Allergic Diseases: Diagnosis and Treatment by Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.),

By Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.), Phil Lieberman MD, John A. Anderson MD (eds.)

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In many patients in whom allergic symptoms are intermittent, the physical examination may be entirely normal when the patient is fIrst evaluated. This should not steer the physician away from the possibility of allergy. In children, it is important to document growth, since growth is delayed in the severely asthmatic child. Also, children on chronic oral corticosteroids may have growth suppression. Increased heart and respiratory rate and pulsus paradoxus may be seen during an acute asthma episode.

Problems in defining normal limits for serum IgE. I Allergy Clin ImmunoI1990;85:440-444. Kristjansson S, Shimizu T, Strannegckd lL, Wennergren G. Eosinophil cationic protein, myeloperoxidase and tryptase in children with asthma and atopic dermatitis. Pediatr Allergy Immuno11994; 5: 223-229. Lockey RF, Benedict LM, Turkeltaub PC, et al. Fatalities from immunotherapy and skin testing. I Allergy Clin Immunol 1987; 79:660-677. Ownby DR. Allergy testing: In vivo versus in vitro. Pediatr Clin North Am 1988; 35: 995-1009.

The physical findings in atopic dermatitis depend on the age of the patient and the stage of the disease. In infants, the pruritic lesions are usually erythemic and oozing, and located on the cheeks and the extensor surfaces of the arms and the legs. Over time, the lesions develop a more macular papular character with vesicles. In the older child and adult, the lesions become increasing crusted and thickened with the typical locations being the neck, ankle, and the antecubital and popliteal fossae.

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