Q:

4/1/2014
f/13 yrs patient with Asthma history for the past 5 years. Asthma was controllable using inhaler, however, the asthma attacks recurrence started to increase with increased level of thick secretions accompanied by vomiting episodes and diagnosed gastritis. The cycle starts with nasal discharge (despite being on Nasonex (MFM speray), followed by chest infection , severe asthma attacks followed by vomiting. Investigation shows high level of IgE > 1100 IU/mL and high level of eosinophils 19.8 (range 2-5). X-ray shows bronchitis. When listening to the lungs, the airways clear but the lower part of the lungs. Sweat chloride test was done, results were normal. Hematology test shows. The patient is not gaining weight. Patient was getting desensitisation shots, after undergoing dust allergen test, which was positive., but stopped due to hospitalisation. Sould we repeat the CF test or/and undertake allergen (food/blood) test. What is the investigation root I should follow?

A:

Thank you for your inquiry.

We are forwarding your inquiry to Dr. Stanley Szefler who is an internationally known expert in asthma. As soon as we hear from Dr. Szefler, we will send his response to you.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Stanley Szefler regarding your inquiry. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Stanley Szefler:
This is a challenging case due to the repeated emesis, gastritis, periodic respiratory distress, chest X-ray findings, and high eosinophil count. I would assess whether there may be a relationship of this periodic episodes to menstrual cycle.

In addition, I would consider whether the cystic fibrosis test should be repeated, especially in view of the failure to gain weight. Genetic testing might be a consideration if this diagnosis is suspected.

In relation to food allergies, I would assess whether there is a specific food that results in the episodes of emesis. If so, it could be either food allergy or an indication of eosinophilic esophagitis.

The high eosinophil count and chest findings might raise consideration of a collagen vascular disease, especially if this occurred with steroid dose withdrawal. an evaluation for Churg-Strauss might be a consideration.

Nevertheless, careful follow-up for weight, chest symptoms and pulmonary function as well as appropriate adjustments of asthma therapy should be considered.

Hope this is helpful.

Stan Szefler, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology