Late-phase allergic reaction in nasal provocation with fungal allergens

Differentiation between asymptomatic sensitization to fungi and clinically relevant allergy is difficult. The aim of this study was to assess the value of nasal provocation with fungal allergens in the diagnosis of allergic rhinitis with special attention to the late phase of monitoring. Eighteen patients with allergic rhinitis and confirmed sensitivity to molds were included in the study. In 16 patients with allergic rhinitis, nasal provocation with fungal allergens was positive. The provocation tests were performed in the asymptomatic period. Stallergenes nasal provocation extracts were used. Extracts were blinded and patients were not informed whether allergen or control solution was tested. The results of both allergen and control solution challenge were compared. Results of the challenge were assessed with symptoms score (after 5 and 30 minutes and 6 and 24 hours), mast cell tryptase level (before and 30 minutes after), and cytological examination of the nasal fluid (before and 6 hours after), and an early and a late-phase of the allergic response was evaluated. Clinical reaction was noted in 16 patients, with significantly marked late phase of the allergic reaction in 14 subjects. The late phase was the only reaction to the challenge in 6 subjects. Tryptase level rose in 2 subjects, whereas significant increase in eosinophils count was observed in 11 patients (Wilcoxon test, p = 0.001). The nasal allergen challenge with fungal allergen seems to be a promising diagnostic method of allergic rhinitis. Late phase of the allergic reaction seems to be an important part of the assessment.

[Fungal allergy--part II]

Allergic reactions caused by fungi, may be present in the airways, skin, eyes, gastrointestinal tract, skin and to cause systemic reaction. Nasal symptoms react as allergic rhinitis. In a small group of patients the allergic fungal rhinosinusitis is present. It is important, because of the way of treatment, to differentiate the AFS from the other forms of chronic rhinosinusitis. The fungi may cause bronchial asthma, allergic bronchopulmonary aspergillosis and allergic alveolitis (hypersensitivity pneumonitis). Diagnostics of the allergic reactions caused by fungi includes routine allergological methods, mycologic culture and direct microscopic examination. The process of reaching the diagnosis of allergic fungal rhinosinusitis and allergic bronchopulmonary aspergillosis may require the CT and histopatologic examination. The treatment of fungal allergic reactions includes allergen avoidance, pharmacotherapy, antifungal treatment (id reactions) and surgical treatment (allergic fungal rhinosinusitis). The immunotherapy is a valuable, and accepted by the WHO therapy of the Cladosporium and Alternaria sensitive patients.

[Fungal allergy. Part I]

Fungal spores are one of the main groups of allergens. They are present in our environment all year long. The concentration of the spores in July and August is 100-1000 higher than pollens. In contrast with the pollens there is a correlation between the spore count and higher risk of medication use, nocturnal asthma attacks, and hospitalization rates. We have presented the clinical classification of fungi, and characterized main indoor and outdoor allergens. The fungi play also an important role in the sick building syndrome. Fungal allergens are not only aeroallergens, they may also get into our body with food. They may also develop contact reactions. Antibiotic allergy is regarded as one of the classic allergic reactions caused by fungi. The id reactions are caused by the fungi from far infection focuses.

[Tinnitus. II.--treatment]

Because of varying origin different therapy of tinnitus methods are applied (surgical, pharmacological, psychotherapy). Treatment of objective tinnitus of vascular origin is usually surgical. It is similar as in the case of tinnitus of mechanical origin. The procedure of operating. Treatment of subjective tinnitus is much more complicated because of difficulties with determining of its occurence. We can separate morbus Ménière, otosclerosis, which require precise treatment. Apart from these disease treatment of subjective tinnitus is multidirectional. It may include pharmacological treatment, psychotherapy, surgical treatment and other methods.

[Tinnitus. I.--pathophysiology]

Tinnitus is a sound impression in one or both ears appearing without any acoustic impulses from the environment. It can be a morbid symptom coming either from different parts of the auditory path (from the external auditory meatus to the auditory area in the cerebral cortex) or other organs. Usually ear noise is accompanied by hypacusis. According to British Tinnitus Association one of ten people suffers from ear noises and about 35-45% of adults have come down with it. This number is still increasing. The older the patients is the more frequent the noises are, especially among women after 40 and men after 50 years old. Because of varying origin different therapy methods are applied (surgical, pharmacological, psychotherapy).

[Head and neck lymphomas in the material of the ENT department of Municipal Hospital in Gdynia in 1977-1996]

The authors present data relating to patients with malignant lymphoma of the head and neck diagnosed at the ENT Department, Municipal Hospital in Gdynia, during the years 1977-1996. The material is analysed in relation to the sex and age of the patient and the localisation of tumour. Some cases are presented in detail depending on localisation or difficulties in diagnosis (lymphoma of the larynx and ethmoidal sinus).

[Thyroid neoplasm with symptoms of carotid body tumor]

The authors present a case of thyroid cancer manifestating itself as carotid body tumor. Fine needle biopsy performed twice and an arteriography suggested this diagnosis.