Allergy & Rhinology最新文献

{"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":"9 ","pages":"2152656718800060"},"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":"9 ","pages":"2152656718783596"},"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":"9 ","pages":"2152656718797803"},"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}

{"title":"Determinants of the Nasal Microbiome: Pilot Study of Effects of Intranasal Medication Use.","authors":"Vijay R Ramakrishnan,&nbsp;Justin Holt,&nbsp;Leah F Nelson,&nbsp;Diana Ir,&nbsp;Charles E Robertson,&nbsp;Daniel N Frank","doi":"10.1177/2152656718789519","DOIUrl":"https://doi.org/10.1177/2152656718789519","url":null,"abstract":"<p><strong>Introduction: </strong>A role for bacteria and other microbes has long been suspected in the chronic inflammatory sinonasal diseases. Recent studies utilizing culture-independent, sequence-based identification have demonstrated aberrant shifts in the sinus microbiota of chronic rhinosinusitis subjects, compared with ostensibly healthy controls. Examining how such microbiota shifts occur and the potential for physician-prescribed interventions to influence microbiota dynamics are the topics of the current article.</p><p><strong>Methods: </strong>The nasal cavity microbiota of 5 subjects was serially examined over an 8-week period using pan-bacterial 16S rRNA gene sequencing. Four of the subjects were administered topical mometasone furoate spray, while 1 subject underwent a mupirocin decolonization procedure in anticipation of orthopedic surgery.</p><p><strong>Results: </strong>Measures of microbial diversity were unaffected by intranasal treatment in 2 patients and were markedly increased in the remaining 3. The increase in microbial diversity was related to clearance of <i>Moraxella</i> spp. and a simultaneous increase in members of the phylum Actinobacteria. Both effects persisted at least 2 weeks beyond cessation of treatment. Transient changes in the relative abundance of several bacterial genera, including <i>Staphylococcus</i> and <i>Priopionibacteria</i>, were also observed during treatment.</p><p><strong>Conclusions: </strong>The effects of intranasal steroids on the sinonasal microbiome are poorly understood, despite their widespread use in treating chronic sinonasal inflammatory disorders. In this longitudinal study, administration of intranasal mometasone furoate or mupirocin resulted in shifts in microbial diversity that persisted to some degree following treatment cessation. Further characterization of these effects as well as elucidation of the mechanism(s) underlying these changes is needed.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":"9 ","pages":"2152656718789519"},"PeriodicalIF":2.2,"publicationDate":"2018-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718789519","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36413547","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":"Tolerance Induction to Antituberculosis Drugs in a Patient With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap.","authors":"Rodrigo Collado-Chagoya,&nbsp;Javier Hernández-Romero,&nbsp;Gumaro A Eliosa-Alvarado,&nbsp;Rubén A Cruz-Pantoja,&nbsp;Rosa I Campos-Gutiérrez,&nbsp;Andrea A Velasco-Medina,&nbsp;Guillermo Velázquez-Sámano","doi":"10.1177/2152656718783618","DOIUrl":"https://doi.org/10.1177/2152656718783618","url":null,"abstract":"<p><p>Tolerance induction and desensitization in Stevens-Johnson syndrome (SJS) or in toxic epidermal necrolysis (TEN) have been described as an absolute contraindication by some authors, but there are cases where there is no treatment alternative. Tuberculosis (TB) remains a leading cause of morbidity and mortality in developing countries and ranks alongside HIV as a leading cause of death worldwide. Severe drug reactions, such as SJS and TEN, occurring in these individuals are lifethreatening. Since alternative therapies for TB are limited, the role of desensitization and reintroduction becomes essential. We describe a case of tolerance induction to anti-TB drugs in a patient with SJS/TEN overlap syndrome using a specifically designed premedication, comedication, and desensitization protocol.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":"9 ","pages":"2152656718783618"},"PeriodicalIF":2.2,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718783618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36376580","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":"Assessment of Different Cetirizine Dosing Strategies on Seasonal Allergic Rhinitis Symptoms: Findings of Two Randomized Trials.","authors":"Eduardo R Urdaneta,&nbsp;Mitesh K Patel,&nbsp;Kathleen B Franklin,&nbsp;Xiaoyan Tian,&nbsp;Mei-Miau Wu","doi":"10.1177/2152656718783630","DOIUrl":"https://doi.org/10.1177/2152656718783630","url":null,"abstract":"<p><strong>Background: </strong>Cetirizine has been shown to be effective for relief of seasonal allergic rhinitis (SAR) symptoms. Allergic rhinitis symptoms have been reported to have circadian variations, with symptoms tending to be most bothersome overnight and in the morning.