Biomedical subjects
Publications and source records attributed to D B Wallerstedt.
The therapeutic perspectives in food allergy are thus based upon known principles and mechanisms of tissue injury mediated by immunologic reactions. A thorough knowledge of these, together with new approaches to the identification, elimination, and modification of these reactions, is essential in the management of the patient with food allergy.
Cough may be defined as a physiologic response to foreign or noxious substances that enter or irritate the respiratory tract. It is the fifth most common symptom complex for which patients seek medical care and which results in more than 30 million office visits per year. When cough is present for more than three weeks it is referred to as chronic or persistent cough. This presentation will examine the differential diagnosis of persistent cough together with a description of the autonomic innervation of the human airways, mechanism(s) of cough, and approach to the patient.
The clinical spectrum of allergic diseases and asthma changes over the life span of the individual and is influenced by a wide variety of anatomic, physiologic, and immunologic factors. Nowhere do these changes play a more important role than in the elderly patient with allergic disease or asthma where the culmination of these events contribute to disease expression, which at times can result in irreversible endstage disease. It is estimated that between 2010 and 2030 the elderly population will increase by 75% and will represent a significant proportion of consumers of total health care resources. This presentation will examine possible mechanism(s) that contribute to the development of late-onset allergic diseases and asthma in the elderly as a possible basis for identification of antecedents of endstage disease and interventive strategies for the prevention of the irreversible consequences in this population.
Allergic rhinitis is the most common chronic condition, with an estimated prevalence in the United States of 5-22%, which increases from infancy, peaks in childhood and adolescence, and decreases in the elderly. As a major cause of morbidity, absenteeism, and restricted activity in both children and adults, allergic rhinitis, similar to asthma, appears to be increasing with time. Allergic rhinitis is commonly defined as seasonal or perennial, depending upon whether symptoms are manifested at defined yearly intervals or throughout the year, respectively. While trees, grasses, weeds, and molds are the most frequent causes of seasonal allergic rhinitis, dust mites and molds are the major contributors to perennial allergic rhinitis. The pathogenesis of allergic rhinitis is based upon interactions of allergen with membrane-bound allergen-specific IgE on the surface of mediator cells, i.e., basophils and mast cells, leading to the release of allergic mediators (both performed and newly synthesized) including histamine, leukotrienes, and eosinophil cationic protein (ECP). These are responsible for both immediate allergic responses characteristic of acute allergic rhinitis and the late inflammatory reactions responsible for chronic allergic rhinitis. The evaluation of rhinitis should include a detailed patient history, a careful physical examination, and appropriate diagnostic tests including skin prick tests or serum assays for allergen-specific IgE. Seasonal allergic rhinitis is readily distinguished from perennial allergic rhinitis by history and confirmed by positive skin tests to causative aeroallergens. It is important to differentiate seasonal rhinitis from non-allergic disorders including infectious rhinitis, structural or anatomic problems such as nasal polyps or septal deviation, rhinitis medicamentosa (due to the overuse of topical vasoconstrictors), hormonal rhinopathy (e.g., pregnancy, hypothyroidism), non-allergic vasomotor rhinopathy, non-allergic inflammatory rhinitis with eosinophils (NARES), or rarely, a neoplasm. A knowledge of the epidemiologic and clinical presentation of allergic rhinitis together with these pathophysiologic mechanisms is essential for a modern-day diagnostic and therapeutic approach to the patient who suffers from allergic rhinitis.
This article describes the emotional needs of allergic and asthmatic patients and their families that must addressed if optimal management and well-being is to be achieved. Health care professionals need to recognize the psychosocial issues of patients and parents, which include the effect of stressors, illness perceptions, fears, and concerns and that the management of asthma and allergies requires a team effort, involving a wide variety of health care professionals, e.g., physicians, nurses, social workers, psychologists, teachers, as well as involvement of voluntary health organizations and local support groups. Asthma self-management educational programs address these emotional needs and provide the foundation for gaining control.