Current Allergy & Clinical Immunology - Volume 26, Issue 1, March 2013

It is an honour for me to present this issue of Current Allergy & Clinical Immunology.

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Allergic rhinitis is a condition that is often trivialised because of its non-life-threatening nature.

Asthma and allergic rhinitis (AR) are thought to be a reflection of the same disease process occurring in varying degrees along one continuous airway, and are often coexistent in the same individual. The evidence supporting this 'one airway' hypothesis is reviewed. Cohort and case-control studies of adults and children reviewed show that AR frequently precedes asthma, conferring a 3-7-fold increased risk for incident asthma. Cross-sectional studies reveal that rhinitis is highly prevalent among asthmatics ranging from 55% to 79%, and severity of rhinitis is positively associated with asthma severity. Pathophysiological interactions between upper and lower airways are appreciated from studies that demonstrate that following exposure to allergens or other triggers (such as histamine, cold dry air) in the nasal mucosa and bronchiolar airways, symptoms may manifest in both upper and lower airways in some individuals, or in only one site in others, despite the presence of pathological reactions along the whole airway. Treatments for AR such as topical corticosteroids and leukotriene modifiers result in improvement of asthma. Randomised trials of immunotherapy for AR have demonstrated a reduction in asthma incidence sustained at 10-year follow-up, and immunotherapy for concurrent asthma/AR has resulted in marked reduction in asthma as well as AR exacerbations.

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Epidemiological, pathophysiological and therapeutic evidence supports the hypothesis that AR and asthma actually represent a spectrum of the same disease affecting one continuous airway.

Allergic rhinitis is often trivialised, but can affect patients' social life, school performance, and work productivity. It may be associated with other medical conditions such as asthma, conjunctivitis, sinusitis and otitis media with effusion. Allergic rhinitis may cause sleep disorders with resulting daytime somnolence and impaired concentration. Other associated disorders include chronic cough, dysphonia, hyposmia and malocclusion.

Allergic rhinitis (AR) is a symptomatic disorder of the nose, induced after allergen exposure, by an IgE-mediated inflammation of the nasal membranes. The symptoms of AR include rhinorrhoea, nasal congestion or blockage, nasal itching, sneezing and postnasal drip. Treatment of patients with AR includes patient education, allergen avoidance, pharmacotherapy and immunotherapy. Allergen avoidance may lessen the severity of disease but is seldom sufficient as a single intervention to control rhinitis. Drugs that can be used for the treatment of allergic rhinitis include intranasal corticosteroids, antihistamines, leukotriene receptor antagonists, cromones, anticholinergics and decongestants. Intranasal corticosteroids are the preferred form of pharmacotherapy for AR, being effective against all the symptoms of AR, with a low incidence of adverse effects. Antihistamines are most effective against rhinorrhoea, sneezing and nasal itching. Allergen specific immunotherapy is the only curative treatment for AR.

Local allergic rhinitis is a new phenotype of rhinitis. The purpose of this review is to discuss the aetiopathophysiology and clinical picture that underlies this form of rhinitis that is typically associated with non-atopic non-allergic rhinitis subjects.

Allergic fungal rhinosinusitis is a distinct form of chronic rhinosinusitis characterised by the formation of nasal polyps, accumulation of eosinophilic mucin and possible bony erosion and mucocoele formation. A type I hypersensitivity to fungi is present. Management is both medical and surgical, with regular follow-up. Endoscopic sinus surgery and systemic and topical corticosteroids play key roles in management. Allergen-specific immunotherapy is an attractive additional treatment.

Bakers have one of the highest rates of occupational disease. They are exposed to a wide variety of irritants and allergens. Baker's eczema and asthma are major causes of significant morbidity and loss of income in this population; however, these occupational diseases continue to be under-recognised. This article reviews the most common irritants and allergens associated with baker's eczema and asthma and interventions to limit exposure.

Mr Brown is 41 years old. He is an economic analyst. His wife is a tax lawyer. They do not have children.

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He has come to see to see Dr Do-a-lot on account of a rash that he has developed over the past few months.

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He describes the rash as raised, red itchy wheals (hives) that appear unexpectedly, mostly on his abdomen, upper thighs and upper arms. They seem to change shape and migrate. They last for a few hours at a time before disappearing spontaneously. At first the symptoms were mild, short-lived and localised to two small patches on either side of his abdomen. Over a period of 3 months the symptoms have increased in severity and frequency to such a degree that they are interfering with his work, his exercise regimen, his relationship with his wife and his sleep. He is at his wits' end.

Doctors have both legal and ethical responsibilities towards their patients. Is it ever acceptable to refuse to treat a patient? In fact, it is, although the healthcare practitioner has to beware of abandonment of the patient. Some of the reasons for refusal to treat that are discussed in this article include risk to the doctor, non-compliance on the part of the patient, conscientious objection to the required treatment, or if the patient is hostile or abusive to the doctor and/or treating team.

Ethics CPD Questionnaire - the 'difficult' patient - may I refuse to treat him?

Breathe free

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AstraZeneca encourages patients to 'stick' with asthma compliance programmes

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Taking affordable, innovative healthcare to the world

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Alvesco^® (ciclesonide)

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Milk allergy components

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Miele broadens their range to meet all customers' needs

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SINGULAIR 4 mg

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Foxair Metered Dose Inhaler (MDI*) - The Seretide equivalent

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New world, New relief for noses and eyes

CPD Questionnaire