The patient with allergies

Endoscopic endonasal repair of a cerebrospinal fluid leak secondary to a meningoencephalocele using a posterior – based middle turbinate flap

Cerebrospinal fluid leaks are rare but remain an important differential diagnosis for patients presenting with persistent, unilateral rhinorrhoea. This case describes a middle-aged female with persistent left sided rhinorrhea. She was minimally responsive to treatment for chronic sinusitis. On re-evaluation, a cerebrospinal fluid leak secondary to a meningoencephalocele was identified. This was subsequently repaired with a pedicled, vascularized graft using an endoscopic endonasal approach. The discussion which follows reviews the management of CSF rhinorrhoea with an emphasis on the available surgical options as well as the materials used for repair.

Heat Shock Protein 60: Identification of an Undetected Allergen from Dermatophagoides farinae

Background

Recently, the incidence of allergic diseases has been on the rise; Dust mite is the major indoor allergen which needs a special consideration.

Objectives

This study was carried out to identify and investigate the molecular properties of a new allergen named Hsp60 and to afford a foundation for future research of the allergic diseases caused by Dermatophagoides farinae.

Materials and Methods

Using polymerase chain reaction (PCR) with degenerate primer, the cDNA of Dermatophagoides farinae Hsp60 was amplified and sequenced. Next, the cDNA fragment was cloned into the prokaryotic expression vector pET-32a for the expression of the Hsp60. Then, it was further characterized by Elisa and Western Blot analysis.

Results

The partial cDNA sequence of the Dermatophagoides farinae Hsp60 was determined, and the recombinant Hsp60 was successfully expressed in Escherichia coli BL21. ELISA and Western blot analysis showed that the recombinant protein could be specifically recognized by SIgE from sera of the Dermatophagoides farina-allergic patients.

Conclusions

Our group has, for the first time, demonstrated the fact that there is an Hsp60 family of Dermatophagoides farinae and analyzed the allergenicity of the Hsp60 with immunological method. These results provide a foundation for further allergological research of the Dermatophagoides farinae Hsp60.

Quality-of-life in insect venom allergy: validation of the Turkish version of the “Vespid Allergy Quality of Life Questionnaire” (VQLQ-T)

Purpose

Methods

Results

Conclusions

AAOA allergy primer: history and physical examination

BACKGROUND

Allergic disease is very common in the general population and makes a significant impact on the quality of life of patients. Immunoglobulin E (IgE)-mediated allergic disease manifests throughout the body, but many signs and symptoms of inhalant allergy are centered in the head and neck region.

METHODS

A thorough yet focused history of allergic symptoms and potential physical examination findings of inhalant allergy are described.

RESULTS

History should include types and timing of symptoms, environmental and occupational exposures, family history, associated diseases, and prior treatment, if any. Physical examination should include the skin and structures of the head and neck region. Nasal endoscopy can be helpful in visualization of nasal polyps.

CONCLUSION

Many times, history alone can serve to make the diagnosis, but physical examination also demonstrates specific findings that confirm the practitioner's presumptive diagnosis of allergic disease. However, should medical treatment fail or the diagnosis be in doubt, further diagnostic investigation with allergy testing should be pursued.

Health-related quality of life in children and adults with respiratory allergy in Colombia: prospective study

BACKGROUND

Allergic diseases are very common, with the estimated cumulative prevalence in Colombia for asthma and allergic rhinitis being 22.7% and 31.3% respectively, and with a clear upward trend. A major social as well as economic impact associated with allergic disease has been described. Because in Colombia there are no studies that assess the Health-Related Quality of Life (HRQOL) in allergic respiratory diseases, our aim is to describe the HRQOL in subjects with respiratory allergy and its association with clinical control variables.

METHODS

A prospective descriptive study was conducted among 76 Colombian subjects with rhinitis and asthma/allergic rhinitis. In order to evaluate the HRQOL, the instruments Kidscreen-27 and SF-36 were applied. The scores obtained in the HRQOL fields were correlated with the following clinical variables: peak expiratory flow (PEF) and peak nasal inspiratory flow (PNIF).

RESULTS

In children, the better HRQL domain is present in the school environment (55.9) and the worst in psychological well-being (39.9). For adults the worst HRQL was found in the emotional function domain (55.6) while the physical function (81.7) had the best. There were no statistical differences between groups of asthma/allergic rhinitis and allergic rhinitis. Subjects with allergic asthma showed a strong correlation between the mental health domain and PEF values (r=-0717, p=0.046).

CONCLUSION

Mental health is more affected than physical health in Colombian subjects with respiratory allergy. There was a strong correlation between the mental health domain and the values of PEF in patients with asthma/allergic rhinitis.

Allergic rhinitis

Familiarity with the diagnosis and management of allergic rhinitis is important for physicians concerned with the nasal airway. Allergic rhinitis is a common and manageable condition that may cause persistent or intermittent symptoms that vary as to duration and severity. Allergic rhinitis impairs quality of life, sleep, school performance, and productivity on a scale that compares with other chronic diseases. Diagnosis is primarily clinical, but supported by allergy testing. Therapeutic options for allergic rhinitis include pharmacotherapy, environmental control, and immunotherapy. More recently, a role for sublingual immunotherapy and turbinate reduction has been reported.

Epidemiology of allergy

Atopic disease represents a spectrum of disorders characterized by abnormal sensitivity mediated by IgE; approximately 20% of Americans suffer from some form of allergic disease. The sequelae of inhalant and food allergies may present in many organ systems. Manifestations of allergic disease in one site are often associated with symptoms from another site. It is important for clinicians to understand the epidemiology of atopic disease and its causes to facilitate implementation of effective treatment and prevention strategies. This review focuses on the epidemiology of inhalant allergies causing allergic rhinitis and asthma and on IgE-mediated food allergies.

Quality-of-life in wasp venom allergy - validation of the German version of the "Vespid Allergy Quality of Life Questionnaire" (VQLQ-d)

BACKGROUND

Little is known about the quality of life of patients who are allergic to insect venom. This fact is due to the lack of specific instruments assessing the interaction of type 1 allergy and its psychological burden.

PATIENTS AND METHODS

The only established questionnaire on health-related quality-of-life in patients with wasp venom allergies is the "Vespid Allergy Quality of Life Questionnaire" (VQLQ). This questionnaire was translated from Dutch into German and validated with 79 patients with wasp venom allergy, including the use of the well-established general quality-of-life questionnaire WHOQOL-BREF.

RESULTS

In the German version VQLQ-d we could reproduce the validity and reliability of the original Dutch version. Cronbach's alpha of the VQLQ-d was α= 0.95. The results of the VQLQ-d corresponded to the total score of the WHOQOL-BREF.

CONCLUSION

The VQLQ-d enables measurement of quality-of-life in patients with wasp venom allergy in the German-speaking population. This economic tool makes it possible to better describe and treat affected patients. Furthermore, it can be used to advance research in this field.