SMS Medical Outcomes Research Project Asthma Outcomes Study. Provider education the next step.

Since the initial meeting of the Asthma Study Group in the summer of 1996, the group worked with MORP staff to develop an outcomes instrument, define a study population, survey more than 800 adults with the diagnosis of asthma, and report the survey results back to the providers involved with those patients. After reviewing the survey results, the group developed an Asthma Toolkit aimed at providing reference materials for physicians and their staff and also useable materials for their patients with asthma. The Asthma Toolkit was produced through the efforts of the study group, the SMS MORP staff and the SMS Marketing and Communications Department. We developed an education program to disseminate the toolkit and improve the care of the patient with asthma. Initial reaction to this educational program has been enthusiastic, and evaluation of the Asthma Toolkit's usefulness is underway.

Inhaled aeroallergen and storage mite reactivity in a Wisconsin farmer nested case-control study.

A nested case-control study was undertaken to assess the role of antibody (Ab) to a panel of antigens associated with hypersensitivity pneumonitis in the development of lung disease among Wisconsin dairy farmers. Immunologic reactivity to a panel of inhaled allergens was assessed in the Ab+ cases and compared to the Ab+ control, Ab- control, and Ab- blue-collar control subjects by skin tests, RAST assays, and a modified American Thoracic Society questionnaire. The most prevalent allergens among the cases as determined by either skin test or RAST assays were the house dust mites (HDM) (21.6%), storage mites (11.2%), grain smuts (11.2%), Cladosporium (7.5%), Aspergillus (6.0%), and cattle (5.2%). No other allergens appeared to be different from in nonfarming populations. Of the storage mite reactors, IgE to Lepidoglyphus destructor (7 of 8) was the most frequently found, followed by Tyrophagus putrescentiae (6 of 8), Glycyphagus domesticus (5 of 8), Chortoglyphus arcuatus (5 of 8), and Acarus siro (2 of 8). L. destructor was also isolated from the farm of one of the cases. There was no difference in the total IgE levels among the groups. Reactions to HDM, storage mites, and grain smuts were significantly more frequent among the cases (p < 0.05). We conclude from this study that there is a significant increase in reactivity to certain inhaled allergens among those dairy farmers reporting barn-associated respiratory symptoms that is unrelated to past exposure to the causative agents of farmer's lung disease.

Dermatophagoides farinae allergen levels from two different sources within the same home: evaluation of two different collection techniques.

The allergens produced by the dust mites of the Dermatophagoides genus are now recognized as one of the major allergens in house dust. Quantification of those allergens helps to evaluate the effectiveness of avoidance measures and specific treatments aimed at the reduction of the mites and their allergens. The present study was undertaken to compare the level of D. farinae allergen collected by a standard vacuum cleaner with a disposable bag and the level of allergen collected by a hand-held vacuum equipped with a special filter. Samples were obtained from the main living area of 18 homes of patients allergic to D. farinae. Using a hand-held vacuum especially equipped with a removable micropore filter, a 2-m2 area of carpet was vacuumed for two minutes and an identical sample was collected from the major upholstered piece of furniture in the room. A third sample was obtained with an upright vacuum fitted with a clean disposable bag. The dust collected was extracted in phosphate buffered saline and resultant extracts were assayed for D. farinae allergen content by microtiter plate RAST inhibition assay. Results from these assays showed a large interhome variability regardless of sampling technique, but intrahome sampling showed remarkable consistency. A linear regression analysis demonstrated all of the comparisons correlated at a probability level of P less than .05. We conclude that dust mite allergen levels collected in a disposable bag vacuum cleaner are reliable indicators of the level of house dust mites present in the homes of patients.

House dust mites in the West Indies.

