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Biomedical subjects

R L Mabry

Publications and source records attributed to R L Mabry.

At least 37 records · Page 2Linked to original sources
PubMed1997

Use of a screening RAST in a large neuro-otologic practice.

Evidence in the literature emphasizes the role of the immune system in disorders of the inner ear and eustachian tube. We initially investigated the presence of inhalant allergy in selected patients seen for otologic problems by means of a screening radioallergosorbent test (RAST), using either a microscreen or a limited antigen panel. This study analyzed the results of tests performed over a 2-year period on 186 patients seen by one of us (WLM) for treatment of vertigo (66%), tinnitus (63%), hearing loss (49%), aural fullness (48%), Meniere's quadrad (27%), balance disturbance other than true vertigo (21%), and eustachian tube dysfunction (4%). We found an incidence of immunoglobulin E-mediated hypersensitivity of nearly 40% in a patient population selected solely for neuro-otologic symptoms and not for sinonasal symptoms. This figure is more than double that quoted for the general population. We also found a surprisingly high incidence of mold antigen atopy in this selected population. Allergy can contribute to a number of otologic symptoms, including eustachian tube dysfunction, vertigo, tinnitus, hearing loss, aural fullness, and nonspecific balance disturbance. Allergy also has been emphasized as an etiologic factor in a portion of patients diagnosed with Meniere's syndrome. A screening RAST, combined with clinical evaluation, appears to be an excellent tool for evaluating these patients for inhalant allergy as part of a comprehensive workup.

Adolescent↗
PubMed1997

The screening RAST: is it a valid concept?

Dr. William King in 1982 advocated the use of a "miniscreen" panel of six antigens to cost-effectively initiate allergy testing. In a study of 100 consecutive patients, we found that a "midiscreen" of nine antigens was more sensitive and efficient and more accurately identified negative responders. However, the miniscreen was also effective if adjusted for regional antigen differences.

Cost Control↗
PubMed1997

Immunotherapy in the treatment of allergic fungal sinusitis.

Recommendations to withhold immunotherapy with fungal antigens from patients with allergic fungal sinusitis (AFS) have been based primarily on retrospectively reviewed, anecdotal case reports and theoretical considerations. A study that was approved by the investigational review board of our institution is ongoing in our department to administer immunotherapy with relevant fungal antigens to patients with histologically proven AFS. After 1 year, no instances of worsening of symptoms as a result of this therapy have been observed. Objective measurement of improvement has been difficult, but our initial clinical impression is that this treatment regimen has resulted in significant reduction in the reaccumulation of crusts and allergic mucin within the sinuses, has led to a reduction in the use of topical nasal steroids, and has made systemic steroid therapy unnecessary, thereby improving the quality of life of the patient. A further study of immunotherapy for patients with AFS is recommended, and suggestions for modification of the current protocol are presented.

Allergens↗
PubMed1997

Quality of life analysis of patients undergoing immunotherapy for allergic rhinitis.

Allergic rhinitis has been conservatively estimated to affect 35 million Americans, with an annual US expenditure of more than $2 billion for treatment. Immunotherapy is generally administered to patients with allergic rhinitis when avoidance is impossible or impractical, when pharmacotherapy provides insufficient relief, and/or symptoms span more than one season. Immunotherapy based on quantified testing (e.g., dilutional intradermal testing [SET] or in vitro methods [RAST, ELISA]) allows administration of antigens in a manner that achieves therapeutic antigen doses more rapidly, yet more safely than immunotherapy administered through a schedule that mixes all antigens at the same concentration and advances on an empirical basis. Sixty patients who received at least one year of quantified testing-based immunotherapy were evaluated using a quality of life questionnaire and individual interviews. Changes in physical, social and emotional well-being were determined. Also investigated were changes in productivity and medication usage. The majority of patients noted significant improvement in all areas within four to six months of initiating immunotherapy, and an overwhelming majority felt that such treatment represented a worthwhile investment of their time and money.

Adult↗
PubMed1996

Correlation of modified radioallergosorbent test scores and skin test results.

In addition to a significantly increased sensitivity as compared with the initial Phadebas radioallergosorbent test, a major advantage of the Fadal-Nalebuff modified RAST is its correlation with skin testing using skin end point titration. This correlation allows physicians to use both these modalities in the diagnosis and treatment of allergic disorders. However, it has been anecdotally believed that the correlation of radioallergosorbent test classes and skin test end points varied somewhat with different antigens. Fifty-three patients were tested by radioallergosorbent test for 12 inhalant antigens common to the North Texas region. These patients subsequently underwent confirmation of their radioallergosorbent test results by application of intradermal tests at a concentration of one fivefold step weaker than the corresponding radioallergosorbent test level (a "RAST minus one" dilution). The relationship between radioallergosorbent test and skin test results will be critically analyzed.

Administration, Inhalation↗
PubMed1996

Making the diagnosis of allergy.

A thorough and continuing history is the primary means for establishing the diagnosis of inhalant allergy. Confirmation of offending allergens may be accomplished by either skin tests or in vitro methods. Clinical judgment is necessary to draw appropriate inferences from the allergy history, confirmatory physical examination, adjunctive tests and specific allergen skin tests or in vitro assays.

Allergens↗
PubMed1995

Pharmacotherapy of allergic rhinitis: corticosteroids.

