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Hyannis, MA, United States

Gordon B.R.,Cape Cod Hospital | Gordon B.R.,Harvard University | Gordon B.R.,Massachusetts Eye and Ear Infirmary | Hurst D.S.,Tufts University | And 2 more authors.
International Forum of Allergy and Rhinology

Background: Intradermal skin testing is a useful allergy diagnostic tool. Although considered safe when properly performed, systemic reactions have been reported. This is the first large, prospective study to record and evaluate all systemic reactions from intradermal skin testing (IDT) to inhalant or food antigens. Methods: A 24-month prospective study by 40 physician practices, recording all IDT tests, including reactions, symptoms, severity, time after injection, and reaction treatments. Results: Eighty systemic reactions (22 major) occurred among 20,530 patients (878,583 wheals). Nine had epinephrine treatment, 4 were observed in an emergency department, and there were no hospitalizations or fatalities. The overall systemic reaction risk was 0.009%. The risk of having a major reaction was 0.003%, or 1 reaction per 933 patients. Conclusion: Intradermal skin tests for inhalants or foods, when performed with appropriate precautions, have a safety profile comparable to skin prick tests. © 2013 ARS-AAOA, LLC. Source

Welch H.J.,Lahey Clinic | O'Donnell T.F.,Tufts Medical Center | Iafrati M.D.,Tufts Medical Center | Gorin D.R.,Cape Cod Hospital | Merport M.,SouthCoast Hospitals Group St
Journal of Vascular Surgery: Venous and Lymphatic Disorders

Many health insurance plan (HIP) policies toward the treatment of chronic venous insufficiency (CVI) are outdated, formulated by administrators with the advice of physicians unfamiliar with CVI, and are not evidence-based. Denial of appropriate care by the HIP is frustrating to both the patient and provider, leading to delays in care and much time and effort in the appeals process. This led to meeting with the HIPs outlining the problems with their CVI policies. Through education of the HIP medical staff and reviewers, the specialists were then asked to review the policies and recommend changes. As a result of the collegial communications with the HIPs, a number of changes were made in their documents regarding treatment of CVI. These include (1) proper nomenclature for the venous systems, (2) the elimination of the need for chronic analgesic medication, (3) treatment for nonaxial varicose veins, (4) decrease in the required length of conservative (ie, elastic compression stockings) treatment prior to surgery from 12 weeks to 6 weeks, among other changes as well. While HIPs seek to reduce expenses and maximize operating margins, they are also tasked with facilitating appropriate access to necessary medical care for their members. Cooperation among physicians can lead to a dialogue between payers and providers, and can lead to positive changes in HIP policies toward the treatment of venous disease. © 2013 by the Society for Vascular Surgery. Source

Gordon B.R.,Cape Cod Hospital
Current opinion in otolaryngology & head and neck surgery

PURPOSE OF REVIEW: Patch testing has rapidly become an important clinical allergy tool, but is underutilized in the evaluation of complex patients, especially when these patients have skin disorders and respiratory allergies, food allergies, or eosinophilic enteritis. Learning when and how to use patch tests thus adds to any practitioner's diagnostic abilities.RECENT FINDINGS: This review discusses selected studies from the past year, grouped into immunology, pediatric testing, contact allergy, food allergy, and drug allergy.SUMMARY: Patch tests can detect a wide range of sensitivities to inorganic and organic chemicals, drugs, biologic molecules, inhalants acting as contactants, food allergens, allergens that have not been commercially extracted, and solid allergens. Because patch tests detect the full range of immunologic reactions, Gell and Coombs type I to IV, they may be uniquely reactive when other allergy tests are negative. Because of the large number of published studies that utilize patch testing, clinicians often can use a literature search of prior studies of similar problems, or for particular allergens, to choose technical details that make successful patch testing more likely. Source

Gordon B.R.,Cape Cod Hospital | Gordon B.R.,Harvard University | Gordon B.R.,Massachusetts Eye and Ear Infirmary
Otolaryngologic Clinics of North America

Vitamin D (vitD3) deficiency occurs frequently and has profound effects on health, especially asthma. This article examines how current knowledge of vitD3 actions and the worldwide distribution of vitD3 deficiency influences everyday clinical allergy practice. Within the limits of current knowledge, the article concisely explains the molecular nature of vitD3 actions, reviews key vitD3 research as it applies to clinical care, answers questions about the potential clinical impact of low vitD3 levels, and discusses use and safety of vitD3 supplements. © 2014 Elsevier Inc. Source

Gordon B.R.,Cape Cod Hospital | Gordon B.R.,Massachusetts Eye and Ear Infirmary | Gordon B.R.,Harvard University
Otolaryngologic Clinics of North America

The allergic march is a progression of atopic disease from eczema to asthma, and then to allergic rhinoconjunctivitis. It appears to be caused by a regional allergic response with breakdown of the local epithelial barrier that initiates systemic allergic inflammation. Genetic and environmental factors predispose to developing the allergic march. There are data to support 4 possible interventions to prevent the allergic march from progressing to asthma: (1) supplements of dietary probiotics, (2) exclusive breast feeding during the first few months of life, or, alternatively (3) use of extensively hydrolyzed infant formulas, (4) treatment with inhalant allergen immunotherapy by either subcutaneous or sublingual methods. © 2011 Elsevier Inc. Source

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