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Background In current practice, allergens in vacuum-collected dust are used as surrogates for inhalable allergens. We developed an air-sampling device that can be used by patients for direct measurement of airborne allergen concentrations in their own homes. Objective To demonstrate the use of this device to establish allergen concentration reference ranges in a target population and to evaluate associations between patient-reported information and measured allergen concentrations. Methods Patients from 5 allergist's practices in the Chicagoland region were provided with instructions, questionnaires, informed consent forms, and samplers to run for 5 days in their bedrooms. Samples were collected from cartridges and assayed by multiplex immunoassays for 12 common household allergens and enzyme-linked immunosorbent assay for ragweed. Results Unique allergen profiles were obtained for 102 patient homes. Samples with allergen concentrations above the limit of detection were as follows: total dust mite, 28%; cat, 61%; dog, 64%; mouse, 12%; rat, 0%; cockroach, 4%; Alternaria, 6%; Aspergillus, 21%; birch pollen 1%; grass, 8%; and ragweed, 5%. Of those, 75 completed questionnaires, providing meta-data for further analysis. Pet allergens correlated significantly with number of pets owned. Humidity correlated with dust mite allergens, open windows with Alternaria and mouse allergens, and high-efficiency particulate air filter use with reduced levels of several allergens. Many other variables showed no significant correlations. Conclusion The combination of ease of use, high air-sampling rate, and sensitive immunoassays permitted the measurement of airborne allergen concentrations in homes and establishment of reference ranges. Patient-reported information permitted identification of factors that could relate to allergen concentrations and suggested remedial measures.

Children with asthma in low-income households in Chicago were participants in a school-based mobile van clinic, Mobile C.A.R.E. Our objective was to investigate whether long-term follow-up changed clinical markers and resource utilization. Children were evaluated by a pediatrician in a mobile allergy clinic and classified and treated based on National Asthma Education and Prevention Program (NAEPP) guidelines. Intervention consisted of assessment of allergic environment with avoidance recommendations, institution of appropriate controller therapy and inhaler technique, education on asthma and asthma management, and expectations for asthma control. Over 20,000 children were screened, 2041 were examined at least once, and 677 children had four follow-up visits. With follow-up, there was a decrease in hospitalizations and emergency room visits. Symptomatic markers (daytime and nighttime cough, wheezing, and dyspnea symptoms), frequency of rescue inhaler use, and a quality-of-life score improved from baseline. These findings suggest that ongoing school interventions may reduce resource utilization and improve clinical symptoms. Primary care physicians may be able to deliver specialized care to large numbers of inner-city children with asthma.

This 3-week prospective, randomized, double-masked, parallel-group study compared ketotifen fumarate 0.025% ophthalmic solution and olopatadine hydrochloride 0.1% ophthalmic solution in 66 patients with seasonal allergic conjunctivitis. The drugs were instilled twice daily. Signs and symptoms were assessed on days 5 (visit 2) and 21 (visit 3). Other efficacy variables were the responder rate (patients with excellent or good global efficacy on days 5 and 21) and patient and investigator ratings of global efficacy. Comfort was evaluated immediately after instillation of the first drop and at each follow-up visit. The frequency of adverse events was the safety assessment. The responder rate was higher with ketotifen than with olopatadine on day 5 (72% vs 54% for patient assessment, 88% vs 55% for investigator assessment) and day 21 (91% vs 55%, 94% vs 42%). Global efficacy ratings were higher with ketotifen, and severity scores for hyperemia and itching were significantly lower. Both drugs elicited comparable comfort ratings. The most common adverse events were burning/stinging and headache.

Background Electrographic changes after insect stings have been reported both with and without systemic symptoms. To our knowledge, however, there have been no reported cases of arrhythmias in the maintenance phase of venom or pollen immunotherapy. Objective We report a case of a patient who developed paroxysmal atrial fibrillation after receiving venom and pollen immunotherapy. This patient was initially evaluated in an outpatient setting, and the events described occurred at an allergist's private office. We believe this is an atypical presentation and would be very pertinent to the practicing allergist. Methods This patient was under the care of a clinical allergist in a private practice with associations to a teaching hospital. Interventions were as described in the body of the paper, more specifically venom and pollen maintenance immunotherapy followed by two doses of 0.3 mL of 1:1,000 concentration epinephrine intramuscularly. Results Patient was found to be in atrial fibrillation along with systemic symptoms immediately after administration of immunotherapy. After epinephrine administration, patient converted back to normal sinus rhythm and systemic symptoms resolved. Conclusions Atrial fibrillation is an atypical presentation of a systemic reaction to immunotherapy.

The prevalence of asthma, asthma hospitalization rates, and asthma mortality are increasing in the United States. Criteria for corticosteroid-dependent asthma and potentially fatal asthma have been described. We report six patients with potentially fatal asthma whose disease became even more life threatening because of psychological, psychosocial, environmental, financial issues, or a combination of these factors. Two of these patients died of asthma. The single common denominator is that owing to a variety of factors these patients are noncompliant with medications, office visits, telephone instructions, or other points of management. Thus the term "malignant" in the context used in this report is to emphasize to patients and physicians that the asthma is unmanageable, not because of the asthma as a disease itself, but because the noncompliance of the patient makes the disease malignant. Patient education and confrontation regarding noncompliance did not reduce major asthma episodes. The patients place themselves at higher risk of death from asthma by not letting the physician help control their asthma. This poses a great dilemma to the physician, who must have the patients' health as the highest priority. A management strategy is outlined for these difficult patients.

We describe a 36-year-old man with recurrent Stevens-Johnson syndrome, which became progressively more severe over a 13-year period. His episodes were apparently preceded by herpes simplex virus oral mucosal infections. A management protocol, including immediate therapy with acyclovir and prednisone at the onset of herpes simplex virus oropharyngitis, is outlined. This management strategy has successfully prevented four subsequent episodes of progression to Stevens-Johnson syndrome. Thus, Stevens-Johnson syndrome associated with herpes simplex virus may be prevented by early use of acyclovir and prednisone. (Arch Intern Med. 1992;152:1513-1516)