DiagnosisThe diagnosis of systemic reactions to insect stings usually presents no difficulty by history, and as a rule the diagnosis has been made before the allergist sees the patient. A differentiation between local and systemic reactions should be made, and although systemic reactions are frequently preceded by increasingly large local reactions with previous stings, a great many people have large local reactions accompanying successive stings, over many years, without ever developing systemic sensitivity.Densensitization treatment is not recommended for patients with local reactions only, regardless of extent. If there was some method of determining which local reactions are the prelude to, or a beginning of, systemic sensitivity, it would be helpful. I n doubtful cases we do serial testing,l and if any positive reactions result, systemic sensitivity is presumed to exist, but we are not sure these are reliable criteria in such a situation. Our experience indicates that many systemic reactions to insect stings, and particularly fatal ones, may be misdiagnosed. It must be remembered that such stings are not confined to warm weather seasons. The paper wasp is an indoor dweller a t times and wakes up very easily when the heat is turned on.
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Among 742 patients with cystic fibrosis studied during the past 4 years, 50 (or 6.7%) were found to have nasal polyposis. Polyps were noted in patients of all ages, the youngest being 2½ years of age. Roentgenograms of the sinuses showed evidence of paranasal sinusitis in each case studied. An allergic investigation was conducted in each of the 50 patients with nasal polyposis. Twenty-four patients presented no evidence of allergy. The clinical severity of the basic disease (cystic fibrosis) was the same in both the allergic and nonallergic group.
A brief description of the clinical course of the patient with nasal polyps is presented. The polyps are often multiple, may cause complete nasal obstruction, and tend to regrow. Their course is beneficially influenced by the administration of broad-spectrum antibiotics or systemic steroids. However, polyps did appear in many patients while on constant broad spectrum antibiotic therapy. Conservative management is suggested. Simple polypectomy is carried out when nasal obstruction is complete. In a small number of patients, repeated polypectomies have been necessary over a number of years. The severity of the pulmonary lesion is not reflected by the degree of alteration of the mucosal linings of the paranasal sinuses. Patients with nasal polyposis, regardless of the presence or absence of allergy, should be examined for evidence of cystic fibrosis, including family history, pulmonary evaluation, and appropriate laboratory tests.
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