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JournalISSN: 1075-7910

Clinical allergy and immunology 

Marcel Dekker
About: Clinical allergy and immunology is an academic journal. The journal publishes majorly in the area(s): Nonallergic rhinitis & Allergen immunotherapy. It has an ISSN identifier of 1075-7910. Over the lifetime, 127 publications have been published receiving 2234 citations.

Papers published on a yearly basis

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Book ChapterDOI
TL;DR: The epidemiological data and characterization of allergic and nonallergic rhinitis has been reviewed and goals for the future include reaching a consensus on the definitions ofrhinitis and rhinococcal subtypes including the establishment of mixed rhInitis.
Abstract: In summary, the epidemiological data and characterization of allergic and nonallergic rhinitis has been reviewed. Chronic rhinitis symptoms are among the most common problems presenting to physicians. When approaching this problem the diagnostic challenge is to determine the etiology, specifically whether it is allergic, nonallergic, or perhaps an overlap of both conditions. Estimates of the prevalence of allergic rhinitis range from as low as 9% to as high as 42%. Although the prevalence of nonallergic rhinitis has not been studied definitively, it appears to be very common with an estimated prevalence in the United States of approximately 19 million. In comparison, the prevalence of mixed rhinitis is approximately 26 million, and allergic rhinitis ("pure" and "mixed" combined) 58 million. Challenges in the differential diagnosis of rhinitis result from two major factors. Not only are presenting symptoms of allergic, nonallergic, and mixed rhinitis often indistinguishable from one another, but also the differential diagnosis of nonallergic rhinitis is extensive. Nonallergic rhinitis is often characterized by onset after age 20, female predominance, nasal hyperactivity, perennial symptoms, and nasal eosinophilia in approximately one-third of the population. Positive tests for relevant specific IgE sensitivity in the setting of rhinitis do not rule out "mixed rhinitis" and may not rule out nonallergic rhinitis. The significance of symptom exacerbation by nonallergic triggers in the setting of allergic rhinitis remains to be determined. Goals for the future include reaching a consensus on the definitions of rhinitis and rhinitis subtypes including the establishment of mixed rhinitis, updating guidelines for the interpretation of nonrelevant positive tests for specific IgE sensitivity, and reaching agreement on the nonallergic triggers that best define VMR or VMR subtypes. Only then can the most applicable research results be obtained. The desired result is the delivery of the most appropriate treatment, specifically tailored to the accurate diagnosis of patients with rhinitis.

208 citations

Book ChapterDOI
TL;DR: The recent cloning of the H3-receptor gene and the anticipated generation of transgenic mice will facilitate this development, and a previously unanticipated complexity has been unravelled within the field of signal transduction.
Abstract: During the past few years, there has been a tremendous increase in our understanding of the histamine receptors Important progress has been made in the development of H1-receptor agonists and the rationalization of H1-receptor-ligand interaction The recent observation of constitutive H1- and H2-receptor activity has led to a reclassification of H1- and H2-antagonists For the H3-receptor, a wide variety of selective and potent ligands are currently available and await clinical application The recent cloning of the H3-receptor gene and the anticipated generation of transgenic mice will facilitate this development Within the field of signal transduction, a previously unanticipated complexity has been unravelled With the cloning of the H3-receptor gene, a similar complexity is to be expected

90 citations

Book ChapterDOI
TL;DR: Their use should be restricted to two uncommon situations: children with urticaria or atopic dermatitis whose pruritus is so severe that the sedation produced by an old H1-antagonist, such as hydroxyzine, is a benefit rather than a risk; and children with anaphylaxis who require intravenous diphenhydramine as adjunctive treatment to epinephrine and other modalities.
Abstract: In children, as in adults, H1-antagonists are useful in the treatment of allergic rhinoconjunctivitis. Level 1 evidence for their efficacy in this disorder has been obtained in many well-designed pediatric studies. The widespread use of H1-antagonists in upper respiratory tract infections or otitis media in children is not supported by a strong scientific rationale. H1-antagonists are not harmful in children with asthma and, indeed, may have some beneficial effects in children with mild asthma. Their role in delaying or preventing asthma from developing in high-risk infants and toddlers is currently an important area of clinical investigation. The evidence base for their use in children with urticaria or atopic dermatitis still contains large gaps. First-generation H1-antagonists are presumed to be safe for use in infants and children. While they have undoubtedly been administered without apparent harm to millions in this age group, they impair CNS function far more commonly than is generally realized. Their use should be restricted to two uncommon situations: children with urticaria or atopic dermatitis whose pruritus is so severe that the sedation produced by an old H1-antagonist, such as hydroxyzine, is a benefit rather than a risk; and children with anaphylaxis who require intravenous diphenhydramine as adjunctive treatment to epinephrine and other modalities. Apart from these exceptions, in patients of all ages, second-generation H1-antagonists free from CNS adverse effects are clearly the medications of choice. Pediatric formulations of the new H1-antagonists cetirizine, fexofenadine, and loratadine are now available for use.

76 citations

Book ChapterDOI
TL;DR: The unavailability of parenterally administered second-generation H1-antagonists limits their usefulness in acute anaphylaxis and perioperative prophylaxis, and should lead to a reevaluation of the usefulness of antihistamines.
Abstract: Anaphylaxis and anaphylactoid reactions are potentially fatal. These disorders are sometimes iatrogenic, and increase with increased exposure to drugs, synthetic substances, and medical procedures. Non-IgE-mediated anaphylactoid reactions are common in medical settings and are clinically indistinguishable from anaphylaxis. These reactions may be unrecognized if a rigid classic definition of anaphylaxis is used. Histamine is a primary mediator of anaphylaxis and signs and symptoms of anaphylaxis can be reproduced by histamine infusion. Histamine triggers a cascade of inflammatory mediators and modulates its own release. H1-antihistamines are adjunctive treatment therapy for acute anaphylaxis and anaphylactoid reactions, in which many mediators of inflammation are involved. Compared with epinephrine, the first-response medication of choice, antihistamines have a slow onset of action, and they cannot block events that occur subsequent to histamine binding to its receptors. Antihistamines are an important component of regimens for the prevention of anaphylaxis and anaphylactoid reactions in patients at risk, and may eventually have more widespread application in the perioperative setting. In some instances, such as with exercise-induced anaphylaxis and reactions to latex in sensitized individuals, prophylaxis regimens are not always effective. H2-antagonists are not detrimental in the therapy of anaphylaxis and many studies show a favorable outcome when combining H1- and H2-antagonist therapy for prophylaxis. They should be added to therapy at the discretion of the treating physician. Because of decreased antimuscarinic and central nervous system side effects, the newer antihistamines can be given in high doses, allowing more complete blockade of histamine receptors. These agents should lead to a reevaluation of the usefulness of antihistamines in both the treatment of acute anaphylaxis and in prophylactic regimens. The unavailability of parenterally administered second-generation H1-antagonists limits their usefulness in acute anaphylaxis and perioperative prophylaxis.

69 citations

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Performance
Metrics
No. of papers from the Journal in previous years
YearPapers
20091
200821
200742
200423
200229
200010