Asthma,Rhinitis, and Nasal Polyp Multimorbidities

The aim of this review is to assist pulmonologists in the management of diseases involving both the upper and lower respiratory tract that are linked by a common, interrelated epidemiology, clinical signs and symptoms, and inflammatory mechanism , asthma, in particular.The document discusses the definitions of the various sinonasal phenotypes associated with asthma: allergic and non-allergic rhinitis and chronic rhinosinusitis with or without nasal polyps. Diagnostic criteria and severity levels are also listed.Particular attention has been given to the 2 main syndromes associated with asthma: (i) allergic rhinitis, the most common, and (ii) chronic rhinosinusitis with nasal polyps, the disease most closely associated with severe asthma.To summarize, the upper respiratory tract should always be evaluated in order to achieve a single diagnosis and comprehensive treatment of the “united airway”.     

A teenager with severe asthma exacerbation following ibuprofen

Aspirin-sensitive asthma, aspirin-intolerant asthma, aspirin- (or non-steroidal anti-inflammatory drug [NSAID]) exacerbated respiratory disease are terms for a disorder commonly described as affecting adults aged > 30y. With this perception, ibuprofen was administered for postoperative pain management to a 17-year-old boy with allergic rhinitis and previous severe asthma (at a time when well controlled), who then had a severe asthma exacerbation. Analysis of the literature in response to this case highlights four points: 1) NSAID-exacerbated asthma is not only a disorder of adults; it occurs in up to of 2% in asthmatic children, approaching probably 30% in older children with severe asthma and nasal disease. 2) The asthmatic reaction is dose-dependent and can occur with sub-therapeutic doses. Oral NSAID/aspirin challenge should be conducted in an environment where a severe asthma exacerbation can be appropriately managed. 3) The therapeutic use of non-selective [COX-1 preferential] NSAIDs should be avoided when sensitivity is known or suspected in adults and teenagers with severe asthma and chronic rhinosinusitis or nasal polyps. Use of these agents in younger children with mild episodic wheeze is probably safe. 4) Paracetamol use is probably safe, but aspirin-exacerbated respiratory disease may occur with clinical doses in a subgroup of aspirin-exacerbated respiratory disease patients. COX-2 selective inhibitors are probably safe, although this is controversial. Opioids and tramadol are suitable analgesic alternatives for patients with known or suspected susceptibility.     

Asthma in Late Adolescents of Western Mexico: Prevalence and Associated Factors

IntroductionGiven the number of changes that occur during late adolescence, it is possible that the behavior of asthma may also be different. The aim of our paper is to determine the prevalence of asthma in a population of late adolescents and its possible association with obesity, tobacco smoke exposure and family history of allergic disease.Methods and subjectsIn a cross-sectional, population-based analytical study design, we selected a stratified random sample of subjects aged 15–18. By modeling risk through logistic regression, we assessed the relationship between asthma and the following covariables: gender, obesity, excess weight, family history of allergic disease and tobacco smoke exposure.Results1600 subjects were included, and the following prevalences were identified: asthma 7.8%, obesity 9.6%, active smoking in the father 2 9.8%, active smoking in the mother 18.6% and active smoking habit in the study subjects 15.1%. In the final model, a significant association was found between asthma and the following variables: (1) asthma in the mother (adjusted OR [aOR]=2.95, 95% CI, 1.55–5.6), (2) history of allergic rhinitis (aOR=4.66, 95% CI, 2.63–8.25), and (3) male sex (aOR=1.48, 95% CI, 1.02–2.15). No association was seen with obesity or tobacco smoking of the parents.ConclusionOur results suggest that maternal history of asthma, personal history of allergic rhinitis and male sex are related with asthma late adolescence, while smoking and being overweight are not.     

Home dampness, current allergic diseases, and respiratory infections among young adults

