Background: Throughout the world, asthma can be a life-threatening disease. Traditional Chinese medicine (TCM) is commonly used among Taiwanese adults to control many diseases.Objective: To analyze the use of Chinese herbal products (CHPs) among adults with asthma in Taiwan.Methods: The use, frequency of service, and the type of CHP prescribed for asthma among adults with asthma were evaluated. The study group consisted of a randomly sampled cohort of 1,000,000 beneficiaries from the National Health Insurance Research Database. Logistic regression was used to estimate the odds ratios (ORs) for use of CHP.Results: Overall, 20,627 asthma patients (85.7%) used TCM. Ding-chuan-tang (panting-stabilizing decoction) was the most frequently prescribed CHP, followed by xiao-qing-long-tang (minor green-blue dragon decoction) and ma-xing-gan-shi-tang (ephedra, apricot kernel, licorice, and gypsum decoction).Conclusion: The use of CHPs among adults with asthma appears high. Ding-chuan-tang containing mahuang is the most commonly prescribed and consumed among adults with asthma. (C) 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
a daily diary. Both drugs reduced pruritus (L = 38%, C = 40%) after a single dose as evaluated by patients. Physician evaluations after a week showed reductions in pruritus (L = 73%, C = 82%, p=0.6) which persisted to the end of study (L = 78%, c = 79%). Similar reductions were seen for number of hives, size of hives, and erythema. At the end of the two weeks, complete relief was seen in 60% of L patients and 53% of C patients. Evaluation of 470
Objective: The purpose of this study was to determine the prevalence of detectable latex-specific IgE in patients being evaluated for allergy.Methods: The AlaSTAT assay was used to test for latex-specific IgE in 200 consecutive serum samples sent to our laboratory for total IgE levels. Samples sent for latex-specific IgE were excluded. The population studied included 87 males and 113 females ranging in age from 1 to 82 years of age. Inhibition studies with a latex extract were performed on all positive samples. Chart reviews and questionnaires provided information regarding risk factors for latex allergy and reactions to latex.Results: Twenty-four (12%) subjects were positive for latex-specific IgE. Seventeen of the 24 positive subjects (70.8%) were <18 years of age and all of the strongly positive subjects (7 or 3.5%) were <18 years of age. The geometric means for total IgE for the latex positive and negative subjects were 351 IU/mL and 80 IU/mL respectively, P < .001. The mean percent inhibition with latex was 66%. Chart reviews and questionnaires revealed only 2 of 24 positive subjects were in high risk groups, none of the positive subjects had any history of reactions to latex, and 22 (98.6%) had evidence of atopic disease.Conclusion: In vitro tests may detect latex specific IgE in atopic individuals, especially children, with no history of recurrent latex exposure and no history of adverse reactions to latex.
OBJECTIVE The information presented will aid the practicing allergist in the recognition and management of pediatric-onset mastocytosis. DATA SOURCES Index Medicus from 1985 to present with keywords: mastocytosis; pediatrics; cutaneous. Limited to English language and to human disease. STUDY SELECTION Information relative to mastocytosis in the pediatric age group to adulthood was reviewed. RESULTS Mastocytosis in children is an uncommon disease and is characterized by mast cell hyperplasia and release of mast cell mediators, particularly in the skin. It generally presents during the first 2 years of life. The most common manifestation is a solitary mastocytoma, with urticaria pigmentosa being the next most frequent manifestation. The most common initial presenting symptom of pediatric mastocytosis is pruritus. Complications of severe mastocytosis include formation of bullae and gastrointestinal bleeding attributed to high levels of circulating plasma histamine, which in turn stimulates gastric acid secretion. CONCLUSION Treatment of pediatric mastocytosis is largely symptomatic. Prognosis seems to be somewhat related to the severity of the disease, with children with less extensive skin involvement tending to have the best chance to have resolution of the disease by adulthood.
Background: Approximately 10 to 15 million Americans are scuba divers. The prevalence of scuba diving and asthma makes it likely some asthmatics will be interested in scuba diving and some scuba divers will have asthma. Conditions present during scuba diving may provoke airway obstruction in asthmatic patients. Further, asthmatic patients may, in theory, face a greater than normal risk of pulmonary barotrauma from lung overdistension on ascent through the water column.Objective: The purpose of this paper is to review the theoretical issues underlying the prohibition against scuba diving for asthmatic patients as advanced by most major diving organizations in the United States and critically examine the relevant accident data.Methods: All reports that dealt with asthma and diving, and all available American accident data including both fatal and nonfatal accidents were reviewed.Results: Actuarial data on the risk of scuba accidents attributable to asthma do not define several important variables likely to affect accident risk during scuba diving. Despite these limitations, careful review indicates the risks of serious morbidity or mortality during scuba diving appears to be inconsequentially elevated in subjects whose asthma was not characterized.Conclusions: Additional data are needed to define accurately risks of diving in subjects with different forms of asthma, however, the available data suggest asthmatic patients with normal airway function at rest, and with little airway reactivity in response to exercise or cold air inhalation, have a risk of pulmonary barotrauma similar to that of normal subjects.
