Seasonal Exacerbations Research Articles

Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history.

Little is known about the epidemiology of rhinitis, particularly the perennial and non-allergic forms. The aim of this study was to compare the symptoms, atopic state, and medical history of individuals with seasonal and perennial rhinitis. Of 7702 adults aged 16-65 years registered with a London general practice, 2969 (30%) were screened by postal questionnaire. Samples of 113 subjects without rhinitis, 51 with seasonal symptoms alone, 128 with perennial symptoms and seasonal exacerbations were then interviewed. Atopic and non-atopic subjects were distinguished by skinprick testing with five common allergens. The estimated minimum prevalence of rhinitis was 24%: 3% had seasonal symptoms only, of whom 78% were atopic; 13% had perennial symptoms only, of whom 50% were atopic; and 8% had perennial symptoms with seasonal exacerbations, of whom 68% were atopic. Seasonal rhinitis was characterised by sneezing, itching, and a high prevalence of diurnal variation in symptoms. The most common provoking factors were dust, pollens, and infections. By comparison, perennial rhinitis was characterised by a higher prevalence of nasal blockage and catarrh, and a lower prevalence of diurnal variation and provocation by pollen. There were no significant differences among the groups in the sociodemographic characteristics examined. Subjects with seasonal rhinitis were more likely to be atopic and to have eczema and a family history of hayfever than those without rhinitis. Those with perennial rhinitis were more likely to have past or current eczema or migraine, be wheezy or labelled asthmatic, or have a family history of nose trouble other than hayfever. Subjects with both seasonal and perennial symptoms presented an intermediate clinical picture. Seasonal and perennial rhinitis differ in their atopic state, clinical presentation, and medical history. The extent to which these differences are genetically or environmentally determined requires further investigation.

Fatalities from immunotherapy (IT) and skin testing (ST)

The Committee on Allergen Standardization of the American Academy of Allergy and Immunology obtained information about 46 fatalities that had occurred during immunotherapy (IT) or skin testing (ST) since 1945. Sufficient information for complete analysis was provided for 30 patients (six for ST and 24 for IT). Of the 30 fatalities, there were 15 male and 15 female fatalities ranging in age from 7 to 70 years (x = 33 years). Known errors of administration accounted for three and possibly an additional three fatalities. Ten fatalities occurred during seasonal exacerbation of the patient's disease, four in patients who had been symptomatic at the time of the injection, two of whom had been receiving beta-adrenergic blockers. Of the 24 fatalities associated with IT, four had experienced previous reactions, 11 manifested a high degree of sensitivity, and four had been injected with newly prepared extracts. Fifteen of the 30 fatalities had received pollen extracts as part of the fatal injection. Of the six fatalities associated with ST, five were due to intradermal testing without prior puncture testing. The signs and symptoms were variable and did not indicate that death was imminent nor predict the cause of death. The time to onset of the reaction was less than 30 minutes in 22/30, more than 30 minutes in 3/30, and not reported in 5/30. The cause of death in 14/16 patients with asthma was respiratory. Epinephrine had been administered to 18, not administered to three, and was either not recorded or unknown in the remaining nine patients. Since seven to 10 million allergen injections are administered yearly, the risk of a fatal reaction is low and may be lessened even further as additional precautions are taken in the selection and treatment of allergic patients and in improved treatment of the anaphylactic reactions.

Multiple sclerosis co-existent with myxedema: An autopsy case report

A 64-year-old woman developed impaired consciousness and vision, sensorimotor paresis, hypothermia, bradycardia, and edema. Symptoms fluctuated with seasonal exacerbations in winter and terminated in coma with respiratory insufficiency at age 69. High CSF protein content and low serum T 4 and TSH levels were noted. Treatment with prednisolone and thyroxin considerably improved her consciousness and edema. The patient suddenly expired of pulmonary embolism. Postmortem examination revealed a marked atrophy of pituitary and thyroid glands, while multiple demyelinating plaques were disclosed in the optic tract and cervical cord. A review of the literature indicates that this is the first report of the co-existence of two such disorders.

Seasonal factors in atopic dermatitis and their relationship to allergy

The number of first visits to an out-patient department by patients with atopic dermatitis, as well as anamnesticat data from such patients, clearly shows seasonal changes in the course of this disease. An obvious relation is demonstrable between seasonal exacerbations and allergy to seasonal allergens.

Respiratory allergy and month of birth.

A total of 476 patients with respiratory allergy were interviewed to establish whether the season of birth influenced the type of allergy experienced. Patients with perennial symptoms did not differ from the general population of the U.K. in the distribution of their months of birth. Patients with summer seasonal symptoms attributable to grass pollen sensitivity were more likely to have been born in December to February than in August to November. This trend was most significant in female patients who did not have associated perennial symptoms and who developed symptoms early in life. Other significant differences were also noted between groups of patients complaining of the same symptoms. More males than females had summer seasonal symptoms whereas more females than males had perennial symptoms. Patients who had both perennial symptoms and summer seasonal exacerbations had a higher incidence of a positive family history of atopy and developed symptoms earlier in life than those patients who had summer seasonal or perennial symptoms only.

