Update on Allergy, Asthma and Sinusitis

W. S. Tichenor, M. D.
New York, New York

The following is selected information from various meetings which I have found interesting, important or provocative. It is not meant to be a comprehensive update.

Update on the 2010
American College of Allergy, Asthma, and Immunology
Meeting in Phoenix

Davis et. al. performed a double blind parallel trial showing effectiveness of Sinusbuster (capsaicin nasal spray) in nonallergic rhinitis.

Santos et. al. reported that it was safe to give sublingual immunotherapy for D. farinae and Timothy grass.

Eisenfeld et. al reported that IVIG and omalizumab were effective in treatment with chronic autoimmune urticaria.

Spector et. al. reported on a Phase II trials which successfully treated chronic idiopathic urticaria with omalizumab.

Arira et. al. reported on a patient with acetaminophen induced skin rash.

Chin et. al reported on 2 patients with silent desensitization of ASA induced Samter's triad. They were non-reactive on challenge with nasal ketoralac, but had reduced symptoms under treatment with aspirin and when it was stopped, had symptoms on reuse.

Owens et. al. reported on a desensitization regimen for 2 patients with allergic reactions to omalizumab starting with subcutaneous treatment of 0.05 ml, then 0.5 ml of a 1.5mg/1.2ml dose and then doubling it until reaching 0.3 cc of a 150 mg/1.2 ml dose.

Cohen et. al. reported that use of a new air filter called "PureNight" improves sleep in patiehts with obstructive disease.

Kamdar et. al reported on the first patient described with anaphylaxis to guaifenesin.

Leonard et. al. as well as Mathew et. al reported on pateints with CVID caused by oral steroids.

Herzog reported that competititve swimming in ozone treated pools caused less nasal congestion than in chlorinated pools.

Update on the 2010
American Academy of Allergy, Asthma, and Immunology
Meeting in New Orleans

Altrich et. al. reported that assessment of Pneumococcal antibody avidity was helpful in assessing immune competence.

Patterson et. al. reported that poor responders to S. pneumoniae are more likely to have sinusitis, reactive airways disease and fatigue with recurrent respiratory infections.

Lotz et. al. reported that almost half of patients with MBL deficiency had a selective antibody deficiency and they frequently had sinusitis, otitis, and pneumonia. 85% required prophylactic antibiotics and 21% required IVIG.

Shah et. al. reported on 3 patients who had anaphylactic reactions to IVIG and had IgA subtype deficiency without IgA antibodies. All patients did well with IgA-depleted Gammagard S/D

Coifman reported on 2 patients who were desensitized to Poison Ivy using serial 10 fold dilutions of 1.13mg urushiol/ml. Patients got 3-fold increase of the extract at 1-2 week intervals starting with 10x the concentration giving a grade 3 reaction on patch testing. End dose was 2 shots of 170 micrograms repeated once.

Plunket reported that glycerinated extract maintained stability at 40 degrees C. for 6 days. Ragweed, olive and English Plantain lost 50% after 3 days.

Pagovich et. al. reported that statins may have a beneficial effect in asthma with a signficant increase in PF for both simvastatin and atorvastatin.

Mintz-Cole et. al. reported that there were distinct differences between immunological response to A. versicolor and C. cladosporioides spores with the first only inducing AHR, airway inflammation and goblet cell hyperplasia at higher doses.

Mudd et. al. reported that baked milk introduction was successful despite milk specific IgE.

Wasserman et. al. reported on successful oral food desensitization in the office.

Desrosiers et. al. reported on several SNP's which were associated with nasal polyps including Fibulin-1, PKD-1, CD-46, and SLC22A4.

Li et. al. reported that 98.8% of patients with a history of anaphylaxis to penicillin with non-reactive skin tests to penicillin can receive cephalosporins.

Sandhu et. al. reported that rosiglitazone improved AHR and FEV-1.

Kaplan et. al. showed that treatment of chronic autoimmune urticaria with omalizumab for 4 months showed improvement for up to 2 years.

Gadde et. al. reported that 20 of 814 patients who used montelukast had psychiatric symptoms. All but 1 reported improvement of resolution over 1-12 weeks.

Castro-Coelho et. al. reported on 9 of 157 patients with severe asthma who had EGD had esophageal candidiasis. They pointed out that it could be an underestimation for obvious reasons.

Wilson et. al. reported on 6 patients who progressed from specific antibody deficiency to CVID. No numerator was described, however.

Ahel et. al. showed that A. fumigatus was present on 85% of commercial mushrooms and was dispersed in the air during washing.

Miller et. al. reported that inflammatory metabolites and toxins were liberated by fungi common in damp buildings.

Nguyen et. al reported that frozen fruits can be used for skin testing for oral allergy syndrome, as opposed to extracts which did not show a correlation.

Kanuga et. al. reported in a meta-analysis that 110/324 patients with CIU who had H. pylori eradicated went into remission.

Kofonow et. al. reported that oral steroids before steroids reduce most cytokines and improve QOL.

Sussman et. al. reported that allergy by prick test to Alternaria was a risk factor for CRS.

Kilty et. al. reported that 8 of 199 pateitns with refractory CRS had alpha-1 antitripsin deficiency

Koterba et. al. reported that 13% of patietns with refractory CRS had an IgE less than 700mg/dl and 22% failied to develop protective antibody levels after vaccination with Pneumovax.

Boseman et. al. found that 4 out of 25 patients with AFS had complications including concomitant ABPA, expansion into the orbital fissure, expansion into the brainstem, and otitis media with tympanic perforation. IgE levels were higher in this group (1590 vs. 597). All four patients responded well to surgery, steroids and funal immunotherapy.

