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Am Fam Physician. 1998 Jul 1;58(1):203-204.

Study Shows That Social Ties Can Affect Immune Systems

(Annual Meeting of the American College of Allergy, Asthma and Immunology) Having a social support system reduces the negative impact of stress on the immune system, according to a study that evaluated the influence of susceptibility to infection and social interactions. A total of 276 subjects were purposely exposed to rhinovirus, and the subjects were monitored to determine which individuals contracted clinical respiratory virus infection. Subjects with three or fewer social ties (e.g., friends, family) were four times more likely to contract the infection than subjects who had six or more social ties. The quality of interactions with friends and family was also found to be important. Stressful relationships do not have the same positive effect. The investigators believe other effective strategies to help keep stress from negatively affecting the immune system include performing a moderate amount of exercise, being optimistic, having a sense of humor, and having a belief system or a religious belief that is comforting.—bruce s. rabin, m.d., ph.d., University of Pittsburgh School of Medicine, Pittsburgh, Pa.

Women Are More Likely Than Men to Experience Anaphylaxis

(American College of Allergy, Asthma and Immunology) Women are twice as likely as men to experience episodes of anaphylaxis, according to a clinical profile of 380 patients who were referred to a university-affiliated allergy practice for the evaluation and management of anaphylaxis. The evaluation included a history, a physical examination and allergy skin tests using a standard food battery including fresh fruits or spices when indicated. The patients ranged in age from five to 79 years and included 223 females and 157 males. An exact cause of anaphylaxis was identified in 54 percent of the patients. These causes included foods and medications. Crustaceans and peanuts were the most common foods to cause anaphylaxis in adults. Nonsteroidal anti-inflammatory drugs were the most common medications to cause anaphylaxis. A cause could not be identified in 46 percent of the patients. Atopy was present in 138 of the subjects. Of the 380 subjects, 57 percent had three or more episodes of anaphylaxis, 18 percent had two episodes and 25 percent had one episode. Probable causes of anaphylaxis in addition to foods and medications were exercise, latex, insect stings and menses/progesterone.—lori m. kagy, m.d., et al., LeBonheur Children's Medical Center, Memphis.

Patient Education Is A Key in Effective Asthma Management

(American College of Allergy, Asthma and Immunology) Treatment of asthma should emphasize prevention and self-management, according to the National Asthma Education and Prevention Program. The Report of the Second Expert Panel on the Guidelines for the Diagnosis and Management of Asthma recommends that goals for the asthma patient include preventing chronic and troublesome symptoms, maintaining near-normal pulmonary function values, maintaining normal activity levels, preventing recurrent exacerbations, optimizing pharmacotherapy with minimal side effects, meeting expectations and achieving satisfaction with medical care. Educated patients will understand the goals of therapy and be able to monitor clinical status, try to control their environment, take medication appropriately and know when to see a physician. Physicians should see patients every three to six months, assess the outcomes, prescribe appropriate therapy, provide written instructions and help patients with the necessary skills to adequately comply with their therapy. Ensuring improved outcomes in the treatment of asthma requires an understanding of patient noncompliance. Patient compliance is affected by communication with the physician, access to care, the patient's perception of disease severity and deviation from expected quality of life.—allan luskin, m.d., Respiratory Institute at Dean Medical Center, Madison, Wis.

Alternative Medicine Is Popular for Treatment of Allergy and Asthma

(American College of Allergy, Asthma and Immunology) The increasing popularity of alternative or complementary therapies in medicine can be attributed to many factors, including antibiotic resistance in infectious diseases, multifactorial aspects of many disease states and the women's rights movement. Consumers spend over $30 billion annually on alternative medicine. The total number of visits by Americans to alternative medicine practitioners exceeds the number of visits to conventional primary care clinicians. A significant amount of nontraditional healing is directed toward allergies, asthma and perceived weaknesses of the immune system. Physicians must be prepared to help patients understand the benefits and risks of nutritional supplementation, herbal remedies and other preventive health measures. Further research is needed to explore differences between suppliers and potential dosing or formulation differences. At present, there are no requirements for standardization of content for herbal remedies. Research is being conducted to further understand how to use alternative treatments outside of traditional medicine.—renata j. m. engler, m.d., Walter Reed Army Medical Center, Bethesda, Md.

New Treatment Option Is Available for Small Cell Lung Cancer

(15th Annual Meeting of the Chemotherapy Foundation) Topotecan hydrochloride for injection (Hycamtin), used as a single agent or in combination with other agents, may offer a new treatment option for persons with small cell lung cancer, according to results from five separate clinical trials. Preliminary results from one Phase II trial showed that patients who received a combination of topotecan and paclitaxel with granulocyte-colony stimulating factor achieved response rates consistent with those observed with currently used first-line chemotherapy. In this small study, 15 patients with previously untreated small cell lung cancer received topotecan in a 30-minute infusion for five consecutive days and paclitaxel, administered on day 5 as a 24-hour infusion over the course of three weeks. Twelve patients were available for evaluation. The overall response rate was 92 percent. Two patients achieved a complete response (disappearance of signs and symptoms of cancer), and nine patients achieved a partial response (at least a 50 percent reduction in tumor size). The one-year survival rate was 50 percent. According to the investigators, additional studies are needed to confirm these results.—david w. ettinger, m.d., Johns Hopkins Oncology Center, Baltimore.



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