Corticosteroids are potent antiinflammatory preparations that have become a mainstay of pharmacotherapy for allergic rhinitis. Numerous forms are available, and these may be administered systemically or locally. It is incumbent upon the prescribing physician to be aware of the general guidelines for use of corticosteroids, the various preparations available, and the potential side effects associated with their administration.

Administration, Intranasal↗
PubMed1995

Radioallergosorbent microscreen and total immunoglobulin E in allergic fungal sinusitis.

One of the commonly held concepts regarding allergic fungal sinusitis is that patients with this disorder also demonstrate allergy to other inhalants. However, few published investigations have confirmed this. In this study serum from 16 consecutive patients with histologically proven allergic fungal sinusitis was tested with a seasonal and a perennial radioallergosorbent microscreen disk. The seasonal radioallergosorbent microscreen combines on one disk antigens for two grasses, two weeds, and two trees, and the perennial disk contains Alternaria and dust mite antigens. Total immunoglobulin E was also determined for each sample. Fifteen of the 16 samples demonstrated a radioallergosorbent class II or greater response to both. The total immunoglobulin E level was greater than 100 units/ml in 14 samples (> 1000 in 4 cases) and 97 units/ml in another. This study addresses the presence of inhalant allergy in patients with allergic fungal sinusitis previously described in case reports. The results support the concept that allergic fungal sinusitis is a true allergic (rather than infectious) disease.

Allergens↗
PubMed1994

Allergic and infective rhinosinusitis: differential diagnosis and interrelationship.

Despite the growing emphasis on sinus surgery, the management of chronic or recurrent sinus problems remains multifaceted and should include consideration of contributory, correctable medical factors. Accurate differentiation between infective or allergic rhinosinusitis is often difficult if based only on history and physical examination. The character (and culture results) of mucus obtained from the sinus ostia region by endoscopy may confirm an infective problem, whereas positive results of specific allergy tests, supported by history, will confirm the presence of significant allergy. If complicating infection is not appropriately controlled, allergic management of rhinosinusitis will yield results that are less than optimum. Failure to recognize and treat contributory allergy may jeopardize the results of sinus surgery performed to resolve chronic infection.

Bacterial Infections↗
PubMed1994

Intranasal steroids in rhinology: the changing role of intraturbinal injection.

Intraturbinal injection of repository corticosteroid has been widely used by otolaryngologists for over four decades. The potential for visual loss when retinal embolization or vasospasm complicate this procedure and the introduction of topical nasal steroid preparations have gradually reduced its usage and reshaped the role of intraturbinal steroid injection in the management of a variety of rhinologic disorders. A review by the author of twenty-five years' experience, including over thirteen thousand intraturbinal corticosteroid injections, shows no visual complications in this large series. However, a decline in the use of this procedure was noted, possibly influenced by several factors. Appropriate roles for intraturbinal steroid injection and topical corticosteroid nasal sprays are suggested.

Administration, Intranasal↗
PubMed1993

Evidence of IgE-mediated hypersensitivity in allergic fungal sinusitis.

Despite documentation of specific immunologic hypersensitivity in a few case reports, controversy continues as to the role of allergy versus true infection in the clinical entity of allergic fungal sinusitis (AFS). Using a modified radioallergosorbent test (RAST) to multiple fungal antigens, 16 patients meeting the histologic criteria of AFS and with positive fungal cultures were compared to 5 control patients with similar preoperative clinical findings but without histologic or culture evidence of AFS. All patients were immunocompetent and none demonstrated histologic evidence of tissue invasion. All AFS patients were RAST-positive to at least one fungal antigen in the family of their cultured organism with positive defined as class 2 or greater. No control patient was RAST-positive to either dematiaceous or Aspergillus fungal antigens. Thus, modified RAST testing can aid in the routine clinical diagnosis of AFS, and it provides further serologic evidence for a type I hypersensitivity in the pathogenesis of AFS.

Adolescent↗
PubMed1993

Therapeutic agents in the medical management of sinusitis.

Surgical approaches to the management of sinus disease have undergone a significant change over the past decade. The rhinologist must appreciate that the medical management of sinusitis also has been radically altered during the past 10 years by the development of newer and better pharmacotherapeutic agents for the treatment of sinusitis. These agents are best employed as part of an ordered approach to treatment with a full knowledge of their proper applications and potential drawbacks.

Adrenal Cortex Hormones↗
PubMed1992

Topical pharmacotherapy for allergic rhinitis: new agents.

The advantages of topical (as opposed to systemic) therapy for allergic rhinitis include the avoidance of undesirable systemic effects and the concentration of therapeutic effect on the target organ. Successful topical therapy requires establishment of a proper diagnosis, followed by effective delivery of the medication to the nasal mucosa. In addition to currently available preparations such as cromolyn sodium and various corticosteroids, several other topical nasal preparations for the treatment of allergic rhinitis are under investigation. These include antihistamines (eg, levocabastine), anti-inflammatory/mast cell stabilizing drugs (eg, nedocromil), new corticosteroids (eg, triamcinolone, budesonide, fluocortin, fluticasone), anticholinergics (eg, ipratropium), and miscellaneous agents (eg, HEPP [IgE pentapeptide]).

Administration, Topical↗