PHOTOCLINIC

Allergic Fungal Sinusitis
August 1, 2008

An 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

American Society of Hypertension Conference

ASH is the largest organization of hypertension researchers and health care providers in the United States committed to preventing and treating hypertension and its consequences. The editors of ConsultantLive bring you updates from the 2013 ASH conference in San Francisco, CA. Read More
Ichthyosis (“Fish-Scale skin”)

Prominent, pigmented polyangular scales on the extensor surfaces of the arms, legs, and trunk suggested recessive X-linked ichthyosis. More in this article.Read More
Wanted: Physician Feedback on Medical Cannabis

Take the survey on medical marijuana and see how your colleagues answered.Read More
Primary Care Physicians - 2012 Physician Compensation Survey Data

More than 1300 physicians of all specialties responded to the 2012 survey. Many of the respondents are primary care physicians. See how your colleagues responded and learn what concerns them most.Read more
Pediatricians - 2012 Physician Compensation Survey Data

Here, the Physicians Compensation Survey reveals how pediatricians responded to various questions related to their field.Read More

FEATURED CONTENT

March 31, 2010

Allergic Rhinitis: Update on Your Therapeutic Choices

Many pharmacological options exist for allergic rhinitis. Intranasal corticosteroids are the most effective medication class for patients with moderate to severe symptoms; those with milder intermittent symptoms can be treated with a second-generation oral or intranasal antihistamine.
More »

November 9, 2009

Managing Allergic Rhinitis: The Role of Pharmacotherapy

While avoidance measures are a key component of the treatment of allergic rhinitis, pharmacological therapies are often needed to adequately control symptoms. Intranasal corticosteroids are highly effective and are particularly useful in patients with moderate to severe disease.
More »

October 1, 2009

Allergic Rhinitis: Update on Diagnosis

Allergic rhinitis is highly prevalent; about 20% of adults in the United States and 25% of children worldwide are affected. It is a major societal expense, with direct costs, attributable to physician visits and medications, of up to $5 billion per year, and indirect costs, mainly stemming from lost productivity, of up to $9.7 billion per year. In the United States, allergic rhinitis results in 3.5 million lost workdays and 2 million lost schooldays each year.
More »

September 11, 2009

Large B-Cell Lymphoma

Progressively worsening nasal congestion and headaches with diplopia and left proptosis for 2 months prompted an ophthalmology consultation for a 67-year-old woman. She had been evaluated multiple times for allergic rhinitis and recurrent sinusitis.
More »

June 2, 2009

Traction Alopecia From Atopic Dermatitis

A 5-month-old Asian boy was brought for evaluation of hair loss and a red, scaly rash on the scalp and body. The rash had not responded to hydrocortisone 2.5% ointment. There was a family history of asthma, food allergies, and allergic rhinitis. His mother had Hashimoto thyroiditis. More »

Showing 6 - 10 of 52 results.

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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