Considerations in difficult-to-control asthma.

Background: Difficult-to-control asthma includes those patients who require treatment with high-dose inhaled glucocorticosteroid (ICS) plus a second controller and/or systemic glucocorticosteroids to manage. The exact percentage of "difficult to treat," "refractory," "severe," or "brittle" asthma is 3% to 10% of all asthmatic patients, but this group of asthmatics use the majority of resources for the entire asthmatic population.

Methods: Medline searches for the terms "difficult to control," "severe," "refractory," "brittle," and asthma were done and the results were reviewed.

Use of intranasal corticosteroids in the management of congestion and sleep disturbance in pediatric patients with allergic rhinitis.

Allergic rhinitis affects a large number of children and exerts a considerable socioeconomic impact. It is underdiagnosed and inadequately treated, which predisposes children to potentially serious comorbidities. Allergic rhinitis symptoms may create nighttime breathing problems and sleep disturbances and have a negative effect on a child's ability to learn in the classroom.

Unanswered questions and warnings involving anti-immunoglobulin E therapy based on 2-year observation of clinical experience.

The relatively rapid development and deployment of a clinically useful monoclonal antibody omalizumab has produced a number of questions still not answered despite massive research and many clinical trials. The mechanism of action as down-regulation of FceR1 receptors in the presence of low free immunoglobulin E (IgE) is incomplete. Some severe allergic asthmatic patients respond almost immediately, others take months, and some never respond.

Comparison of the efficacy of combined fluticasone propionate and olopatadine versus combined fluticasone propionate and fexofenadine for the treatment of allergic rhinoconjunctivitis induced by conjunctival allergen challenge.

Background: One approach to treating allergic rhinoconjunctivitis is the concomitant use of an intranasal spray such as fluticasone propionate to alleviate nasal symptoms and a topical or systemic agent to relieve ocular symptoms. It has not yet been determined whether a topical or systemic agent is more effective for the latter purpose.

Objective: This study compared the efficacy of combined use of fluticasone and olopatadine with combined use of fluticasone and fexofenadine in the treatment of the signs and symptoms of allergic rhinoconjunctivitis.