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Allergen-specific nasal provocation testing: review by the rhinoconjunctivitis committee of the Spanish Society of Allergy and Clinical Immunology.

Specific nasal provocation testing (NPT) consists of eliciting a response from the nasal mucosa by controlled exposure to allergens. It is indicated in the diagnostic confirmation of allergic rhinitis and when discrepancies arise or difficulties exist in the assessment of a patient's medical history and the results of skin and/or serological tests.

The technique is also applied to evaluate sensitivity to the allergen, the efficacy and safety profile of treatment, and in research on the pathophysiological mechanisms of nasal response to allergens. NPT also provides information on the etiology of occupational respiratory diseases of allergic origin. Although there have been many studies and publications on the use and standardization of bronchial provocation tests with allergen, few analyze specific NPT.

In this review, the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology discuss the methodology, monitoring, and assessment of allergen-specific NPT in order to provide a practical and up-to-date review of the technique.

Annual temperature and the prevalence of frequent ear infections in childhood.

The aim of this study was to determine if changes in annual temperature influence the prevalence of frequent otitis media (FOM) and respiratory allergy in children.

METHODS: Annual prevalence data for FOM (defined as 3 or more ear infections per year), respiratory allergy, and seizures (nonrespiratory, control condition) in children were extracted from the National Health Interview Survey for 1998 to 2006. Average US annual temperatures for the same period were recorded from the Environmental Protection Agency. Complex samples logistic regression analyses were performed to identify possible correlations between annual temperature and each of the 3 disease conditions, controlling for age and sex.

RESULTS: A total of 113 067 children were studied (mean age, 8.6 years; 51.1% girls). Overall prevalences (±95% confidence interval) were 6.3% ± 0.2%, 11.8% ± 0.2%, and 0.7% ± 0.1% for FOM, respiratory allergy, and seizures (nonrespiratory, control condition), respectively. Average annual temperatures ranged from 53.64°F to 55.09°F. Regression analysis found that annual temperature did not influence the prevalence of FOM (P = .681); male sex and younger age were associated with a higher prevalence of FOM (P = .025 and P < .001, respectively). Similarly, annual temperature did not influence prevalence of respiratory allergy (P = .883); male sex and increasing age were associated with a higher prevalence of respiratory allergy (both P < .001). Annual temperature and sex did not influence seizure prevalence; however, increasing age was negatively associated.

CONCLUSIONS: Changes in average annual temperature do not appear to influence the prevalence of otitis media or respiratory allergy. This negative finding suggests that although global warming continues to affect our environment, childhood otolaryngologic disease prevalence may not be directly influenced.

Blocking the Leukotriene B4 Receptor 1 Inhibits Late Phase Airway Responses in Established Disease.

Most of the studies investigating the effectiveness of blocking the leukotriene B4 (LTB4) receptor 1, BLT1, have been performed in models of primary or acute allergen challenge. The role of the LTB4-BLT1 pathway in secondary challenge models, where airway hyperresponsiveness (AHR) and airway inflammation have already been established, has not been defined.

We investigated the effects of blocking BLT1 on early and late phase development of AHR and airway inflammation in previously sensitized and challenged mice.

Methods: Female BALB/c mice were sensitized (days 1 and 14) and challenged (primary, days 28-30) with ovalbumin (OVA). Six weeks later (day 72), mice were challenged (secondary) with a single OVA aerosol and the early and late phases of AHR and inflammation were determined. Specific blockade of BLT1 was attained by oral administration of a BLT1 antagonist on days 70-72.

Results: Administration of the antagonist inhibited the secondary OVA challenge-induced alterations in airway responses during the late but not early phase, as demonstrated by decreases in AHR, bronchoalveolar lavage (BAL) neutrophilia and eosinophilia 6 and 48 hrs after secondary challenge. The latter was associated with decreased levels of KC, MIP-2, and IL-17 in the airways.

Conclusions: These data identify the importance of the LTB4-BLT1 pathway in the development of late phase allergen-induced airway responsiveness following secondary airway challenge, in mice with established airway disease.

More Than Just A Cough? Asthma Common, Serious In Children

Asthma is the leading cause of hospital visits and missed school days in children, according to the National Institute of Health. A chronic condition, pediatric asthma requires continual care to prevent serious, life-threatening asthma attacks.

In recognition of National Asthma and Allergy Awareness Month in May, a Geisinger expert offers advice on how to manage your child's asthma. According to the Respiratory Health Association, more than 9.5 million U.S. children under age 18 are living with asthma...

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