Biomedical subjects

Warner W Carr

Publications and source records attributed to Warner W Carr.

8 recordsLinked to original sources

PubMed2005

Comparison of test devices for skin prick testing.

BACKGROUND: Allergy skin testing guides developing avoidance plans and writing an immunotherapy prescription. The goal for the allergist is to apply allergen skin testing to the appropriate patient population by using a device that minimizes both false-negative and false-positive findings while minimizing patient discomfort. New skin testing devices continue to be developed with a trend toward production of multiheaded devices. Data on the performance of these devices in a head-to-head prospective fashion are limited. OBJECTIVE: Our goal was to study 8 commonly used devices to compare their performance in a head-to-head fashion. METHODS: In a prospective, double-blind fashion, the performance of 8 skin test devices was evaluated. Devices were tested with histamine and saline on both the arms and back of each subject. Devices were rotated over 4 testing sessions, at least a week apart, so each device was tested in each anatomic testing location. Performance elements examined included wheal, flare, pain, sensitivity, specificity, and intradevice variability. RESULTS: We found significant differences in all areas of device performance among all devices examined. Multiheaded devices also demonstrated significant intradevice variability and were more painful than single devices. Furthermore, multiheaded devices had larger reactions on the back, whereas single devices had larger reactions on the arms. CONCLUSION: Statistically significant differences exist among all devices tested. Providers should consider this data when choosing a device that suits their practice setting and ensure that technicians are sufficiently trained on the correct use of that device.

Adult↗

PubMed2004

Acute eosinophilic pneumonia among US Military personnel deployed in or near Iraq.

CONTEXT: Acute eosinophilic pneumonia (AEP) is a rare disease of unknown etiology characterized by respiratory failure, radiographic infiltrates, and eosinophilic infiltration of the lung. OBJECTIVES: To describe a case series of AEP, illustrate the clinical features of this syndrome, and report the results of an epidemiologic investigation. DESIGN, SETTING, AND PARTICIPANTS: Epidemiologic investigation of cases of AEP identified both retrospectively and prospectively from March 2003 through March 2004 among US military personnel deployed in or near Iraq. Survivors were offered a follow-up evaluation. MAIN OUTCOME MEASURE: Morbidity and mortality related to AEP. RESULTS: There were 18 cases of AEP identified among 183,000 military personnel deployed in or near Iraq during the study period, yielding an AEP incidence of 9.1 per 100,000 person-years (95% confidence interval, 4.3-13.3). The majority of patients (89%) were men and the median age was 22 (range, 19-47) years. All patients used tobacco, with 78% recently beginning to smoke. All but 1 reported significant exposure to fine airborne sand or dust. Known causes of pulmonary eosinophilia (eg, drug exposures or parasitic disease) were not identified. Epidemiologic investigation revealed no evidence of a common source exposure, temporal or geographic clustering, person-to-person transmission, or an association with recent vaccination. Six patients underwent bronchoalveolar lavage (median eosinophilia of 40.5%). All patients developed peripheral eosinophilia (range, 8%-42%). Mechanical ventilation was required in 67% for a median of 7 (range, 2-16) days. Two soldiers died; the remainder responded to corticosteroids and/or supportive care. Twelve individuals were reevaluated a median of 3 months after diagnosis. At that point, 3 patients reported mild dyspnea and 1 reported wheezing. All patients had finished treatment and had either normal or nearly normal spirometry results. None had recurrent eosinophilia. CONCLUSIONS: AEP occurred at an increased rate among this deployed military population and resulted in 2 deaths. Failure to consider AEP in the differential diagnosis of respiratory failure in military personnel can result in missing this syndrome and possibly death. The etiology of AEP remains unclear, but the association with new-onset smoking suggests a possible link.

Acute Disease↗

PubMedDate not supplied

A comparison of two single-headed and two multi-headed allergen skin test devices.

Given the potential differences in performance of skin test devices, the purpose of this study was to prospectively assess the performance of two single-headed and two multiheaded devices for allergy skin testing in terms of wheal size, sensitivity, specificity, intradevice variability, and pain level. Two single-headed devices (Greer Pick, Duotip-Test) and two multiheaded devices (Multi-Test II, OMNI) were tested in 15 subjects in a prospective partially blind fashion looking at wheal reactions and pain using histamine and glycerol-saline on the arms and back. Differences among devices in wheal size and pain were noted. Sensitivity, specificity, and intradevice variability were calculated. Differences between corner and interior heads in multiheaded devices were analyzed. No significant differences were observed in wheal size between Greer Pick (7.1+/-1.4 mm) and Duotip-Test (7.2+/-1.6 mm). Multiheaded devices were significantly different in wheal size compared with each other and to the single-headed devices (Multi-Test II, 5.4+/-1.7 mm; OMNI, 3.3+/-1.2 mm). Single-headed devices were more sensitive (100% each, 95% CI of 92-100%) than the multiheaded devices. Multi-Test II was significantly more sensitive (83%, 95% CI of 78-87%) than OMNI (57%, 95% CI of 51-62%). There was significant intradevice variability for the multiheaded devices with corner heads being significantly more sensitive than interior heads. Specificities for all devices were equally good (-97%). Pain was greater for multiheaded devices than single-headed devices but was generally mild. In conclusion, this study supports the idea that single-headed devices may be more sensitive and consistent than multiheaded devices. Multi-Test II is more sensitive than OMNI. In multiheaded devices, corner heads are more sensitive than interior heads.