Uzzaman et al. found that 40% of patients with CRSwNP had elevated levels of CCL23 in polyp tissue. CCL23 is a ligand for CCR1 and expressed on monocytes, dendritic cells and endothelial cells and is elevated in patients with atopic dermatitis.

Gutekunst et. al. reported on finding an IgE to H. pylori. They suggeseted that it may have a mechanism in patients with asthma and atopic dermatitis.

Doreswamy et. al. reported that it was possible to induce tolerance to lipopolysaccharide in regard to inflammatory response.

Nakajima et. al. reported that in mice, maternal exposure to BPA in a dosage of 10/mg/ml caused allergic sensitization and bronchial inflammation in offspring.

Anderson et. al. found that there was no difference in air samples of mold taken through slit cassettes at flow rates of 5 LPM and 15 LPM.

Keet et. al. found that oral and sublingual treatment of milk allergy were both effective in milk allergic children.

Barnes et. al found that concentrations of bleach commonly used in household cleaning (38 mM) would denature fungal allergens in Alternaria and Cladosporium.

Torres et. al. found that 1/3 of patients who were allergic to amoxicillin/clavulanic acid were allergic to just clavulanic acid.

Erwin et. al. found that there were 3 phenotypes of eosinophilic esophagitis: non-sensitized, milk-sensitized and those with multiple pollen allergies

Shah et. al. found that the following drugs were likely to interfere with allergy skin tests: TCA's, H-1 blockers, benzodiazepines, atypical antidepressants/sedatives and possibly H2 blockers. SSRIs, SNRIs and PPIs were not found to interfere.

Tzachev et. al described that the MucoAd solution ( active ingredient in Sinol) was best delivered by the Precision Pipette.

Parisi et. al. found the nasal congestion adn atopy is common in patients with fibromyalgia.

Romero et. al. showed that the H3 receptor antagonist PF-03654746 reduced allergic symptoms better than fexofenadine plus pseudoephedrine.

Boxco et. al. found that using a novel budesonide dispersion with a device called the AeroNeb vibrating nebulizer (Aerogen Ltd., Ireland) was more effective than nebulized corticosteroids.

Karagic et. al. reported that patients receiving an Osteopathic Manuever Technique (OMT) called rib-raising for asthma did better objectively than with albuterol alone.

Chatameteekul et. al. reported that 30% of children with chronic sinusitis with normal immunoglobulin levels had a specific antibody deficiency

Russell et. al. found that common and plantar warts responded to intralesional therapy with 1:100 of a Candida extract. If an initial response was not optimal, a cell mediated immunity panel was placed with Trichoderma, and Trichophyton in the same concentrations and Tetanus in a 1:10 dilution. Subsequent treatment was based on the result of the panel.

Ko et. al. showed that treatment of wheat with a fermented soybean extract reduced IgA and IgE antibody reactions to the digested wheat protein. Gliadin and gluten were also significantly reduced.

Chung et. al. showed that magnetic beads attached with chlorogenic acid ( a phenolic) attract major peanut allergens

Abbot et. al. showed that using skin prick testing vs. serial end point titration showed less time to maintenance and lower cost. Efficacy was not compared.

Jones, et. al. reported on a oral desensitization regimen for egg allergy.

Soutter et. al. reported on efficacy of food allergen avoidance in pregnancy reducing the likelihood of peanut and egg allergy in the infants.

Update on the 2009
American College of Allergy, Asthma, and Immunology
Meeting in Miami

Nsouli et. al. found that long term nasal saline irrigation may worsen sinusitis. [It is known, however, that if irrigation is done with a device which does not prevent backflow from irrigation, the device can become contaminated with organisms from the nose and sinuses].

Kuzume et. al. reported that children allergic to egg could be desensitized with oral egg injestion.

Altrich et. al. showed that a test for pneumococcal antibody avidity after pneumococcal vaccination can be helpful in assessing response to the vaccine.

Wechsler et. al reported that bronchial thermoplasty may be helpful in pastients who do not respond to standard treatment for asthma.

Huynh et. al. reported that a patient who was treated with omalizumab for asthma was able to be desensitized to honeybee when he could not be desensitized previously.

Yang et. al. reported that acupuncture was help in treatment of allergic asthma.

Resnick et. al. reported that the herbal medicine ASHMI was helpful in treatment of a patient with severe persistent asthma.

Dinov et. al. reported on desensitization of an allergy to human seminal plasma, however the patient was required to have intercourse every 48 hours to maintain desensitization.

Nsouli, TM et. al. reported that the combination of a nasal topical decongestant with a topical steroid may prevent development of rhinitis medicamentosa as well as having a synergistic effect in nasal decongestion.

Nsouli S, reported that a combination of mupiricin ointment and amoxicillin/clavulanate worked better than amoxicillin/clavulanate alone in patients with chronic sinusitis who were atopic.

Update on the 2009
American Academy of Allergy, Asthma, and Immunology
Meeting in Washington D.C.

Simons reported on increased absenteeism and poor performance in schools in which there were adverse building conditions including mold.

Fuiano et. al. reported on the usefulness of a atopy patch test for both atopic dermatitis and also respiratory symptoms.

Shimoide et. al. reported on a cure rate of 87% and an improvement rate of 12% using chinese medicine for treatment of atopic dermatitis.

Belibi et. al. reported on the use of Shea butter as an emollient for eczema.

Lane et. al. reported on the use of N-acetyl cysteine (NAC) reducing late phase response in the nose after a Ragweed challenge. They used .137 ul of a 20% NAC solution.

Pityn reported on increased mold exposure during lawn mowing, particularly Cladosporium, but also Alternaria, Rusts and Smuts, and Pithomycetes.

