Carol A Saltoun

Northwestern University, Evanston, IL, United States

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Publications (25)77.61 Total impact

  • Joy Hsu, Carol A Saltoun, Pedro C Avila
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    ABSTRACT: The purpose of this review is to highlight recently published important articles on upper airway diseases and allergen immunotherapy. We review articles on rhinitis, sinusitis, conjunctivitis, and immunotherapy. New insights into epidemiology, pathophysiology, diagnosis, and therapy are described for each of the above diseases.
    The Journal of allergy and clinical immunology 03/2012; 129(3):646-52. · 12.05 Impact Factor
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    ABSTRACT: Asthma in the elderly is underdiagnosed and undertreated, and there is a paucity of knowledge on the subject. The National Institute on Aging convened this workshop to identify what is known and what gaps in knowledge remain and suggest research directions needed to improve the understanding and care of asthma in the elderly. Asthma presenting at an advanced age often has similar clinical and physiologic consequences as seen with younger patients, but comorbid illnesses and the psychosocial effects of aging might affect the diagnosis, clinical presentation, and care of asthma in this population. At least 2 phenotypes exist among elderly patients with asthma; those with longstanding asthma have more severe airflow limitation and less complete reversibility than those with late-onset asthma. Many challenges exist in the recognition and treatment of asthma in the elderly. Furthermore, the pathophysiologic mechanisms of asthma in the elderly are likely to be different from those seen in young asthmatic patients, and these differences might influence the clinical course and outcomes of asthma in this population.
    The Journal of allergy and clinical immunology 09/2011; 128(3 Suppl):S4-24. · 12.05 Impact Factor
  • Bradley R Sabin, Carol A Saltoun, Pedro C Avila
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    ABSTRACT: The purpose of this review is to highlight recently published important articles on upper airway diseases and immunotherapy. We review articles on rhinitis, sinusitis, conjunctivitis, and immunotherapy. New insights into epidemiology, pathophysiology, diagnosis, and therapy are described for each of the above diseases. Regarding immunotherapy, we discuss numerous clinical trials on sublingual and subcutaneous immunotherapy, mechanisms of immunotherapy, safety, and use of modified allergens and biological agents for immunotherapy.
    The Journal of allergy and clinical immunology 02/2011; 127(2):342-50. · 12.05 Impact Factor
  • Roopen R Patel, Carol A Saltoun, Leslie C Grammer
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    ABSTRACT: Several studies suggest that asthma is undertreated in the elderly population. To determine if the use of a simple telephone intervention can improve asthma care in the elderly. Fifty-two elderly subjects with asthma who required their rescue inhalers more than twice a week and had at least one emergency department or urgent care visit in the previous year were randomized to an intervention or control group. All subjects received two telephone calls over a 12-month period. The intervention group received an asthma-specific questionnaire and the control group received a general health questionnaire. Medication use and health care utilization were evaluated at the beginning and end of a 12-month period. The study was completed by 23 control and 25 intervention subjects. Baseline data were similar in both groups. After 12 months, 72% (n = 18) of the intervention group were on an inhaled corticosteroid compared with 40% (n = 10) of the control group (p = 0.08). The intervention group had fewer emergency department visits when compared with the control group (p = 0.21). Sixty-four percent (n = 16) of the intervention group had an asthma action plan compared with 26% (n = 6) in the control group (p = 0.01). This study suggests that asthma care in the elderly can be improved using a simple telephone intervention. Clinicians need to recognize that under treatment of asthma in the elderly still exists and to use alternative methods such as a simple telephone questionnaire to improve care in this population.
    Journal of Asthma 03/2009; 46(1):30-5. · 1.85 Impact Factor
  • Carol Saltoun, Pedro C Avila
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    ABSTRACT: The purpose of this review is to highlight important articles on upper airway diseases and immunotherapy that appeared in 2007. Advances in rhinitis include the realization that allergic rhinitis might be caused by local nasal IgE sensitization to aeroallergens in the absence of systemic evidence of IgE sensitization. After inhalation, allergens might reach systemic circulation. Epidemiologic studies continue to show that allergic rhinitis impairs school performance and is a risk factor for future asthma. New pathways are being identified in chronic sinusitis, as well as in different types of allergic ocular diseases. New treatments for patients with allergic rhinitis include use of beta-1,3-glucan, a mushroom product that can reduce allergic symptoms by inducing T(H)1 response, and olopatadine nasal spray. Studies on immunotherapy in 2007 suggest that sublingual immunotherapy induces similar immunologic alterations as those induced by subcutaneous immunotherapy, although to a lesser degree. Among allergists in the United States, there is a sizable variation in clinical practice, particularly related to concomitant administration of immunotherapy and beta-blockers, to administration of angiotensin-converting enzyme inhibitors, and to patients with HIV or autoimmune diseases. The combination of omalizumab with allergen subcutaneous immunotherapy can enhance clinical efficacy. Recombinant technology can modify allergen structure to prevent binding to IgE (allergenicity) while enhancing immunogenicity (stimulation of T cells), which might improve the safety and efficacy of immunotherapy.
