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Oppenheimer JJ. Epicutaneous immunotherapy in grass-induced allergic rhinitis. Curr Allergy Asthma Rep 2011; 11:91-3. [PMID: 21113742 DOI: 10.1007/s11882-010-0165-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Oppenheimer JJ, Peters SP. Is the maintenance and reliever approach the answer? Ann Allergy Asthma Immunol 2010; 104:112-7. [PMID: 20306813 DOI: 10.1016/j.anai.2009.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the efficacy of the maintenance and reliever (M+R) approach in the treatment of asthma exacerbations. DATA SOURCES PubMed, MEDLINE, and Cochrane database searches using the key words formoterol and budesonide, dynamic dosing, adjustable dosing, and M+R therapy. STUDY SELECTION Articles were selected based on their relevance to the topic of this review. RESULTS Several studies have examined dynamic dosing of the long-acting beta-agonist formoterol combined with budesonide in the treatment of asthma. Most of these studies have shown reductions in asthma exacerbations. Although obvious concern arises regarding increase in dose of the long-acting beta-agonist component, no significant signal of morbidity or mortality has been seen. Potential concerns regarding the studies performed thus far include the fact that all have been sponsored by the pharmaceutical industry and have required beta-agonist response as an inclusion criterion. CONCLUSIONS Although many of the data regarding this approach are positive, not all the studies have demonstrated efficacy. It is hoped that future non-pharmaceutical company-sponsored research will clarify this issue and, should efficacy be confirmed, shed light on the mechanism of action.
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Katial RK, Oppenheimer JJ, Ostrom NK, Mosnaim GS, Yancey SW, Waitkus-Edwards KR, Prillaman BA, Ortega HG. Adding montelukast to fluticasone propionate/salmeterol for control of asthma and seasonal allergic rhinitis. Allergy Asthma Proc 2010; 31:68-75. [PMID: 20167147 DOI: 10.2500/aap.2010.31.3306] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Limited information exists comparing fluticasone propionate/salmeterol combination (FSC) versus montelukast (MON) in patients with coexistent asthma and allergic rhinitis. The purpose of this study was to compare the addition of MON to patients receiving FSC on asthma control while experiencing asthma and allergy symptoms. Additionally, the effect of fluticasone propionate aqueous nasal spray (FPANS) and MON were assessed in allergic rhinitis control. Symptomatic patients (n = 1385) with asthma and seasonal allergic rhinitis were randomized to receive FSC, 100/50 micrograms twice daily; FSC twice daily + FPANS, 200 micrograms once daily; FSC twice daily + MON, 10 mg once daily; or MON once daily for 4 weeks during the allergy pollen season. Patients recorded peak expiratory flow, rescue albuterol use, and asthma and rhinitis symptoms. No additional improvements in overall asthma control were seen when MON was added to FSC. Treatment with FSC produced significant (p < 0.001) improvements in all clinical and patient-reported measures versus MON. FSC + FPANS was superior to FSC + MON (p < or = 0.001) in improving daytime and nighttime total nasal symptom scores. Adverse events were similar. In patients with asthma and allergic rhinitis, adding MON to FSC provided no additional benefit in asthma control. FSC resulted in superior improvement in asthma control compared with MON. FPANS also provided superior nasal symptom control versus MON in allergic patients treated with FSC for asthma. Optimal disease control in patients with asthma and allergic rhinitis should be achieved by the most effective therapy directed toward each disease component.