</p><p><strong>Objective: </strong>To evaluate the effects of different cetirizine dosing schedules in comparison to twice daily (BID) chlorpheniramine and placebo on SAR symptoms at 12 and 24 hours postdose.</p><p><strong>Methods: </strong>Study 1 subjects received cetirizine 10-mg once daily in the morning (QAM), cetirizine 10-mg once daily at bedtime (QHS), cetirizine 5-mg twice daily, or placebo. Study 2 subjects received cetirizine 5-mg QAM, cetirizine 10-mg QHS, chlorpheniramine 8-mg BID, or placebo. The primary end point was total symptom severity complex (TSSC); TSSC was the sum of symptom severity ratings averaged over the 2-week study period. Post hoc analyses of reflective symptom severity assessed in the morning (TSSC_AM) and in the evening (TSSC_PM) were conducted to evaluate cetirizine's effects at 12 and 24 hours postdose.</p><p><strong>Results: </strong>In study 1, subject- and investigator-assessed TSSC was significantly lower in all cetirizine groups versus placebo (<i>P</i> ≤ .003). In study 2, subject-assessed TSSC was significantly lower in all cetirizine groups versus placebo (<i>P</i> ≤ .04) and was numerically lower for investigator-assessed TSSC. Post hoc analyses demonstrated that cetirizine significantly improved TSSC_AM at 12 and 24 hours postdose versus placebo in both studies regardless of dosing schedule. TSSC_PM significantly improved at 12 and 24 hours postdose in all study 1 cetirizine groups versus placebo. In study 2, versus placebo, TSSC_PM significantly improved at 12 hours postdose in cetirizine 5-mg QAM group and numerically improved at 24 hours postdose in cetirizine 10-mg QHS group.</p><p><strong>Conclusion: </strong>Regardless of dosing regimen, cetirizine demonstrates effective 24-hour relief of SAR symptoms, particularly on TSSC_AM, which assesses overnight and early morning symptom control.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":"9 ","pages":"2152656718783630"},"PeriodicalIF":2.2,"publicationDate":"2018-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718783630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36328835","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":"Evaluation of Montelukast for the Treatment of Children With Japanese Cedar Pollinosis Using an Artificial Exposure Chamber (OHIO Chamber).","authors":"Kazuhiro Hashiguchi,&nbsp;Kimihiro Okubo,&nbsp;Yoichi Inoue,&nbsp;Hirotaka Numaguchi,&nbsp;Kumi Tanaka,&nbsp;Nobuyuki Oshima,&nbsp;Anish Mehta,&nbsp;Chisato Nishida,&nbsp;Itori Saito,&nbsp;George Philip","doi":"10.1177/2152656718783599","DOIUrl":"https://doi.org/10.1177/2152656718783599","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the efficacy of montelukast in reducing seasonal allergic rhinitis symptoms in Japanese children with Japanese cedar (JC) pollinosis induced in an artificial exposure chamber (OHIO Chamber).</p><p><strong>Methods: </strong>Pediatric patients aged 10 to 15 years sensitive to JC pollen entered a randomized, double-blind, single-site, crossover study. After confirmation of an allergic response to a JC pollen exposure for 3 hours in the OHIO Chamber during the screening period, subjects received either montelukast 5 mg chewable tablets or placebo for a 7-day treatment period, followed by a 3-hour pollen exposure in the chamber. After a 7-day washout period, subjects crossed over to the other treatment. Subjects were instructed to self-assess their nasal symptoms using 5-point scale for every 30 minutes. The primary end point was the change from baseline (just before entering the exposure chamber for each exposure) in total nasal symptom score (TNSS; the sum of nasal congestion, nasal discharge, and sneezing scores) over 3 hours of pollen exposure. Adverse events (AEs) were evaluated throughout the study.</p><p><strong>Results: </strong>A total of 220 subjects (median age, 12 years) received treatment. For TNSS, the between-group difference in the change (95% confidence interval) was -0.01 (-0.11 to 0.10); the change between placebo and montelukast 5 mg was not significant. TNSS in the screening and treatment periods after receiving placebo for 7 days was 1.58 and 1.31, respectively, suggesting a placebo response. On account of high placebo response, a post hoc analysis was conducted. The analysis in a subgroup of subjects who did not show placebo response demonstrated a difference in the efficacy between montelukast and placebo (nominal <i>P</i> < .037). The most common AE was positive urine protein (4.6% with montelukast vs 7.8% with placebo).