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BACKGROUND: Asthma morbidity and mortality continue to increase especially in the inner cities despite medical advances in disease management. OBJECTIVE: To investigate the clinical outcomes of inner city asthma patients treated in an allergy clinic. METHODS: Phase 1 involved random review of medical records of 100 asthma patients treated in an allergy clinic for 2 consecutive years, assessing the frequency of hospitalizations, emergency room visits (ERV) and asthma severity during three periods; 1 year prior to initial visit (year 0) and during the first (year 1) and second (year 2) years of intervention. Phase 2 involved administration of quality of life (QOL) survey to 23 patients volunteered from allergy clinic (group I), and 21 patients volunteered from emergency room (group II), treated by primary care or emergency room physicians during the previous year. RESULTS: The frequency of hospitalizations and ERV significantly declined over time (P < .001) with greatest declines during year 1. Disease severity of all patients significantly declined over time (P < .001); good compliers had significant improvement over poor compliers (P < .023). Quality of life scores were significantly lower for both groups than for the general population; and although the scores were higher in the allergy clinic group than in the non-allergy clinic group, significant differences were achieved only in mental health and social functioning domains. CONCLUSIONS: Patients treated in an allergy clinic demonstrate superior clinical outcomes.

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Although studies that use the double-blind placebo-controled food challenge (DBPCFC) suggest that the prevalence of food allergy is about 2%, public belief in food allergy appears to be considerably higher. The study was undertaken to determine the magnitude and features of the American public's belief in food allergy by surveying a large, demographically balanced population. A simple question about food allergy was incorporated into a broad, self-reported, mailed consumer questionnaire. Demographically representative American households (5000) were surveyed by means of quota sample in 1989, 1992, and 1993. The response rate was 79, 75, and 74%, respectively. Of responding households, 16.2, 16.6, and 13.9%, respectively, of responding households reported an average of 1.17 household members with food allergy. Individuals reported to be allergic to foods were more likely to be female, particularly adult women. Male individuals with reported food allergy tended to be young, whereas no such skew was noted among female subjects. Geographic differences were observed in reported food allergy, with the highest rate in the Pacific region. Milk and chocolate were the individual foods most frequently implicated in food allergy. Trends were consistent over the time period studied. Perceived food allergy is widespread and persistent. The characteristics and demographic patterns of this belief are not reflective of known food allergy epidemiology derived from studies in which the DBPCFC is used.

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BACKGROUND: Although studies that use the double-blind placebo-controlled food challenge suggest that the prevalence of food allergy is about 2%, public belief in food allergy appears to be considerably higher. OBJECTIVE: The study was undertaken to determine the magnitude and features of the American public's belief in food allergy by surveying a large, demographically balanced population. METHODS: A simple question about food allergy was incorporated into a broad, self-reported, mailed consumer questionnaire. Five thousand demographically representative American households were surveyed by means of quota sample in 1989, 1992, and 1993. RESULTS: The response rates were 79%, 75%, and 74%, respectively. Of responding households, 16.2%, 16.6%, and 13.9%, respectively, reported an average of 1.17 household members with food allergy. Individuals reported to be allergic to foods were more likely to be female, particularly adult women. Male individuals with reported food allergy tended to be young, whereas no such skew was noted among female subjects. Geographic differences were observed in reported food allergy, with the highest rate in the Pacific region. Milk and chocolate were the individual foods most frequently implicated in food allergy. Trends were consistent over the period studied. CONCLUSIONS: Perceived food allergy is widespread and persistent. The characteristics and demographic patterns of this belief are not reflective of known food allergy epidemiology derived from studies in which the double-blind placebo-controlled food challenge is used.

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Ten asthmatics selected for their tendency to experience frequent acute exacerbations were instructed in peak flow measurement. Each subject then recorded estimated peak flow (EPF) and measured peak flow (PF) at home twice daily. Data for up to 56 consecutive observations (4 weeks) per subject were analyzed. The correlation coefficient between EPF and PF following PF drops of 15% was .993 overall and was not significantly different following PF drops even greater than 25%. The absolute and proportional differences between PF and EPF were also not significantly affected by the magnitude of PF drop but decreased over time indicating improved accuracy of estimates with practice. Asthmatics can be trained to estimate accurately acute drops in airflow. Such ability has not been demonstrated in prior studies which utilized verbal symptom reports as indicators of subjective perception of airflow. Accurate perception would be a useful aid in achieving early recognition of acute exacerbations and in improving medication compliance. It is an adjunct to regular peak flow measurement, not a substitute for it.

