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Biomedical subjects

R L Mabry

Publications and source records attributed to R L Mabry.

At least 55 records · Page 3Linked to original sources
PubMed1992

Significance of borderline levels of specific IgE obtained by FAST-Plus assay.

The significance of "borderline" levels of allergen-specific IgE as measured by in vitro assays has been questioned. Patients whose specific IgE tests Patients were tested for twelve antigens using the FAST-Plus methodology. All 0/1 results were checked using skin tests at a 1:500 concentration. Positive (histamine) and negative (diluent) controls were used. The antigen-induced wheals were compared with those produced by a control wheal of 2% glycerine (the glycerine concentration in a 1:500 dilution). Positive wheals were arbitrarily considered to be those whose diameter after 10 minutes exceeded that of the glycerine control wheal by 2 mm or more. Using the limits of calibrator fluorescence for the FAST-Plus test in effect before 1990, a significant discordance between skin test results and the class 0/1 in vitro readings was evident. Using the standards in effect since 1990, marked concordance between class 0/1 results and positive skin tests was noted. This was most marked for pollens, less so for molds. Using current standards, FAST-Plus class 0/1 results are best considered positive (pending clinical confirmation), rather than negative.

Antigens↗
PubMed1992

Overview: the allergic reaction and site-based therapy.

The successful management of upper respiratory tract allergy is based on a triad of interdependent approaches that, with rare exceptions, must all be considered in every allergic patient. They consist of allergen avoidance with environmental control measures, pharmacotherapy with use of a step-care approach, and immunotherapy. Environmental control measures should be used to prevent events that trigger and sustain the condition. Once started, the allergic reaction includes the release of mediators of inflammation that produce well-known symptoms of allergic rhinitis. Treatment should consist of a step-wise, rational approach that includes site-based therapy with one or more drugs acting at different sites. The drugs used are antihistamines, decongestants, cromolyn sodium, and corticosteroids. Immunotherapy should be considered at any step, because it offers the only curative approach.

Humans↗
PubMed1992

Corticosteroids in the management of upper respiratory allergy: the emerging role of steroid nasal sprays.

Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis, not just those of atopic origin. However, this potent class of drugs also has the greatest potential for adverse effects and complications. Proper use requires that they be used only after failure of more conservative measures, at the smallest effective dose, for the shortest possible time, and preferably should be administered by the topical intranasal route. Topical corticosteroids, concentrated at the area involved, offer significant relief to patients with allergic rhinitis, and although only a relatively small amount of drug is taken up systemically, cautions for proper use are important. Topical steroids should be used only after accurate diagnosis. They must adequately contact the nasal mucosa, and patients should be properly instructed in their use and monitored for local and systemic side effects. Currently available topical preparations--dexamethasone, beclomethasone, flunisolide, and triamcinolone--have differing characteristics. The use of a preparation with a high margin of safety reduces the risk of undesirable systemic effects.

Administration, Intranasal↗
PubMed1992

Blending skin endpoint titration and in vitro methods in clinical practice.

The definitive diagnosis of allergy involves proving the presence of allergen-specific IgE. This had traditionally been done by skin testing, the most precise method being skin endpoint titration. In vitro diagnostic methods offer advantages over skin tests and have become increasingly popular with both patients and physicians. However, thorough knowledge of skin testing techniques and interpretation of results is necessary for the physician using in vitro test methods and also allows moving back and forth between the two modalities in the preparation of antigen treatment sets and adjustment of immunotherapy dosage.

Antibody Specificity↗
PubMed1990

Pharmacotherapy with immunotherapy for the treatment of otolaryngic allergy.

The total management of the patient with inhalant nasal allergy involves the triad of environmental control, pharmacotherapy, and immunotherapy. The latter treatment may not be necessary in all cases, but definitive testing for the responsible allergens may allow proper avoidance measures. Pharmacotherapy and immunotherapy are complementary, not mutually exclusive, and are a major part of the therapeutic armamentarium of the allergist.

Adrenal Cortex Hormones↗
PubMed1988

Inferior turbinoplasty: patient selection, technique, and long-term consequences.

When conservative medical management of symptomatically enlarged inferior turbinates is ineffective, the obstructing tissue may be reduced by an intramucosal or extramucosal destructive procedure (such as electrocautery, cryotherapy, or laser vaporization), or by conservative surgical resection. In the latter instance, enlarged conchal bones may be removed by the technique of turbinate submucous resection, while diffuse stromal hypertrophy necessitates partial resection of the inferior turbinates. A number of techniques of inferior turbinate surgery have been described. I have used the procedure of "inferior turbinoplasty" with increasing frequency for more than 9 years. Three to five years after such surgery, a detailed followup of 40 patients revealed none of the once-feared sequelae of turbinate resection, such as bleeding, crusting, foul nasal discharge, or bothersome postnasal drainage. Histologic examination of turbinates almost 5 years after turbinoplasty revealed fibrosis and scarring, with a marked decrease in mucous gland population, and normal mucosa. To obtain the best possible functional result inferior turbinate surgery is a necessary adjunct to most septal surgery. If conservatively done, it does not impair normal turbinate function. It must be stressed, however, that if the underlying cause of the turbinate hypertrophy is not addressed, recurrent obstruction can and probably will occur.

Adolescent↗
PubMed1986

Rhinitis of pregnancy.

Nasal stuffiness as a consequence of pregnancy has been accepted as a distinct pathologic entity for years. Although estrogen can produce nasal mucosal edema through a cholinergic action, other factors may also cause or influence nasal congestion associated with pregnancy. These include allergy, infection, stress, and rebound rhinitis. A survey of 66 randomly selected pregnant women near term and of 16 pregnant women treated for "rhinitis of pregnancy" suggests that rhinitis solely attributable to pregnancy may not exist as a primary entity. Suggestions for further study of this problem are offered.

Adult↗