    The Journal of allergy and clinical immunology 10/2008; 122(3):481-7. · 12.05 Impact Factor
  • Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2007; 119(1).
  • Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2006; 117(2).
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    Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2006; 117(2).
  • C. A. Saltoun, R. E. Story, L. C. Grammer
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    ABSTRACT: RationaleMedication noncompliance is one of many factors that lead to the sub-optimal management of asthma in elderly patients. Several hypotheses as to why elderly patients are non-compliant have been made including multiple medical problems requiring numerous prescriptions and the high cost of prescription medications. Our study compares medication non-compliance rates in two different populations of elderly patients with asthma in an effort to better understand the obstacles to appropriate management of asthma in elderly patients.
    Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2004; 113(2).
  • R. E. Story, C. A. Saltoun, L. C. Grammer
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    ABSTRACT: RationaleAs the U.S. population ages, asthma in the elderly is an increasing problem. Several studies suggest that asthma is under-diagnosed and under-treated in elderly populations. Our study assesses asthma treatment and symptom control using National Asthma Education and Prevention Program (NAEPP) guidelines in a population of asthmatics 60 years and older.
    Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2004; 113(2).
  • C. A. Saltoun, P. Yarnold, L. C. Grammer
    Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2003; 111(1).
  • Daryn Abraham, Carol A Saltoun
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2003; 89(6):561-5. · 3.45 Impact Factor
  • Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2002; 109(1).
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    ABSTRACT: Idiopathic anaphylaxis presents a problem requiring rapid diagnosis and initiation of therapy. Some cases are complex and difficult to assess. We present four cases of unusual complexity to illustrate diagnostic and therapeutic problems. Two cases were found not to be idiopathic anaphylaxis, one being undifferentiated somatoform idiopathic anaphylaxis and the other very severe urticaria. Various conditions can be or mimic idiopathic anaphylaxis, and patience and observation can result in reasonable outcomes.
    Allergy and Asthma Proceedings 04/2000; 21(3):141-4. · 2.19 Impact Factor
  • Carol A Saltoun
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    ABSTRACT: Specific allergen immunotherapy (IT) has long been used to treat allergic rhinitis and asthma. Review of the literature from the past 5 years continues to support this use of IT as the only disease-modifying treatment of allergic disease currently available. In addition, studies suggest that allergen IT may prevent the progression of allergic disease. In monosensitized patients, IT may prevent polysensitization. In younger patients with allergic rhinitis only, IT may prevent the new onset of asthma. Although these studies require further validation, the evidence is important enough to consider disease prevention as one of the indications for prescribing allergen IT.
    Allergy and Asthma Proceedings 23(6):377-80. · 2.19 Impact Factor
  • Tara F Carr, Carol A Saltoun
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    ABSTRACT: Urticaria, also known as hives, may affect up to 20% of the population at some time in their lives. Urticaria is characterized by extreme pruritus and described as erythematous, raised, circumscribed lesions with central pallor that blanch with pressure. The pathogenesis of urticaria involves mast cell activation, with subsequent release of histamine and other vasoactive mediators, leading to increased vascular permeability of postcapillary venules and development of edema, erythema, and pruritus. Urticaria is closely associated with angioedema in 40% of individuals; ∼10% of patients experience angioedema without urticaria. Urticarial lesions often are generalized with multiple lesions in no specific distribution; angioedema tends to be localized, commonly affecting the face (periorbital and perioral regions), tongue, uvula, soft palate or larynx, extremities, and genitalia. Urticaria is subdivided into acute and chronic urticaria based on duration of symptoms. Acute urticaria lasts <6 weeks and an identifiable cause may be discovered such as food products, medications (aspirin, nonsteroidal anti-inflammatory drugs, and antibiotics), or insect stings. Urticaria lasting >6 weeks is designated as chronic urticaria, and an etiology is seldom identified and thus considered idiopathic. Chronic urticaria may have an autoimmune basis. There is a well-documented association between autoimmune hypothyroidism (Hashimoto's disease) and urticaria and angioedema with higher incidence of antithyroid (antithyroglobulin and antiperoxidase) antibodies in these usually euthyroid patients. Furthermore, studies have revealed a circulating IgG antibody directed against the IgE receptor (F(Cε)RIα) or IgE in 40-60% of patients with chronic urticaria. Histamine 1-receptor antagonists (antihistamines) are initial therapy.
