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PHOTOCLINIC

Allergic Fungal Sinusitis
August 1, 2008

Image 1An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.
 
PRACTICAL POINTERS

"Tune In" to Injection Trepidation
June 9, 2010

To allay children's fears about immunizations or allergy shots, keep a pocket-sized, battery-operated radio in the office.

"Left, Right, Right, Left" for Best Nasal Spray Delivery
May 5, 2010

For my patients who use nasal spray, I advise them to use the right hand to spray into the left nostril and the left hand to spray into the right nostril.

Hold the Spray Until Morning
October 6, 2009

Advise patients who are receiving continuous positive airway pressure (CPAP) therapy and who use a corticosteroid nasal spray for allergies to spray in the morning rather than at bedtime. If the spray is used in the evening, CPAP may dry it out, making it less effective.

Better Direction for Nasal Spray
December 31, 2006

Children sometimes have difficulty using nasal sprays for allergies.

Cross Your Heart to Prevent Nasal Injury
December 31, 2006

To prevent epistaxis or damage to the septum from the use of a corticosteroid nasal spray, advise patients to cross their arms and spray with the hand contralateral to the target nostril.
 
PATIENT RESOURCES
National Healthcare Disparities Report, 2011
www.ahrq.gov - 3/16/12
National Healthcare Quality Report, 2011
www.ahrq.gov - 3/16/12
Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011
www.cdc.gov - 8/25/11
 
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Seasonal Allergies
 
FEATURED CONTENT
April 1, 2005
How to get your patient's allergic rhinitis under control
Abstract: For some patients with allergic rhinitis, symptoms can be reduced substantially by the use of allergen avoidance measures. However, many patients require pharmacotherapy, including antihistamines, decongestants, and intranasal corticosteroids, to adequately control their symptoms. The oral antihistamines are effective in reducing rhinorrhea, itching, and sneezing but are not effective against nasal congestion. Intranasal azelastine has been shown to be beneficial in patients with... More »
August 1, 2003
Asthma Therapy:
ABSTRACT: Many patients with presumed mild intermittent asthma have unrecognized persistent symptoms; these can be elicited with specific questioning about coughing, wheezing, shortness of breath, chest tightness, nighttime awakenings, and exercise intolerance. Asthma severity may vary with the season. For asthmatic patients with predictable seasonal allergies, prescribe inhaled corticosteroids for a few weeks or months beginning 2 to 3 weeks before usual symptom onset. Successful... More »
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DERMCLINIC

Case 2: How would you treat this pruritic eruption that resists topical corticosteroids?
July 6, 2009

For the past year, a 15-year-old boy has had a pruritic eruption on his shins. His mother suspects that his soccer shin guards are the cause; however, he wears them over his socks. Topical corticosteroids have not been effective.

 
JOURNAL SCAN
Risk of hypospadias in offspring of women using loratadine during pregnancy: a systematic review and meta-analysis.
pubmed.gov - 1/1/08
Loratadine, a second-generation antihistamine, is commonly used to treat seasonal allergies. Some studies have suggested that use of loratadine by pregnant women increases the risk of hypospadias in male offspring.|This meta-analysis was designed to assess the strength of the association between loratadine and hypospadias.|To locate pertinent articles published in any language from January 1989 until August 2007, we searched electronic databases (MEDLINE, OVID, EMBASE, SCOPUS, TOXLINE Special, ReproTox, TERIS, CINAHL and others), conference proceedings and bibliographies. Studies were eligible for this analysis if they were cohort, case-control or case series studies that reported the incidence of hypospadias in the offspring of women who were or were not exposed to loratadine during pregnancy. Two authors independently extracted information on study design, participant characteristics, measures of outcome, control for potential confounding factors and risk estimates using a
Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.
pubmed.gov - 9/19/97
Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo.|We sought studies from computerised bibliographies and contracts with researchers, institutions, manufacturers, individual collectors, homeopathic conference proceedings, and books. We included all languages. Double-blind and/or randomised placebo-controlled trials of clinical conditions were considered. Our review of 185 trials identified 119 that met the inclusion criteria. 89 had adequate data for meta-analysis, and two sets of trial were used to assess reproducibility. Two reviewers assessed study quality with two scales and extracted data for information on clinical condition, homeopathy type, dilution, "remedy", population, and outcomes.|The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in favour of
Good allergy practice--standards of care for providers and purchasers of allergy services within the National Health Service. Royal College of Physicians and Royal College of Pathologists.
pubmed.gov - 7/1/95
Allergic diseases affect at least 15% of the population and are the cause of much ill-health. 'Clinical immunology and allergy', the term used by the Department of Health in England and Wales for this area of specialization, is recognized as a separate specialty of medicine under the National Health Service. Many organ-based hospital consultants (e.g. chest physicians) have allergy as a special interest or subspecialty. Allergists deal largely with 'itch, sneeze, cough and wheeze' and so are experts in: summer hay fever (seasonal, allergic, conjunctivorhinitis); perennial rhinitis (symptoms of a 'permanent cold'); allergic asthma (including occupational asthma); allergy to stinging insects (especially wasps and bees); allergy to drugs; allergy-related skin disorders, i.e. urticaria, angioedema, atopic eczema and contact dermatitis; food allergy and food intolerance; anaphylaxis (acute generalized allergic reaction); evaluating the role of allergy in non-specific/polysymptomatic illness
 
