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Patients history, clinical findings, pulmonary function and necessary therapy are combined for a diagram, which should easily allow to grade childhood asthma for general practitioners, pediatricians and consultants of the health insurance. The grading system is based on the cited literature, dealing in part with the matter, and on the international consensus report on asthma.

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The preferred form of acute bronchodilator therapy is to administer aerosolized beta-agonist by a metered-dose inhaler. Many patients cannot use this device efficiently, the major problem being coordination of dose release with inspiration. A new breath-actuated inhaler (the Autohaler actuator) has been developed to overcome this problem. The objective of this study was to evaluate patient's and staff's perceptions of this device. Ninety-eight percent of patients rated the device easy to use and 83% rated the overall use as excellent or good. The staffs rated it as excellent or good for 93% of patients. It was concluded that patients would accept this device, and greater patient compliance could be realized.

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In a multicenter open study involving 620 patients suffering from recurrent infections of the upper and lower respiratory tract aged between 12 and 89 years, the tolerability of an oral bacterial lysate was investigated. On the basis of the nature and frequency (1.9%) of adverse effects, and an analysis of the laboratory investigations over an observation period of three months, overall tolerability was adjudged to be excellent. The frequency and severity of infections was reduced. In 75% of the cases, both physician and patient considered the augmentation of the body's defense mechanisms by immunoactivation to have been of benefit. The favourable risk-to-benefit ratio results in a high level of acceptance of immunotherapy, and 96% of the patients completed the study as planned.

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In a simple blind pilot study we have examined the protective effect of loratadine, a new H1 histamine receptor antagonist, against bronchoconstriction induced by histamine inhalation. Six patients with an episodic or continuing obstructive bronchial disease and proven bronchial hyperreactivity were submitted to two identical histamine challenges, first without premedication and then after three days' treatment with 10 mg loratadine daily. The mean FEV1 fall in the first test after histamine inhalation was 33% and in the second test after pretreatment with loratadine only 3.3% (p less than 0.01). Five out of six patients have shown complete protection against histamine-induced bronchoconstriction, in one patient the protection was partial. We conclude that loratadine effectively inhibits histamine-induced bronchoconstriction and could be useful in the prophylactic treatment of asthma and obstructive bronchitis.

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The sciences of immunology and allergology have common roots and could be considered as twins. Historical highlights in discoveries of allergic and immunologic phenomena are mentioned and the IgE-mediated allergic reaction is described as a form of immunologic processes. The knowledge in basic and clinical immunology as well as in experimental and applied allergology has grown enormously in the last two decades and the possibilities of making the best of the immense amount of new information are discussed (basic and post-graduate training, journals on immunology and allergology, attendance at congresses).

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A new in vitro screening test for inhalant allergy (Phadiatop, Pharmacia Uppsala, Sweden) was evaluated for its effectiveness in identifying allergic patients. The test is based on the radio-allergo-sorbent-test (RAST). Specific IgE antibodies to different inhalant allergens are detected simultaneously. Serum samples from 300 patients and controls were run with Phadiatop. 96% of 150 patients with proved allergic disease were correctly identified by Phadiatop. 92% of 150 individuals without clinically relevant allergic hypersensitivity were found correctly to be negative. Allergic disease was proved or excluded by case history, skin prick test, RAST and, in some cases, additionally by provocation challenge.

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UNLABELLED: 32 patients (15 men, 17 women) of between 15 and 28 years of age were examined in a prospective study using a staged histamine test and a running test. A special anamnesis was prepared. Following a methodic preliminary examination two methods of the exercise test were compared with one another in 16 patients based on running freely and on the endless tape ergometer-in the form of a two-stage test with measurement of the heart rate. An anamnestic pointer was seen in each of 7 patients with pronounced bronchial hyperreactivity; in moderate hyperreactivity only 1 out of 9 patients had an anamnestic pointer. In 29 of 43 patients, anamnesis and the result of the exercise test agreed. Of 9 patients with exercise induced asthma, 3 had moderate hyperreactivity and 6 a very pronounced one. Free run and two-stage test on the endless tape yield the same result in respect of exercise induced asthma in all 16 patients. CONCLUSIONS: 1. Anamnesis has a good predictive value in respect to exercise induced asthma. 2. This is confirmed: no exercise induced asthma without bronchial hyperreactivity, but the former is not necessarily always a sequence of the latter. 3. It is possible to standardise the running test on the endless tape with definite load and estimation of the efficiency; however, the simple running test in which the patient adjusts the load in accordance with his subjective feeling, is equally valid for arriving at a clinical diagnosis of exercise induced asthma.

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Serum samples obtained from 55 patients with confirmed asthma induced by house dust mites, and 30 control subjects with no mite allergy, were investigated for specific IgG antibodies against the mites Dermatophagoides pt. and far. In 23 of the 55 asthmatics, specific hyposensitization treatment had previously been performed. Patients with allergic mite-induced asthma proved to have significantly higher specific IgG antibody titres than the control subjects. The difference between the groups with and without prior desensitization was not significant. All subjects with no IgE-mediated allergy vis-a-vis house dust mites (controls) had detectable specific IgG antibodies against both mites.

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To investigate the question as to a possible allergic cause of disease of the airways, a new laboratory method has now become available (Phadiatop, Pharmacia Freiburg im Breisgau), which enables the physician who is not a specialist in allergology, to obtain initial orientation on the presence of an IgE-mediated allergic condition affecting the airways. The procedure is capable of identifying allergen-specific antibodies against ten different inhalation allergens, simultaneously and undifferentiated. It is available either as a radioimmunoassay or an enzyme immunoassay.

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Sixteen patients were included in the analysis of this double-blind crossover study comparing the effect of sodium cromoglycate, reproterol, sodium cromoglycate plus reproterol, and placebo in exercise-induced asthma. Both the sodium cromoglycate and the reproterol-containing treatment significantly inhibited exercise-induced asthma. The best protection is effected by the combination of sodium cromoglycate and reproterol. A synergistic effect of both medications could not be confirmed statistically so that their combined effect is simply additive.

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Six adolescents with allergy or intolerance to non-steroidal anti-inflammatory drugs (NSAID) showed different types of reaction (asthma, urticaria, anaphylactoid reaction). The results of 60 oral or bronchial challenges in asthmatic adolescents with no positive history of NSAID-intolerance are presented. NSAID should be prescribed very carefully after detailed medical history--especially in adolescents with obstructive lung disease. Compound drugs should be avoided. Any indication of allergy or intolerance to NSAID should lead to careful oral or bronchial challenge tests for diagnosis to find out a well-tolerated alternative drug. The patient should receive an allergy-passport and show it to any attending physician.

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