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Kerwin EM, Oppenheimer JJ, LaForce C, Parasuraman B, Miller CJ, O'Dowd L, Goldman M. Efficacy and tolerability of once-daily budesonide/formoterol pressurized metered-dose inhaler in adults and adolescents with asthma previously stable with twice-daily budesonide/ formoterol dosing. Ann Allergy Asthma Immunol 2009; 103:62-72. [PMID: 19663129 DOI: 10.1016/s1081-1206(10)60145-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The goal of asthma therapy is to control symptoms using minimal pharmacologic intervention. OBJECTIVE To evaluate the efficacy and tolerability of once-daily budesonide/formoterol vs once-daily budesonide in patients stable with twice-daily budesonide/formoterol. METHODS This double-blind, 12-week study enrolled 619 patients 12 years and older with mild to moderate asthma. After 4 to 5 weeks of twice-daily budesonide/formoterol pressurized metered-dose inhaler (pMDI), 80/4.5 microg x 2 inhalations (320/18 microg/d), stable patients were randomized 1:1:1:1 to 2 inhalations twice daily of budesonide/formoterol pMDI, 80/4.5 microg (320/18 microg/d), or 2 inhalations once daily (evening) of budesonide/formoterol pMDI, 160/4.5 microg or 80/4.5 microg (320/9 microg or 160/9 microg/d), or budesonide pMDI, 160 microg (320 microg/d). RESULTS All budesonide/formoterol groups maintained significantly more favorable evening predose forced expiratory volume in 1 second (FEV1), morning peak expiratory flow (PEF), daytime/nighttime asthma symptoms, nighttime rescue medication use, and rescue medication-free days vs budesonide. Variables evaluated during the end of the once-daily dosing interval (evening predose FEV1, evening PEF, daytime asthma symptoms, and daytime rescue medication use) significantly favored twice-daily budesonide/formoterol vs all treatments. Twice-daily budesonide/formoterol demonstrated significantly more favorable results for symptom-free and asthma control days vs all treatments and awakening-free nights vs budesonide. Asthma Quality of Life Questionnaire and Asthma Control Questionnaire results significantly favored twice-daily budesonide/formoterol vs budesonide (P < or = .018). All treatments were well tolerated. CONCLUSIONS Pulmonary function and asthma control were more effectively maintained with all budesonide/formoterol regimens vs once-daily budesonide and with twice-daily budesonide/formoterol at twice the daily formoterol dose vs both once-daily budesonide/formoterol doses.
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Oppenheimer JJ. Overcoming Steroid Insensitivity in Respiratory Disease. Ann Allergy Asthma Immunol 2008. [DOI: 10.1016/s1081-1206(10)60327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To review the available evidence on treating chronic cough to relay a thoughtful, evidence-based approach for the diagnosis and treatment of chronic cough. DATA SOURCES MEDLINE, PubMed, EMBASE, and CINAHL were searched using the following keywords: cough, asthma, gastroesophageal reflux, sinusitis, rhinitis (allergic, seasonal), postnasal drip, vocal cord dysfunction, lung disease (interstitial), bronchiectasis, and bronchoscopy. STUDY SELECTION Studies were selected based on their relevance to the diagnosis and treatment of chronic cough. Because of a lack of randomized prospective studies, nonrandomized and retrospective studies were considered, with their strengths and limitations noted. RESULTS Few randomized controlled trials have addressed the diagnosis and treatment of chronic cough. There are several prospective noncontrolled trials for adults with chronic cough that found a high percentage of cough resolution when using an approach that focused on the diagnosis and treatment of the most common causes: asthma, gastroesophageal reflux disease, and upper airway cough syndrome. Preliminary studies in children support an approach that distinguishes between a wet and dry cough, as well as an in-depth investigation of any specific symptoms that point to an underlying chronic illness. CONCLUSION Allergists, as experts in treating upper airway and lower airway disorders, are uniquely poised to diagnose and treat chronic cough.
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Abstract
PURPOSE OF REVIEW Despite our knowledge of asthma pathophysiology and several guidelines, studies have indicated growing morbidity. This review highlights the rationale for the trend in asthma care of separating asthma control from asthma severity. RECENT FINDINGS Recent research has highlighted why asthma morbidity continues to be such a conundrum. This includes the variability of asthma control over time, inability to achieve total asthma control in some patients, disagreement between various measures of asthma control and the lack of an agreed tool for determining asthma control. SUMMARY By dissociating asthma control and severity, the clinician may focus on the level of control during each encounter, independent of asthma medication. One can still build upon the step-up and step-down algorithm, while reinforcing control of asthma as the ultimate goal. Asthma control connotes the status of the disease, highlighting the dynamic nature of this illness both as the response to a trigger as well as therapy. Although more aggressive intervention may be required to achieve adequate control in severe persistent asthma versus mild persistent disease, the goal of appropriate asthma control remains constant in the spectrum of asthma severity.