BACKGROUND: The relation between home dampness and respiratory symptoms among adults is well confirmed, but data on specific allergic diseases and respiratory infections is more limited. Individual factors that may enhance susceptibility to the effects of home dampness are mainly unknown. METHODS: The association between home dampness and current physician diagnosed asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis, common colds, and bacterial respiratory infections was studied in a questionnaire survey of 10 667 Finnish first year university students aged 18-25 years. The dampness categories analysed were visible mould and visible mould or damp stains or water damage during the last year. In multivariate analyses adjustment was made for parental education, active and passive smoking, type and place of residence, pets, and wall to wall carpets. The interaction effect of atopic heredity and dampness was investigated. RESULTS: Visible mould or damp stains or water damage was reported by 15.0% of the respondents. In multivariate models there was a positive association between home dampness and current asthma, allergic rhinitis, and atopic dermatitis, as well as common colds > or =4 times per year and other respiratory infections, but not between home dampness and allergic conjunctivitis. The strongest association was found between exposure to visible mould and asthma (OR 2.21, 95% CI 1.48 to 3.28) and common colds (OR 1.49, 95% CI 1.18 to 1.87). The risk of current asthma in damp homes was highest among subjects with atopic heredity. CONCLUSIONS: The risk of current asthma, allergic rhinitis, and atopic dermatitis was higher in damp homes. Of the respiratory infections, the risk of common colds was most clearly increased.     

Eosinophilic bronchitis: clinical manifestations and implications for treatment

Airway inflammation with eosinophils is now reported to occur not only in asthma but in other airway diseases such as cough variant asthma, chronic cough, atopic cough, episodic symptoms without asthma, allergic rhinitis, and COPD. Although the prevalence of eosinophilic bronchitis (EB) is less than in asthma, the causes, mechanisms and treatment of EB in these conditions appears to be similar to asthma where allergen induced IL-5 secretion and symptoms are readily responsive to inhaled corticosteroids. The prognosis of EB without asthma is not known but it may be a precursor for asthma and, if so, recognition of this syndrome may permit effective treatment and reduction in the rising prevalence of asthma. Induced sputum analysis allows recognition of EB in clinical practice. The place of the asthma treatment paradigm with early and sustained corticosteroid treatment needs to be defined in EB without asthma. Airway wall remodelling can occur in rhinitis, COPD, and cough variant asthma with EB. The mechanisms and long term implications of this complication in EB without asthma need to be clarified.     

The role of leukotrienes in nasal allergy.

OBJECTIVE: This review focuses on the role of cysteinyl leukotrienes (cysLTs) in nasal allergy. The purpose was to provide knowledge of the role of cysLTs in the pathophysiology of nasal allergy and the role of antileukotrienes in the treatment of nasal allergies.Materials and methods We conducted a literature review. RESULTS: The proinflammatory effects of cysLTs have been well described in asthma. Antileukotrienes have proved to be an effective anti-inflammatory treatment for asthma patients. Similar to pathogenesis of asthma, cysLTs exert potent inflammatory effects in the upper airways and play a role in the pathogenesis of allergic rhinitis and other nasal allergies. CONCLUSION: Antileukotriene treatment appears to be beneficial in nasal allergies. Allergic rhinitis is a complex, IgE-mediated inflammatory disease of the upper airways. It is the most common allergic disease, occurring in 10% to 30% of adults and up to 30% of children. It may be perennial or seasonal. Sneezing, itching, watery rhinorrhea, and nasal obstruction are classic symptoms. It may impair cognition, school/work performance and productivity, behavior, mood, and quality of life. On physical examination, clear secretions, nasal congestion, pink-bluish nasal mucosa, the allergic salute, and allergic shiners may be detected. Allergic rhinitis is a common comorbid condition with asthma, sinusitis, otitis media, nasal polyposis, and respiratory infections.     

Prevalence of bronchial hyperresponsiveness and asthma in a rural adult population.

The prevalence of bronchial hyperresponsiveness in adult populations is not known. To document its prevalence and distribution and to determine the factors associated with it, a random sample of the adult population of Busselton, Western Australia, was studied. Spirometric function, bronchial responsiveness to histamine, and atopic responses to skin prick tests were measured. Respiratory symptoms were determined by questionnaire. Data were obtained from 916 subjects. Of these, 876 underwent a histamine inhalation test and bronchial hyperresponsiveness to histamine (defined as a dose of histamine provoking a 20% fall in FEV1 equal to or less than 3.9 mumol) was found in 10.5%. Another 40 subjects with poor lung function were tested with a bronchodilator and 12 were found to have bronchial hyperresponsiveness (defined as a greater than 15% increase in FEV1), making the total prevalence of bronchial hyperresponsiveness 11.4%. The prevalence of current asthma, defined as bronchial hyperresponsiveness plus symptoms consistent with asthma in the last 12 months, was 5.9%. The distribution of bronchial hyperresponsiveness in the studied population was continuous. There was a significant association between it and respiratory symptoms, atopy, smoking, and abnormal lung function (p less than 0.001 for all associations). There was no association with age, sex, or recent respiratory tract infection.     

