Allergy & Rhinology最新文献

{"title":"Not All Rashes Are Allergic: Keratoderma Blennorrhagicum-Like Rash Masquerading as Contact Dermatitis.","authors":"Maxwell Y Li, Jason Kolfenbach, Alan Schocket","doi":"10.1177/2152656718811566","DOIUrl":"https://doi.org/10.1177/2152656718811566","url":null,"abstract":"A 56-year-old Caucasian man was referred to the allergy clinic for evaluation of palmoplantar dermatitis. The patient’s rash developed one year prior to presentation. He described erythema, pruritus, and hyperkeratosis of the involved skin with the eventual development of deep fissuring. He had a history of onychomycosis of his toenails but no history of fungal skin rash. He was exposed to solvents, mineral spirits, and gasoline through his occupation in home renovation and wearing neither nitrile nor cotton gloves alleviated his symptoms. Prior evaluations were carried out by primary care and dermatology. He had been treated with topical emollients, topical steroids (including potent agents such as clobetasol) for suspected atopic dermatitis, and topical antifungal agents as well (although KOH prep was negative). All prior treatments failed to resolve his severe palmoplantar rash. His medical history included hypertension, obesity, fatty liver disease, uveitis, bilateral total hip arthroplasty, and a history of childhood allergic rhinitis for which he underwent allergen immunotherapy and was quiescent at the time of evaluation. The physical examination was significant for moderately erythematous, hyperkeratotic, well-defined plaques on the palmoplantar surfaces of the hands and feet without dorsal involvement. Fissuring was seen at the fingertips and the plantar surface of the feet (Figure 1(A) to (D)) without associated pustulosis. There were no obvious nail pitting, oil spots, nor onycholysis, and scalp examination was normal. External examination of the eyes and oral examination were both normal. No appreciable synovitis was documented on peripheral joint examination, but the patient appeared “stiff” with ambulation as well as when stepping down from the examination table. Patch testing result revealed a weak positive reaction to gold sodium thiosulfate and an irritant reaction to thimerosal. Common sensitizers of allergic contact dermatitis in the construction worker were evaluated. The patient did not have reactions to potassium dichromate found in cements, biocides such as isothiazolinones, rubber chemical, and metal allergens (ie, chrome, thiurams, carbamates, mercaptobenzothiazole) accounting for foot dermatitis from work boot materials, and epoxy resin. These results, along with the patient’s history, led to decreased suspicion for either contact or atopic dermatitis. Given the patient’s history of uveitis (which upon review of the chart was recurrent and associated with HLA-B27 positivity), the hyperkeratotic and plaque-like appearance of his lesions, and the concern for possible axial spine disease based on examination, formal radiographs were obtained (Figure 2) and a referral to rheumatology was initiated. His rheumatologic evaluation confirmed decreased range of motion at the spine with an abnormal occiput to wall test of 8 cm, abnormal Schober’s test (10–12 cm increase with flexion and no reversal of lumbar lordosis), and decrease","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718811566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36768834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Management of Lacrimal System Dysgenesis and Dacryocystoceles in Fraser Syndrome: A Case Report and Literature Review.","authors":"Megan E Falls,&nbsp;Michael P Rabinowitz,&nbsp;Jacqueline R Carrasco,&nbsp;Mindy R Rabinowitz","doi":"10.1177/2152656718804905","DOIUrl":"https://doi.org/10.1177/2152656718804905","url":null,"abstract":"<p><strong>Background: </strong>Fraser syndrome is an autosomal recessive disorder characterized primarily by syndactyly, cryptophthalmos, urinary tract anomalies, ambiguous genitalia, and laryngeal anomalies. A 28-year-old man with Fraser syndrome presented with cryptophthalmos, microphthalmia, lacrimal system dysgenesis, and chronic sinusitis.</p><p><strong>Objective: </strong>The patients' clinical condition and surgical treatment are described. A literature review was conducted, and articles relevant to the case are presented.</p><p><strong>Methods: </strong>Case report.</p><p><strong>Results: </strong>To our knowledge, this is the first published case report of endonasal management of dacryocystoceles in a Fraser syndrome patient. The patient was treated via endoscopic endonasal marsupialization and drainage.</p><p><strong>Conclusion: </strong>Fraser syndrome patients may initially present to many different specialties as the spectrum of clinical manifestations is broad. Physicians treating these patients should take a collaborative approach to surgical and medical management.