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Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, Wald ER, Khan DA, Blessing-Moore J, Lang DM, Nicklas RA, Oppenheimer JJ, Portnoy JM, Schuller DE, Tilles SA, Borish L, Nathan RA, Smart BA, Vandewalker ML. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2006; 116:S13-47. [PMID: 16416688 DOI: 10.1016/j.jaci.2005.09.048] [Citation(s) in RCA: 224] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oppenheimer JJ, Casale TB. Next generation antihistamines: therapeutic rationale, accomplishments and advances. Expert Opin Investig Drugs 2002; 11:807-17. [PMID: 12036424 DOI: 10.1517/13543784.11.6.807] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Antihistamines, among the most commonly prescribed drugs in the world, have evolved considerably since the first generation was introduced >50 years ago. The first generation antihistamines (e.g., chlorpheniramine, diphenhydramine, promethazine and hydroxyzine) are still widely available and in use today. These drugs have considerable sedative effects caused by their ability to cross the blood-brain barrier. The next generation of antihistamines to emerge in the market were devoid of these sedative effects; however, two (terfenadine and astemizole) have shown rare but lethal cardiotoxic side effects. The third generation antihistamines, metabolites of the earlier drugs, have demonstrated no cardiac effects of the parent drugs and are at least as potent. Many have exhibited superior pharmacokinetic and pharmacological profiles, including an improved onset of action and duration of effect. The clinical benefit of these newer oral antihistamines will clearly help improve the quality of life of patients with chronic allergies.
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Abstract
BACKGROUND Allergic contact dermatitis to Alstroemeria has been well documented; however, occupational allergy to this decorative flower has never been reported in the literature. OBJECTIVE We describe a florist with complaints of a sense of throat tightness, allergic rhinoconjunctivitis, urticaria, and facial angioedema attributable to the handling of this popular flower. METHODS An allergy skin testing by the puncture technique and a challenge test are performed in a private office. A staff member is used as a control for the skin testing. Main outcome measures are the subject's clinical symptoms. RESULTS The allergy skin testing reveals positive response to Alstroemeria (Peruvian lily), but negative to Stargazer lily, solidago, and few other flower extracts. In the challenge test, the subject develops conjunctival injection, postnasal drip with nasal congestion, and cough. CONCLUSIONS This is the first report of a type I allergic reaction to Alstroemeria and illustrate the ease of in-office performance of skin testing and challenge to flowering plants.
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Cain WT, Cable G, Oppenheimer JJ. The ability of the community pharmacist to learn the proper actuation techniques of inhaler devices. J Allergy Clin Immunol 2001; 108:918-20. [PMID: 11742268 DOI: 10.1067/mai.2001.119153] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Today, greater responsibility is placed on community pharmacists for the education of patients than ever before. Thus community pharmacists were recruited for this study and asked to demonstrate the proper steps in the actuation sequences of 3 inhaler devices. Baseline measurements were followed by an instructional session on the proper actuation technique, and then a posttest was conducted 4 to 6 weeks later. The mean changes between baseline and postinstruction percentage scores for the metered-dose inhaler device, the Turbuhaler, and the Diskus were (mean +/- SD) 17.1% +/- 15.4%, 22.6% +/- 18.7%, and 38.4% +/- 19.6%, respectively. This study demonstrates that a single instructional session can dramatically improve a community pharmacist's ability to demonstrate the correct method of actuation.