Air Pollution and Recent Symptoms of Asthma,Allergic Rhinitis,and Atopic Eczema in Schoolchildren Aged Between 6 and 7 Years

ObjectiveThe objective of the study was to analyze the relationship between air pollutants and the prevalence of recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years.Patients and MethodsThe prevalence of recent (previous 12 months) symptoms of allergic diseases was obtained by means of the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), Spain, with the participation of 7 centers (Asturias, Barcelona, Bilbao, Cartagena, La Coruña, Madrid, and Valencia) and 20 455 schoolchildren aged between 6 and 7 years, from 2002 to 2003. The pollutant detection systems of the aforementioned centers provided the mean annual concentrations of sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and total suspended particulate matter.ResultsThe annual average concentration of SO₂ showed a significant association with a higher prevalence of recent severe asthma (adjusted odds ratio [aOR] between level-1 and level-3 pollution, 1.32; 95% confidence interval [CI], 1.01–1.73), rhinitis (aOR, 1.56; 95% CI, 1.39–1.75), and rhinoconjunctivitis (aOR, 1.70; 95% CI, 1.45–2.00). The annual average concentration of CO was associated with a higher prevalence of rhinitis (aOR, 1.65; 95% CI, 1.34-2.04), rhinoconjunctivitis (aOR, 1.76; 95% CI, 1.31–2.37), and eczema (aOR, 1.55; 95% CI, 1.17–2.04). The annual average concentration for NO₂ and total suspended particulate matter showed inverse associations with the prevalence of nocturnal dry cough.ConclusionsFindings suggest that air pollutants such as SO₂ and CO increase the risk of recent symptoms of asthma and allergic rhinitis in schoolchildren aged between 6 and 7 years in Spain.     

支气管哮喘患者人群慢性肾脏病流行病学调查

目的 了解支气管哮喘患者人群慢性肾脏病流行病学现状。 方法 选择≥14岁的支气管哮喘患者为研究对象进行问卷调查、体格检查和肾脏损伤及相关危险因素检测。根据相关疾病诊断标准对资料进行分析。 结果 郑州市14岁以上支气管哮喘患者人群蛋白尿、血尿和估算肾小球滤过率（eGFR）下降患病率为别为9.41%、10.37%和3.03%,均高于普通人群。CKD患病率高达17.38%,女性显著高于男性（21.47%比13.99%,χ2 = 6.060,P = 0.014）;CKD1～5期患病率分别为8.61%、5.10%、3.03%、0.48%和0.16%。在哮喘分期中,急性发作期CKD患病率为24.42%,显著高于慢性持续期和临床缓解期（χ2 = 12.445,P = 0.002）;急性发作期蛋白尿和eGFR下降患病率均高于其他两期（χ2 = 19.619,P ＜ 0.01和χ2 = 9.305,P = 0.010）。 结论 支气管哮喘人群具有较高的肾脏损伤发生率,尤其在急性发作期,应重视此人群肾损害的评估。     

The role of rhinitis in chronic otitis media.

OBJECTIVE: We investigated the role of allergic rhinitis in chronic otitis media (otitis media with effusion [OME] and chronic perforation of the tympanic membrane) in S?o Paulo, Brazil and whether there is any association between these diseases. STUDY DESIGN AND SETTING: We studied 51 patients followed in the otologic group of the Otorhinolaryngology Division of the University of S?o Paulo Hospital. The patients were divided into 3 groups: allergic rhinitis, nonallergic rhinitis with eosinophils syndrome (NARES), and patients with types of rhinitis or without rhinitis. We analyzed the age, gender, intensity of the nasal disease, surgical procedure, and surgical results in each group. RESULTS: We found about 50% of patients presenting with nasal disease and nasal eosinophilia (33.33% of allergic and 15.69% of NARES). CONCLUSION: Nasal disease has an impact on otologic middle ear disease, considering that the normal nasal mucosa do not have eosinophils.     