Barnes reported on the correlation of Alternaria and other large spores including Curvularia and Epicoccum.

Dumon reported that there are house dust mites on moldy walls.

Nashed reported that daily use of antihistamines for over 1 year may be associated with a decreased risk of cancer.

Wiens reported on a decrease in antibiotic use and office visits in 2 patients with chronic sinusitis who were immunized with the Pneumovax vaccine.

Joh et. al. reported on several cytokines and growth factors which were incresaed in Eosinophilic esophagitis. These included eotaxin, RANTES, GCSF, IFN-G, IL-15, as well as several others.

Agrawal et. al. reported on the usefulness of a "fine mechanical filter air cleaner" removing dust mites.

Varshney et. al reported on the usefulness of oral immunotherapy increasing the clinical tolerance of peanuts in peanut allergic children.

Mehta reported on the usefulness of Xolair in a double blind, placebo controlled trial in treatment of patients with chrnoic sinusitis.

Jones et. al. reported on the usefulness of oral immunotherapy in a double blind, placebo controled trial in peanut allergic children.

Levetin et. al. reported that fungal fragments may play a signifcant role in mold sensitive patients

Warner reported that itraconazole and fluconazole both may modify inflammatory reactions by modulating the release of IL-10 et. al.

Stillerman et. al. reported that the use of a PUREZONE HEPA filtration pillow device reduces nocturnal symptoms.

Meyer et. al. reported that antibiotic use in infancy was associated with an increase in risk of allertic rhinitis.

Update on the 2008
American College of Allergy, Asthma, and Immunology
Meeting in Seattle

Blair et. al. reported on the risk of albuterol HFA inhalers clogging if they are not washed regularly.

Mendez-Inocencio et. al. reported on 6 patients with allergies and recurrent infections and found that all of them had a specific antibody deficiency.

Levine reportedon the use of a combination of dextromethophan, dexbrompheniramine, and theobromine for chronic unexplained cough.

Update on the 2008
American Academy of Allergy, Asthma, and Immunology
Meeting in Philadelphia

Worl et. al. reported that montelukast may reduce local reactions after allergy immunotherapy.

Bezdecny et. al. reported that a herbal medication called ASHMI is helpful in asthma.

Mohar, et. al. reported that olopatadine nasal spray is helpful for allergic rhinitis.

Popov et. al. found that a methylcellulose solution called MucoAd would decrease mucociliary clearance. This may be helpful in prolong the time medications remain in contact with the mucosa.

Chang et. al. found that using oxymetazoline and a nasal steroid in 131 patients (either separately or in combination) in patients with rhinosinusitis along with hypertonic saline irrigation and, in some cases, a macrolide, did not cause a rebound in a period as long as 23 months. 2/29 patients had an increased intraocular pressure.

Asaka et. al. showed that Alternaria can induce cytokine production (IL-8, GM-CSF, and MCP-1) in CRS patients, but not normals.

Demuth et. al. validated the eROQ in an electronic format.

Cox et. al. reported on 5 year follow up on bronchial thermoplasty and concluded that it has a satisfactory safety profile.

Codina reported that there is a large variation in the levels of fungal spores in outdoor samples collected within a short time of each other.

Schmechel et. al. reported that Alternaria antigens may cross react with numerous other antigens. Reports of Alternaria antibodies in dust for example must be proven to be specific to Alternaria before the assumption that Alternaria is present.

Reijula reported that patientís symptoms related to indoor air quality were more common in water damaged buildings.

Midoro-Horiuti reported that maternal exposure to Bisphenol A increases the likelihood of allergic sensitization in mice.

Shinohara et. al. reported that taking probiotic yogurt by a pregnant woman and offspring reduced histamine reactivity on skin testing.

Palma-Carlos et. al. reported on the use of skin testing for NSAIDS hypersensitivity.

Hirdt reported that Xolair can be effective at the maximum recommended dose in patients with IgE levels greater than 700 IU/ml.

Lindemann et. al. reported that a medical food, Efficas Care (containing 0.75 g gamma linolenic acid and 0.5 g eicosapentaenoic acid per serving) can improve asthma by decreasing leukotriene synthesis.

Giavini-Bianchi et. al. reported on 4 patients treated with inhaled glucocorticosteroids for asthma with esophageal candidiasis and pointed out that there is a 37% prevalence of candidiasis in patients treated with inhaled fluticasone.

Juriwala et. al. reported on 3 patients with HIV who were treated with allergy immunotherapy. All patients had stable CD4 levels. One patient had a transient increase in viral load, but it became undetectable at 26 weeks.

Bloom et. al. showed that it was possible to detect mycotoxins from molds in building materials using mass spectrometry.

Holbreich showed that fresh food extracts were more efficacious for skin testing especially for egg, milk, corn and potato.

Watson et. al. showed that Xolair can be an effective treatment for IgE mediated food allergy.

Lazarovich showed that a combination of fluticasone (110-440mcg BID) and salmeterol (21 mcg BID) or formoterol (6 mcg BID) in each nostril reduced the number of courses of prednisone and antibiotics in patients with sinusitis.

Desrosiers et. al. showed that UV light may have potential for treatment in polyposis.

Walsh (Dr. Tichenorís nurse practitioner) et. al. showed that atypical mycobacteria (also called non-tuberculous mycobacteria) can cause sinusitis. Ms. Walsh was also featured on a health segment on WABC-TV on this topic.

Chang showed that sinusitis was helped with long term treatment with oxymetazoline, nasal steroids, hypertonic saline, and macrolides. (Note that I do not agree entirely with the treatment plan).

