemic symptoms have occurred during severe episodes. Physical urticarias are responsible for approximately 20% to 30% of all cases of chronic urticaria. A basic knowledge of these unusual disorders is important for all healthcare providers. This article covers the following types of physical urticarias: dermatographism, cholinergic urticaria, local heat urticaria, exercise-induced anaphylaxis, vibratory angioedema, solar urticaria, and aquagenic urticaria.

Use of immunotherapy in the management of presumed anaphylaxis to the deer fly.

BACKGROUND: Anaphylactic reactions to biting insects are generally thought to be rare events. Diagnostic and therapeutic standards for these events are not well documented in the literature. OBJECTIVE: We describe a case report of a patient with multiple suspected immunoglobulin (Ig)E-mediated anaphylactic reactions to biting insects, specifically deer flies (Chrysops sp.), as well as a successful response to immunotherapy. METHODS: Prick and intradermal testing with deer fly whole-body extract and measurement of specific IgE were performed to help determine the extent of the patient's hypersensitivity. Immunotherapy was subsequently administered with whole-body deer fly extract. RESULTS: Skin testing was unable to differentiate between the patient and normal controls. In vitro testing was positive in the study patient but only at a low level. After initiating immunotherapy, the patient had repeated exposures to deer fly bites but failed to develop symptoms consistent with his previous anaphylactic episodes. Followup testing on the patient revealed no significant change in the level of skin reactivity or specific IgE. CONCLUSIONS: Anaphylaxis consistent with an IgE-mediated mechanism to Chrysops sp. is a real phenomenon and is amenable to immunotherapy for the prevention of life-threatening sequela after exposure. Skin testing using whole-body extract appears to be unreliable. In vitro testing was better able to discern a true sensitivity, although the difference between patient and controls was small.