The Corticosteroid Dose Graph: Use in determination of corticosteroid requirements, characterization of patients, and prevention of seasonal exacerbation in corticosteroid-dependent patients

Sixty-three corticosteroid(CS)-dependent asthmatics were evaluated by a method which records asthmatic exacerbations as a function of change in CS dosage. This method, the Corticosteroid Dose Graph (CSDG), is a graphic representation of the patients' narrative charts. It is useful in assessing and directing the care of these patients and in evaluating the efficacy of altered therapeutic regimens in asthmatics. The CSDG categorizes cooperative patients (CP) and distinguishes these patients from those who are less cooperative (LCP). Evaluation of the progress of CP by the graphic analysis system showed that CP have fewer severe exacerbations of asthma than LCPs. Evaluation of the 63 patients by this graphic method shows a significantly increased incidence of asthmatic exacerbations in the Chicago area in October as compared to other months. The CSDG also demonstrates that some individuals experienced significantly increased numbers of asthma exacerbations at certain times of the year unique to themselves. Because the, CSDG predicts exacerbations, it was shown to be applicable to prevent such exacerbations by prophylactic increase in CS dose during a high-risk season for selected CS-dependent asthmatics.

Seasonal nephrotic syndrome. Description and immunological findings.

Three cases are described showing a seasonal exacerbation of their nephrotic syndrome in association with an atopic trait and grass pollen allergy. The first patient has a history of four consecutive seasonal relapses each requiring steroid therapy. Following a course of desensitization injections he has now been free of relapse for 3 consecutive years. The second patient has also had a recurrent steroid-sensitive nephrotic syndrome often associated with the pollen season and allergic rhinitis. In this patient a course of cyclophosphamide has reduced his tendency to relapse. The third patient who has been on continuous prednisone therapy shows a seasonal increase in proteinuria. Serum changes in the first two patients include: a seasonal rise in total and grass pollen specific IgE; the continued presence of grass pollen specific IgG throughout the year but with a reduction during the pollen season in association with a more pronounced fall in the total IgG level; a depression in the C3 level in association with each major relapse; a mild rise in the I-K titre and a positive result in the Clq test for circulating complexes. A renal biopsy performed on the first patient when in relapse showed minor histological changes only and IgG, IgM, IgA, IgD, IgE, C3 and fibrinogen were undetectable by immunofluorescent examination. The probable mechanism for the development of proteinuria in these patients is discussed.

Cryopathies: a review. Classification; diagnostic and therapeutic considerations.

In recent years certain disorders associated with marked intolerance to cold have received considerable attention. There is no generally accepted terminology or classification of cold sensitivity syndromes, and furthermore, cold intolerance has not been previously considered as a clinical entity. Following exposure to cold, affected patients commonly exhibit several of the following<i>signs and symptoms:</i>cyanosis, numbness, Raynaud's phenomenon; urticaria, purpura of skin and mucous membranes; vascular occlusions resulting in visual disturbances, deafness, or pulmonary infarctions; ulceration, necrosis, gangrene; hemolytic anemia, hemoglobinuria; rigors and fever.^2,3,66,184Seasonal exacerbations and remissions are characteristic. The term<i>cryopathy</i>is suggested as an all-inclusive term for these clinical conditions.^1,184Presently available diagnostic and therapeutic methods make possible a reasonably precise differentiation between the various entities. The following etiological<i>classification of cryopathies</i>is suggested: Cryoglobulinemias Cryofibrinogenemias Paroxysmal cold hemoglobinurias: Cold agglutinin syndrome Cold hemolysin syndrome Cold intolerance in

The clinical evaluation of air-borne and house dust fungi in New Jersey

I T HAD been observed for some time t,hat many patients have seasonal exacerbations of vasomotor rhinitis and asthma which occur out of, and also during, the regular pollen seasons. In a normal winter, our area is covered with snow from about December 26 to February 15. With the onset of the February thaw, certain patients developed symptoms of respiratory allergy which occurred occasionally, or would be almost constant until the following winter snows, Others had symptoms perennially. Testing with the usual tree, grass, and weed pollen extracts, some of these patients gave negative skin reactions, They may or may not have given positive house dust and inhalant reactions. The winters of the past four years in New Jersey have had very little snow, and the symptoms presented by these patients took on a perennial phase. During the winter of 1947 to 1948, when the ground was covered by snow from December 26 until February 15, all symptoms disappeared in this group of patients, only to return with the thaw of mid-February. In an effort to discover any new causative air-borne agents to account for the a,bove phenomena, we, under the auspices of the New Jersey Allergy Society, and with the aid of the Department of Plant Pathology of the School of Agriculture, Rutgers University, started a survey of air and house dust. A Wells Air Centrifuge was used to collect twice weekly samples of air into sterile water. A fixed amount of air was run through the machine, and the resultant solution was then plated on Petri dishes in serial dilutions. By this method it was found that the slower growing organisms were not lost, that is, overgrown by the faster growing ones. At the same time, twenty-four hour air slides were made with other centrifuges, directly onto a celluloid strip. These slides were used to correlate the results of the air cultures. On these slides we found fungus spores which could not be cultured, such as smuts, rusts, mushroom, mildews, and puffballs. These spores were identified by going to nature; field trips were made, and trees, leaves, grass, forage plants, cereal grasses, rot,ted wood, etc., were examined in order to determine the source of the fungi. House dust samples were obtained using a special vacuum cleaner which could be cleaned and sterilized between uses. Dusts were collected only from mattresses and overstuffed furniture. This dust was plated on Petri dishes, in dilutions of I.-20, l-40, l-60, I.-80, a total of 2.041 grams of house dust hnv-

The sedimentation rate in hay fever: Before and during the seasonal exacerbation

The sedimentation rate in hay fever: Before and during the seasonal exacerbation