Van Zele et. al. showed that oral methylprednisolone for 4 weeks reduced polyp size, but the effects did not last for more than 1 month.

Sabirov et. al. reported that Alternaria specific IgE and ECP levels in nasal tissue homogenates correlated with incidence of nasal polyps.

Passalacqua et. al. reported that SLIT with honeybee venom could be effective in treatment of large local reactions.

Hamilos et. al. showed that secondhand smoke can combine with viral pathogens to increase inflammation in CRS.

Gevaert et. al..showed that mepolizumab (an IL-5 inhibitor) was effective in reducing nasal polyps for 2 months after treatment..

Update on the 2007
American Academy of Allergy, Asthma, and Immunology
Meeting in San Diego

Gupta et. al. reported a case of life threatening bronchospasm to levalbuterol.

Visy et. al. reported a case of H. Pylori triggering hereditary angioedema.

Medeiros et. al. reported a case of vocal cord edema from exposure to hydrocarbon vapors.

Park reported a case of asthma triggered by M. pneumoniae.

Sheth et. al reported on using Methylene Blue for treatment of refractory anaphylaxis.

Buchmiller reported on using a single day ASA desensitization.

Torres reported on cross reactivity between penicillins and cephalosoporins with the same side chain.

Naimi reported on 2 patients with profound lymphopenia with AFS.

Vegh reported that treatment with anti-leukotrienes reduced anaphylaxis severity with rush desensitization.

Rasp reported that there was a positive effect by Anti-IgE on nasal polyps.

Levetin et. al. reported elevated levels of molds after Katrina in New Orleans.

Ward et. al. reported that Cladosporium may be as potent as dust mites in causing allergy and asthma.

Obayon et. al. reported that the September asthma peak may be due to molds.

Okamo et. al. reported that PGE2 synthase and PGD2 synthase may affect polyps Klemens et. al. reported high levels of pro-inflammatory cytokines in NARES.

Frigas from the Mayo clinic reported beneficial affects from oral itraconazole in CRS.

Des Roches et. al. reported that exposure to peanut in breast milk and in utero may increase the likelihood of a peanut allergy.

Salomon et. al. reported a protocol for desensitization of IVIG.

Green et. al. reported that allergy to Paecilomyces variotii was common in atopic patients.

Wolbert et. al. reported angioedema due to blueberry.

Karakelides et. al. reported on the use of Danazol in chronic urticaria.

Efraim et. al. reported that eosinophiles in peripheral blood and polyps have a different set of surface receptors.

Varghese et. al. reported that blowing the nose into a sheet of wax paper yielded a higher count of total cells compared to the Rhinoprobe.

Storms et. al. reported that Mucinex for one week in patients with respiratory illness improved general health and mucus related symptoms.

Lleonart et. al. reported a 7.4% incidence of latex allergy in factory workers who used latex gloves with talcum powder.

Abrahamsson et. al. reported that Probiotics may reduce IgE associated exzema in 2 year olds.

Update on the 2006
American College of Allergy, Asthma, and Immunology
Meeting in Philadelphia

Smits et. al. presented information about a rapid desensitization protocol which reduces the risk of reactions. They altered the usual protocol by stopping the rapid desensitization at a dose of .1 to .5 cc of a 1:1000 dilution.

Santilli presented information cautioning against assuming that remediation against mold will always remove all of the mold. Remediators do not always perform their tasks optimally.

Scarupa et. al. used zileuton for treatment of urticaria with good results.

Sakali et. al. reported that eratication of H. pylori was helpful in treatment of urticaria.

Moon et. al. treated a patient with ABPA with oral itraconazole for a period of 2 years with a significant reduction in steroid usage.

Morris et. al. did preliminary studies suggesting the sublingual immunotherapy may be helpful for treatment of poison ivy dermatitis.

Hiyama et. al. compared patients with surgical versus medical treatment of sinusitis. They found that at 1 year there was no statistical difference between the 2 groups.

Sherris et. al. (including myself) showed that physicians were generally dissatisfied with treatment of chronic sinusitis.

Update on the 2006
American Rhinologic Society
Meeting in Toronto

Bendouah et. al. showed that increased concentrations of antibiotics may be helpful in reducing the amount of S.aureus under biofilms. Liu et. al. showed that tobacco smoke impacts negatively on chronic sinusitis.

Singh et. al. showed that long term (16 week) treatment with clarithromycin may be helpful in treatment of chronic sinusitis,

A general discussion of the technique of balloon sinuplasty suggested that it was primarily useful in patients with isolated maxillary sinus disease.

Update on the 2006
American Academy of Allergy, Asthma, and Immunology
Meeting in Miami Beach

Menendez showed that Xolair may help patients with fungal sinusitis.

Mahakittikun et. al. showed that woven allergy covers prevent dust mite penetration, but non-woven and laminated covers do not.

Corominas et. al. showed that food allergies were frequent in patients with pollen rhinitis

Ko et. al. showed that the chinese herbal medicine FAHF-2 blocked peanut anaphylaxis in mice.

Ogden et. al. showed that cellular reactivity to Candida was increased in children with non-allergic food hypersensitivity to cow's milk protein.

Poole et. al. showed that if exposure to cereal grains is delayed until after 6 months of age, the likely of wheat allergy increases.

Scholl et. al. showed that sucralfate fed to pregnant mice increased the likelihood of sensitization to food proteins.

Tripathi et. al. showed that S. aureus is present in tissue and polyps in patients with chronic rhinosinusitis both with and without nasal polyps.

Hutcheson et. al. showed that anti-staphylococcal entertoxin was found in 49% of patients with chronic hyperplastic rhinosinusitis, but IgE to > 3 enterotoxins was only found in allergic fungal sinusitis and eosinophilic fungal rhinosinusitis.