    Allergy and Asthma Proceedings 33 Suppl 1:S70-2. · 2.19 Impact Factor
  • Priyanka Gupta, Carol Saltoun
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    ABSTRACT: Specific allergen immunotherapy is the administration of increasing amounts of specific allergens to which the patient has type I immediate hypersensitivity. It is a disease modifying therapy, indicated for the treatment of allergic rhinitis, allergic asthma, and hymenoptera hypersensitivity. Specific IgE antibodies for appropriate allergens for immunotherapy must be documented. Indications for allergen immunotherapy include (1) inadequate symptom control despite pharmacotherapy and avoidance measures, (2) a desire to reduce the morbidity from allergic rhinitis and/or asthma or reduce the risk of anaphylaxis from a future insect sting, (3) when the patient experiences undesirable side effects from pharmacotherapy, and (4) when avoidance is not possible. Furthermore, patients may seek to benefit from economic savings of allergen immunotherapy compared with pharmacotherapy over time. Several studies have reported that immunotherapy in children with allergic rhinitis appears to prevent the development of new allergic sensitizations and/or new-onset asthma. Humoral, cellular, and tissue level changes occur with allergen immunotherapy including large increases in antiallergen IgG(4) antibodies, a decrease in the postseasonal rise of antiallergen IgE antibodies, reduced numbers of nasal mucosal mast cells and eosinophils, induction of Treg cells, and suppression of Th2 more than Th1 lymphocytes. There is a corresponding increase in IL-10 and transforming growth factor beta. In the United States, allergen immunotherapy is administered by the subcutaneous route in the physician's office, whereas primarily in some countries in Europe, it is administered for allergic rhinitis and asthma by the sublingual route by the patient at home.
    Allergy and Asthma Proceedings 25(4 Suppl 1):S7-8. · 2.19 Impact Factor
  • Rachna Shah, Carol A Saltoun
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    ABSTRACT: Acute severe asthma, formerly known as status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy such as inhaled albuterol, levalbuterol, or subcutaneous epinephrine. It is a medical emergency that requires immediate recognition and treatment. Oral or parenteral corticosteroids should be administered to all patients with acute severe asthma as early as possible because clinical benefits may not occur for a minimum of 6-12 hours. Approximately 50% of episodes are attributable to upper respiratory infections, and other causes include medical nonadherence, nonsteroidal anti-inflammatory exposure in aspirin-allergic patients, allergen exposure (especially pets) in severely atopic individuals, irritant inhalation (smoke, paint, etc.), exercise, and insufficient use of inhaled or oral corticosteroids. The patient history should be focused on acute severe asthma including current use of oral or inhaled corticosteroids, number of hospitalizations, emergency room visits, intensive-care unit admissions and intubations, the frequency of albuterol use, the presence of nighttime symptoms, exercise intolerance, current medications or illicit drug use, exposure to allergens, and other significant medical conditions. Severe airflow obstruction may be predicted by accessory muscle use, pulsus paradoxus, refusal to recline below 30°, a pulse >120 beats/min, and decreased breath sounds. Physicians' subjective assessments of airway obstruction are often inaccurate. More objective measures of airway obstruction via peak flow (or forced expiratory volume in 1 second) and pulse oximetry before oxygen administration usually are helpful. Pulse oximetry values >90% are less commonly associated with problems although CO(2) retention and a low Pao(2) may be missed.
    Allergy and Asthma Proceedings 33 Suppl 1:S47-50. · 2.19 Impact Factor
  • Alan P Koterba, Carol A Saltoun
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    ABSTRACT: Asthma is a chronic inflammatory disorder of the airways resulting physiologically in hyperreactivity and clinically in recurrent episodes of wheezing, chest tightness, or coughing. Airway inflammation, smooth muscle contraction, epithelial sloughing, mucous hypersecretion, bronchial hyperresponsiveness, and mucosal edema contribute to the underlying pathophysiology of asthma. Diagnostic tests such as methacholine or mannitol challenges or spirometry (pre- and postbronchodilator responses) help to identify such underlying pathophysiology via assessments of bronchial hyperreactivity and lung mechanics but are imperfect and ultimately must be viewed in the context of a patient's clinical presentation including response to pharmacotherapy. The National Asthma Education and Prevention Program Expert Panel Report (2007) classifies asthma into either intermittent or persistent, and the latter is either mild, moderate, or severe. Some patients change in either direction from intermittent to persistent asthma. In addition, patients with asthma may be classified as allergic (IgE mediated), nonallergic (often triggered by viral upper respiratory tract infections or no apparent cause), occupational, aspirin-exacerbated respiratory disease, potentially (near) fatal, exercise induced, and cough variant asthma. In the latter, the patients have a nonproductive cough that responds to treatment for asthma but not with antibiotics, expectorants, mucolytics, antitussives, beta(2)-adrenergic agonists, treatment for acid reflux, or rhinosinusitis. Thus, cough variant asthma is in the differential diagnosis of chronic cough.
    Allergy and Asthma Proceedings 33 Suppl 1:S28-31. · 2.19 Impact Factor
  • Kelly K Newhall, Carol Saltoun
    Allergy and Asthma Proceedings 25(4 Suppl 1):S5-6. · 2.19 Impact Factor