</p><p><strong>Conclusions: </strong>Although montelukast was well tolerated, this study did not demonstrate a treatment difference between active drug and placebo in Japanese children exposed to JC pollen in the OHIO Chamber.<b>Trial Registry</b>: ClinicalTrials.gov, NCT01852812.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":"9 ","pages":"2152656718783599"},"PeriodicalIF":2.2,"publicationDate":"2018-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718783599","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36328834","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 a Novel Photoelectrochemical Oxidation Air Purifier on Nasal and Ocular Allergy Symptoms.","authors":"Nikhil G Rao,&nbsp;Ambuj Kumar,&nbsp;Jenny S Wong,&nbsp;Ravi Shridhar,&nbsp;Dharendra Y Goswami","doi":"10.1177/2152656718781609","DOIUrl":"https://doi.org/10.1177/2152656718781609","url":null,"abstract":"<p><strong>Background: </strong>Photoelectrochemical oxidation (PECO) is a new air purification technology developed to reduce circulating indoor allergens. PECO removes particles as small as 0.1 nm with the destruction of organic matter otherwise not trapped by a traditional filter and removes volatile organic compounds.</p><p><strong>Objective: </strong>We hypothesized that with daily use, the device would reduce user nasal and ocular allergy total symptom scores (TSS) within 4 weeks.</p><p><strong>Methods: </strong>The study was performed among 46 individuals with self-reported allergies using a portable PECO air purifier. Self-reported TSS were calculated at baseline and weekly for 4 weeks following initiation of continuous use of the system. TSS was the sum of total nasal symptom scores (TNSS) and total ocular symptom scores (TOSS) for the week.</p><p><strong>Results: </strong>There was a statistically significant change in overall TSS from baseline to 4 weeks (10.1 at baseline and 4.35 postintervention) resulting in a mean difference of 5.75 (95% confidence interval [CI] 4.32-7.18; <i>P</i> < .0001). There was a statistically significant change in TNSS from baseline to 4 weeks (6.3 at baseline and 3.04 postintervention) resulting in a mean difference of 3.26 (95% CI 2.33-3.19; <i>P</i> < .0001). There was a statistically significant change in TOSS from baseline to 4 weeks (3.82 at baseline and 1.3 postintervention) resulting in a mean difference of 2.52 (95% CI 1.74-3.3; <i>P</i> < .0001).</p><p><strong>Conclusion: </strong>With the use of PECO air purification technology, TSS, TNSS, and TOSS decreased significantly. These improvements were consistent over the 4-week course of device use.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":"9 ","pages":"2152656718781609"},"PeriodicalIF":2.2,"publicationDate":"2018-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718781609","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36288327","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":"Relationship Between Rhinitis, Asthma, and Eczema and the Presence of Sensitization in Young Swiss Adults.","authors":"Urs C Steiner,&nbsp;Lucas M Bachmann,&nbsp;Micheal B Soyka,&nbsp;Stephan Regenass,&nbsp;Lukas Steinegger,&nbsp;Elsbeth Probst","doi":"10.1177/2152656718773606","DOIUrl":"https://doi.org/10.1177/2152656718773606","url":null,"abstract":"<p><strong>Background: </strong>Rhinitis is a very common disease with allergies being the most frequent causative factor. It can co-occur together with asthma and eczema in atopic as well as in nonatopic patients.</p><p><strong>Objectives: </strong>To assess the prevalence of allergic sensitization within patient groups with rhinitis in consideration of the co-occurring disorders of asthma and eczema.</p><p><strong>Methods: </strong>Students of the third year of medical school completed an anonymous questionnaire on age, gender, and clinical symptoms, such as seasonal rhinitis, perennial rhinitis, asthma, and eczema, and underwent an ImmunoCAP Rapid test. We calculated the prevalence of sensitization within subgroups of patients reporting allergic disorders, such as rhinitis, asthma, and eczema.