Sinus Imaging for Diagnosis of Chronic Rhinosinusitis in Children.
Curr Allergy Asthma Rep. 2012 Feb 2;
Authors: Leo G, Triulzi F, Incorvaia C
Abstract
Chronic rhinosinusitis (CRS) is a relatively common disease in children but is often overlooked because at times the clinical symptoms are subtle and nonspecific. This makes imaging very important in the diagnosis. Among the different techniques, plain radiography has limited utility, whereas CT scan and MRI have a major role in evaluating the modifications caused by the disease. In particular, a CT scan provides higher resolution of bone and soft tissue and removes the overlapping structures that are present in conventional radiography. CT is recommended in isolated sphenoid sinusitis, is essential in diagnosing fungal sinusitis, and is the technique of choice when orbital complications are suspected. MRI allows investigation of not only the morphology of structures, but their intrinsic biophysical and biochemical properties, such as water content, cellular density, lipid or blood product deposits, and fibrosis. MRI allows better soft tissue differentiation and high spatial resolution images depicting fine details. When indicated, MRI with contrast gadolinium-based agents may better characterize the local disease extension or its diffusion beyond paranasal and nasal cavities and has excellent contrast resolution. A combination of CT and MRI is useful in cases of diagnostic difficulties, especially when complications are involved.
PMID: 22297923 [PubMed - as supplied by publisher]
Olfaction is an essential chemosensory system in the living world. Although less appreciated in humans, smell impairment significantly affects many aspects of quality of life. Smell disorders may be caused by an impaired nasal airway or by lesions in the olfactory system, leading to reduced or distorted smell perception. The most common causes of smell disorders are aging, upper respiratory tract infection, sinonasal disease, and head trauma. Recovery is rarely complete. Counseling is important in progressive or severe smell loss. In patients with distorted smell perception, antidepressant medication is sometimes necessary. Best response to treatment is achieved for nasal obstruction and sinonasal inflammatory disease. Treatment of olfactory impairment caused by sinonasal disease includes medication with topical and systemic steroids, or surgery for refractory cases. Although there are reports that surgical resection of olfactory neurons may lead to reinnervation and recovery of smell, adequate treatment of the smell loss remains an unmet need.
PMID: 22297924 [PubMed - as supplied by publisher]
Allergic rhinitis is a major medical and socioeconomic problem due to its troublesome local symptoms, negative impact on quality of life, association with reduced productivity and increased absenteeism, its widespread nature, and the rapidly rising medical costs associated with the disease. Its handling depends on improved understanding of genetic, biological, environmental, and lifestyle predisposing factors, and the development of new and effective treatment strategies, both medically and focusing on the way we are living.
PMID: 22287064 [PubMed - as supplied by publisher]
Allergic rhinitis (AR) is characterized by immune-mediated inflammation of the nasal mucosal lining. Although this chronic disease is not fatal, it is associated with many debilitating symptoms. Like many other chronic diseases, AR has a wide range of clinical aspects, and comorbidities such as asthma, rhinosinusitis, dermatitis, and conjunctivitis may accompany the disease to different degrees. These comorbidities and features determine the clinical phenotypes of AR. Different phenotypes and other characteristics of AR are discussed in this review. It is important for clinicians to be aware of these variable clinical phenotypes of AR to diagnose and treat the disease properly.
PMID: 22274541 [PubMed - as supplied by publisher]
Role of Medical Therapy in the Management of Nasal Polyps.
Curr Allergy Asthma Rep. 2012 Jan 25;
Authors: Alobid I, Mullol J
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses regarding its cause, remains poorly understood. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, postnasal drip, and facial pain or pressure. Among the objectives of CRSwNP management are to eradicate nasal polyps from nasal and sinusal cavities, eliminate symptoms, and prevent recurrences. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating CRSwNP. Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.
PMID: 22274542 [PubMed - as supplied by publisher]
Peripheral and tissue eosinophilia are usually associated with a variety of inflammatory, malignant, and infectious conditions. As the presence of eosinophils in the tissues may cause significant cellular damage to vital organs such as the heart, tissue eosinophilia should be diagnosed and treated promptly. One operative way to evaluate eosinophilic disorders is to classify them into extrinsic and intrinsic. While extrinsic eosinophilic disorders are usually due to the production of eosinopoietic factors derived from T cells or tumor cells, the intrinsic types generally are the result of genetic mutations in the eosinophilic lineage. As we understand more the biology of eosinophils, only a few eosinophilic disorders remain idiopathic. The purpose of this article is to help the clinician classify in an operational manner most eosinophilic disorders, using the extrinsic and intrinsic model. This may facilitate not only a better understanding of the role of eosinophils in these disorders, but also help the systematic clinical work-up and potential treatment of affected patients.
PMID: 22160831 [PubMed - as supplied by publisher]
Management of Multiple Drug Allergies in Children.
Curr Allergy Asthma Rep. 2011 Dec 3;
Authors: Dioun AF
Abstract
Children with multiple drug allergies are likely to require treatment with one or more of the drugs to which they may have had a reaction, when there is no alternate effective drug available. Detailed review of their history and/or use of appropriate diagnostic studies will help determine the potential safety of readministering the desired drug as well as the method for its readministration, most likely in the form of a drug challenge or desensitization. A practical approach to the diagnosis and treatment of children with multiple drug allergies is described in this review.
PMID: 22139903 [PubMed - as supplied by publisher]
Much has been written about hereditary angioedema (HAE) in recent literature; however, the prevalence of angiotensin-converting enzyme inhibitor-induced angioedema (ACEiIA) far exceeds that of HAE. Similarly, multiple therapies have been developed for HAE, yet no definitive therapy is available for ACEiIA. In this article, we discuss the mechanism, prevalence, pathophysiology, and management of ACEiIA, with focus on newer therapies recently approved for HAE and how they may be effective for ACEiIA.
PMID: 22127615 [PubMed - as supplied by publisher]
The Likelihood of Remission of Food Allergy in Children: When Is the Optimal Time for Challenge?
Curr Allergy Asthma Rep. 2011 Nov 29;
Authors: Wood RA
Abstract
Although diagnostic testing methods for food hypersensitivity have improved over time, both in vivo and in vitro methods are significantly flawed, especially as evidenced by the frequent occurrence of false-positive test results. Because of these limitations, oral food challenge testing remains an essential element in the diagnosis and management of food allergy. In fact, the double-blind, placebo-controlled food challenge remains the gold standard for the diagnosis of food allergy. In this review, we focus on the optimal timing of oral food challenges, especially for patients with a known food allergy, to determine if the food allergy may have been outgrown.
PMID: 22125089 [PubMed - as supplied by publisher]
Therapeutics in Food Allergy: The Current State of the Art.
Curr Allergy Asthma Rep. 2011 Nov 19;
Authors: Otsu K, Fleischer DM
Abstract
Food allergy is an increasing public health dilemma in Westernized countries, yet no viable treatments are currently available for those who are afflicted. The only options available for patients with food allergies are prevention of reactions by strict avoidance of the offending food(s) and symptomatic treatment of any adverse effects from accidental exposures. Approaches are being pursued to develop treatments, and allergen-specific therapies such as oral immunotherapy, sublingual immunotherapy, and epicutaneous immunotherapy with different foods have shown promise. Other modalities are also being investigated, potentially leading to the discovery of novel therapeutic options.
PMID: 22101989 [PubMed - as supplied by publisher]
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