allergy
Desensitization versus intraturbinal injection of corticosteroid for nasal allergy: indications, effectiveness, and patient acceptance.

Mabry RL.

Severe allergic nasal symptoms often require corticosteroids for control. Although I most often utilize intraturbinal injection, they may also be administered systemically (oral or intramuscular) or as nasal aerosols. I advise allergy testing and desensitization for refractory cases unresponsive to conservative management, or instances of recurrent severe symptoms requiring repeated intranasal steroid injections (eg, six or more in one year, five or more per year for two years). A survey of patients who had been treated by both allergy desensitization and intranasal steroid injection revealed a much greater patient acceptance of the latter treatment. Desensitization was judged by most patients as good to fair in providing relief, while all patients questioned in a random sampling rated intranasal steroid injection excellent to good. About half the patients had discontinued their allergy injections, generally because of lack of results or growing tired of repeated injections. Intranasal steroid injection affords good symptomatic relief for the patient with severe allergic rhinitis, while allergy desensitization offers the only "cure" possible. Both measures have a place in the management of nasal allergy. However, patients must be advised of the goals and limitations of each measure.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7071637&dopt=Abstract allergy medicine



allergy
Food allergy in young adults: perceptions and psychological effects.

Lyons AC, Forde EM.

School of Psychology, Massey University, New Zealand. a.lyons massey.ac.nz

Although food allergy can have serious health consequences, little is currently known about people's perceptions of food allergy. The present study examined the differences in awareness and perceptions of food allergy and anxiety between young people with and without a food allergy. Participants completed a questionnaire which asked about their perceptions and knowledge of allergies, perceived health competence and anxiety. Of the 162 participants 24 reported they were allergic to at least one food; these people perceived that their allergy had significantly less of an impact on their lives than others believed it would. Allergy status interacted with perceived health competence to affect anxiety. People with an allergy and with high health competence reported the greatest anxiety levels. Very few of the sample knew the meaning of the term 'anaphylaxis'. Findings are discussed in terms of health education implications and possibilities.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15231052&dopt=Abstract allergy medicine



allergy
Investigative methods for natural rubber latex allergy in the UK.

Lowe JG, Green CM, Nasser SM.

Department of Dermatology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. j.graham.lowe tuht.scot.nhs.uk

Allergy to natural rubber latex (NRL) has become an important health issue in recent years, but little is known about how this condition is investigated by physicians in the UK. This postal questionnaire of British dermatology and allergy specialists shows substantial variation in diagnostic practice, most notably with regard to the utilization and choice of starting dose of commercial latex prick test dilutions, reliance on allergen-specific immunoglobulin E measurement, investigation of associated fruit allergy and provision of resuscitation equipment/method of consent when challenge testing. 17% of responding physicians who investigate for NRL allergy do not perform prick test or glove challenge because of the potential risk of anaphylaxis or lack of resuscitation facilities. 87% of allergy clinic specialists report no reduction in the number of patients presenting as new referrals with suspected NRL allergy. These findings suggest a need for robust guidance to achieve more consistent investigative practice by those dealing with this condition.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15701123&dopt=Abstract allergy medicine



allergy
Obesity is associated with increased risk of allergy in Vietnamese adolescents.

Irei AV, Takahashi K, Le DS, Ha PT, Hung NT, Kunii D, Sakai T, Matoba T, Yamamoto S.

1Department of Food Science and Nutrition, Faculty of Human Life and Environment, Nara Women's University, Nara City, Japan.

BACKGROUND:: The prevalence of allergic diseases has remarkably increased in the last decades in tandem with the number of obese individuals. Results of studies on obesity and allergic diseases are controversial, and most of them are related to asthma and asthma-like symptoms. OBJECTIVE:: In our study, we evaluated the association of several obesity indices and the prevalence of allergic diseases, including bronchial asthma, allergic rhino-conjunctivitis, atopic dermatitis and food allergy. DESIGN:: Cross-sectional study. RESULTS:: From a total of 1185 adolescents (49.3% boys) aged 12 to 17 y old, 19.3% reported a physician-diagnosed allergic disease, and 35.3% reported undiagnosed allergic symptoms. Logistic regression analysis revealed a higher risk of allergy in children of middle (OR=2.02, CI: 1.12-3.64) and high (OR=2.40, CI: 1.25-4.61) compared to low socioeconomic status, in subjects reporting industrial emissions in the neighborhood (OR=2.19, CI: 1.40-3.41), and in adolescents with parental history of allergy (OR=1.92, CI: 1.26-2.92). Body mass index (BMI) and percentage of body fat (%BF) were significantly related to allergy (OR=1.16, CI: 1.01-1.34 for BMI; OR=1.03, CI: 1.01-1.06 for %BF). After controlling for socioeconomic status, industrial emissions and parental history of allergy, only %BF remained statistically significant (OR=1.03, CI: 1.01-1.06). Food allergy was not related to obesity in our study population, and when adolescents with food allergy were excluded from the analysis, the odds of having allergy increased 28% with each increase in SD of BMI (OR=1.28, CI: 1.05-1.57) and 5% for each unit increase in the percentage of body fat (OR=1.05, CI: 1.01-1.08). CONCLUSION:: In conclusion, being overweight was associated with an increased risk of allergy in our study population. Our results point towards an association between being overweight and rhino-conjunctivitis, but not food allergy. No association was observed with other allergic diseases.European Journal of Clinical Nutrition advance online publication, 9 February 2005; doi:10.1038/sj.ejcn.1602120.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15702126&dopt=Abstract allergy medicine



allergy
Food allergy and the gastrointestinal tract.