Kowalski et. al. showed that polyp tissue in patients who are sensitive to aspirin may release 15-HETE but not LTC4. This may have implications regarding treatment.

Steinke et. al. showed that hypoxic conditions increase proinflammatory and other cytokines. Reoxygenation may decrease inflammation.

Rawas-Qalaji et. al. showed 40 mg sublingual tablets of epinephrine resulted in plasma concentrations similar to 0.3 mg IM injections.

Edmondson et. al. found that patients exposed to mold may demonstrate both IgE and non-IgE related symptoms including possibly trichothecenes.

Pinto et. al. showed that a locus on 7q31 may influence disease susceptibility for chronic rhinosinusitis.

Koreck et. al. showed that intranasal phototherapy may be helpful for treatment of allergic rhinitis. This involved low dose UVB, UVA, and visible light. It was thought to be due to apoptosis induction of T cells and eosinophiles, but not basophils. The primary side effect was nasal dryness.

Naclerio et. al. showed that montelukast reduces allergic rhinitis in mice, but increased bacterial growth in the nose.

Azar et. al. showed that cyclical neutropenia can be associated with antibody deficiency.

Casper showed that corn can be a trigger for eosinophilic esophagitis.

There were discussions about a paper published recently suggesting that irrigation with Lasix may be helpful in treatment of sinusitis.

Update on the 2005
American College of Allergy, Asthma, and Immunology
Meeting in Anaheim

Villaveces showed that 90% of patients with chronic headaches responded to instillation of a combination of 1 cc of a combination of lidocaine and neosynephrine which was pipetted into the nose while in a supine position with necks extended.

Nsouli et. al. showed that reformulating beclomethasone as a HFA preparation helps reduce the likelihood of thrush.

Hersh et. al. showed that a patient with AFS due to Aspergillus improved with allergy immunotherapy.

Rains et. al. showed that Amphotericin B can be use in CRS patients who were refractory to surgery.

Ponda et. al. described a diabetic patient with nasal thrush due to intranasal steroids

Lee et. al. described a patient with CRS who responded well to omalizumab

Thailer et. al. showed that exhaled breath condensate pH is a marker for silent gastroesophageal reflux. It has been previously shown to be a marker of pulmonary inflammation.

Raphael, et. al. showed that pseudoephedrine has potential for prevention of sinusitis.

Update on the 2005
American Rhinologic Society
Meeting in Los Angeles

Bolger et. al. presented information on the new baloon sinuplasty technique in which a guidewire is placed into the sinus with fluoroscopy, a balloon is then guided over the wire into the blocked ostium and then inflated to open the ostium. There is more information on the Acclarent website.

Becker showed that injection of sinonasal polyps with steroids can be done safely (1 incidence of transient diplopia in 1495 injections).

Venkatraman showed that many organisms from sinus cultures were able to form biofilms.

Kountakis showed that Proteomic analysis using Surface Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-TOF-MS) revealed serum proteins with 89% sensitivity and 77% specificity for CRS.

Desrosiers showed that it was possible to determine in the laboratory whether organisms are able to form biofilms.

Pletcher showed that direct coronal CT images were better than reformatted iamges for visualization of sinusitis.

Levine showed that Dead Sea Salt (Oasis nasal spray) is effective as an irrigation and spray

Update on the 2005
American Academy of Allergy, Asthma, and Immunology
Meeting in San Antonio

Joks, et. al presented data suggesting that minocycline treatment can reduce oral steroid dependence in asthma.

Gadgil et. al. showed that a new inhaled steroid, ciclesonide, is as effective as budesonide in asthma control.

Srivastava, et. al. showed that a chinese herb, (ASHMI), could be used for asthma treatment.

Oliviera et. al. showed that monthly intravenous methylprenisolone could be used as an alternative to daily prednisone with fewer side effects.

Schmitt et. al. showed that it is rare for cystic fibrosis to be diagnosed as a result of finding nasal polyps as a first manifestation of the disease.

Nsouli et. al showed that bovine collagen can cause reactive autoimmunity.

DeMarco, et. al. showed that homes in Florida often contain high levels of mold spores even when there was no clear moisture problem.

Levy, et. al. showed that aeroallergen sensitization occurs commonly in patients with eosinophilic esophagitis.

Alam et. al. showed that patients on beta-blockers who have anaphylaxis do not have increased mortality and take less time to resuscitate.

Desrosiers et. al. showed that S. aureus and P. aeruginosa are the principal pathogens after endoscopic sinus surgery.

Casale et. al. showed that Xolair (omalizumab) can prevent allergic reactions to allergy immunotherapy.

Calderon et. al. showed that Grass pollen tablets can be given as sublingual immunotherapy

Hofman et. al. showed that the most common cause of severe bronchial asthma is due to fungal infection with Aspergillus fumigatus. Detection was by PCR and IgG to the fungus.

Yao showed that treatment with pneumococcal vaccines may improve patients with sinopulmonary infections who have low pneumococcal antibody titers

Sun et. al. showed that some patients with headaches after IVIG can have them due to glucose in the preparation.

Mosby et. al. showed that an infant with disseminated MAC infection had complete interferon gamma receptor deficiency.

Cho et. al. showed that mold exposure in the home is associated with wheezing in atopic infants.

Sercombe et. al. from Sydney showed that a halogen immunoassay of mold in air samples is more accurate than cultures for determining conidia for many different species.

Hill et. al. suggested that interstitial cystitis may be associated with allergic rhinitis and asthma and responded to Xolair.