The purpose of this study was to determine the role of the house dust mite. Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df), in allergic diseases on the island of St. Lucia. Dust samples were taken from living quarters of patients and hospital volunteers. The level of Df antigen in these living quarters was measured by RAST inhibition. All samples showed Df antigen within a large range of values. Prick tests were done to house dust mite and molds on 91 patients with suspected allergic disease with 63 (69%) reacting to at least one antigen. Of these, 56 (88.9%) reacted to one or both mites. House dust mite is a major allergen in St. Lucia.

Evaluation of multi-allergen dipstick screening test.

In order to determine the diagnostic performance of the Quidel Allergen Screen (QAS), 43 patients characterized by standard skin prick test and intradermal testing for atopic sensitivity were evaluated, in parallel, using Phadebas RAST and QAS to detect the presence of serum IgE. The Quidel Allergen Screen and RAST were compared with the investigator's clinical assessment. The differences between QAS and RAST are not statistically significant. The QAS appears to be equal to the Phadebas RAST in sensitivity and specificity and thus offers a rapid, easily interpreted in vitro method for the detection of specific serum IgE.

The development of asthma after tracheobronchial aspiration of a foreign body.

To evaluate whether a tracheobronchial foreign body (TBFB) itself or its removal by bronchoscopy with the patient under general anesthesia predisposed children to asthma, we surveyed 58 children who had a TBFB removed at the Mayo Clinic between 1970 and 1978. A control group included children who had undergone tonsillectomy or adenoidectomy. Asthma developed in four children in each group. Children with a TBFB do not seem to be predisposed to the development of asthma.

Immunochemical measurement of airborne mouse allergens in a laboratory animal facility.

The major allergens from the mouse, including mouse serum albumin (MSA) and mouse urinary protein complex, are present in various concentrations in urine, serum, and pelts of mice. Subjects clinically sensitive to laboratory animals were screened by the RAST for specific IgE antibodies to mouse urine (MU), MSA, and mouse pelt extract (MPE). Twenty-four hour air samples from both a mouse-care room (2000 mice) and an immunology laboratory (five to 100 mice) were collected with a high-volume air sampler that retained particles greater than 0.3 micron with 95% efficiency. Eluates from the filter sheets were dialyzed, lyophilized, reconstituted in water, and used as fluid-phase inhibitors in the MU RAST and MPE RAST. MPE allergenic activity could be quantitated in filter eluates from both locations, but MU allergenic activity could be quantitated only in the mouse-care room. Airborne allergen content ranged from 1.8 to 825 ng/m3 and varied with both the number of mice and the degree of work activity in the rooms. The sampling and assay techniques described can be used to accurately quantitate amorphous airborne allergens.

Occupational asthma in a florist caused by the dried plant, baby's breath.

A 34-year-old gift shop owner with a history of virus-induced bronchospasm and seasonal allergic rhinitis developed daily asthma when he began working with dried plants. Extracts were made from these dried plants, including baby's breath. German statice, leather leaf fern, and eucalyptus. Intradermal skin tests with these extracts were positive for the dried plant, baby's breath (Gypsophilia panniculata). The patient's serum contained elevated levels of IgE antibody to baby's breath extract, his leukocytes released histamine after challenge in vitro with the baby's breath extract, and bronchial challenge with baby's breath extract produced greater than 20% fall in his FEV1 from baseline. He recovered fully after avoiding the plant. This is the first report of a case of IgE-mediated occupational asthma involving the dried plant, baby's breath.

Respiratory syncytial virus infection: ten-year follow-up.

Studies within the last 20 years have shown that the incidence of asthma is increased in children who have been hospitalized with bronchiolitis due to respiratory syncytial virus. To evaluate such respiratory consequences in an ambulatory population, a follow-up study was done of 37 children who had respiratory syncytial virus infection documented at a community pediatric clinic in 1968 when they were younger than 4 years. This study, done ten years later by chart review and parental interview, showed that asthma had subsequently been diagnosed in three (8%). Thus, an increased risk for the development of asthma after respiratory syncytial virus infection was not found. Comparison of these data with those from previous reviews questions a causative role for respiratory syncytial virus in childhood asthma.