1 The Place of Allergy in Clinical Medicine 12 Nonallelic Rhinitis 2 Basic, "Need-to-Know" Immunology 13 Food Allergy 3 Preparation of the Office for Allergy 14 Pediatric Allergy 4 Interaction with the Patient 15 Allergy and Sinus Disease 5 Testing Methods for Inhalant Allergy 16 Allergic Fungal Sinusitis 6 Environmental Control (Avoidance) 17 What Lies Ahead? 7 Pharmacotherapy of Allergic Rhinitis A1 Interrelationships Among Pollens and Plant-Derived Foods 8 Vial Preparation and Immunotherapy A2 Pollen Guide 9 Standardized Extracts A3 Typical Allergy History; Example of Titration and Mixing Form; Diet Diary 10 Blending Skin Testing and In Vitro Testing in Clinical Practice A4 Hidden Sources of Common Allergenic Foods 11 Allergic Emergencies A5 Genetic Relationships and Potential Cross-Reactivities of Nonbotanical (Animal) Foods FFMM..iinndddd iiii 88//2200//1100 99::5588::2255 AAMM ALLERGY IN ENT PRACTICE The Basic Guide Second Edition Thieme ALLERGY IN ENT PRACTICE The Basic Guide Second Edition Hueston C. King, M.D., F.A.C.S., F.A.A.O.A., RA.C.A.A.I. Clinical Professor of Otolaryngology-Head and Neck Surgery University of Texas Southwestern Medical Center Dallas, Texas and University of Florida College of Medicine Gainesville, Florida Richard L. Mabry, MD., F.A.C.S., F.A.A.O.A., Sc.F.A.C.A.A.I. Clinical Professor of Otolaryngology-Head and Neck Surgery University of Texas Southwestern Medical Center Dallas, Texas and University of Texas Medical Branch Galveston, Texas and University of Texas Health Science Center San Antonio, Texas Bruce R. Gordon, M.D., RA.A.O.A. Instructor Department of Laryngology and Otology Harvard Medical School Boston, Massachusetts and Associate Staff Massachusetts Eye and Ear Infirmary Boston, Massachusetts and Chief of Otolaryngology Cape Cod Hospital Hyannis, Massachusetts Bradley F. Marple, M.D., F.A.A.O.A. Associate Professor and Vice-Chairman Department of Otolaryngology-Head and Neck Surgery University of Texas Southwestern Medical Center Dallas, Texas. Cynthia S. Mabry, R.N., B.S.N,, C.O.R.L.N.* Former staff nurse and otolaryngic allergy specialist Department of Otolaryngology-Head and Neck Surgery University of Texas Southwestern Medical Center Dallas, Texas †Deceased Thieme Medical Publishers New York Stuttgart Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Associate Editor: Owen Zurhellen Consulting Editor: Esther Gumpert Director, Production and Manufacturing: Anne Vinnicombe Production Editor: Becky Dille Marketing Director: Phyllis Gold Sales Director: Ross Lumpkin Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: TechBooks Printer: Maple The Sheridan Book Group Cover artwork concept by Bradley F. Marple, M.D. Library of Congress Cataloging-in-Publication Data Allergy in ENT practice: the basic guide / Hueston C. king . . . [et al.]. — 2nd ed. p.; cm. Rev. ed. of: Allergy in ENT practice / Hueston C. King, Richard L. Mabry, Cynthia S. Mabry. Includes bibliographical references and index. ISBN 1-58890-276-5 (alk. paper)— ISBN 3-13-112762-7 (alk. paper) 1. Allergy. 2. Respiratory allergy. 3. Otolaryngology. [DNLM: 1. Hypersensitivity. 2. Otolaryngology—methods. WD 300 A434215 2004] I. King, Hueston C. II. King, Hueston C. Allergy in ENT practice. RC584.A433 2004 616.97—dc22 2004002853 Copyright ©2005 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally pro tected by copyright. Any use, exploitation or commercialization outside the narrow limits set by copyright leg islation, without the publisher's consent, is illegal and liable to prosecution. This applies in particular to Pho tostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage. Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the mate rial herein have consulted sources believed to be reliable in their efforts to provide information that is com plete and in accord with the standards accepted at the time of publication. However, in the view of the pos sibility of human error by the authors, editors, or publisher, of the work herein, or changes in medical knowledge, neither the authors, editors, or publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or com plete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a repre sentation by the publisher that it is in the public domain. Printed in the United States of America 54321 TMP ISBN 1-58890-276-5 GTV ISBN 3 13 112762 7 Table of Contents FOREWORD FROM THE FIRST EDITION ix FOREWORD TO THE SECOND EDITION x PREFACE FROM THE FIRST EDITION xi DEDICATION FROM THE FIRST EDITION xi PREFACE TO THE SECOND EDITION xii INTRODUCTION: ABOUT THIS BOOK xiii CHAPTER 1: THE PLACE OF ALLERGY IN CLINICAL MEDICINE 1 CHAPTER 2: BASIC, "NEED-TO-KNOW" IMMUNOLOGY 5 CHAPTER 3: PREPARATION OF THE OFFICE FOR ALLERGY 23 CHAPTER 4: INTERACTION WITH THE PATIENT 67 CHAPTER 5: TESTING METHODS FOR INHALANT ALLERGY 105 CHAPTER 6: ENVIRONMENTAL CONTROL (AVOIDANCE) 155 CHAPTER 7: PHARMACOTHERAPY OF ALLERGIC RHINITIS 178 CHAPTER 8: VIAL PREPARATION AND IMMUNOTHERAPY 205 CHAPTER 9: STANDARDIZED EXTRACTS 268 CHAPTER 10: BLENDING SKIN TESTING AND IN VITRO TESTING IN CLINICAL PRACTICE 280 CHAPTER 11: ALLERGIC EMERGENCIES 297 CHAPTER 12: NONALLERGIC RHINITIS 323 CHAPTER 13: FOOD ALLERGY 333 CHAPTER 14: PEDIATRIC ALLERGY 368 CHAPTER 15: ALLERGY AND SINUS DISEASE 386 VII VIII TABLE OF CONTENTS CHAPTER 16: ALLERGIC FUNGAL SINUSITIS 399 CHAPTER 17: WHAT LIES AHEAD? 415 APPENDIX 1: INTERRELATIONSHIPS AMONG POLLENS AND PLANT-DERIVED FOODS 428 APPENDIX 2: POLLEN GUIDE 441 APPENDIX 3: TYPICAL ALLERGY HISTORY; EXAMPLE OF TITRATION AND MIXING FORM; DIET DIARY 457 APPENDIX 4: HIDDEN SOURCES OF COMMON ALLERGENIC FOODS 463 APPENDIX 5: GENETIC RELATIONSHIPS AND POTENTIAL CROSS-REACTIVITIES OF NONBOTANICAL (ANIMAL) FOODS 466 INDEX 471 Foreword from the First Edition Scholars, teachers, friends—Drs. Hueston King and Richard Mabry are all these. They are also scientists who, in this book, contribute essential knowl edge to the present and future generations of otolaryngic allergists. Mrs. Cynthia Mabry, an experienced otolaryngic allergy nurse, adds a very special aspect, not previously available, to this textbook. Allergy in ENT Practice, sub titled A Basic Guide, encompasses all aspects of basic allergy and will be a remarkable resource for physicians in any field of medicine who are preparing to add allergy to their practices. It answers questions that invariably arise in the course of a practice, and provides references to advanced data that a physician may wish to investigate to understand better the basic science of the practice of allergy. In addition, it should become the companion of allergy assistants in every office. These authors possess a wealth of knowledge and, in an easy-to-understand way, offer it both to beginning students and to those beyond the basic stage who need answers to fill gaps in their practical knowl edge. I value their willingness to teach, and their friendship. Helen Fox Krause, M.D., F.A.C.S., F.A.A.O.A. Clinical Professor of Surgery Department of Otolaryngology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania IX