BACKGROUND:Rates of death from asthma in the United States have increased progressively since 1978. OBJECTIVE:To identify recent trends in asthma mortality. METHODS:The National Center for Health Statistics supplied asthma mortality data (ICD 493), and the Bureau of the Census supplied population data that permitted calculation and graphing of mortality data by age group, race, sex, and region and calculation and tabulation of mortality rates by state. The Departments of Health and Vital Statistics of Australia, Canada, Great Britain, and New Zealand provided data that permitted calculation and graphing of rates of death from asthma (ICD 493) in those countries. RESULTS:Rates of death from asthma in the United States increased from 0.8 per 100,000 in 1977 and 1978 to 2.0 in 1989, fell to 1.9 in 1990 and then increased again to 2.0 in 1991. Rates have been much higher for blacks than whites; age-adjusted rates for blacks increased from 1.5 in 1977 and 1978 to 3.5 in 1991; those for whites, from 0.5 in 1977 to 1.2 in 1991. Rates of death from asthma have increased with age and across time have increased in almost all age groups. The greatest proportional increase has occurred at 10 to 14 years of age with rates of 0.1 in 1979, 0.5 in 1987, and 0.4 in 1991. Rates of death at 5 through 34 years of age have increased for both blacks and whites in all regions of the country. Increases in rates of death from asthma have also occurred in other countries, but rates have been falling in New Zealand since the peak of 8.1 in 1980 and in Australia since the peak of 5.7 in 1989. CONCLUSIONS:The recent plateau in increases in rates of death from asthma in the United States may suggest effectiveness of improved management of asthma that may have followed increased awareness of the importance of optimal management.
Background: Proteins eluting from surgical gloves and other medical rubber products elicit immediate local and systemic hypersensitivity reactions in latex-allergic subjects but detailed knowledge about the amount and allergenic potential of these proteins is scanty.Objective: To protect latex-allergic people and to diminish the risk of sensitization, adequate methods are needed to measure and monitor the allergen content of surgical latex gloves.Methods: Extracts of six surgical and one household latex glove brand were studied. Bradford and Lowry methods were used for total protein measurements. Sera from 17 latex-allergic patients were used as a source of latex IgE antibodies. Allergen content of extracts was studied in vitro by immunoblot, crossed radioimmunoelectrophoresis and immunospot methods, and in vivo by skin prick testing in 35 latex-allergic patients.Results: The total protein concentration of the glove extracts varied from 3 to 337 mu g/g glove. The Bradford method gave lower values than the Lowry method. Immunoblotting showed allergenic rubber proteins in four of the seven glove brands. Ten proteins in two surgical and six proteins in one household glove brand bound latex IgE antibodies in a heterogeneous manner. The results from crossed radioimmunoelectrophoresis and immunospot assays were mostly in line with immunoblotting findings. Extracts from five of the seven glove brands elicited positive prick tests; in all five also the presence of allergens could be shown by in vitro tests. Prick test reactivity and total protein concentration were not directly correlated.Conclusions: In vitro assays showed considerable variation in the total protein and allergen contents of different latex glove brands. The amount of protein eluting from the gloves did not always correlate with their allergenicity in skin prick tests indicating that total protein measurement is not a sufficient method to monitor the allergenic properties of latex gloves.
This open-label, placebo-controlled study was undertaken to assess the safety and effectiveness of bitolterol mesylate in pediatric asthma patients. Bitolterol mesylate was administered in increasing doses of 0.5 to 3.5 mg by continuous-flow nebulization on separate days to children 4 to 12 years of age. Pulmonary function tests and vital signs were measured before and for up to eight hours after each treatment. Bronchodilation was defined as a > or = 15% increase in FEV1 over baseline. Onset, magnitude, and duration of bronchodilation all showed general dose-related improvements. Onset of bronchodilation occurred within five minutes in 66% to 82% of all treatments. The mean maximum percent increase in FEV1 ranged from 35% to 52% for all doses. Median durations of bronchodilation in responding patients ranged from four and one tenth to more than eight hours. Bitolterol was well-tolerated with all adverse effects being mild to moderate in severity and transient in nature. Although the incidence of cough, increased pulse rate, and tremor were relatively low, they did increase slightly with the 2.5- and 3.5-mg doses. No significant clinical laboratory or electrocardiographic findings were noted. We conclude that doses of 1.0 and 1.5 mg bitolterol mesylate administered by continuous-flow nebulization are safe, effective, and well-tolerated for the treatment of asthma in pediatric patients.