Cheung et. al. showed that a budesonide nasal wash may be helpful in patients with chronic hyperplastic sinusitis and nasal polyps.

Spangler et. al. found that olopatadine nasal spray was more effective than Flonase for seasonal allergic rhinitis.

Rembold showed that neem (margosa) oil, which is available in Europe, can be used to control dust mites, although it does not have an acaricidal effect. The most effect products were TN-MP100 and Milbiol.

Gevaert et. al. from Stammberger's group showed that anti IL-5 can shrink polyps for 4 weeks after a single IV treatment.

Farid et. al. found that patients with urticaria have a higher incidence of thyroid autoantibodies and can respond to treatment with thyroxine.

Pajno et. al found that there was a 5% incidence of celiac disease in children with urticaria, even if there were no overt symptoms of celiac disease.

Nakonechna et. al. found a possible correlation between food allergy and infection with H. pylori. They also found an effect on urticaria if patients with ulcers were treated with PPI's or H2 antagonists.

Friedman et. al. found that removal of an Aspergillus mycetoma in the maxillary sinus helped a patient with urticaria.

Ravikumar reported on two anosmic patients who responded well to zileuton.

Kline et. al. reported that Xolair and rush immunotherapy worked better than rush immunotherapy alone.

Mehta et. al. from the Mayo clinic reported that Alternaria is a potent enhancer of Th-2 like immunity to bystander antigens.

Townsend et. al. reported that 5% tea tree oil has antifungal activity on sheetrock.

Endo et. al. reported that 9.6% of patients with nasal polyps had a concomitant immunodeficiency, with 24.7% having aspirin sensitivity. Allergy to aeroallergens occurred in 73.3%.

Rizzo et. al. reported that benzalkonium chloride impaired mucociliary clearance in normal volunteers.

Tripathi et. al. reported that there was increased eosinophiles in polyp tissue and found that there was suggestive evidence that staphylococcal superantigens may be a factor in the eosinophilic inflammation

Update on the 2004
American College of Allergy, Asthma, and Immunology
Meeting in Boston

Cartwright et. al. treated a woman with seminal fluid allergy who developed anaphylaxis after her first unprotected intercourse after giving birth to her first child. She successfully received intravaginal densitization, but must have exposure to seminal fluid at least every 5 days, otherwise she will develop local reactions.

Castro et. al. suggested that Honey Bee Venom may be safely used to treat Multiple Sclerosis, larger studies need to be done to determine efficacy.

Nsouli et. al. found that COX-II inhibitors can be used in patients that are allergic to naproxen.

Kim et. al. demonstrated a patient with active asthma with normal spirometry. The nitrous oxide levels were abnormal.

Tamura et. al. from Japan demonstrated efficacy of a new transdermal preparation of a beta-2 agonist called tulobuterol which was added to an inhaled corticorsteroid.

Korenblat et. al showed that ciclesonide MDI has a lower incidence of thrush than beclomethasone MDI.

Malka-Rais et. al. showed that Vioxx was helpful in one patient with chronic urticaria. This obviously needs to be repeated with other COX-II inhibitors since Vioxx has been taken off the market.

Saturno et. al. identified a group of pediatric patients who did not respond to the Prevnar vaccine.

Guidos et. al. showed that montelukast (in combination with steroids and surgery) was effective in treatment of nasal polyps associated with asthma.

Overholt showed that Astelin nasal spray was helpful in treatment of rhinitis symptoms in patients with sinusitis or asthma.

Suryadevara and Hamilos showed that patients with chronic rhinosinusitis with nasal polyps are more symptomatic that patients without polyps.

Update on the 2004
American Rhinologic Society
Meeting in New York

The 50th anniversary meeting provided a extended time for interaction and many useful papers.

Desrosiers et. al. presented information showing that use of topical corticosterois in the nose will reduce the number of bacteria recovered at the time of endoscopic sinus surgery, both first time and revision, especially staphylococcus species.

Dubin et. al. presented a meta-analysis of studies comparing middle meatal cultures to aspirate cultures. They found that out of 188 cultures there was a sensitivity of 85% and a specificity of 56% showing that middle meatal cultures were a sensitive method of obtaining a culture diagnosis.

Stringer et. al. provided an evidence based analysis showing the antimicrobial nasal washes could be effective in treatment of sinusitis.

Lang et. al. discovered that an inflammatory mediator, glycodelin, may play a role in chronic sinusitis and polyps and may be able to be used as a diagnostic test.

Cingi et. al. studied sublingual immunotherapy and found it to be useful in treatment.

Otto et. al. found that oral corticosteroids with FESS followed by topical steroids with leukotriene antagonists were helpful in treating anosmic patients.

Caughey et. al. found that septal deviation, concha bullosa and infraorbital ethmoid cells may worsen narrowing of the OMC.

Ferguson et. al. showed that telithromycin and moxifloxacin had comparable efficacy in acute rhinosinusitis.

Hwang et. al. showed that there was poor delivery to the sinuses with a passive nebulizer and spray bottle in both normals as well as post-operative patients. It was better with a vortex nebulizer.

Ferguson et. al. showed that there was a biofilm which can develop in patients with chronic sinusitis. A film of glycocalyx may protect bacteria or fungi from contact with antimicrobials. This has been documented with Pseudomonas, S. aureus, and Alternaria as well as other organisms. In addition, the organisms which are contained inside the biofilm may have different sensitivity than those which are cultured, since they are outside the biofilm. Removing the biofilm may require surgery.

Tripathi et. al. found that Staph superantigens activate T cells and suggest a potential link to inflammation in patients with chronic sinusitis and polyps.

Houser presented a patient with the empty nose syndrome who was helped with implanted acellular dermis to replace the turbinate tissue.

