Seasonal Allergies

abstract: Subcutaneous allergen immunotherapy is clearly beneficial in the treatment of select patients with allergic rhinitis or asthma. However, this therapy is underused, partly because it requires administration in a medical facility. Sublingual immunotherapy (SLIT) may be a promising alternative; it appears to be associated with fewer adverse effects, which suggests that it might be administered at home. Currently, there is no FDA-approved formulation for SLIT in the United States. However, allergists are showing increased interest in this therapy, and an approved formulation may be available in the near future. A number of studies have shown the clinical efficacy of SLIT, but many questions remain unanswered, including the effective dose, optimal treatment schedules, and overall duration of treatment. (J Respir Dis. 2007;28(4):162-168)

LONDON -- On the eastern Mediterranean island of Crete, where olive oil is the primary source of fat, children with allergic rhinitis are uncommon, found a British team.

Allergic disorders are becoming more common. For example, about 20% of Americans have allergic rhinitis, which accounts for more than 10 million office visits each year. Most of these visits are to primary care clinicians.

SAN DIEGO -- Nearly half of all patients with seasonal allergies cite symptoms that can be triggered by non-allergic irritants, many of them linked to indoor air quality problems.

A study conducted in France provides further evidence of how allergic rhinitis adversely affects quality of life. Léger and associates found that allergic rhinitis impairs all dimensions of sleep quality.

Many patients with postnasal drip syndrome, allergic rhinitis, or sinusitis use nasal saline solution erratically and only a few drops at a time. Be sure to tell patients that they must flush their nasal passages with a generous amount of saline solution at least 4 or 5 times a day to have an effect.

Children sometimes have difficultyusing nasal sprays for allergies.

For 15 years, a 33-year-old man hashad scale on the soles of his feet;the condition has failed to respondto various topical antifungal agents.He has no other rashes. He ishealthy except for a history of seasonalallergies controlled by overthe-counter medications.

To prevent epistaxis or damage to theseptum from the use of a corticosteroidnasal spray, advise patients to crosstheir arms and spray with the handcontralateral to the target nostril.

Although spraying aerosolized corticosteroidsin the anterior nostrilsis sufficient to treat allergic rhinitis,these medications must be depositedin the posterior nasopharynx to beeffective in conditions such as snoringand eustachian tube dysfunction.

ROCKVILLE, Md. -- The FDA today approved Omnaris (ciclesonide), a corticosteroid nasal spray, for hay fever symptoms in adults and children 12 years of age and older.

BALTIMORE -- An investigational hay fever vaccine appears to reduce the symptoms of ragweed allergy for up to two years after a course of only six injections, according to researchers here.

As with any potential exposure, the initial approach should be to establish the patient's diagnosis before attempting to determine the effect of a potential exposure. The main differential diagnoses to consider for a patient who has cough and wheezing that may be associated with an exposure are asthma, chronic obstructive pulmonary disease, allergic rhinitis, and vocal cord dysfunction.

Abstract: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling allergens in the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis. (J Respir Dis. 2006; 27(10):435-440)

ABSTRACT: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis.

My patient, in whom allergic rhinitis has been diagnosed, has been receiving weekly allergy shots since June 2003 and has benefited greatly. However, she complains that she sometimes smells "cigarette smoke" for periods of 2 to 3 days. What might be the cause of this?

ROCHESTER, Minn. -- An elevated inflammatory response in patients with atopic allergic diseases, especially allergic rhinitis, may predispose them to Parkinson's disease, suggested researchers here.

Patients with allergic rhinitis are genetically predisposed to producing specific IgE antibodies in response to environmental allergens, such as tree, grass, or ragweed pollen or cat, dog, or dust mite allergens. Patients must have symptoms suggestive of allergies and positive skin or serologic test results that correlate with their symptoms.

A review of the environmental determinants of allergic rhinitis and asthma, including house dust mites, cats, dogs, and cockroaches.

Avoidance of allergens and irritants known to cause or aggravate allergic rhinitis and asthma is a key component in the management of these disorders.

Allergy testing can be done any time that allergy is suspected, and it should be done if it is not clear whether the patient's symptoms are related to allergic or nonallergic causes. Seasonal allergies can often be controlled with medication--either a single medication or a combination. If this is possible, then allergy testing is not really necessary. The test results might be interesting to the patient and health care provider but would not change what they would do.

A 24-year-old woman complained of a rash on both feet and legs. She had also had intermittent pain in both ankles for the past year.

For the past few weeks, pruriticpatches have been erupting on a38-year-old man’s extremities. He recallsthat similar lesions occurredduring the last 2 winters. The patienthas a history of seasonal allergies;he owns a cat and 2 dogs.

A 3-day history of intermittent fainting spells brings a 49-year-old man to youroffice. His only significant medical history includes seasonal allergic rhinitis,for which he takes terfenadine, and mild depression, which is being treatedwith amitriptyline. A week ago, he began taking erythromycin, 500 mg qid,for acute pharyngitis.

What is your opinion of using intramuscular (IM) injections of corticosteroids,such as triamcinolone acetonide, for seasonal allergies?

A number of inflammatory diseases have been associated with an increased risk of atherosclerosis. Knoflach and colleagues report findings that support a link between allergic diseases, such as allergic rhinitis and asthma, and atherosclerosis. Their findings came from 2 studies: the Bruneck study, which included 826 men and women aged 40 to 70 years, and the Atherosclerosis Risk Factors in Male Youngsters (ARMY) study, which included 141 male participants aged 17 or 18 years.

A 24-year-old Korean woman, who was 20 weeks' pregnant, was referred to an allergist for an elimination diet and evaluation of the risk of allergies to her unborn child. She had a several-year history of perennial allergic rhinitis with seasonal exacerbations.

Abstract: Chronic rhinosinusitis can be caused or aggravated by a number of factors, including bacterial, viral, and fungal infections; asthma; allergies; and obstruction caused by nasal polyps or a deviated nasal septum. The diagnosis can usually be established clinically. Imaging studies are not routinely necessary, but a CT scan of the sinuses should be obtained if the patient has significant ocular or orbital symptoms or if sinus surgery is planned. Treatment consists of antibiotics, with consideration of a change in the regimen if the patient has already received a full course of a first-line agent. The course of treatment may need to extend to 4 weeks. Also consider adjunctive therapy, such as intranasal corticosteroids and decongestants. Patients who have allergic rhinitis may also benefit from an antihistamine and/or a leukotriene modifier. Sinus surgery is reserved for patients who do not respond to medical therapy. (J Respir Dis. 2005;26(10):415-422)

The onset of atopic dermatitis can be seen in infants who have a family history of inhalant allergies, (eg, seasonal allergy, allergic rhinitis, or allergy-induced asthma). The cheeks and large flexural folds of affected children are erythematous and scaly. Involved areas of the trunk and extremities may exhibit discrete patches or a generalized rash.

Vitamin E has been evaluated for the treatment and prevention of several different chronic diseases in numerous clinical trials over the past 2 decades. However, only a limited number of studies have investigated the potential therapeutic or prophylactic effect of vitamin E on allergic rhinitis and respiratory infections. In contrast to trials on cardiovascular disease, which have failed to demonstrate a benefit from vitamin E supplementation,1,2 there is mounting evidence that this essential vitamin may be useful for prevention of the common cold and treatment of allergic rhinitis.