Asthma And Allergy

Drug Store News, August 24, 1998 by Kendall R.ph. Shaw

A quick look at some of what is happening in the world of research that can affect your practice, your patients and you Steroid-resistant asthma prevalent in African-Americans The Journal of Allergy and Clinical Immunology (1998; 101:594-601) reports that of the 15 million people in the United States with asthma, 10 percent are steroid-insensitive, in that their condition does not significantly improve with steroid therapy.

Asthma is considered steroid-insensitive after therapy with high doses of inhaled corticosteroids with less than 15 percent improvement. Research at the National Jewish Medical and Research Center in Denver indicates that the problem is substantially more prevalent than anticipated. Of 164 teenagers tested, 25 percent had SI. Data also confirmed observations that African-Americans typically outnumber whites in this SI category. African-Americans with asthma are generally more ill with a higher mortality rate than whites, but the reasons remain unclear. Socioeconomic factors could be the base of the findings, with poorer patients having greater exposure to allergens (debris of cockroaches and dust mites in particular) and poorer access to health care. Since SI is seen as a function of severe prolonged inflammation, research is needed to determine if African-Americans genetically mount a stronger immune response to allergens or if other factors are responsible for their asthma problems. GERD and asthma Patients with both gastroesophageal reflux disease and asthma often experience dramatic improvement in asthma symptoms when the GERD is effectively treated, according to a study reported in the July issue of Chest. Between 50 percent and 90 percent of asthma sufferers also have GERD, a significant observation in itself, but when GERD is controlled, many patients no longer even need treatment for asthma. One theory suggests that since the esophagus and bronchial tree are so closely related, chemical irritation and spasm in the esophagus also triggers bronchospasm-sort of virtual irritation to the bronchial tree. Another assumes that micro-aspiration of stomach acid with GERD causes real bronchial irritation and ensuing bronchospasm. Changes in asthma severity at puberty The British Medical Journal (June 26, 1998) reports the observation that asthma in early childhood is more prevalent in boys than girls, a phenomenon that tends to reverse by early adulthood. A study of 27,826 children in Nottingham, England, showed the change to begin reliably around puberty, leading researchers to believe that hormone levels may heavily influence severity of asthma. On the other hand, the sexes may tend to have different levels of exposure to allergens, and air-way size tends to increase with normal growth to a greater extent in males at this point in life than in females. Avoiding insect stings With the recent recall of EpiPen and EpiPen Jr. Kits due to possible defects, concern was raised that the number of emergency treatments for allergic reactions to insect stings would be rising dramatically. Without ready availability of proper self-treatment, allergic patients are significantly more vulnerable to severe reactions. Fire ants top the list of most problematic venomous insects in the United States, covering 260 million acres in the Southern states. Bees, wasps, hornets and yellow jackets are also high on the list. Together, these insects send over half a million people to the emergency room each year with severe allergic reactions. Those allergic to insect stings often change their lifestyles in fear of stinging insects, sometimes opting to completely avoid outdoor activities, but evaluation and treatment by an allergy specialist can help minimize misunderstanding and emotional trauma associated with the allergy. Here are some avoidance tips: * Avoid sweet-smelling perfumes, hair sprays, colognes and deodorants. * Avoid wearing bright-colored clothing, and keep as much skin covered as possible. * Avoid yard work and gardening. * Keep screens on doors and windows. * Avoid driving with car windows open. * Avoid wearing sandals or walking barefoot in the grass. * Avoid drinking from open beverage cans. Stinging insects attracted by sweet drinks may enter a can. * Make sure outdoor garbage cans are covered with tight-fitting lids. Patients should also be aware that: * Insect repellents won't work. * They are most active during the summer and early fall. * Yellow jackets nest in the ground and in walls, while hornets and wasps nest in bushes, trees and on building exteriors. * Eradicate fire ants with attractant baits of soybean oil, corn grits or chemical agents. Allergies and rheumatoid arthritis According to the Annals of the Rheumatic Diseases (July 1998), the prevalence of allergic rhinitis in patients with rheumatoid arthritis is half that for those without RA. Patients who have allergic rhinitis and RA experience fewer and milder RA symptoms than those without allergic rhinitis, as well as slower progression of RA. Since the tendency to develop atopic conditions (total IgE production) is hereditary and controlled by the cytokine environment provided by relative prevalence of TH1 and TH2 cells; a means of manipulating these parameters might become an effective prevention for RA.