The aim of this study was to assess the influence of some risk factors for onset and remission of allergic rhinitis and asthma in Swedish adults. A random sample of 1,370 subjects, age 20 to 44 yr was investigated by means of postal questionnaires in 1990 and 1993. Skin prick tests were conducted in 1991-1992. The association between risk factors and onset or remission of allergic rhinitis and asthma was estimated using multivariate logistic regression analysis. Onset of allergic rhinitis was associated with sensitization to birch (odds ratio [OR] = 6.5), Parietaria (OR = 7.4); and pets (OR = 3.0) and with female sex (OR = 1.9). Onset of asthma was associated with allergic rhinitis (OR = 4.9), sensitization to pets (OR = 2.4); and with smoking (OR = 3.0). Onset of asthma was strongly associated with allergic rhinitis among atopics (OR = 5.7), but onset of asthma and rhinitis also tended to be related among nonatopics (OR = 3.5). A strong association between smoking and onset of asthma was found among nonatopics (OR = 5.7). In conclusion, sensitization to pollens and pets were risk factors for onset of allergic rhinitis, whereas allergic rhinitis, sensitization to pets, and smoking were risk factors for onset of asthma.

I In nc cr re ea as se ed d p pr re ev va al le en nc ce e o of f s sl le ee ep p d di is st tu ur rb ba an nc ce es s a an nd d d da ay yt ti im me e s sl le ee ep pi i--n ne es ss s i in n s su ub bj je ec ct ts s w wi it th h b br ro on nc ch hi ia al l a as st th hm ma a: : a a p po op pu ul la at ti io on n s st tu ud dy y o of f y yo ou un ng g a ad du ul lt ts s i in n t th hr re ee e E Eu ur ro op pe ea an n c co ou un nt tr ri ie es s ABSTRACT: The aim of this study was to investigate whether asthma is associated with decreased quality of sleep and increased daytime sleepiness. The study involved a random population of 2,202 subjects supplemented by 459 subjects with suspected asthma, aged 20-45 yrs. The subjects were from Reykjavik (Iceland), Uppsala and Göteborg (Sweden) and Antwerp (Belgium), and participated in the European Community Respiratory Health Survey. The investigation included a structured interview, methacholine challenge, skinprick tests and a questionnaire on sleep disturbances. Participants in Iceland and Sweden also estimated their sleep times and made peak expiratory flow (PEF) recordings during a period of 1 week. Asthma was defined as self-reported physician-diagnosed asthma with current asthma-related symptoms (n=267).Difficulties inducing sleep (DIS) and early morning awakenings (EMA) were about twice as common, and daytime sleepiness 50% more common, in asthmatics compared with subjects without asthma. After adjusting for possible confounders, a positive association was found between asthma and: DIS (odds ratio (OR)=1.8); EMA (OR=2.0); daytime sleepiness (OR=1.6); snoring (OR=1.7); and self reported apnoeas (OR=3.7). Allergic rhinitis, which was reported by 71% of subjects with asthma, was independently related to DIS (OR=2.0) and daytime sleepiness (OR=1.3). A significant correlation was found between the number of asthma-related symptoms and sleep disturbances (p<0.001).Asthma is associated with decreased subjective quality of sleep and increased daytime sleepiness. Concurrent allergic rhinitis may be an important underlying cause of sleep impairment in asthmatic patients.

Both accidental and intentional non-adherence with controller therapy is common among adult asthmatics. The reasons for suboptimal adherence seem to be accessible through education of both patients and caregivers.

Local anaesthetics (LA) are widely used drugs. Adverse reactions are rare but may be caused by delayed-type hypersensitivity reactions and probably also immediate-type reactions. As it is not always easy to clinically differ between these subtypes, allergy skin testing should be considered. Although numerous test protocols have been published, how patients with hypersensitivity reactions to LA are ideally evaluated remains a topic of discussion. This review attempts to generate a comprehensive update on allergic reactions to LA and to present an algorithm that can be used for the evaluation of patients suspected with immediate-and delayed-type immune reactions. Literature was examined using PubMed-Medline, EMBASE, Biosis and Science Citation Index. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and delayed-type allergic immune reactions.