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Background: Asthma exacerbation patterns are cyclic in nature and often correlate with air particle concentrations., Objective: To examine the relationship between asthma-related emergency department (ED) visits and outdoor air quality for pediatric and adult patients in a high asthma prevalence area, the New York City borough of the Bronx., Methods: Numbers of daily asthma-related adult and pediatric ED visits during one complete year (1999) were obtained from the seven major Bronx hospitals. Daily values of nitrogen oxides (NO(x)), ozone (O(3)), sulfur dioxide (SO(2)), and pollen counts were acquired., Results: Asthma-related ED visit numbers were highest in December-January and lowest in July. There were three distinct peaks of increased asthma ED visits: winter (December-January), spring (late April-May), and fall (October). The spring peak was the most striking and coincided with high tree pollen counts (tree pollen: r = 0.90, p = .03). We observed a positive correlation between asthma ED visits in the winter and SO(2) and NO(x) levels. Winter peaks of SO(2) and NO(x) in early December appeared to precede the winter asthma peak., Conclusions: The spring asthma peak is closely associated with increased tree pollen counts, and the asthma increase at this time is likely due to allergic reactions to pollen. No significant associations could be established with the fall peak. The winter peak correlates with elevated SO(2) and NO(x) levels.

Background: Despite the existence of numerous dermatology-specific quality-of-life questionnaires, there exists a need for a well-validated instrument to evaluate and monitor patients with chronic urticaria., Objective: To develop and validate a novel chronic urticaria-specific questionnaire, the Urticaria Severity Score (USS)., Methods: The USS was developed with 12 questions and 7 response options per question included in the final questionnaire. The USS was pilot tested on 28 patients with symptomatic chronic urticaria, and a modified version was tested in 80 patients. In this latter group, the USS was compared with the previously validated Dermatology Life Quality Index (DLQI). Patients completed both questionnaires at baseline and at follow-up (median, 2 weeks). Spearman rank correlation tests were used to compare the USS with the DLQI. At a subsequent visit, 9 additional patients completed the USS to evaluate test-retest reliability., Results: There was a positive correlation between the USS and DLQI at baseline (r = 0.64) and follow-up (r = 0.69). The test-retest reliability correlation for the USS was adequate (r = 0.96) (P = .001). The USS was more sensitive in detecting symptom improvement than the DLQI. The mean (SD) "raw score" change from baseline to follow-up for the USS was 9.95 (12.80), whereas the mean (SD) change from baseline to follow-up for the DLQI was 2.25 (4.87)., Conclusions: The USS is a valid and reliable instrument for monitoring urticaria severity. The USS is more sensitive than the DLQI for quantifying urticaria severity and may be moreapplicable in the evaluation of urticaria-specific treatment efficacy.

Cytosolic glucocorticoid receptor (GR) binding studies on immune tissues demonstrate that the thymus exhibits three to four times higher levels of GR protein than the spleen. High levels of GR are consistent with the exquisite sensitivity of the thymus to glucocorticoid exposure. Nevertheless, whole cell binding studies reveal similar levels of GR in immature thymic T lymphocytes and more mature, splenic T lymphocytes. Moreover, whole cell binding techniques indicate that neutrophils (which represent roughly 30% of splenic leukocytes) exhibit higher GR than both T and B lymphocytes, further contradicting results from cytosolic binding studies. To address these inconsistencies, GR protein was assessed in immune cells and tissues using cytosolic radioligand binding. Western blot analysis, and immunocytochemistry. Consistent with previous cytosolic receptor binding studies on immune tissue homogenates, thymic T cells were found to have higher levels of GR than T cells isolated from the spleen. In addition, neutrophils were found to have fewer GR than lymphocytes and monocytes. These results indicate a meaningful relationship between receptor expression and known sensitivity to glucocorticoids.