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Symposium summary
Symposium
summary
Charles E. Reed, MD Rochester, Minn
During the symposium the contributors, who have backgrounds in surgery, pediatrics, and internal medicine, and the otolaryngologists and allergists have had a unique opportunity to exchange information and views. We come away with broader and more comprehensive concepts of the problems of allergic diseases of the upper respiratory tract. Discussion of the anatomic as well as the immunologic factors that contribute to the pathogenesis were considered, along with the surgical, pharmacologic, and immunologic methods of treatment. Our patients will be the ultimate beneficiaries of the symposium. The individual papers in the symposium speak for themselves. Perhaps in summary I might touch on questions that remain for future synopses. Many speakers talked about diagnosis, particularly differential diagnosis, but the vexing problem of vasomotor rhinitis, which is neither an allergic, immunologic, nor a surgical disorder, was mentioned only in passing. My personal view has been that it is primarily a psychophysiologic disorder, but after listening to the. presentations I realize that we need more research into the possible anatomic and physiologic bases of this disorder. What, exactly, are the structural and functional bases for the perception of nasal stuffiness and discomfort? Another problem that brings many patients to their physicians is repeated upper respiratory tract infections. At present we have poor answers for these people who seem to have many more “colds” than other family members. We do not know whether they really do have more viral infections and, if so, why they have them. Are they more likely to have infection rather than simple colonization by rhinovirus? Do they have some as yet undefined subtle defect in nonspecific resistance to infections? Could they perhaps make exuberant amounts of interferon-like cytokines? Why Reprint requests: Charles E. Reed, MD, Division of Allergic Diseases, Mayo Clinic, 200 1st Street SW., Rochester, MN 55905.
1066
do some children and adults develop asthma with rhinovirus infections? IgE antibody has been reported with respiratory syncytial virus infections, but attempts to identify IgE antibody to rhinoviruses have been unfruitful. Possibly these local infections release products that act on distant organs to provoke asthma. If so, identification of these products is needed to allow a rational approach to therapy. Perhaps these people do not have a psychophysiologic nasal reaction. During the symposium, we heard quite a bit about advancements in pharmacologic management of upper airway diseases, and I am sure that we are going to continue to hear about new ways of altering nasal physiology as information about the molecular mechanisms of these disorders unfolds. As an internist who rarely sees patients with secretory otitis media, I was especially intrigued with eustachian tube function and new ways of investigating and managing recurrent otitis media in children. Surgeons have been searching for ways to predict which operation is likely to help which patient. Although there is much to learn, we should not underestimate the practical value of current surgical techniques for otitis and paranasal sinusitis. When I was a resident at Roosevelt Hospital some 45 years ago, the relationship between sinus infection and asthma was hotly debated. It still is. I think the reason that the issue has not been settled is that it is very difficult to investigate. So we are grateful to Dr. Slavin for his courage and skill in tackling this stormy issue and making sense of it. Certainly there is no lack of topics for the organizers to arrange another meeting like this for us. We all look forward to coming back again in a year or two to discuss additional topics, and some of these topics revisited. On behalf of all of the audience, I express our thanks to the organizers and the sponsors for inviting us to this excellent conference center and for organizing this stimulating discussion.
summary
Charles E. Reed, MD Rochester, Minn
During the symposium the contributors, who have backgrounds in surgery, pediatrics, and internal medicine, and the otolaryngologists and allergists have had a unique opportunity to exchange information and views. We come away with broader and more comprehensive concepts of the problems of allergic diseases of the upper respiratory tract. Discussion of the anatomic as well as the immunologic factors that contribute to the pathogenesis were considered, along with the surgical, pharmacologic, and immunologic methods of treatment. Our patients will be the ultimate beneficiaries of the symposium. The individual papers in the symposium speak for themselves. Perhaps in summary I might touch on questions that remain for future synopses. Many speakers talked about diagnosis, particularly differential diagnosis, but the vexing problem of vasomotor rhinitis, which is neither an allergic, immunologic, nor a surgical disorder, was mentioned only in passing. My personal view has been that it is primarily a psychophysiologic disorder, but after listening to the. presentations I realize that we need more research into the possible anatomic and physiologic bases of this disorder. What, exactly, are the structural and functional bases for the perception of nasal stuffiness and discomfort? Another problem that brings many patients to their physicians is repeated upper respiratory tract infections. At present we have poor answers for these people who seem to have many more “colds” than other family members. We do not know whether they really do have more viral infections and, if so, why they have them. Are they more likely to have infection rather than simple colonization by rhinovirus? Do they have some as yet undefined subtle defect in nonspecific resistance to infections? Could they perhaps make exuberant amounts of interferon-like cytokines? Why Reprint requests: Charles E. Reed, MD, Division of Allergic Diseases, Mayo Clinic, 200 1st Street SW., Rochester, MN 55905.
1066
do some children and adults develop asthma with rhinovirus infections? IgE antibody has been reported with respiratory syncytial virus infections, but attempts to identify IgE antibody to rhinoviruses have been unfruitful. Possibly these local infections release products that act on distant organs to provoke asthma. If so, identification of these products is needed to allow a rational approach to therapy. Perhaps these people do not have a psychophysiologic nasal reaction. During the symposium, we heard quite a bit about advancements in pharmacologic management of upper airway diseases, and I am sure that we are going to continue to hear about new ways of altering nasal physiology as information about the molecular mechanisms of these disorders unfolds. As an internist who rarely sees patients with secretory otitis media, I was especially intrigued with eustachian tube function and new ways of investigating and managing recurrent otitis media in children. Surgeons have been searching for ways to predict which operation is likely to help which patient. Although there is much to learn, we should not underestimate the practical value of current surgical techniques for otitis and paranasal sinusitis. When I was a resident at Roosevelt Hospital some 45 years ago, the relationship between sinus infection and asthma was hotly debated. It still is. I think the reason that the issue has not been settled is that it is very difficult to investigate. So we are grateful to Dr. Slavin for his courage and skill in tackling this stormy issue and making sense of it. Certainly there is no lack of topics for the organizers to arrange another meeting like this for us. We all look forward to coming back again in a year or two to discuss additional topics, and some of these topics revisited. On behalf of all of the audience, I express our thanks to the organizers and the sponsors for inviting us to this excellent conference center and for organizing this stimulating discussion.