The Colorado Asthma Ski Day, an annual cross-country and alpine skiing event, encourages children with asthma to participate fully in outdoor winter sports. Since cold air and exercise can trigger bronchospasm, we examined the peak expiratory flow rates of 80 children who attended Asthma Ski Day 1992 or Asthma Ski Day 1993 to establish a safety profile for this event. Peak expiratory flow rates were measured prior to skiing, at lunchtime, and at the end of the day's activities. We asked the children to pretreat with their regular medications, as prescribed by their physicians, to use their bronchodilator inhalers p.r.n., and to report to our medical station if an episode of acute asthma occurred. The average age of the participants was 9.5 years, and the average baseline daytime peak flow rate was 100.03% of predicted. The average percent change in peak flow rates during the day was an increase of 5.00%. Our results demonstrate that with medical supervision, peak expiratory flow rate monitoring, and properly administered medications, peak flow rates can be stabilized and even improve during cold-weather exercise to an extent that safety concerns need not restrict children with asthma from engaging in exercise or cold-weather sports. The Colorado Asthma Ski Day can serve as a model event for other organizations that want to promote outdoor activities for children with asthma.
BACKGROUND:Only a few groups have reported on idiopathic anaphylaxis. We analyzed our experience with idiopathic anaphylaxis, especially in regards to prognosis.METHODS:Thirty-seven patients with the diagnosis of idiopathic anaphylaxis were retrospectively identified by a medical records search from 1989-1992. Thirty-five patients were evaluable and a telephone questionnaire was conducted to determine the current treatment and course of their idiopathic anaphylaxis since their initial evaluation.RESULTS:Patient ages ranged from 26 to 71 years (mean 48), 72% were women, and 43% were atopic. Frequent episodes of idiopathic anaphylaxis (> 5/year) occurred in 31%. At follow-up (mean 2.5 years), 21 patients (60%) had resolution of idiopathic anaphylaxis, and the frequency of anaphylaxis was decreased in nine, increased in two, and the same in three patients. Only three patients were still having frequent episodes and two required chronic glucocorticoids. Patients with frequent idiopathic anaphylaxis treated with only antihistamines and adrenergics underwent remission or improvement as frequently as those treated with chronic glucocorticoids.CONCLUSIONS:These results are similar to other reports of idiopathic anaphylaxis and indicate a generally favorable prognosis. Some patients with frequent idiopathic anaphylaxis improved without the need for glucocorticoids. Well controlled studies may be required to analyze the role of glucocorticoids in this disease.
Serum immunoglobulin A, and G subclasses were measured in patients with ulcerative colitis, Crohn's disease, and in normal controls. Significant differences were noted in elevated total gamma globulin in both disease groups: in elevated IgG1 in ulcerative colitis and elevated IgG2 in patients with Crohn's disease. These differences were not significantly related to disease activity in either disease although higher levels were observed in those with moderate and severe disease.
Urban minority families with children with asthma often live in homes with allergen and irritant exposures harmful to these children. We enrolled 392 African-American asthmatic children, male and female, aged 5 to 12, from 42 schools in Washington, DC and Baltimore, MD. The project is designed to test the effectiveness of school-based asthma education interventions, community-based asthma health workers' programs, and the combination on these children. Baseline telephone interviews were carried out with the primary home care-givers for demographic data and for environmental home exposures that exacerbated asthma. Exposures stated to cause wheezing in the children were cigarette smoke in 72%, dust in 53%, cats in 34%, dogs in 27%, and roach exposure in 15%. Fifty-six percent of children live with cigarette smoke exposure, 73% of which is from mothers. This was a highly symptomatic group with 44% reporting two or more days per week of restricted activity and 62% reporting two or more episodes of night symptoms per week. Those with mattress covers on beds had significantly fewer emergency department visits in the past 6 months than those without covers. Over one-third of parents reported children taking two bronchodilators without anti-inflammatory agents. Less than 20% were reported using anti-inflammatory medications. Decreasing asthma severity in this population entails the prevention and control of known risk factors in the home environment. Emphasis must be placed on cigarette smoking cessation programs, covering mattresses, and dust and animal dander control. Primary care physicians require education on the role of anti-inflammatory medications.
Coloring agents are frequently added to drugs, foods, and cosmetics. If approved by the FDA, these additives may be added or substituted without notifying physicians. A patient developed angioedema, wheezing, urticaria, and dizziness one hour after taking the first Premarin tablet from a new refill. She had previously tolerated Premarin daily for 7 months without any adverse reactions. The new tablets were noted to be a slightly different shade of maroon and subsequent investigation revealed that the dye formulation had been changed (FD&C red #3 and FD&C yellow #6 were changed to FD&C red #40 and D&C #27). Puncture skin testing with a suspended tablet from the new Premarin batch was positive but was negative to a different drug (dye-free). Premarin skin testing in two normal volunteers was negative. The patient has since tolerated transdermal estrogen without any adverse reactions. These findings suggest that an additive in the Premarin tablet, most likely one of the new dyes, and not the estrogen, was the cause of the anaphylaxis. Physicians need to be aware that inactive ingredients can be changed without warning and these new constituents may cause sudden and potentially very severe allergic reactions to previously tolerated medication.