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718804905","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36621315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Trials of Nasal Patency and Dermal Tolerability With External Nasal Dilators in Healthy Volunteers.","authors":"John Ward,&nbsp;Renee Ciesla,&nbsp;William Becker,&nbsp;Gilbert Marava Shanga","doi":"10.1177/2152656718796740","DOIUrl":"https://doi.org/10.1177/2152656718796740","url":null,"abstract":"<p><strong>Background: </strong>External nasal dilator strips are used as nonpharmacological therapy to reduce snoring and daytime sleepiness. In a product improvement initiative, a marketed strip (BRNS) and 2 prototype nasal strips were evaluated.</p><p><strong>Objective: </strong>To compare the nasal patency and multiple-use dermal tolerability of the BRNS and prototype nasal strips using both objective and subject-reported outcome measures.</p><p><strong>Methods: </strong>Two studies were conducted separately in healthy volunteers ≥18 years of age. A single-day nasal patency randomized crossover study assessed minimal cross-sectional area (MCA; second restriction) and nasal volume (using acoustic rhinometry); nasal inspiratory flow and resistance (using posterior rhinomanometry); and subject-reported evaluations of the BRNS compared with the butterfly strip and teardrop strip prototypes. A single-center, randomized, controlled, parallel-group, evaluator-blinded study assessed dermal tolerability of the BRNS and the butterfly strip over 7 consecutive nights of use, using the Dermal Response Scale (DRS) and subject-reported comfort and ease of removal.</p><p><strong>Results: </strong>In the Patency study (N = 50), all 3 strips demonstrated significant improvement from baseline in MCA, nasal volume, and nasal flow parameters (resistance and peak flow). The prototype strips demonstrated significantly more improvement in nasal volume than the BRNS, and the butterfly strip showed significantly more improvement in MCA than the BRNS; all strips were similar with respect to nasal flow and subject-reported nasal breathing outcomes. In the Dermal Tolerability study (N = 82), all subjects scored 0 (no evidence of irritation) on the DRS at all 7 morning assessments; the BRNS was numerically, but not significantly, superior to the butterfly strip on subject-reported outcomes.</p><p><strong>Conclusion: </strong>The Patency study demonstrated significant improvement from baseline in nasal dimensions and flow for all 3 evaluated strips; between-strip differences were confined to nasal dimensions. Both the BRNS and butterfly strip were generally well tolerated, with no evidence of dermal response over 7 consecutive nights of use.<b>ClinicalTrials.gov identifiers:</b> NCT01105949 and NCT01495494.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718796740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36573931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of <i>Nigella sativa</i> Nasal Spray on the Treatment of Chronic Rhinosinusitis Without a Nasal Polyp.","authors":"Ahmad Rezaeian,&nbsp;Sanaz Amoushahi Khouzani","doi":"10.1177/2152656718800059","DOIUrl":"https://doi.org/10.1177/2152656718800059","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis (CRS) is a common inflammatory disease of nasal and paranasal sinuses, with many treatment methods available for the management of this disease. Recently, herbal medicines have shown a significant impact on inflammatory diseases such as CRS, and one of these herbal medicines is <i>Nigella sativa</i>. Therefore, the current study aimed to evaluate the effectiveness of <i>N. sativa</i> in patients with CRS without nasal polyp (CRSsNP).</p><p><strong>Methods: </strong>In this randomized clinical trial, 65 patients with mild to moderate CRSsNP were enrolled based on the inclusion criteria. Patients were divided randomly into 2 parallel groups: intervention and placebo groups. Patients in the intervention group received 2 puffs/day of <i>N. sativa</i> nasal spray (1 g/day of <i>N. sativa</i>) and in the placebo group received 2 puffs/day of sodium chloride spray 0.65%.</p><p><strong>Results: </strong>Thirty-one patients (19 men and 12 women) in the intervention group and 34 in the placebo group (18 men and 16 women) were evaluated. Lund-McKay, Lund Kennedy, and Sino-Nasal Outcome Test-22 scores were assessed for both groups after 8 weeks of treatments. These scores decreased significantly in both groups. However, these scores were significantly lower in the intervention group compared with the placebo group (<i>P</i> < .0001, for all).</p><p><strong>Conclusion: </strong>The use of <i>N. sativa</i> nasal spray has symptom reliever effect with no adverse effects in patients with CRSsNP.