Bischoff S, Crowe SE.

Department of Gastroenterology, Hepatology, and Endocrinology, University Medical School of Hannover, Hannover, Germany.

PURPOSE OF REVIEW: Adverse reactions to food resulting in gastrointestinal symptoms are common in the general population. Although only a minority of individuals complaining of such symptoms have immune-mediated reactions to food (food allergy), gastrointestinal food allergies do exist in both children and adults. This review provides an update on the pathogenesis and clinical management of food allergy manifesting in the gut, emphasizing recent developments in the field. RECENT FINDINGS: Recent studies have broadened our understanding of the innate gastrointestinal defense systems and the role of the gut flora for protection against allergy. These findings support the hygiene theory in which microbial challenge in early life is thought to protect against the development of allergic disease. New insights into the regulation of mast cells and eosinophils, their homing to the intestine, and their interaction with the specific immune system and the enteric nervous system have been given. In parallel, the molecular structure of major food allergens is being unraveled, and new therapies that focus largely on modulating the immune response to food antigens have been developed. SUMMARY: These new findings have important implications for the diagnosis and management of food allergies. The availability of recombinant allergens will improve methods to diagnose and treat food allergy, and genetic engineering will allow future therapies such as vaccination against food allergy. Emerging knowledge of the role of the gut flora in mucosal immunity will enhance strategies to prevent and treat food allergy using probiotics such as Lactobacillus GG. Such new approaches will extend existing options for managing food allergy and preventing anaphylaxis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15703638&dopt=Abstract allergy medicine



allergy
Better documentation through standardized forms: what progress have we made since the 1800s?

Cox L.

Nova Southeastern University Ostheopathic School of Medicine, Allergy Asthma Center, Fort Lauderdale, Florida 33334, USA.

It has been over a century since allergy skin testing and immunotherapy were first utilized. Both have withstood the test of time and numerous challenges such as cromolyn, antihistamines, and leukotriene modifiers that have threatened to make them obsolete, to continue to play a prominent role in the diagnosis and treatment of the allergic patient. Considerable advances in the understanding of immunotherapy mechanisms and effective allergen dosing as well as improved extract quality have been made in recent years. However, there appears to be a lag in the widespread implementation of these advances into clinical practice, where a broad wide range of practice patterns exists. The wide diversity of allergy practice patterns is likely because of the absence of a uniform curriculum in allergy and immunology training programs. Recently, practice parameters have been developed by the American Academy of Allergy, Asthma and Immunology' Immunotherapy Committee and the Joint Task Force on Practice Parameters, an organization that represents the American Academy of Allergy, Asthma, and Immunology and American College of Allergy, Asthma, and Immunology, aimed at promoting a consistent, objective scientific approach to allergy skin testing and immunotherapy. Standardized allergy skin test and immunotherapy forms were designed to incorporate these guidelines. The following article summarizes the recommendations of the practice parameters and reviews some of the clinical evidence that lends support to these guidelines, which are intended to enhance the safety and efficacy of allergy skin testing and immunotherapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15709452&dopt=Abstract allergy medicine



allergy
In vitro analysis of birch-pollen-associated food allergy by use of recombinant allergens in the basophil activation test.

Erdmann SM, Sachs B, Schmidt A, Merk HF, Scheiner O, Moll-Slodowy S, Sauer I, Kwiecien R, Maderegger B, Hoffmann-Sommergruber K.

Department of Dermatology and Allergology, University Hospital of Aachen, Aachen, Germany. serdmann ukaachen.de

BACKGROUND: Basophil activation is associated with the expression of CD63. In birch-pollen-associated food allergy to celery, carrot and apple, Bet v 1, Api g 1, Dau c 1 and Mal d 1 are major allergens. Recombinant allergens have not yet been used in the CD63-based basophil activation test (BAT). OBJECTIVE: To evaluate the feasibility of using recombinant allergens in the BAT in the diagnosis of allergy to apple, carrot and celery and to compare results with routine tests, i.e. skin prick tests (SPTs) and specific IgE. METHODS: Thirty-two patients with an oral allergy syndrome induced by apple, carrot or celery and 22 controls were studied. SPTs were performed with native foods. Specific IgE was determined by the CAP method and basophil activation by flowcytometry upon double staining with anti-IgE/anti-CD63 monoclonal antibodies after incubating with purified recombinant Bet v 1, Bet v 2, Api g 1, Dau c 1 and Mal d 1. RESULTS: By the combined use of the BAT and the CAP method, sensitization to Bet v 1 and Bet v 2 was detected in 100 and 25% of all subjects, respectively. Sensitivity of specific IgE for apple, carrot and celery was 60, 70 and 75% with corresponding specificities of 64, 86 and 82%. Sensitivity of the BAT for Mal d 1, Dau c 1 and Api g 1 was 75, 65 and 75% with corresponding specificities of 68, 100 and 77%. CONCLUSIONS: The BAT using recombinant allergens provides a valuable new in vitro method for the detection of sensitization to foods. Although double-blind placebo-controlled food challenges remain the gold standard to confirm food allergy, the CD63-based BAT with recombinant allergens may supplement routine tests for allergy diagnosis. Copyright (c) 2005 S. Karger AG, Basel.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15713985&dopt=Abstract allergy medicine