OTOLARYNGOLOGIC ALLERGY

CONTENTS

PrefaceM. Jennifer Derebery and J. David Osguthorpe

New Horizons in the Management of Allergy 771Berrylin J. Ferguson

Over the last year, the understanding of early childhood allergenexposures and their impact on the development of allergy has radi-cally changed. This article reviews these epidemiologic discoveries,although they have not yet led to therapeutic initiatives.

The Importance of Allergy in the Practiceof Otolaryngology 781Richard L. Mabry

Allergy in the practice of otolaryngology is not confined to patientswith typical hay fever symptoms. The otolaryngologist encountersallergy as a primary cause or secondary contributor to a number ofotologic, rhinologic, and laryngologic syndromes and disorders.The practitioner of otolaryngology should be prepared to recognizethese situations and to address them appropriately. Training andresources are available to help the physician wishing to achievethis capability, no matter the current level of understanding andexpertise.

Clinical Practice Guidelines and Specific AntigenImmunotherapy 789John A. Fornadley

Allergy immunotherapy is a safe, effective treatment modality inselected patients. The length of therapy and the wide variety ofpatient sensitivities make it difficult to develop and test evi-dence-based guidelines in all areas of immunotherapy. A reviewof techniques and the evidence supporting them is provided in thisarticle.

VOLUME 36 Æ NUMBER 5 Æ OCTOBER 2003 v

Addressing the Prevalence of Respiratory Allergyin the Home Environment 803Richard C. Haydon III

Respiratory allergy prevalence has always depended both on ge-netic predisposition and specific environmental allergenic stimula-tion that leads to sensitization and eventual symptomatic disease.Changes brought about by modern technology that have affordeda higher quality of life have also accidentally increased the levels ofmany respirable and ingestible allergens in the environment. Inmany cases these higher levels of exposure have exceeded individ-ual thresholds, resulting in the phenotypic expression of allergy inmany individuals who were previously asymptomatic even thoughthey were genotypically predisposed to developing allergies. Pre-valence can be decreased only if susceptible populations are iden-tified as early as possible through careful family history taking andappropriate testing for sensitivity and if exposure to selected aller-gens is controlled.

Cost-effective Pharmacotherapy for Inhalant AllergicRhinitis 825James A. Hadley

Although allergic rhinitis is sometimes considered a trivial disease,it is a significant cause of morbidity that can lead to significantmedical treatment costs, reduced work productivity, and lost timefrom school. Most patients are children and adolescents. Pharma-cotherapy reduces the symptoms of inhalant allergies and providesan improved quality of life for these patients. Traditional use ofmedications such as antihistamines and decongestants may incursignificant health care costs. This article investigates the currentcosts of pharmacomanagement of this important problem with at-tention to the various forms of treatment.

Adding Allergy to Your Practice 837Michael J. Parker, Jami Lucas

The ability to blend the management of allergic disease into thegeneral treatment of head and neck disease is core to the otolaryn-gologist’s role as regional specialist of the upper aerodigestivetract. Allergy training is now considered an integral componentof the residency curriculum established by the American Boardof Otolaryngology. By obtaining any needed additional trainingthrough organizations such as the American Academy of Otolaryn-gic Allergy (AAOA) and by validating that education by obtainingfellowship status in the AAOA, the postgraduate otolaryngologistwho adds allergy to his or her practice will find the techniques tobe safe, effective, and of great benefits to patients.

vi CONTENTS

Current In Vivo and In Vitro Screens for Inhalant Allergy 855John H. Krouse, Robert J. Stachler, and Anand Shah

When routine medical management of allergies is inadequate, di-agnostic testing is often suggested to characterize the nature ofthe symptoms better and to provide more specific therapies direc-ted toward the identified sensitivities. Otolaryngologists can thenapply antigen-specific treatments and counseling either to supple-ment or to replace ineffective therapies. This article discusses thepractice of screening in the diagnosis of inhalant allergy. It reviewsthe conceptual basis for screening and discusses the clinical useful-ness of various approaches to screening for allergic diseases. It con-cludes with a discussion of current models of screening methodsand techniques.

Cutaneous Testing for Allergy Diagnosis: Comparisonof Methods in Common Use 869Edwyn L. Boyd

Practitioners who treat allergic patients must be familiar with thetests that are available to assist them in establishing the diagnosis.They must also understand the strengths and weaknesses of eachof the techniques, devices, and grading systems at their disposaland that there is no criterion standard skin test. This article dis-cusses the various techniques used in skin testing for allergy, theirgrading systems, and their advantages and disadvantages.