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Eighteen asthmatics, aged 7 to 43, rated their breathing on a scale of 0 to 5 (worst to best). They were then informed of their predicted normal peak expiratory flow rate (PEFR) and instructed in proper PEFR measurement. Each subject then estimated and measured PEFR under physician supervision and subsequently rated breathing, estimated and measured PEFR at home twice daily recording the observations. At the initial home observation, the correlation coefficient (r1) between estimated and measured PEFR was .98. After ten observations r1 was greater than or equal to .97 in all 18 subjects (group mean .99). The r1 remained unchanged in those subjects who completed 28 and 42 observations. The r1 was .98 when only the observations where measured PEFR was less than 20% predicted were considered, demonstrating the validity of the relationship during abnormal expiratory flow. Multiple regression analysis showed no significant trend in the difference between estimated and measured PEFR over time after the initial observation. Of 12 subjects, 4 were significant underestimators of PEFR and 3 were overestimators, but the magnitude of either tendency was relatively small. The correlation coefficient (r2) between a subjective verbal breathing score and measured PEFR ranged from -.23 to .92 on an individual basis over the three time periods, with statistically significant group mean values of .37, .39, and .45 at 10, 28, and 42 observations, respectively. The r2 for observations where measured PEFR was abnormal was only .14 and not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

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The reliability and accuracy of salivary theophylline levels as a predictor of serum theophylline levels was investigated in 28 hospitalized chronic asthmatics, free of other chronic diseases, on continuous aminophylline infusion for greater than 24 hours. Twenty paired blood and saliva theophylline levels from 12 patients (group 1) were used to develop a formula for predicting serum theophylline levels from salivary levels. Twenty-one paired blood and saliva theophylline levels from 16 patients (group 2) were used to test the formula obtained. The formula predicted the serum theophylline concentration within 1.51 microgram/mL in 76% of the samples and within 1.88 microgram/mL in 100% of the samples. There was an excellent correlation between the predicted and actual serum theophylline concentrations, r = .93; thus under controlled conditions of steady-state pharmacokinetics in patients free of other diseases, salivary theophylline levels can be used to accurately predict serum levels.

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We presented a patient with status asthmaticus treated with a combination of theophylline and prednisone who developed a perforated gastric ulcer. The relative etiologic significance of the stress of status asthmaticus, administration of theophylline, or corticosteroids is open to question. The literature, except for anecdotal reports, does not support a significant increase of ulcers in asthmatic patients on either theophylline or steroids. A study following large patient groups on theophylline and a combination of theophylline and steroids might clarify the risk of ulcer formation in patients being treated with these medications for asthma.

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A redesigned Peak Flow Whistle is described. It was evaluated and compared to the Wright Peak Flow Meter (WPFM) and the Vitalograph Pulmonary Monitor (VPM) using a laboratory flow system. These devices were evaluated for accuracy at steady flows, resistance characteristics, measurement of drift and dynamic accuracy. All devices tested correlated to a significant degree for accuracy at steady flows. The resistance of the WPFM and VPM increased with higher flows, whereas the Cardboard Peak Flow Whistle (CPFW) decreased. After pulsing the CPFW did not show any drift in calibration. The dynamic accuracy of the CPFW was excellent. Thus the accuracy of the CPFW and its lower cost makes it a practical device for measuring peak flows.

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The Wright peak flow meter (WPFM), the pediatric WPFM, the mini-WPFM (MWPFM), the Vitalograph pulmonary monitor (VPM), and prototypes of the newly designed peak flow whistle (PFW) were evaluated and compared under controlled laboratory conditions. With steady flows, all devices compared significantly with the pneumotachygraph standard (p less than 0.001). At transient flows there was distortion of the wave form by the VPM, with significant reduction in the generated peak flow. All devices except the PFW demonstrated progressive increases in resistance with higher flows. The PFW showed a progressive decrease. The WPFM and the pediatric WPFM demonstrated adequate calibration corrections for this increasing resistance. The MWPFM gave slightly higher values than the pneumotachygraph and graph standard. Results with all devices were found to be reproducible after 350 pulses of transient flow of 4 L/sec and no interinstrument variance was detected in the paired devices. Flow values measured at air temperature of 37 degree C tended to be lower than those measured at 28 degree C, but this was not significant at the p less than 0.05 level.

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A peak flow (PF) measuring device, the Peak Flow Whistle (PFW), has recently been designed. The principle of a threshold activated reed is utilized to register PF, which differs significantly from the spring distortion mechanism utilized in currently marketed devices. Prototypes of the PFW were tested in the laboratory and in clinical settings as part of our preliminary studies. When compared with a pneumotachograph in the laboratory, the values correlated significantly (p less than .0001). In field studies both in asthmatic and non-asthmatic children, the PFW values correlated significantly (p less than .0001) with those of the Wright Peak Flow Meter and performance was found to be satisfactory.

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A group of asthmatics treated in a clinic setting were compared to a group treated by private allergists. Statistical differences were found regarding family income, racial distribution, family structure, educational level, reading habits, management of acute asthma attacks, housing, living space, school absences and hospital admissions.

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