MEDLINE
Childhood exposure to fine particulate matter and black carbon and the development of new wheeze between ages 5 and 7 in an urban prospective cohort.
pubmed.gov - 9/14/12
While exposures to urban fine particulate matter (PM(2.5)) and soot-black carbon (soot-BC) have been associated with asthma exacerbations, there is limited evidence on whether these pollutants are associated with the new development of asthma or allergy among young inner city children. We hypothesized that childhood exposure to PM(2.5) and the soot-BC component would be associated with the report of new wheeze and development of seroatopy in an inner city birth cohort.|As part of the research being conducted by the Columbia Center of Children's Environmental Health (CCCEH) birth cohort study in New York City, two-week integrated residential monitoring of PM(2.5), soot-BC (based on a multi-wavelength integrating sphere method), and modified absorption coefficient (Abs*; based on the smoke stain reflectometer) was conducted between October 2005 and May 2011 for 408 children at ages 5-6 years old. Residential monitoring was repeated 6 months later (n=262) to capture seasonal variability.
Physical comorbidity of migraine and other headaches in US adolescents.
pubmed.gov - 8/1/12
To examine the pattern and extent to which other physical conditions are comorbid with migraine and other headaches in youth in a representative sample of the US population.|The National Comorbidity Survey-Adolescent Supplement is a face-to-face survey of adolescents aged 13-18 years in the continental US. Sufficient information to assess the International Headache Society's criteria for migraine with and without aura over the past 12 months was available in the diagnostic module. A caretaker/parental self-administered report was used to assess a broad range of other physical conditions. The sample for these analyses was 6843 adolescents with systematic caretaker/parent reports.|Adolescents with any headaches reported higher rates of other neurologic conditions, including epilepsy (OR, 2.02; 95% CI, 1.04-3.94), persistent nightmares (OR, 2.28; 95% CI, 1.34-3.87), and motion sickness (OR, 1.6; 95% CI, 1.07-2.4), as well as abdominal complaints (OR, 2.36; 95% CI, 1.59-3.51). Asthma (OR,
Clinical inquiries. Intranasal steroids vs antihistamines: which is better for seasonal allergies and conjunctivitis?
pubmed.gov - 7/1/12
Intranasal steroids provide better relief for adult sufferers, according to nonstandardized, nonclinically validated scales. Steroids reduce subjective total nasal symptom scores (TNSS)--representing sneezing, itching, congestion, and rhinorrhea--by about 25% more than placebo, whereas oral antihistamines decrease TNSS by 5% to 10% (strength of recommendation [SOR]: B, systematic review of randomized controlled trials [RCTs], most without clinically validated or standardized outcome measures). Intranasal steroids improve subjective eye symptom scores as well as (or better than) oral antihistamines in adults who also have allergic conjunctivitis (SOR: A, systematic review, RCTs).
 
NEWS
Medical News: AAAAI: Seasonal Allergy Patients Also Bugged by Non-Allergic Irritants
www.medpagetoday.com -
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.
Medical News: ACAAI: Flu Vaccine Safe for Kids With Severe Egg Allergy
www.medpagetoday.com -
BOSTON -- Seasonal influenza vaccines appeared safe in children with the most severe allergies to egg protein, according to a prospective trial reported here.
ACAAI News, Meeting Coverage plus CME
www.medpagetoday.com -
11/15/2006. PHILADELPHIA -- Seasonal asthma exacerbations among children requiring hospitalizations don't seem to correlate with seasonal allergen prevalence, suggesting that other factors may be at work. ... 11/15/2006|. PHILADELPHIA -- Allergic
 
CLINICAL TRIALS
Omalizumab (Xolair) and Allergy Shots For the Treatment of Seasonal Allergies
www.clinicaltrials.gov -
Preference for Clarinex Tablets vs Allegra Tablets in Patients With Seasonal Allergies (P03178)(COMPLETED)
www.clinicaltrials.gov -
Preference for Clarinex Tablets vs. Allegra Tablets in Patients With Seasonal Allergies (Study P03179)(COMPLETED)
www.clinicaltrials.gov -
 
PRACTICE GUIDELINES
www.naspghan.org/user-assets/Documents/pdf/Meeting%20materials/CL%20Lunch%20Handouts/Lunch%201.pdf
www.naspghan.org -
National Guideline Clearinghouse | Allergic rhinitis.
www.guidelines.gov -
National Guideline Clearinghouse | The diagnosis and management of rhinitis. An updated practice parameter.
www.guidelines.gov -



 
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Finding Physician Work-Life Balance in the Small Moments
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At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.
Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz,  May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD,  May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.
 

 
 
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