Jo A. Douglass

Summary: International studies report marked increases in the prevalence of food allergy, along with increases in hospital admissions and emergency presentations for severe allergic reactions due to foods. The prevalence of self‐reported food allergy is common, but generally exceeds that which can be verified from challenge studies, although nut allergies appear to be an important exception to this rule. Studies examining food allergy deaths suggest that those who die of food allergy usually have co‐existent asthma. Adolescents and young adults are at most risk, and adrenaline auto‐injectors are sub‐optimally used. Food chemical sensitivity is very commonly reported but not usually verified by challenge testing. However, the exception to this is sulphite sensitivity, which can elicit reproducible reactions in some. The increasing prevalence of severe food allergies and awareness of its risk in those with asthma demands an especially rigorous approach to the diagnosis and management of co‐existent food allergy and asthma, especially in young people who appear to be at most risk from death from severe food allergy. Cite this as: A. Gillman and Jo A. Douglass, Clinical & Experimental Allergy, 2010 (40) 1295–1302.

Many patients who describe a history of allergy to penicillin do not prove to be allergic and can be treated safely with penicillin. After a period of 2 years where testing of penicillin allergy was not possible, a new commercial kit has recently become available. We report our initial experience with use of the kit with 29 patients and discuss one patient who experienced anaphylaxis during i.d. testing.

Allergy is defined as an immune‐mediated inflammatory response to common environmental allergens that are otherwise harmless. The diagnosis of allergy is dependent on a history of symptoms on exposu...

Decreased FEV1 in response to bronchial provocation challenge remains the method of choice for diagnosing EIB in elite athletes, but the exact level of fall which represents an abnormal response still needs to be determined

Background. Asthma treatment guidelines currently recommend a ‘therapeutic partnership’ to achieve best care. It is frequently assumed that individuals presenting to emergency departments with asthma do not have a good doctor–patient relationship. We asked what is the nature of patients' relationships with their doctors in those presenting to hospital emergency departments for asthma care. Methods. A qualitative study of all consenting individuals aged 18–70 years who presented to a hospital emergency department over 2 months was carried out. Sixty-two participants (19 male) engaged in in-depth interviews which were taped, transcribed and underwent thematic analysis. Questionnaire data were also collected and asthma severity determined. Results. Nearly all patients (61/62) had a doctor whom they saw for their asthma. Patients made thoughtful choices on where they sought care according to their needs. Our findings identified that perceptions of doctors' competence, listening to patients and time constraints were important influences on doctor–patient relationships. Participants had strong expectations that their personal disease experience would be acknowledged by their doctors. Conclusion. This group of patients had doctors who cared for their asthma. The acceptability of medical care was determined as much by patient choice as by the quality of the doctor–patient relationship.

Background:  Subgroups of asthma patients have extremely severe respiratory symptoms that require chronic use of steroids for disease control. These patients are at risk of significant side‐effects from chronic exposure to high doses of oral steroids. Intra­venous immunoglobulin (IVIG) has immunomodulatory properties as shown by its use in some immune disorders. A few trials have suggested a possible benefit in individuals with severe asthma.Aims:  To evaluate the role of IVIG as an adjunctive therapy in steroid‐dependent asthma, monitoring the outcomes of lung function and measured reduction in oral steroid requirementMethod:  Seven patients with severe steroid‐dependent asthma were given IVIG at a dose of 1 g/kg each month for 6 months. Baseline pulmonary function tests and immunoglobulin levels were obtained. At the end of 6 months, the end‐points observed were lung function and the degree of reduction in the dose of oral steroids. The number of hospital admissions during the 12 months following commencement of IVIG was compared with the preceding 12 months.Results:  There was a significant reduction in daily prednisolone dose from 56 ± 31 mg to 39 ± 35 mg (P = 0.04, Wilcoxon rank sum test) and a decrease in the number of hospital admissions from 5.9 ± 2.9 to 3.6 ± 3.5 (P = 0.04). No significant improvement occurred in lung function.Conclusion:  IVIG provides a potentially important adjunctive therapy in severe steroid‐dependent asthma, reducing steroid requirement and decreasing hospital admissions, but not improving lung function. (Intern Med J 2003; 33: 341−344)

Footnotes Competing interests None declared

Objectives: To investigate the perspectives of patients with asthma on the use of an action plan and the implementation of this plan during an asthma attack that culminated in a visit to an emergency department. Design: Qualitative study. Setting: Tertiary teaching hospital, suburban hospital, and rural hospital. Participants: 62 patients aged 18 to 69 years who presented to an emergency department with asthma over a two month period. Results: 29 participants described having action plans given to them by their doctors. Most patients with action plans reinterpreted their plan from the perspective of their own experiences with asthma. 33 patients did not have an action plan, the most common reason being that they had not been given one by their doctor. Some occupational groups were significantly less likely to have been given an action plan by their doctor than others. Most patients with an action plan found them useful for management of their asthma. Conclusions: Action plans were viewed positively by patients. Participants modified their prescribed plan according to their experience of asthma. To facilitate the implementation of a prescribed action plan, doctors need to acknowledge and include the patient's personal experience of their disease. What is already known on this topic: Action plans for the self management of asthma are standard and have been shown to improve patient outcomes and to protect against death from asthma when provided in written form Factors that enable patients with asthma to implement an action plan and their perspectives on the use of such plans have not been explored in an individual context What this study adds: Most patients with action plans found them useful Most patients modified their plans according to their perceptions of severity and likely disease outcome Clinicians must engage with a patient's experience of asthma to facilitate the use of an action plan