Environmental control of allergens

The accuracy of symptom-based definition of chronic rhinosinusitis

OBJECTIVE

Currently, the diagnosis of chronic rhinosinusitis (CRS) is a symptom-based definition. This study aims to study, verify and evaluate the predictive value of the symptom-based definition of CRS and compare this with objective tests.

METHODS

Seven hundred and sixty-eight adults, who were referred from primary care centers as patients who met the definition of CRS, were enrolled in the study. The patients were divided into two groups according to their allergic status. The patients were subjected to nasal endoscopy and computed tomography (CT) on the same day.

RESULTS

The results showed 73.15% of the nonallergic patients with symptom-based diagnosed CRS and 65.34% of the allergic patients with symptom-based diagnosed CRS had no CT and endoscopic pathology (Endoscopic score 0 + CT score 0). Nasal discharge was the most common major symptom in all patients from both groups who had pathologic endoscopic and/or CT scan scores.

CONCLUSIONS

It is well established that symptoms are very important in the diagnosis of CRS. However, two major symptoms are insufficient for diagnosis. Therefore, endoscopy and CT have important differential diagnostic roles. Our study showed that in patients with three major symptoms, CT pathology may be sufficient for definitive diagnosis. However, in patients with two major symptoms such as nasal discharge and/or low grade nasal polyposis, endoscopy becomes considerably more important due to inspective findings. If no endoscopic findings are found, the importance of the CT scans is increased.

Addressing the prevalence of respiratory allergy in the home environment

Respiratory allergy prevalence has always depended both on genetic predisposition and specific environmental allergenic stimulation that leads to sensitization and eventual symptomatic disease. Changes brought about by modern technology that have afforded a higher quality of life have also accidentally increased the levels of many respirable and ingestible allergens in the environment. In many cases these higher levels of exposure have exceeded individual thresholds, resulting in the phenotypic expression of allergy in many individuals who were previously asymptomatic even though they were genotypically predisposed to developing allergies. Prevalence can be decreased only if susceptible populations are identified as early as possible through careful family history taking and appropriate testing for sensitivity and if exposure to selected allergens is controlled.

Comparison of outdoor allergenic particles and allergen levels

INTRODUCTION

Spore and pollen counts have been used traditionally to determine aeroallergen exposure. Using a liquid based collector and enzyme immunoassays, we have developed methods for measuring airborne allergen concentrations. In this work we test the hypothesis that airborne allergen concentrations are directly related to spore and pollen counts.

METHODS

Test samplers used included a high-volume cyclonic liquid impinger (SpinCon) and a standard spore trap (Burkard). Samples were collected on a weekly basis from May to October and were analyzed microscopically for spores and pollen grains. The liquid samples were analyzed by enzyme-linked immunoassay for the presence of allergens from Alternaria, Cladosporium, Aspergillus, oak, fescue, ragweed, and plantain. Specific Alternaria allergens Alt al and GP70 also were measured.

RESULTS

Pollen counts for the SpinCon and Burkard collectors were similar, though spore counts were lower with the SpinCon. Detectable amounts of three of the seven allergenic species including fescue, ragweed, and Alternaria were present in air samples. Concentrations of pollens were seen in their respective seasons while fungal allergen levels varied throughout the period. Allergen levels generally agreed with particle counts, however peak allergen levels and peak particle counts for individual species did not correlate well.

CONCLUSIONS

At flow rates of 236 L/min, the SpinCon is comparable to the Burkard for counting airborne pollen and spores. Samples collected by the SpinCon permit quantitative determination of allergen levels in outdoor air. The poor correlation between measured airborne allergen and related particles indicates the potential for significant allergen exposure in the absence of identifiable particles in air.

How to write about pollen

BACKGROUND

Clinicians and palynologists (pollen specialists) often have different ways of expressing the same thing when they write about pollen.

OBJECTIVE

This brief paper considers the confusing use of the word pollens that is frequently encountered in medical literature.

METHODS

Three common uses for the word pollens are considered citing examples from clinical literature. The problems associated with each case are explored.

RESULTS

Words and phrases that can serve as suitable alternatives to the word pollens are presented. The advantages of these alternatives are discussed.

CONCLUSION

The word pollens represents a vague usage that obscures the author's intended meaning. Consistent application of the suggested alternatives will enhance the transmission of key concepts in the medical literature.

Allergy for the laryngologist

Allergic disease can affect any portion of the respiratory tract, including the larynx, trachea, bronchial tree, nasal cavity, paranasal sinuses, nasopharynx, and pharynx. This review evaluates laryngeal manifestations of allergic disease and the impact of allergic mechanisms in disorders, within the scope of laryngology.

Practical environmental modifications for the inhalant allergy patient

Environmental management of inhalant allergens is an important part of a comprehensive allergy management program and is the most controllable aspect by the patient. The safest and most effective way to eliminate an allergic reaction is to eliminate exposure to the antigen that provokes the response. The basic control principles for all inhalant allergens are to (1) remove the source of the allergen if possible, (2) remove accumulated allergen, and (3) prevent the return of the allergen. This article examines the published evidence for environmental control measures in terms of effectiveness, cost, and ease of implementation.