C reactive protein levels are increased in non-allergic but not allergic asthma: a multicentre epidemiological study

BACKGROUND: High sensitivity C reactive protein (HsCRP) is an inflammatory marker known to be related to smoking, obesity, and cardiovascular disease. A study was undertaken to determine whether HsCRP is related to respiratory symptoms, asthma, atopy, and bronchial hyperresponsiveness in population samples from three countries. METHODS: HsCRP was measured in 1289 subjects from three centres in ECRHS II: Reykjavik, Uppsala and Tartu. The HsCRP values ranged from <0.01 mg/l to 70.0 mg/l and were divided into four equal groups (< or = 0.45, 0.46-0.96, 0.97-2.21, and >2.21 mg/l). RESULTS: HsCRP increased with increasing body mass index (r = 0.41; p<0.0001) and was higher in smokers than in never smokers (p = 0.02). A significant relationship was found between increased HsCRP levels and respiratory symptoms such as wheeze, attacks of breathlessness after effort, and nocturnal cough (p<0.0001). The crude odds ratio (95% CI) for the probability of non-allergic asthma was 3.57 (1.83 to 6.96) for subjects in the 4th quartile compared with the 1st quartile of HsCRP. This association remained significant after adjusting for study centre, age, sex, body weight, and smoking history (OR 2.19 (95% CI 1.04 to 4.63)). No significant relationship was observed between HsCRP and allergic asthma or bronchial responsiveness. CONCLUSIONS: Raised levels of HsCRP are significantly associated with respiratory symptoms and non-allergic asthma but not with allergic asthma.     

Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete

BACKGROUND: Atopy is not uncommon among children living in rural Crete, but wheeze and rhinitis are rare. A study was undertaken to examine whether this discrepancy could be attributed to a high consumption of fresh fruit and vegetables or adherence to a traditional Mediterranean diet. METHODS: A cross-sectional survey was performed in 690 children aged 7-18 years in rural Crete. Parents completed a questionnaire on their child's respiratory and allergic symptoms and a 58-item food frequency questionnaire. Adherence to a Mediterranean diet was measured using a scale with 12 dietary items. Children underwent skin prick tests with 10 common aeroallergens. RESULTS: 80% of children ate fresh fruit (and 68% vegetables) at least twice a day. The intake of grapes, oranges, apples, and fresh tomatoes-the main local products in Crete-had no association with atopy but was protective for wheezing and rhinitis. A high consumption of nuts was found to be inversely associated with wheezing (OR 0.46; 95% CI 0.20 to 0.98), whereas margarine increased the risk of both wheeze (OR 2.19; 95% CI 1.01 to 4.82) and allergic rhinitis (OR 2.10; 95% CI 1.31 to 3.37). A high level of adherence to the Mediterranean diet was protective for allergic rhinitis (OR 0.34; 95% CI 0.18 to 0.64) while a more modest protection was observed for wheezing and atopy. CONCLUSION: The results of this study suggest a beneficial effect of commonly consumed fruits, vegetables and nuts, and of a high adherence to a traditional Mediterranean diet during childhood on symptoms of asthma and rhinitis. Diet may explain the relative lack of allergic symptoms in this population.     

Miniseminar: Chronic rhinosinusitis: The impact of allergic rhinitis management

Chronic rhinosinusitis is a common medical condition encountered throughout the world. Allergic rhinitis has a high prevalence in the general population and is a condition that affects up to half of patients with chronic rhinosinusitis. As the recognized experts in the care of medical problems affecting the nose, otolaryngologists spend a significant portion of their professional time evaluating and managing chronic rhinosinusitis.The current miniseminar will investigate the impact of allergic rhinitis on the pathophysiology and optimal management of chronic rhinosinusitis. A variety of teaching methods, including lectures, slide presentations, interactive discussions, and reviews of recent literature will be utilized to help the attendee develop a science-based approach to incorporate the management of allergic rhinitis into the treatment of patients with chronic rhinosinusitis. First, the updated definition of chronic rhinosinusitis, as recently reported by the Chronic Rhinosinusitis Task Force, will be reviewed, emphasizing the clinical and research applications of the definition. The epidemiologies of the 2 conditions will then be discussed, exploring the role of allergic rhinitis in the development and propagation of chronic rhinosinusitis. Information will also be presented about possible etiologies of the increasing incidence of allergic rhinitis. After focusing on the relationship of allergic rhinitis and chronic rhinosinusitis, the miniseminar will progress to a discussion on the role of evaluation and management of allergic rhinitis in the treatment of chronic sinusitis. Particular attention will be given to the timing of allergic rhinitis management for patients approaching the need for surgical intervention. This portion will discuss the use of optimal allergy identification and treatment to help avoid the need for primary or repeat surgery, and to improve the long-term outcomes in patients who undergo surgical treatment. The treatments discussed will include allergen avoidance, the latest topical and systemic pharmacotherapy options, and immunotherapy. The last portion of the miniseminar will review the outcomes data published in the recent literature to investigate the value of allergic rhinitis management in the treatment of chronic rhinosinusitis. At the conclusion of the miniseminar, the attendee will have received a thorough explanation of the impact of allergic rhinitis on the pathogenesis and treatment of chronic rhinosinusitis.     