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Cain WT, Oppenheimer JJ. The misconception of using floating patterns as an accurate means of measuring the contents of metered-dose inhaler devices. Ann Allergy Asthma Immunol 2001; 87:417-9. [PMID: 11730185 DOI: 10.1016/s1081-1206(10)62924-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients and physicians have searched for a reproducible method of determining the amount of medication that a metered-dose inhaler (MDI) contains as well as a reliable method of determining when their MDI is empty. Previously, patients have been instructed to float their canister in water, and depending upon the position attained, have been able to estimate the amount of medication within the canister. OBJECTIVE To investigate whether the floating patterns of MDIs are a reliable method of determining the contents contained within an inhaler canister, including that of the newer devices containing the non-chlorofluorocarbon (CFC) propellant. METHODS Fifteen albuterol sulfate MDIs (Proventil HFA; Schering, Kenilworth, NJ), 15 triamcinolone acetonide MDIs (Azmacort; Rhĵne-Poulenc Rorer, Collegeville, PA), and 15 fluticasone propionate MDIs (Flovent; GlaxoSmith Kline, Research Triangle Park, NC) were obtained from their respective companies. Each device was floated in a clear container full of water before any actuations. The devices were then actuated into the air at 2-minute intervals and each subsequently floated following 25%, 50%, 75%, and 100% of the prescribed number of actuations and its position within the container observed. The canisters were then actuated until no visual spray was produced from the nozzle and again their floating positions within the container observed. RESULTS Each of the three MDIs tested had unique floating patterns both before any actuation as well as throughout the various actuations. CONCLUSIONS This study demonstrates that the floating method is not an accurate means by which patients can identify the amount of medication contained within an inhaler device. This includes both conventional MDIs containing CFC propellant, as well as the newer non-CFC MDIs.
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Milks CJ, Oppenheimer JJ, Bielory L. Comparison of emergency room asthma care to National Guidelines. Ann Allergy Asthma Immunol 1999; 83:208-11. [PMID: 10507264 DOI: 10.1016/s1081-1206(10)62641-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND National Asthma Education and Prevention Program (NAEPP) guidelines were first released in 1991. To date there have been no studies published comparing them with actual care given. OBJECTIVE The aim of this study was to compare the documented care given in the emergency room (ER) of an urban tertiary care hospital with 1991 NAEPP guidelines. METHODS A total of 1858 urban emergency room records with a diagnosis of asthma or reactive airway disease were recovered in 1 year (9/95 to 8/96) from pediatric and adult patients seen in the ER. Ten percent (n = 181) of the charts were reviewed for documentation of history, assessment of severity of attack, treatment given, and disposition. RESULTS History of present attack was documented consistently in all age groups. Nocturnal symptoms were noted in 11%, and frequency of beta agonist use in 38% of the charts. Previous ER visits, hospitalization, ICU admissions, and intubations (HCUM) were documented in 70%. Accessory muscle use was recorded in 76% of the infants and 21% of the adults. Peak flows were obtained in 31% of children and 64% of adults. Steroids were given in the ER in 59% of infants, 83% of children, and 49% of adults. Pediatric patients were referred to their primary care provider 90%, and to pulmonary or allergy clinic 4% of the time. Adults were referred to allergists or pulmonologists 32% of the time. CONCLUSION There are significant differences in ER evaluation and treatment when compared with the 1991 NAEPP guidelines. Differences also exist between various age groups within the same institution.
