A fundamental feature of asthma is abnormal airway function, now recognized to result from both acute and chronic inflammatory changes. Central to the development of these inflammatory changes may be the activation of T cells and the release of pro‐inflammatory cytokines. In the skin, a similar cascade of events may underlie the pathogenesis of atopic dermatitis. Asthma and atopic dermatitis often share several features that may be important in their pathogenesis: T‐cell infiltration of the tissues, elevated IgE levels, and a history of known triggers associated with positive immediate skin‐test reactions. In both diseases administration of intravenou immune globulin (IVIG) on a regular basis appears to reduce the need for systemic corticosteroids, reduce symptoms and for asthmatics, reduce hospitalization costs. Although the mechanism of action of IVIG in these disorders remams to be defined, it may be exhibiting significant anti‐inflammatory activity. IVIG may be a potent alternative in the treatment of severe, steroid‐dependent allergic disorders, reducing steroid dependency.

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Vocal cord dysfunction (VCD) is a condition defined by an abnormal adduction of the vocal cords. The signs and symptoms of VCD-throat tightness, change in voice quality and airflow obstruction sufficient to cause wheezing, chest tightness, shortness of breath, and cough-are commonly associated with exercise. VCD and exercise-induced bronchospasm (EIB), the term for exacerbation of asthma associated with physical exertion, are both aggravated by exercise and characterized by dyspnea. The clinical presentation of VCD is often dramatic and its misdiagnosis as asthma, EIB, or upper airway obstruction has led to inappropriate treatment including highdose corticosteroids, intubation, and tracheostomy.1 The diagnosis of VCD is best established by observing the vocal cords through a fiberoptic rhinolaryngoscope while the patient is symptomatic.2,3

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