Tag Archives: Medscape

What Else About Allergy is Out There?

It’s difficult to find good material on the internet related to the practice of #allergy. Here is one such blog site: http://blogs.medscape.com/garystadtmauer.  This blog originates from New York and the practice website is http://www.cityallergy.com.  I will periodically post comments & articles from Dr. Stadtmauer’s blog and I’ve included one below about the coexistence of systemic allergy (that’s a positive skin or blood test) and LOCAL allergic rhinitis which has all the signs & symptoms of allergy, but guess what–skin & blood testing is all negative.  Very frustrating for #patients to experience allergy symptoms, but go in to their local allergist and find nothing. I wish treatment would be more satisfactory, but as you can imagine, it’s unknown what allergens to mix up for your allergy recipe if all testing is negative.  Continue reading What Else About Allergy is Out There?

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Is There Anything Vitamin D Doesn’t Cause?

Vitamin D Deficiency Linked to Vocal Cord Dysfunction

Vitamin D deficiency is associated with exercise-induced paradoxical vocal cord dysfunction (VCD) in young athletes, according to research presented here at the World Allergy Organization XXII World Allergy Conference (WAC). The study was conducted during the winter in a town above 45 degrees latitude.Exercise can be associated with exercise-induced bronchospasm (EIB) or laryngospasm, which can be mistaken for asthma. The researchers had previously demonstrated that vitamin D deficiency is associated with VCD during a hyperventilation test, especially in hypocapnic conditions.Of the participants, 16 (43%) were atopic and 6 (16%) reported that they had previously been diagnosed with asthma. None used drugs or had had respiratory infections in the previous month, and all had normal results on lung function tests. In isocapnic conditions on hyperventilation testing, 10 participants experienced EIB and 12 experienced exercise-induced VCD. Under hypocapnic conditions, 8 participants experienced EIB and 15 had exercise-induced VCD.Vitamin D deficiency (serum 25-hydroxycholecalciferol < 25 ng/mL) was recorded in 18 participants (49%). Athletes with exercise-induced VCD had significantly lower serum levels of vitamin D than those without it, in both isocapnic (19.1 ± 1.8 vs 25.7 ± 1.5 ng/mL; P = .013) and hypocapnic (20.2 ± 1.9 vs. 26.2 ± 1.8 ng/mL; P = .029) conditions.

The researchers found no correlation between vitamin D and EIB.

“I think the role of vitamin D and other micronutrients [in respiratory problems] is still poorly understood, and for sure they have a role both in this particular syndrome, but also in airway inflammation and so also asthma. I think it’s an interesting field to be expanded,” Enrico Heffler, MD, PhD, from the University of Torino, Italy, who presented the research at a poster session here, told Medscape Medical News.

Dr. Heffler also related a previous case study of a patient with severe vitamin D deficiency who experienced VCD and bronchospasm; symptoms and lung function were significantly improved after vitamin D supplementation.

“This study is fascinating because it links vitamin D deficiency to something new. [The researchers] need to do a double-blind placebo-controlled trial in these individuals,” Glenis Scadding, MD, a consultant allergist and rhinologist at the Royal National Throat, Nose and Ear Hospital, London, United Kingdom, who attended the session, told Medscape Medical News.

Dr. Heffler and Dr. Scadding have disclose no relevant financial relationships.

World Allergy Organization XXII World Allergy Conference (WAC); Abstract 3018. Presented December 6, 2011.

How Do I Find Immunodeficiency?

  Immunodeficiency–does my child get too many infections?  How can I tell?  Read on in the following journal article.  Author information and citation listed at the end.  I’ll summarize for you.  Before I begin, take a look at this 3 minute (yes really) video on immunodeficiency; it will help with background information. 
 
April 11, 2011 — Three main warning signs may help identify children with underlying primary immunodeficiency diseases (PID), according to the results of a retrospective survey reported online April 11 and will appear in the May print issue of Pediatrics.  “Children with severe, recurrent, or unusual infections may have an underlying …PID,” write Anbezhil Subbarayan, MBBS, from the Department of Paediatric Allergy and Immunology, University of Manchester, Royal Manchester Children’s Hospital in Manchester, United Kingdom, and colleagues.
 
“Ten warning signs have been promoted by patient support groups to help identify children with PID, but the signs have never been tested in a rigorous scientific study.”

The objective of the study was to examine the efficacy of these 10 warning signs in the prediction of defined PID among 563 children evaluated at 2 tertiary PID centers in northern England. Medical records were reviewed for 430 children with a defined PID and 133 children for whom thorough workup did not result in a diagnosis of a specific PID.

Factors most predictive of PID were

  • A family history of immunodeficiency disease
  • Sepsis treated with intravenous antibiotics in patients with neutrophil PID (primary immunodeficiency)
  • Failure to thrive in children with T-lymphocyte PID.  In simple terms, this means you just don’t grow.
  • When these 3 signs were present, PID was correctly identified in 96% of patients with neutrophil and complement deficiencies and in 89% of children with T-lymphocyte immunodeficiencies.
  • The only warning sign that correctly identified patients with B-lymphocyte PID was a positive family history.  These are patients with NO antibody production–the “bubble boy” 

    A real life example of the bubble boy--read on to find out why

“PID awareness initiatives should be targeted at hospital pediatricians and families with a history of PID rather than the general public,” the study authors write. “Our results provide the general pediatrician with a simple refinement of 10 warning signs for identifying children with underlying immunodeficiency diseases.”

“Delayed diagnosis of PID may be associated with increased morbidity and mortality,” the study authors conclude. “In children presenting with infection, pediatricians should always inquire about a family history of PID, as this is the best predictor that the patient may also have an underlying immunodeficiency….In those with recurrent or severe infections, clinical features other than family history are often not helpful and a lower threshold is required for requesting antibody testing in which the diagnosis of a B-cell immunodeficiency is suspected.”

Selective antibody deficiency shows up a little bit differently in that children will often have recurrent ear infections or sinus disease.  A different disease altogether!

Pediatrics. Published online April 11, 2011.

Laurie Barclay, MD

Freelance writer and reviewer, Medscape, LLC

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.