In Vitro Testing for Allergy Diagnosis 879Ivor A. Emanuel

Highly reproducible, accurate, and quality-controlled in vitro testscan assist physicians in the evaluation of allergic problems andare likely to be used widely in the future. Both in vitro and skinmethods are appropriate modalities for the diagnosis of allergicrhinitis. Optimally performed skin tests and in vitro tests detect IgEantibody accurately and reproducibly. Results of both tests cor-relate equally well with allergic signs and symptoms produced byexposure to the specifically tested allergen. Both tests can be usedas grounds for instituting avoidance therapy and immunotherapyefficiently and economically.

Allergy Management for the Otolaryngologist: SelectingAllergenic Extracts for Inhalant Allergy Testingand Immunotherapy 895Andrew I. Dzul

The proper selection of allergen extracts is important in maintain-ing an efficient allergy practice. This article discusses pollen andmold spore selection, which may be relevant to an individual prac-titioner’s testing survey. The selection of tree, grass, and weed pol-len extracts depends on the location of the clinician’s allergy

CONTENTS vii

practice. Allergenic extract should also be selected based on the al-lergenicity of the plant’s pollen. Examples of pertinent allergenictrees, grass, and weed pollen are given in this article. The complex-ities of mold spore testing and selection are also emphasized anddiscussed at some length.

Approaches to Testing for Food and ChemicalSensitivities 917Bruce R. Gordon

This article is an introduction to the topic of testing for allergy orsensitivity to foods and chemicals. The clinical patterns of foodand chemical sensitivity and the diagnostic methods for determin-ing the existence andmagnitude of reactions to either foods or chem-icals are surveyed. Concepts of fixed, anaphylactic food allergy andcyclic, non–IgE-mediated food allergy are reviewed and con-trasted, and the relative benefits of the appropriate tests for eachtype are discussed. The pathophysiology of acute and chronic chem-ical toxicity is briefly reviewed and compared with true chemicalallergy, and useful screening and definitive tests to identify eachtype are identified.

Allergy and the Contemporary Rhinologist 941Bradley F. Marple

This article explores current evidence relative to the impact of al-lergy on the practice of rhinology, specifically focusing on bothacute and chronic rhinosinusitis. Current strategies for the treat-ment of allergic diseases are reviewed also.

Allergy and the Contemporary Laryngologist 957Stephen J. Chadwick

Laryngology, a subspecialty within the subspecialty of otolaryngol-ogy, has come into its own. This article addresses the integration ofallergy within this discipline. It considers both the direct and themore common indirect effects of allergy on the larynx. The rolesof respiratory disease, gastroesophageal reflux, medication, angioe-dema, food sensitivity, and select aspects of the environment arediscussed.

Allergy and the Contemporary Otologist 989M. Jennifer Derebery, Karen I. Berliner

Allergy may affect the auricle, middle ear, or labyrinth. This articlediscusses the role that allergy plays in diseases of each of theseparts of the ear. It reviews the immune and allergic activity ofthe ear, as it is currently understood, and suggests mechanismsby which a classic allergic or autoimmune response may result in

viii CONTENTS

otologic symptoms. Various treatment modalities, including spe-cific allergic testing and treatment techniques, are described.

Anaphylaxis 1009Michael C. Noone, J. David Osguthorpe

Anaphylaxis is an amplified, harmful immunologic reaction thatoccurs after re-exposure to an antigen to which an organism has be-come sensitive. True anaphylaxis is a systemic reaction caused byantigen-specific cross-linking of IgE molecules or complement pro-teins on the surface of tissue mast cells and peripheral blood baso-phils, resulting in the immediate release of potent mediators.Immediate systemic reactions that resemble anaphylaxis but arenot caused by an IgE-mediated immune response are referred toas anaphylactoid reactions. It is important for physicians, espe-cially those who treat allergies, to understand the pathophysiology,know the treatment for, and recognize the clinical signs of anaphy-laxis.

Contact and Chemical Sensitivities in the HospitalEnvironment 1021Kim E. Pershall

This article reviews contact sensitivity by site, the immunologicand toxic mechanisms for injury, and the agents most likely to beencountered in the hospital environment. Organic and inorganicmaterials associated with allergic reaction or toxic injury are pre-sented. Solvents and solutions are reviewed for injury potential.

Index 1035

CONTENTS ix