Schuivende panelen

Schuivende panelen was de titel van een partijprogramma uit de jaren tachtig. Deze rede is echter geen politiek manifest. Hoewel een wetenschapper in staat moet zijn om politiek te bedrijven en de Allergologie als discipline sinds haar oprichting speelbal geweest is van politieke krachten gaat deze lezing vooral over verschuivingen en ontwikkelingen in het vakgebied. rede In verkorte vorm uitgesproken ter gelegenheid van het aanvaarden van het ambt van bijzonder hoogleraar met als leeropdracht Allergologie aan het Erasmus MC, faculteit van de Erasmus Universiteit Rotterdam, op 20 april 200

Positive and negative AIT trials: What makes the difference?

Background: Allergen immunotherapy has proven to be efficacious in allergic rhinitis and asthma. However, results from randomised clinical trials may vary substantially. Clinical trials may unexpectedly fail. The purpose of this review is to discuss the possible factors that may contribute to a successful or unsuccessful study. Methods: Descriptive review exploring the possible causes of negative outcomes in allergen immunotherapy trials. Results: A series of factors may lead to negative results. Among of these are underpowering of the study, low allergen content in tested extracts, insufficient allergen exposure during monitoring and recruitment of inappropriate patients. In addition, the choice of the primary endpoint may be critical. Discussion: A clinical trial aims to evaluate the efficacy of an agent. However, studies with potential effective compounds may fail because of methodical issues. Sometimes, they are the cause of discrepancies between successful phase II and unsuccessful phase III trials. To understand more about failure of studies, investigators and editors should be encouraged to publish negative trials

Comparison of nasal responsiveness to histamine, methacholine and phentolamine in allergic rhinitis patients and controls

In a selected group of rhinitis patients with an IgE‐mediated allergy to house dust mites the nasal response to insufflation of histamine chloride, methacholine and phentolamine was demonstrated to be higher than in a control group. With the methods used histamine chloride was better at discriminating between healthy subjects and patients than methacholine or phentolamine. This discrimination was shown by assessing the severity of reflex‐mediated symptoms such as the number of sneezes and the amount of secretion, and not by differences in nasal airway resistance. Copyrigh

Nasal hyperreactivity

The subject of this thesis is nasal hyperreactivity or hyperresponsiveness in allergic and nonallergic rhinitis. Hyperreactivity represents an altered state of the upper or lower airways, resulting in an exaggerated response to non-specific stimuli encountered in the environment. Generally, hyperrea.ctivity is a major feature of the disease leading to recurrent or chronic symptoms. In allergic rhinitis and asthma hyperreactivity will reinforce the response after allergen exposure. Although it is known that patients with allergic and non-allergic rhinitis often react with symptoms to environmental non-specific stimuli, standardized and generally accepted tools for measurement of nasal hyperreactivity are not available. Many investigators demonstrated a relation between hyperreactivity of the lower airways and IgE-mediated allergy, especially with respect to the link between hyperreactivity and late phase allergic reactions. However, in nasal allergy a relative backlog exists regarding insight into interactions between IgE-mediated reactions and nasal hyperreactivityThis thesis focuses on answering two questions: L How to measure nasal hyperreactivity ? 2. What is the role and clinical significance of nasal hyperreactivity, especially in nasal allergy ? After a review of the literature (part I, Chapter 2) the current methods of assessment of nasal hyperreactivity are analysed (part II). To this end, nasal challenges with various non-specific stimuli were performed in allergic and non-allergic rhinitis patients compared to healthy subjects (chapters 3,4 and 5). Subsequently the clinical aspects of hyperreactivity in nasal allergy (part III) have been investigated. The relevance of hyperresponsiveness was analysed with respect to the daily symptoms of the patie

Nasal allergy to avian antigens

This study describes the case of a patient who developed symptoms of rhinoconjunctivitis on exposure to budgerigars and parrots. An IgE‐mediated allergy to budgerigar, parrot and pigeon antigens was demonstrated using both in‐vivo challenge tests (skin and nasal provocation tests) and in‐vitro investigations (radio‐allergo‐sorbent test, histamine release test). The study shows that the development of nasal disease can be associated with allergy to avian antigens. Copyrigh