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718800059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36614320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Meningoencephaloceles Endoscopic Endonasal Repair: Our Experience.","authors":"Hetal K Marfatia,&nbsp;Kartik A Parelkar,&nbsp;Adhara Chakraborty,&nbsp;Shampa Mishra","doi":"10.1177/2152656718802408","DOIUrl":"https://doi.org/10.1177/2152656718802408","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients presenting with a nasal mass is uncommon and a high index of suspicion for it to be a meningoencephalocele is essential. Majority of these are congenital and require early intervention owing to the risk of meningitis. Surgery in these cases is very challenging because of the risk of anesthesia and limited space.</p><p><strong>Objective: </strong>This study aimed to describe our technique and experience in managing pediatric meningoencephaloceles.</p><p><strong>Methods: </strong>A retrospective study of 19 pediatric patients (age ranging from 40-day-old infants to 11.5-year-old children) was conducted at our tertiary care center from January 2012 to February 2017. Patients presenting with an intranasal meningoencephalocele were treated by endoscopic approach, using otological microinstruments. After detailed imaging and clinical evaluation, a tailored repair, using fat/fascia/cartilage, a multilayer closure, was carried out in all cases.</p><p><strong>Results: </strong>All patients had a successful repair and recovery, except for one death following an episode of convulsion. There was a minor circumferential narrowing of the nasal vestibule and synechia formation in 2 of our cases.</p><p><strong>Conclusion: </strong>Transnasal endoscopic repair of meningoencephalocele is minimally invasive. It avoids permanent anosmia and is cosmetic. A combination of miniaturized instruments and a 4-mm 0° nasal endoscope gives excellent visual field and an adequate working space. Owing to the larger defects in congenital meningoencephaloceles, a multilayer repair provides excellent outcomes.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718802408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36600035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.1177/2152656718806726","DOIUrl":"https://doi.org/10.1177/2152656718806726","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/2152656718783630.].</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718806726","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36600036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Potency of Indian Dust Mite Allergen Skin Prick Test Extracts Compared to FDA-Approved Extracts: A Double-Blinded Randomized Control Trial.","authors":"Devasahayam J Christopher,&nbsp;Narmada Ashok,&nbsp;Aruna Ravivarma,&nbsp;Deepa Shankar,&nbsp;Erik Peterson,&nbsp;Phuong T Dinh,&nbsp;P K Vedanthan","doi":"10.1177/2152656718796746","DOIUrl":"https://doi.org/10.1177/2152656718796746","url":null,"abstract":"<p><strong>Background: </strong>Skin prick testing is the most important diagnostic tool to detect immunoglobulin E-mediated allergic diseases. With increase in the number of allergy tests performed in India, it is imperative to know the potency of indigenous extracts in comparison with U.S. Food and Drug Administration (USFDA)-approved extracts.</p><p><strong>Methods: </strong>A randomized comparison trial of Indian manufactured and USFDA-approved extracts of <i>Dermatophagoides pteronyssinus</i> (DP) and Dermatophagoides <i>farinae</i> (DF) was done at Christian Medical College & Hospital, Vellore, India from April 2014 to June 2015, to compare the skin test reactivity of indigenous allergen extracts of dust mites against validated allergen. Study enrollment included 197 patients with allergic disorders that showed sensitivity to dust mite during routine allergy skin testing. Study participants were tested with varying dilutions of DP and DF indigenous extracts along with USFDA-approved allergens in a blinded fashion. Results were recorded, and statistical significance was calculated using the Friedman rank sum test.</p><p><strong>Results: </strong>Using the Friedman rank sum test with a Tukey adjustment for multiple comparisons, we found that the extracts in each dilution were significantly different (<i>P</i> < .0001). The full strength indigenous extracts, B-DF (DF allergen standard extract from Bioproducts and Diagnostics, India) and C-DF (DF allergen extract from Creative Diagnostics, India) extracts, had mean wheal sizes of 7.69 (standard deviation [SD] 9.91) and 31.01(SD 51.04), respectively. The full strength S-DF (DF allergen extract from Jubilant Hollister Stier, Spokane, WA, USA) had a mean wheal size of 109.97 (SD 162.73), which was significantly higher (<i>P</i> < .0001) than both the indigenous extracts. For each of the dilutions, the S-DF mean wheal size was significantly greater than that of the corresponding B-DF and C-DF wheal sizes. The full strength indigenous C-DP (DP allergen extract from Creative Diagnostics, India) had mean wheal size of 39.37 (SD 51.74). The full strength standard S-DP (DP allergen extract from Jubilant Hollister Stier, Spokane, WA, USA) extract had a mean wheal size of 167.66 (SD 270.80), which was significantly higher (<i>P</i> < .0001) than the indigenous C-DP extract. Similar differences were seen across all dilutions.