</p><p><strong>Results: </strong>Questionnaires and ImmunoCAP Rapid tests of 1513 medical students were analyzed. The participants' self-reported presence of seasonal/perennial rhinitis, asthma, and eczema was compared to the presence of sensitization. Data of 1467 subjects could be analyzed. Seasonal rhinitis was the most common symptom, followed by eczema, asthma, and perennial rhinitis. The participants were differentiated into 16 subgroups according to the combined clinical manifestations of the different symptoms and association to sensitization within subgroups. The prevalence of sensitization ranged from 18% in subjects reporting only eczema without any other symptom to 100% in those reporting to have asthma, seasonal/perennial rhinitis, and eczema together. In subjects reporting no sign or symptom at all, the prevalence of sensitization was 19%. Seasonal rhinitis was the strongest single predictor for sensitization with the highest proportion of sensitized participants in all symptom combinations (67%-100%), followed by perennial rhinitis (31%-100%), asthma (30%-100%), and eczema (18%-100%).</p><p><strong>Conclusion: </strong>Rhinitis most often is associated with allergen sensitization, and the probability of sensitization is substantially enhanced by co-occurrence of asthma. A careful assessment of clinical signs and symptoms is important and enables the selection of patients in whom targeted diagnostic analysis and therapy is appropriate.<b>Trial registration:</b> retrospectively registered by the Cantonal Ethics Committee Zurich on 22.01.2016; Nr: 08-2016.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":"9 ","pages":"2152656718773606"},"PeriodicalIF":2.2,"publicationDate":"2018-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718773606","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36286324","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":"The Eyes Have It: Eyelid Swelling and Rash in a 79-year-old Woman With Macular Degeneration.","authors":"Renee S Kleris,&nbsp;Anjeni Keswani,&nbsp;Patricia Lugar","doi":"10.1177/2152656718763385","DOIUrl":"https://doi.org/10.1177/2152656718763385","url":null,"abstract":"<p><strong>Introduction: </strong>A 79-year-old woman with macular degeneration was referred to the Allergy/Immunology clinic for the evaluation of a potential allergy to anti-vascular endothelial growth factor (anti-VEGF) treatments. The patient developed urticaria and eyelid swelling immediately following a retinal injection of aflibercept, which she had previously tolerated. She previously had allergic reactions following ranibizumab and bevacizumab injections. Injections of anti-VEGF treatments were discontinued given concern for allergy with progression of the patient's disease.</p><p><strong>Objective: </strong>To assess the culprit medication(s) responsible for hypersensitivity reactions following anti-VEGF injections for macular degeneration.</p><p><strong>Methods: </strong>Medication records were reviewed for each retinal injection. All medications used in each procedure, including the anti-VEGF therapy (aflibercept), topical anesthetics (tetracaine and proparacaine hydrochloride), and antiseptic (povidine), were evaluated with skin testing. She was additionally tested for alternative anti-VEGF therapies (ranibizumab and bevacizumab) as she was thought to have allergies to these agents by prior history. A test dose challenge was completed for aflibercept, ranibizumab, and bevacizumab.</p><p><strong>Results: </strong>Skin prick and intradermal testing were negative to aflibercept, ranibizumab, bevacizumab, and povidine. Intradermal testing was positive to tetracaine and proparacaine hydrochloride. The patient passed test dose challenges to aflibercept, ranibizumab, and bevacizumab. Due to her positive hypersensitivity testing to 2 ester anesthetics, the patient underwent skin prick and intradermal testing to the amide anesthetic, lidocaine. This was negative and the patient tolerated a graded challenge to lidocaine. She was deemed to have an immunoglobulin E (IgE)-mediated hypersensitivity to ester-type local anesthetics. She successfully resumed anti-VEGF therapy with an amide local anesthetic.</p><p><strong>Conclusions: </strong>The reason for this consult was the concern for hypersensitivity to a biologic anti-VEGF medication. The culprit allergen, the local anesthetic, could have been overlooked without an assessment of all medications used during the procedure. This case highlights the importance of a thorough allergy evaluation of all medications used during procedures to determine the causative agent.<b>Chief Complaint:</b> Eyelid swelling and rash after ophthalmic procedures for macular degeneration.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":"9 ","pages":"2152656718763385"},"PeriodicalIF":2.2,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656718763385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36288588","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}