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Luka RE, Oppenheimer JJ, Miller N, Rossi J, Bielory L. Delayed hypersensitivity to thimerosal in RhO(D) immunoglobulin. J Allergy Clin Immunol 1997; 100:138-9. [PMID: 9257799 DOI: 10.1016/s0091-6749(97)70206-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Oppenheimer JJ, Nelson HS. Seasonal variation in immediate skin test reactions. ANNALS OF ALLERGY 1993; 71:227-9. [PMID: 8372994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Seasonal variation in the size of immediate prick skin tests was examined in relation to changes in seasonal pollen exposure. Immediate skin test reactions to serial 5-fold dilutions of: (1) a specific pollen during its season (short ragweed), (2) a specific pollen from an earlier season (tree), (3) a perennial allergen (D farinae, D pteronyssinus, or cat), and (4) histamine were examined at the projected trough of ragweed-specific IgE (2nd week in July), at the peak ragweed pollen count (3rd week August), at the estimated peak in ragweed-specific IgE (4th week in September) and at a time of no pollen exposure (2nd week in February). All 30 subjects had symptoms of rhinitis during the ragweed season and a 3 mm or greater wheal to: 100,000 AU/mL of short ragweed, 1:20 wt/vol of a tree exact, and a perennial allergen either 100,000 AU/mL of cat or 10,000 AU/mL of D farinae or D pteronyssinus. The median equivalent dose (dose of skin test material required to produce the median skin test index score) for the four time periods revealed significant seasonal differences. The reactions in October and February were significantly greater than those in July and August for all skin test agents. Histamine, ragweed, and trees showed maximal sensitivity in October, while perennial allergens demonstrated a peak in skin test sensitivity during mid-February.
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Hamilos DL, Oppenheimer JJ, Nelson HS, Wenzel S, Driscoll S, Lockey RF, Golden DB, Fan L, Sanks RJ, Bock SA. Suggested approaches for research protocols involving the potential for life-threatening reactions. J Allergy Clin Immunol 1993; 91:1101-20. [PMID: 8509573 DOI: 10.1016/0091-6749(93)90312-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
These guidelines are intended to reduce the potential for serious or life-threatening reactions when clinical research is conducted. The following issues were addressed: identifying the risks involved in the research, providing adequate safeguards in the protocol design and during withholding of medication, anticipating risks, minimizing the chances for human error, providing resuscitative equipment sufficient to deal with the most serious anticipated life-threatening reactions, planning for medical support in case of a life-threatening emergency, and optimizing the use of medical personnel and expertise to handle emergency situations. The guidelines also discuss important general issues about protocol design and implementation and the human subject consent form, which should facilitate the approval of protocols by the governing institutional review board. The guidelines are not meant to be inflexible or applicable to all research situations. However, it is our hope that they will allow for clinical research to be conducted in a manner that affords the research subjects a high degree of protection from unnecessary and possibly fatal injuries.
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Oppenheimer JJ, Nelson HS, Bock SA, Christensen F, Leung DY. Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol 1992; 90:256-62. [PMID: 1500630 DOI: 10.1016/0091-6749(92)90080-l] [Citation(s) in RCA: 341] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Peanut and peanut products are a common food in the diet. Peanuts are also one of the most common foods responsible for food-induced anaphylaxis. Patients rarely lose sensitivity to peanuts. Although the ideal treatment is avoidance, this is often not possible because of hidden exposures; therefore, a more effective treatment is needed. Subjects with confirmed peanut allergy were treated in a double-blind, placebo-controlled study with peanut immunotherapy or placebo. Objective measures of efficacy included changes in symptom score during double-blind placebo-controlled peanut challenge (DBPCPC) and titrated end point prick skin tests (PST). Three subjects treated with peanut immunotherapy completed the study. These subjects displayed a 67% to 100% decrease in symptoms induced by DBPCPC. Subjects also had a 2- to 5-log reduction in end point PST reactivity to peanut extract. One placebo-treated subject completed the study. This subject had essentially no change in DBPCPC symptom scores or PST sensitivity to peanut. Two other placebo-treated subjects underwent a second PST session. These subjects had a 1- to 2-log increase in skin test sensitivity to peanut. All peanut-treated subjects were able to reach maintenance dose, and in no case did an anaphylactic reaction occur secondary to the peanut immunotherapy. The current study provides preliminary data demonstrating the efficacy of injection therapy with peanut extract and provides a future line of clinical investigation for the treatment of this potentially lethal disease. It should be noted, however, that the rate of systemic reactions with rush immunotherapy was 13.3%.(ABSTRACT TRUNCATED AT 250 WORDS)
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Oppenheimer JJ, Tonnesen MG, Nelson HS. Case report: an unusual reaction to foods? ANNALS OF ALLERGY 1992; 68:17-21. [PMID: 1736715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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