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We evaluated 13 workers with respiratory symptoms apparently related to occupational exposure to powdered rose hips. Nine workers had asthma, five had rhinitis, and one worker had urticaria. Seven workers had evidence of IgE specific for rose hips based on positive skin prick tests and positive in vitro tests. Four workers with histories suggestive of asthma related to work exposure underwent bronchopulmonary challenges with rose hips, and two workers had positive challenges with greater than 20% declines in FEV1 measurements. We conclude that rose hips are occupational allergens capable of producing asthma.

Intranasal flunisolide is an effective treatment for allergic rhinitis. Flunisolide has high bioavailability when administered to normal subjects (50% of an intranasal dose reaches the systemic circulation) with minimal systemic effects. Bioavailability in patients with active rhinitis averages 62.4 +/- 15.7%. The oral dose bioequivalent to 100 micrograms intranasally is 500 micrograms. To define the comparative trial and systemic effects of intranasal flunisolide in patients with active allergic rhinitis, a multicenter, randomized, double-blind, placebo-controlled study was conducted during the 1983 ragweed hayfever season. Ninety-nine patients with ragweed hayfever for greater than or equal to 2 years and positive prick skin tests to ragweed were randomly allocated to one of three treatment groups: 0 = oral flunisolide 500 micrograms b.i.d. and intranasal placebo b.i.d.; N = intranasal flunisolide 50 micrograms per nostril b.i.d. and oral placebo b.i.d.; P = intranasal and oral placebo b.i.d. Treatment continued for 4 weeks. Patients kept daily symptom scores. Patients were evaluated by a blinded observer every 2 weeks and were globally evaluated at the study's end. Data were analyzed for each center and pooled. There were no significant differences in symptom severity of sneezing, nasal congestion, and throat itch in the 0 (oral flunisolide) and P (placebo) groups. N (nasal flunisolide) was significantly more effective than O or P (P less than or equal to 0.005) for each symptom for at least one 2-week period. Global evaluation demonstrated control of overall hayfever severity for N (nasal flunisolide) but not for O (oral flunisolide). We conclude that the therapeutic efficacy of flunisolide is achieved by topical and not by systemic action.

Described are the cases of two patients who presented with vocal cord hematomas consequent to poor control of anticoagulation. Both patients presented with hoarseness and cough. One required intubation due to respiratory obstruction. Vocal cord hematomas should be considered in patients who present with upper airway symptoms while anticoagulated.