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Update in Allergy and Immunology
- 1998-99 Series; John Roberts, MD, Editor From Oregon Health Sciences University, Portland, Oregon. Requests for Reprints: Mark T. O'Hollaren, MD, Department of Medicine, Oregon Health Sciences University, 0P30, 3181 SW Sam Jackson Park, Portland, OR 97201. Current Author Addresses: Dr. O'Hollaren: Allergy Clinic, 511 SW 10th Avenue, Suite 1301, Portland, OR 97205.
We are just beginning to understand the associations between the immune system's physiology and clinical symptoms. This knowledge is facilitating the development of new therapies for allergic disorders. We begin with a review of new guidelines for the asthma therapy that, in part, stem from our new understanding of immune pathophysiology. We then review several advances in asthma therapy related to medication timing, longer-acting inhaled β2 agonists, and leukotriene antagonists and summarize current thinking on mortality related to asthma. We discuss the immune response in allergic rhinitis, the role of inhalant allergens in allergic rhinitis, and associations between asthma and allergic rhinitis. Finally, we address latex allergy, a growing clinical problem for health care workers.
Asthma
Asthma affects up to 15 million Americans and is the most common chronic disease of childhood. It accounts for more than 100 million days of missed school or work, results in 470 000 hospitalizations a year, and causes more than 500 deaths annually. Mortality rates have increased during the past 10 years, despite new treatments, and African-American persons suffer disproportionately high mortality.
Second National Heart, Lung, and Blood Institute Guidelines Were Issued
Guidelines for the Diagnosis and Management of Asthma: Expert Panel Report 2. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute; 1997. NIH publication no. 97-4051.
The National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program convened two expert panels to prepare guidelines that provide physicians and other health care professionals with recommendations, based on scientific evidence, to aid in the diagnosis and management of asthma. Their reports were issued in 1991 and 1997. A summary of the 1997 recommendations follows.
It is now known that asthma is a chronic inflammatory disorder of the airways whose symptoms and signs result from a complex interaction of many …
