Five stages of allergic bronchopulmonary aspergillosis were identified in 40 patients studied for several years. The stages are acute, remission, exacerbation, corticosteroid-dependent asthma, and fibrotic. The acute stage has all criteria of the disease and responds to prednisone. The remission stage is free from significant asthma or exacerbations. The exacerbation stage has recurrent flares of acute allergic bronchopulmonary aspergillosis. The corticosteroid-dependent asthma stage may have recurrent exacerbations of allergic bronchopulmonary aspergillosis and severe asthma. The fibrotic stage is an advanced stage of radiographic abnormalities with asthma, irreversible and partially reversible obstructive pulmonary function changes, and poor prognosis. Measurement of IgE and IgG antibodies against Aspergillus fumigatus is of diagnostic value in all stages.

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Monosodium glutamate (MSG) has a long history of use in foods as a flavor enhancer. In the United States, the Food and Drug Administration has classified MSG as generally recognized as safe (GRAS). Nevertheless, there is an ongoing debate exists concerning whether MSG causes any of the alleged reactions. A complex of symptoms after ingestion of a Chinese meal was first described in 1968. MSG was suggested to trigger these symptoms, which were referred to collectively as Chinese Restaurant Syndrome. Numerous reports, most of them anecdotal, were published after the original observation. Since then, clinical studies have been performed by many groups, with varying degrees of rigor in experimental design ranging from uncontrolled open challenges to double-blind, placebo controlled (DBPC) studies. Challenges in subjects who reported adverse reactions to MSG have included relatively few subjects and have failed to show significant reactions to MSG. Results of surveys and of clinical challenges with MSG in the general population reveal no evidence of untoward effects. We recently conducted a multicenter DBPC challenge study in 130 subjects (the largest to date) to analyze the response of subjects who report symptoms from ingesting MSG. The results suggest that large doses of MSG given without food may elicit more symptoms than a placebo in individuals who believe that they react adversely to MSG. However, the frequency of the responses was low and the responses reported were inconsistent and were not reproducible. The responses were not observed when MSG was given with food.

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Summary A patient had at least 15 hospital admissions for symptoms of acute dyspnoea accompanied by loud stridorous sounds. These episodes had been diagnosed as acute airway obstruction and she was treated on all occasions on an emergency basis. In the absence of a definitive etiology and with other clues, it was then recognized that the patient was imitating the clinical appearance of laryngeal obstruction. Following the establishment of this, psychiatric care was initiated with the goal of rehabilitation of the patient, and there have been no further episodes to the present time.

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