Catalano et. al. presented a study of patients with chronic sinusitis treated with oral itraconazole, topical itraconazole and a leukotriene inhibitor as well as FESS in which 26/75 were able to be weaned off medication, 38/75 had marked control on the protocol and 11/75 were not responsive (15%).

LaCroix presented information showing the S. aureus could be demonstrated intracellularly in epithelial cells in patients with chronic sinusitis using immunofluorescent staining and confocal microscopy.

Update on the 2004
American Rhinologic Society
Meeting in Phoenix

DelGaudio and Otto presented reasons for frontal recess obstruction: Mucosal disease or polyps, retained frontal recess cells, lateralized middle turbinate, scarring, neoosteogenesis.

Solares et. al. suggested that mupirocin irrigation ( 22 g of 2% ointment in 1 liter of NS. Irrigate for 4-6 weeks BID) was helpful in patients with MRSA.

Perloff and Palmer showed that rabbits experimentally infected with Pseudomonas developed bacterial biofilms in all 22 animals and 21/22 had positive cultures for Pseudomonas. Manning and Marple showed that there was a significant increase in AFS cases around the 32nd parallel.

Update on the 2004
American Academy of Allergy, Asthma, and Immunology
Meeting in San Francisco

Sherris, Ponikau et. al. (from the Mayo clinic) reported on a randomized, double-blind, placebo controlled trial on the use of Amphotericin B in treatment of patients with chronic sinusitis. Treated patients received 20 ml by irrigation of Ampho B (250 micrograms/ml sterile water). There were significant changes in both endoscopic scores and CT scans. There was also a significant difference in mucus levels of interleukin-5 and eosinophil-derived neurotoxin ( increased in placebo and decreased in treated group.)

Kirtsreesakul found that Clarinex reduced sinusitis in mice with allergic rhinitis.

Andrews et. al. found that levabuterol caused less hyperactivity and inattentiveness in children with asthma compared with albuterol.

Hendeles et. al. compared patients with exercise induced asthma, who were treated with fluticasone and either salmeterol or montelukast. He found that albuterol functioned better as a rescue inhaler in those patients treated with montelukast than with salmeterol.

Smith et. al.(abstract available, but poster not available) report a new immunodeficiency presenting with chronic sinusitis, a single CF mutation, and as well as a low IgG level and poor response to Pneumovax, Tetanus, H. influenza, polio and isohemagglutins.

Madaan, et. al. reported on 40 patients with selective polysaccharide deficiency who presented with pneumonia, sinusitis, otitis and other diseases. 1/3 responded to IVIG.

Santilli, et. al. ( poster not available) reported on a patient with mold exposure in her car which caused her symptoms.

Husman et. al. ( poster not available) reported on an increase in autoimmune disease in patients exposed to mold.

Bartra et. al. reported on a prevalence of mold sensitivity in Spain of 26% of patients with allergic rhinitis or asthma.

Golden et. al. reported on venom immunotherapy for large local reactions. He defined that as > 16 cm.

Maria et. al. reported that 82% of patients treated with sublingual ragweed immunotherapy maintained benefits after treatment.

Ogbogu et. al. suggested that a triptan given 2 hours before IVIG may be helpful in reducing headaches caused by IVIG.

Mian et. al. suggested that patients with chronic urticaria who are not responseive to treatment may be helped with cyclosporine ( positive skin tests) or dapsone.

Seavolt et. al. found that living in a peanut free home may increase the risk of unintended peanut ingestion for patients who are allergic. Almost all of the ingestions were not at home.

Toskala et. al. found that mucociliary function did not improve in the maxillary sinus 6 months after ESS.

Yao et. al. suggested that P. acne may cause chronic sinusitis.

Leibman et. al. suggested that sensory attributes were important in regard to patient preferences for nasal steroids.

Keith et. al reported that montelukast improved symptoms in patients with nasal polyps.

Baraniuk et. al. reported on 3 different groups with sinusitis: polyps, non-polyps and ASA sensitive.

Steinke et. al. reported that there was a polymorphism in the LTC4S gene which was found in greater frequency in patients with chronic inflammatory or hyperplastic eosinophilic sinusitis (categorization based on presence or absence of eosinophils). Likewise with the PAI-1 gene with respect to chronic inflammatory sinusitis.

Burge et. al. reported on removal of bacteria in a 1000 cu. ft. chamber by the Sharper image Quadra filter. The effective air exchange rate was 3 air changes/hr. There was no report on pollen, dust or fungi. There was no report on effect on patients. The Quadra works on the principle of electrostatic precipitation. Please see the allergy section in the website for information regarding air filters.

Sercombe et. al. reported on fungi found in the nose. The most common fungi found were Cladosporium, Epicoccum, Penicillium, Aspergillus, and yeasts.

Dokic et. al. reported that ozone increases neutrophiles in the lower airways and increases inflammatory cytokines.

Chudnow et. al. reported on a increase in environmental allergises in patients with Crohn's disease.

Jacob et. al. reported on a new immunoassay which will allow quantitative assay of antibodies to all 24 serotypes of pneumococcal antigens contained in current vaccines.

Sokol reported on anaphylaxis to Cidex-OPA in 4 patients following cystoscopy.

Gendreau-Reid et. al. found that a preservative free diet was helpful in 75% of patients with chronic urticaria. It was less helpful in patients with dermographism.

Demuth et. al. reported on the effectiveness of treatment with Pulmicort for eosinophilic esophagitis in a child.

Update on the 2003
American College of Allergy, Asthma, and Immunology
Meeting in New Orleans

Chien and Saca found that there was no association between anaphylaxis and use of ACE inhibitors in patients on immunotherapy.