Safety and efficacy of radioallergosorbent test-based allergen immunotherapy in treatment of perennial allergic rhinitis and asthma.

OBJECTIVE: This study was undertaken to demonstrate the safety and efficacy of in vitro, radioallergosorbent test (RAST)-based inhalant allergen immunotherapy. STUDY DESIGN AND SETTING: Prospective 22 year single site clinical study, with outcome evaluations of 480 perennial allergic rhinitis patients, including 96 with concomitant asthma. RESULTS: Rhinitis symptom control after 2 years of immunotherapy was excellent in 32.5% of patients, good in 45.6%, and fair in 14.2%. There was no improvement in 7.7%. For patients with asthma, 81% had good or excellent pulmonary symptom improvement, and no patient failed to improve. No severe reactions occurred, but there were 5 limited systemic reactions, or 0.008% of injections, during a 2.5-year mean immunotherapy treatment course. CONCLUSION: RAST-based immunotherapy is safe and effective for patients with perennial allergic rhinitis, with or without concomitant asthma. Significance This is the first large, multiyear study of safety and efficacy of RAST-based immunotherapy for treatment of perennial allergic rhinitis and asthma. EBM rating: C.     

Anesthesia in bronchial asthma

Asthma is defined as a chronic inflammatory airway disease in response to a wide variety of provoking stimuli. Characteristic clinical symptoms of asthma are bronchial hyperreactivity, reversible airway obstruction, wheezing and dyspnea. Asthma presents a major public health problem with increasing prevalence rates and severity worldwide. Despite major advances in our understanding of the clinical management of asthmatic patients, it remains a challenging population for anesthesiologists in clinical practice. The anesthesiologist's responsibility starts with the preoperative assessment and evaluation of the pulmonary function. For patients with asthma who currently have no symptoms, the risk of perioperative respiratory complications is extremely low. Therefore, pulmonary function should be optimized preoperatively and airway obstruction should be controlled by using steroids and bronchodilators. Preoperative spirometry is a simple means of assessing presence and severity of airway obstruction as well as the degree of reversibility in response to bronchodilator therapy. An increase of 15% in FEV1 is considered clinically significant. Most asymptomatic persons with asthma can safely undergo general anesthesia with and without endotracheal intubation. Volatile anesthetics are still recommended for general anesthetic techniques. As compared to barbiturates and even ketamine, propofol is considered to be the agent of choice for induction of anesthesia in asthmatics. The use of regional anesthesia does not reduce perioperative respiratory complications in asymptomatic asthmatics, whereas it is advantageous in symptomatic patients. Pregnant asthmatic and parturients undergoing anesthesia are at increased risk, especially if regional anesthetic techniques are not suitable and prostaglandin and its derivates are administered for abortion or operative delivery. Bronchial hyperreactivity associated with asthma is an important risk factor of perioperative bronchospasm. The occurrence of this potentially life-threatening condition in anesthesia practice varies from 0.17 to 4.2%. The anesthesiologists' goal should be to minimize the risk of inciting bronchospasm and to avoid triggering stimuli. As increases in airway resistance are noticed, therapy should be directed towards optimizing oxygenation and proper diagnosis needs to be established. With deepening anesthesia level and aggressive pharmacological management utilizing both, beta-agonists and steroids, respiratory failure may be properly controlled.     

卵清蛋白致敏SD大鼠上下呼吸道炎症反应动物模型的构建

目的：以卵清蛋白为致敏原,建立具有变应性鼻炎和变应性哮喘为主要特征的大鼠模型,观察大鼠模型上下呼吸道炎症反应及病理改变。方法：采用6-8周雄性SD大鼠,随机分为变应性鼻炎组10只,变应性鼻炎对照组10只,变应性哮喘组10只,变应性哮喘对照组10只,以卵清蛋白致敏并激发制成变应性鼻炎和变应性哮喘模型。HE染色和甲苯胺蓝染色分别检测变应性鼻炎模型和变应性哮喘模型鼻黏膜及肺组织中EOS、MC的表达。结果：变应性鼻炎组、变应性哮喘组大鼠卵清蛋白激发后出现了典型的变应性鼻炎、变应性哮喘症状（评分〉5分）,鼻黏膜和肺组织可见较多的嗜酸粒细胞和肥大细胞浸润,且两组鼻黏膜和肺组织中EOS、MC数明显多于相应对照组（P〈0．05）。结论：卵清蛋白致敏SD大鼠能够成功建立变应性鼻炎和变应性哮喘动物模型,有望为上、下呼吸道炎症反应的诊断、治疗及研究工作提供有效方法及组织形态学依据。     

Response of the nose to exercise in healthy subjects and in patients with rhinitis and asthma.

