Short-term follow-up of episodic wheeze and predictive factors for persistent wheeze.

Allergy Asthma Proc. 2013 Nov;34(6):42-6

Authors: Topal E, Bakirtas A, Yilmaz O, Ertoy Karagol IH, Arga M, Demirsoy MS, Turktas I

Abstract
Wheezing phenotypes may not be stable, and phenotype transitions may occur over time. This study investigates the natural course of episodic viral wheezing (EVW) and identifies the risk factors that predict persistence of wheezing through short-term follow-up. The medical records of children <3 years of age at hospital admission and classified as having EVW were retrospectively screened by two pediatric allergists. A total of 236 children were classified as having EVW between January 2010 and February 2011. The median follow-up period was 19.5 months. At the end of follow-up, wheezing persisted in 145 patients (61.4%) and changed to multiple-trigger wheeze in 37 patients (15.7%). Factors associated with persistent wheeze were age at initial wheezing <24 months, anti-inflammatory treatment at the time of diagnosis, history of severe episodic wheeze in the previous year, wheezing requiring systemic steroids in the previous year, frequent episodic wheeze, parental asthma, and a positive modified asthma predictive index (mAPI) for major criteria (each, p < 0.05). The logistic regression analysis revealed three independent risk factors: anti-inflammatory treatment at the time of diagnosis (p = 0.03), history of severe episodic wheeze in the previous year (p = 0.02), and a positive mAPI for major criteria (p = 0.02). The initial wheezing phenotype may vary over time. History of severe episodic wheeze in the previous year, anti-inflammatory treatment at the time of diagnosis, and a positive mAPI for major criteria predicts persistent wheeze at short-term follow-up.

PMID: 24169051 [PubMed - in process]

Hypersensitivity pneumonitis: The dug-well lung.

Allergy Asthma Proc. 2013 Nov;34(6):59-64

Authors: Sharma BB, Singh S, Singh V

Abstract
Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is caused by a variety of environmental agents and may present as occult respiratory illness. HP represents a potentially curable subgroup of interstitial lung disease. This study was designed to examine a group of patients with HP due to a unique mechanism of environmental exposure. Five patients with HP were retrospectively identified, from our hospital records, admitted during the period of March 2007 to February 2011 with history of exposure to dug wells. The mode of exposure was specified as multiple entries into a dug well for different reasons. Other modes of exposure were considered as criteria of exclusion. All of the five patients had subacute HP based on available clinical, radiographic, immunologic, and supportive evidence and exposure. There were additional allergic bronchopulmonary aspergillosis-like features in one patient who did not have antecedent asthma. The evaluation of patient records indicated a fungal etiology. The air and soil from selected wells were tested for fungal organisms. Both settings grew Aspergillus as the predominant species. This novel mechanism of HP is labeled "dug-well lung" because the disease was attributed to exposure to dug wells. Lung disease may result from exposure to a dug well. Farmers or mechanics, climbing down these damp wells for a multitude of reasons, are prone to develop HP. The public health care personnel and farming community should be made aware of this potential occupation-related health hazard.

PMID: 24169053 [PubMed - in process]

Hypersensitivity to antihistamines.

Allergy Asthma Proc. 2013 Nov;34(6):488-96

Authors: Shakouri AA, Bahna SL

Abstract
Antihistamines are the cornerstone of allergy therapy and are not expected to cause hypersensitivity reactions. We describe two cases, one had urticaria to multiple anti-H1-preparations and the other had anaphylaxis to hydroxyzine. We also provide a review of the English literature on reported reactions regarding causative preparations and manifestations. The latter showed a wide range; most commonly urticaria/angioedema, contact dermatitis, anaphylaxis, and fixed drug eruption (FDE). Most reported cases were young to middle age adults, with apparent predilection to female subjects. The onset of reactions varied from a few minutes for anaphylaxis and urticaria/angioedema, several hours for maculopapular rashes, or longer for contact dermatitis and FDE. Almost all antihistamines have been reported as causing reactions; cetirizine was the most common oral preparation followed by its parent drug, hydroxyzine. Doxepin cream was the most commonly implicated topical preparation in causing contact dermatitis. A causal relationship is often difficult to recognize because the reaction may be similar to the disease being treated with that antihistamine preparation. Reactions to one preparation are likely to occur, but not always, to other members of the same class. Diagnosis is based on clinical suspicion and may be verified by challenge testing. Except for patch testing in contact dermatitis or fixed eruption, other tests have not shown optimal reliability. In most cases, challenge testing with multiple preparations would identify one or more preparations that can be tolerated. Although hypersensitivity to antihistamines seems to be very rare, awareness of the problem would reduce its misdiagnosis.

PMID: 24169055 [PubMed - in process]

Managing asthma during pregnancy.

J Am Assoc Nurse Pract. 2013 Oct;25(10):513-21

Authors: Rance K, O'Laughlen MC

Abstract
PURPOSE: Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A woman's respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence-based approach that recognizes the patient's changing needs.
DATA SOURCES: Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012.
CONCLUSION: With the implementation of evidence-based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby.
IMPLICATIONS FOR PRACTICE: Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.

PMID: 24170482 [PubMed - in process]