</p><p><strong>Conclusion: </strong>The indigenous extracts have significantly lower potency compared to USFDA-approved extracts; hence, there is an urgent need for policy makers to institute stringent criteria for standardization of antigens in India.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718796746","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36531871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Exposure to New Car Interiors in Patients With Asthma and Allergic Rhinitis.","authors":"Amber N Pepper,&nbsp;Adeeb Bulkhi,&nbsp;Catherine R Smith,&nbsp;Matthias Colli,&nbsp;Karl-Christian Bergmann,&nbsp;Torsten Zuberbier,&nbsp;Thomas B Casale","doi":"10.1177/2152656718800060","DOIUrl":"https://doi.org/10.1177/2152656718800060","url":null,"abstract":"<p><strong>Rationale: </strong>Vehicle interiors are an important microenvironment for atopic subjects. This study evaluated the subjective and objective physiologic and clinical effects of exposing subjects with asthma and allergic rhinitis to new 2017 Mercedes vehicles during 90-minute rides.</p><p><strong>Methods: </strong>Ten adult asthmatics with allergic rhinitis were assessed before and 45 and 90 minutes into rides in a 2017 Mercedes-Benz S-Class sedan and GLE-Class SUV on 2 separate days. Assessments included spirometry, fractional exhaled nitric oxide, peak nasal inspiratory flow, asthma symptom scores, and physical examinations.</p><p><strong>Results: </strong>Of the 10 subjects, 6 were women, mean age was 32 years, and 6 and 4 were using chronic asthma controllers or intranasal corticosteroids, respectively. None of the subjects had worsening of asthma or rhinitis symptoms during the rides. There were no statistically significant changes from baseline in forced expiratory volume in 1 second, forced expiratory volume in 1 second:forced vital capacity ratio, forced expiratory flow at 25%-75% of vital capacity, fractional exhaled nitric oxide, or peak nasal inspiratory flow at 45 or 90 minutes into the rides with either Mercedes vehicle (all <i>P</i> values > .1 using generalized linear mixed model).</p><p><strong>Conclusion: </strong>The interior environment of the tested Mercedes vehicles did not cause changes in subjective or objective measures of asthma and allergic rhinitis. We suggest that this model system can be used to test other vehicles for putatively adverse effects on patients with allergic respiratory disorders.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718800060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36514137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhinolithiasis: A Misleading Entity.","authors":"Hayat Adib,&nbsp;Mohamad Ali El Natout,&nbsp;Georges Zaytoun,&nbsp;Usamah Al Hadi","doi":"10.1177/2152656718783596","DOIUrl":"https://doi.org/10.1177/2152656718783596","url":null,"abstract":"<p><strong>Introduction: </strong>Rhinolithiasis is a rare entity; it entails a stone located in the nasal cavity. The entity presents with different signs and symptoms that can be easily confused with other more common clinical entities such as chronic rhinosinusitis. However, it can also mimic sinonasal tumors, making its proper diagnosis crucial.</p><p><strong>Materials and methods: </strong>In this article, we present a case series of 15 patients over the past 13 years between 2002 and 2015 who were seen in the clinics at the American University of Beirut Medical Center. We will shed light on the common presenting symptoms, physical examination findings, proper diagnostic modalities, and treatment options. Our data will be compared to the literature.</p><p><strong>Conclusion: </strong>Rhinolithiasis could present with a wide spectrum of signs and symptoms and could be overlooked or mistaken for other diagnosis such as sinusitis or malignancy. It could be differentiated from other entities by rigid nasal endoscopy and computed tomography scan. The diagnosis of rhinolithiasis requires a high index of suspicion.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718783596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36503454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum.","authors":"","doi":"10.1177/2152656718797803","DOIUrl":"https://doi.org/10.1177/2152656718797803","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/2152656718783599.].</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718797803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36435494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}