BACKGROUND--Although the nose and the bronchi are both involved in the process of regulating respiratory heat exchange, thermal changes may precipitate airway obstruction during exercise but rarely cause nasal obstruction in patients with rhinitis. The cause of the different response of the nose and bronchial tree has hardly been investigated. This study was performed to assess the response of the nose during exercise in the presence of rhinitis, asthma, and in normal controls. METHODS--Ten healthy subjects (group 1), 15 patients with asthma and rhinitis (group 2), 10 with rhinitis only (group 3), and 11 with asthma only (group 4) were included in the study. Exercise was performed on a bicycle ergometer for six minutes, reaching a heart rate of 80% of predicted. Bronchial and nasal responses were measured by forced expiratory volume in one second (FEV1) and posterior rhinomanometry, respectively. A drop in the FEV1 of 20% or more was considered a positive exercise induced asthma challenge test. RESULTS--Heart rate and ventilation increased by a similar proportion in the four groups. The FEV1 significantly decreased in asthmatic patients (groups 2 and 4) but it did not change in healthy subjects (group 1) or in those with rhinitis (group 3). Thirteen asthmatic patients developed exercise induced asthma. Nasal patency increased with exercise by a similar proportion in all groups, and no differences were detected between those with rhinitis (groups 2 and 3) and those without (groups 1 and 4). Nasal patency had returned to basal values at 25 minutes after completion of exercise in the four groups. The nose of patients with exercise induced asthma, however, remained significantly more patent than in patients without exercise induced asthma between 10 and 30 minutes after exercise. CONCLUSIONS--These results suggest that the nose responds differently from the bronchi during exercise induced airway obstruction: whereas the bronchial tree responds by becoming narrowed, the nose becomes more patent. These findings suggest that the mechanisms regulating the response of the nose to exercise are different from those involved in the response of the bronchial tree.     

Alternate Occurrence of Allergic Disease and an Unusual Form of Interstitial Cystitis

Background : It has been postulated that interstitial cystitis can be induced by an allergy. This is partly based on the observation that many patients with interstitial cystitis also have allergic diseases. In this study, an allergic evaluation was conducted on patients with interstitial cystitis complicated by bronchial asthma, a typical allergic disease.
Methods : Clinical histories were obtained and biopsy specimens from the vesical walls of the study patients were examined histologically. Cutaneous tests and IgE radioallergosorbent tests (RAST) were performed. Further, intravesical provocation tests were carried out using IgE RAST-positive antigens, and histamine release assays were performed on the vesical biopsy specimens using anti-lgE antibodies.
Results : Five of 6 patients alternately exhibited symptoms of allergic disease and bladder symptoms. The eosinophil and mast cell counts in the vesical biopsy specimens of these 5 patients were increased. Furthermore, an intravesical provocation test performed using the IgE RAST-positive antigen was positive in 4 patients. The mean vesical biopsy specimen histamine release was 1 7.7% for patients with interstitial cystitis with bronchial asthma which was significantly higher than that for interstitial cystitis patients without bronchial asthma (8.9%) or the control group (4.5%). The prognosis of patients with interstitial cystitis with allergic complications was relatively good.
Conclusion : Patients with bronchial asthma exhibited hypersensitivity both generally and locally in the bladder. The alternation phenomenon was observed between the hypersensitive organs.     

Pediatric anesthesia and recent developments in asthma in children

Asthma is a chronic inflammatory disease and the physiological consequence is bronchial hyperresponsiveness to different stimuli. With the worldwide increase in the prevalence of asthma, an increased number of asthmatics are likely to require anesthesia for surgical procedures. Recent investigations described the role played by different environmental agents in asthma, and clarified assessment and management strategies which can be applied to anesthesia in order to decrease the morbidity related to perioperative bronchospasm in children with asthma.