Adolescent↗

PubMedDate not supplied

Clinical pearls and pitfalls: peanut allergy.

A case of pediatric peanut allergy is presented. Pathophysiology, clinical characteristics, diagnostic test, case management, and natural history are reviewed. Clinical Pearls and Pitfalls include: (1) About 20% of young infants will outgrow peanut allergy, especially if IgE levels measured by ImmunoCAP RAST are less than SkU/L. (2) Cases of resensitization have been documented after negative peanut oral challenges. (3) Only a negative food challenge can provide convincing evidence that the patient has outgrown his or her peanut allergy.

Child↗

PubMedDate not supplied

Oral allergy syndrome (pollen-food allergy syndrome).

A case of Oral Allergy syndrome or Pollen-Food Allergy Syndrome is briefly discussed. The clinical characteristics, diagnosis, pathogenesis, and management of this syndrome are discussed followed by clinical pearls and pitfalls for the practicing allergist. Symptoms generally occur with the ingestion of raw fruits/vegetables and nuts; cooked foods are not a problem. Symptoms are caused by a heat-labile protein in fruits, vegetables, and nuts that cross-reacts with proteins in aeroallergens. Cross-reactive proteins share homologous epitopes, and several groups with similar homologous proteins have been identified; many of these groups are referred to as pathogenesis-related proteins.

Adult↗

PubMedDate not supplied

Anaphylaxis and epinephrine prescribing patterns in a military hospital: underutilization of the intramuscular route.

Epinephrine is the only definitive treatment of anaphylaxis, and recent evidence suggests that the intramuscular route has superior pharmacokinetics to subcutaneous administration. There is little data regarding what route is commonly used in clinical practice. The objective of this article is to determine the rate of epinephrine use in cases of anaphylaxis and route of administration utilized. A retrospective review was made of 220 medical records with the primary diagnosis of urticaria, angioedema, or anaphylaxis over a 28-month period at a military medical center. Twenty-four cases of anaphylaxis identified in the records. Demographics, along with signs and symptoms of those experiencing anaphylaxis, were similar to other published reports. Epinephrine was given in only 50% of cases and largely by the subcutaneous route. No intramuscular epinephrine was administered. H1 blockers and steroids were the most commonly administered treatments. H2 blockers were given at the same rate as epinephrine. An autoinjector was prescribed in 29% of cases with instruction on its use documented in 13%. An allergy referral was made in 29% of cases. Greater educational efforts and collaboration are needed between the allergy community and other providers regarding the importance of administering epinephrine intramuscularly, prescribing autoinjectors, and referring to an allergist in cases of anaphylaxis.

Adolescent↗

PubMedDate not supplied

A 34-year-old man with chronic itching and peripheral and submucosal eosinophilia.

A 34-year-old man with peripheral eosinophilia, chronic pruritus, and colonic eosinophilic infiltration is presented as a patient-oriented problem-solving case report to show the important aspects of differential and specific diagnosis, treatment, prognosis, and caveats in the approach to the workup of the patient with eosinophilia. Allergic rhinitis, asthma, atopy, and drug-induced eosinophilia should come to mind in the initial differential diagnosis of any patient with peripheral eosinophilia. Also included in the differential after allergic disease processes would be the general categories of infectious, neoplastic, and the various forms of organ-specific eosinophilic infiltration and idiopathic syndromes. The importance of ruling out infectious causes for eosinophilia is paramount, especially given the dangers of immunosuppressive treatments often used to treat other conditions associated with eosinophilia.

Adult↗

PubMedDate not supplied

Improvements in skin-testing technique.

Allergy skin testing is the primary modality used in the diagnosis of allergic diseases and guides development of treatment and avoidance plans. The goal of the Allergist is to skin test the appropriate population with a device and technique that minimizes pain while maximizing sensitivity and specificity. The debate involving the use of intradermal versus skin-prick testing in the diagnosis of aeroallergy has been long lasting. Past and present medical literature will be reviewed, establishing the lack of diagnostic use of intradermal testing in the setting of aeroallergy. New skin devices continue to be developed with a trend toward production of multidevices. Performance characteristics of various skin test devices will be reviewed with an emphasis on sensitivity, specificity, and variability of skin-prick testing devices. Significant statistical differences exist between all devices tested and reported in the literature. Whether these statistical differences equate to clinical differences is not known. With this review the practicing allergist should carefully evaluate multiple different devices and choose a device that suits their practice needs. In addition, allergists must ensure that technicians are sufficiently trained on the correct use of their device and should conduct continuing education to ensure that proper skin testing techniques are being used in their practice. Finally, the use of skin testing in pediatrics will be reviewed with a focus on safety. Care should be taken when skin testing infants < or = 6 months of age, especially in the setting of eczema and a family history of atopy.

Humans↗