Skin tests, T cell responses and self-reported symptoms in children with allergic rhinitis and asthma due to house dust mite allergy

Abstract BACKGROUND: In allergic responses, a distinction is made between an early-phase response, several minutes after allergen exposure, and a late-phase response after several hours. During the late phase, eosinophils and T cells infiltrate the mucosa and play an important role in inflammation. OBJECTIVE: The aim of this study was to examine the relationship between allergen-induced late-phase skin responses and in vitro T cel

Intranasal cold dry air is superior to histamine challenge in determining the presence and degree of nasal hyperreactivity in nonallergic noninfectious perennial rhinitis

The objective of the study was to compare cold dry air (CDA) and histamine in differentiating patients with nonallergic noninfectious perennial rhinitis (NANIPER) from control subjects. Nasal reactivity (nasal patency, mucus production, and sneezing) in 16 symptomatic nonsmoking patients with NANIPER and seven nonsmoking control subjects was measured with standardized CDA and histamine provocation series in a randomized crossover study. Intranasal CDA resulted in increased mucus production and nasal blockage in a dose-dependent manner in patients with NANIPER but not in control subjects. Sneezing did not occur. The reproducibility of CDA for patency and mucus production was good. Sen

The relationships between nasal hyperreactivity, quality of life, and nasal symptoms in patients with perennial allergic rhinitis

Background: A clinical test that could inform the clinician about the severity of a patient's nasal symptoms and health-related quality of life (QOL) would be very useful. Objective: We attempted to determine whether, in patients with perennial allergic rhinitis, nasal challenge with histamine could be used to estimate daily symptoms and QOL. Methods: Forty-eight patients with perennial allergic rhinitis were challenged with histamine to determine nasal hyperreactivity. Nasal response was monitored by the number of sneezes, the amount of secretion, and a symptom score. Daily nasal symptoms were recorded during the 2 preceding weeks. Patients also completed a rhinitis QOL questionnaire. Results: Responsiveness to histamine and total daily nasal symptoms were moderately correlated (r = 0.51, p = 0.001). Comparison of total daily nasal symptoms with the overall QOL score showed a moderate correlation (r = 0.59, p &lt; 0.001). Nasal response to histamine and overall QOL score were also correlated (r = 0.43, p = 0.0052). However, overall QOL and daily nasal symptoms could be predicted by wide 95% confidence intervals only for each decade of nasal responsiveness to histamine (expressed as a composite symptom score). Conclusion: In patients with perennial allergic rhinitis nasal hyperreactivity as determined by histamine challenge, QOL, and daily nasal symptoms are moderately correlated. Therefore nasal histamine challenge can be used as a tool for estimating the severity of daily nasal symptoms and QOL, although it cannot predict nasal symptoms and QOL very accurately.</p

Routine abdominal ultrasonography has limited value in the care for patients with indolent systemic mastocytosis

Objectives: Systemic mastocytosis (SM) is a myeloproliferative disease characterized by the accumulation of aberrant mast cells. Since advanced subtypes of SM can lead to organ dysfunction and shortened survival, timely recognition of progressive disease is important for the adequate treatment of SM patients. Methods: Here, we report the results of our cohort study on the value of routine abdominal ultrasonography for the detection of progression of indolent systemic mastocytosis (ISM). Results: We included 88 patients with ISM, of whom 9 developed new hepatosplenomegaly during follow-up. In this group, the median serum tryptase level increased by 11.60 μg/l, compared with a decrease of −0.20 μg/l in the 79 patients with unchanged ultrasonography results (p = 0.016). A change in liver and/or spleen size never led to a change in clinical classification, nor management. Discussion: Based on the finding that a change in ultrasonography findings did not correlate to disease progression in general, it appears that isolated hepatosplenomegaly does not have prognostic implications in patients with ISM. Conclusions: Routine abdominal ultrasonography is redundant in the follow-up of patients with ISM. A combination of physical examination with serum tryptase levels can be used to screen for hepatosplenomegaly