Cogen and Cogen found that Stachybotris can cause positive skin tests.

Li et. al. found that inflammation may influense nasal polyps and that steroids may help in treating the inflammation.

Luccioli et. al. found that mold allergies can be triggered by oral ingestion of molds in foods.

Leynadier et. al. found that Xolair was useful in treating eye and skin symptoms in patients with latex allergy.

Kollmeier and Simon found that phenylephrine nasal spray can cause facial flushing.

Mabudian and Kumar found that intravenous immunoglobulin (IVIG) can cause thrombocytopenia.

Di Gesu et. al. found that aspirin induced urticaria could be prevented with montelukast with aspirin desensitization.

Nathan et. al. presented a paper on the ROQ ( Rhinitis Outcomes Questionnaire) discussing the usefulness of this tool in evaluating patients. Dr. Tichenor was one of the authors.

Ponikau and Borish present an update on chronic hyperplastic eosinophilic sinusitis. Dr. Ponikau is using voriconazole nasal spray in some patients. Pulmicort is also being used as a nasal spray in a bulb syringe, 1/4cup water with a nebule.

Dykewicz presented an update on hyperplastic sinusitis. He included information about the use of furosemide in patients with chronic hyperplastic sinusitis with nasal polyposis. He also presented papers on the usefulness of Biaxin in reducing markers of mucosal inflammation in the sinuses.

Update on the 2003
American Rhinologic Society
Meeting in Orlando

Perloff and Palmer reported that there is a biofilm present on stents placed in patients after frontal sinus surgery. These biofilms can prevent antibiotics from effectively killing the bacteria.

Dennis reported that allergic fungal sinusitis can be treated with reduction of fungi in the environment and in the nose.

Tabaee et. al. reported that topical application of mitomycin-C did not reduce scarring after endoscopic sinus surgery.

Jafek et. al. reported that Zinc nasal gel (e.g. Zicam) can cause anosmia.

Update on the 2003
American Academy of Allergy, Asthma, and Immunology
Meeting in Denver

Passalacqua et al reported that sublingual immunotherapy is effective in children for treatment of allergy and asthma to dust mite.

Khemici et. al reported that nebulized saline with the RinoFlow was helpful in treatment of nasal obstruction for patients that were not satisfied with previous therapy.

Coffinet et al reported that young children with chronic rhinosinusitis had less eosinophilic inflammation than adults.

Lowery et al reported an IgE antibody to Staphylococcus enterotoxins in patients with chronic sinusitis and nasal polyposis which may contribute to inflammation.

Pasha et al reported that an IgG-3 subclass deficiency was found in a large percentage of their patients with chronic sinusitis.

Hofman et al reported that half of patients with chronic sinusitis had positive cultures for fungi and 88% had IgG against them. There was a good response to Fluconazole.

Shah et al reported that budesonide nasal spray was preferred over fluticasone in regard to smell and test.

Fowler et al reported that IV antibiotics resolved chronic sinusitis in 29% of patients with chronic sinusitis, however only one antibiotic was used and 26% discontinued treatment early, which is much higher than our experience.

Brawley et al reported that a high percentage of patients with ADHD had allergic rhinitis which they speculated there could be an interrelationship which might contribute to cognitive defects and sleep disturbance.

Pries et al evaluated patients with chronic cough and found that a significant number had negative methacholine challenges with sputum eosinophilia . Those patients with eosinophilic bronchitis respond to inhaled corticosteroids.

Baroody et al found that patients with allergic rhinitis had evidence of increased inflammation in the maxillary sinuses during pollen season.

Tanner et al found a recurrence rate of 57% in patients with sphenoid sinusitis an average of 10 months later.

Spector et al found that montelukast nebulized through the SinuNeb was beneficial in 9/13 patients.

Amon et al found that patients with nickel allergy may react to the new Euro coins.

Notman et al found that Cipro skin testing was helpful in diagnosing adverse drug reaction to fluoroquinolones.

Yeates reported that patients with hoarseness due to inhaled corticosteroids could be successfully treated with QVAR, probably due to smaller particle size.

Edmondson et al reported on patients with symptoms due to toxic mold. Symptoms included rhinitis, cough, headache, dyspnea, fatigue, memory loss and dysuria.

Leung et al reported on the effects of anti-IgE therapy with TNX-901 on patients with peanut allergy. Patients were able to increase tolerance on average from Ĺ a peanut to almost 9 peanuts.

Welch et al reported on the efficacy of diagnosing ciliary dyskinesia based on failure to note ciliary movement on examination of a specimen from a Rhinoprobe placed in a drop of sterile saline. If no movement was noted on 2 occasions, electron microscopy was done.

Wagenmann et al found that allergy, asthma, nasal polyps, previous sinus surgery and a high preoperative CT score were poor prognostic factors after FESS. Allergy appeared to be the only factor that could be therapeutically influenced.

From here we would suggest going to:

Older updates


When should the ENT refer to the allergist


Return to the Table of Contents

Last updated January10, 2011

Any comments on this site would be appreciated. Please send mail
to wtichenor@sinuses.com. We will attempt to answer as many
questions as is feasible personally, but are obviously limited
due to time constraints. Any items of general interest will be
included within the website.

The contents of sinuses.com © 1997-2011 by Wellington S. Tichenor, M.D. Reproduction for educational, not-for-profit purposes is permitted if this source is credited and the author of this website is notified of any reproduction for other than personal use. If used on the internet, a link would be appreciated.

T of C|What is Sinusitis|Treatment Regimen|FAQ|For MD's|Allergy|Asthma| Bookmarks|E-Mail