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Abstract4.78), p<0.01) were increased and did not markedly decrease when the analysis was Background -A case-control study was restricted to the more severe asthmatic undertaken to investigate the hypothesis subjects. that the use of the long acting agonist Conclusions -Although these findings are salmeterol increases the risk of a nearnot conclusive, particularly because of the fatal attack of asthma.small numbers involved in some subgroup Methods -The cases comprised adanalyses, they suggest that the use of salmissions to the intensive care unit (ICU) meterol by patients with chronic severe for asthma in 14 major hospitals within asthma is not associated with a sigthe Wessex region in 1992. For each of nificantly increased risk of a near-fatal the cases four age-matched controls were attack of asthma. If a near-fatal asthma selected from asthma admissions to the attack is considered to be an intermediate same hospital during the same period. Instep in a process by which a severe attack formation on prescribed drug therapy for of asthma may become fatal, these results the 48 cases and 185 controls was collected would suggest that salmeterol is unlikely from the hospital admission records.to be associated with an increased risk of Results -The patients admitted to the ICU death, at least by this mechanism. had greater chronic asthma severity and (Thorax 1998;53:7-13) had generally been prescribed more asthma drugs than the control admissions Keywords: asthma, mortality, near-fatal attacks, salto hospital. The relative risk of a near-fatal meterol, case-control study.attack of asthma in patients prescribed inhaled salmeterol was 2.32 (95% CI 1.05 to 5.16), p=0.04. However, the salmeterol Following the association of the agonists relative risk decreased to 1.42 (95% CI 0.49 isoprenaline forte and fenoterol with epidemics to 4.10), p=0.52 when the analysis was of asthma mortality 1 and the detailed inrestricted to the more chronically severe vestigations of the different acute and long term patients (those in the subgroup of patients side effects of agonist drugs, 2 3 there has been with a hospital admission for asthma in considerable interest and concern regarding the previous 12 months). These findings the safety of agonist drug therapy and, in suggest that the increased unadjusted relImmunopharmacology particular, the new generation of long acting terpretation is supported by the finding in use. [6][7][8] Investigations of the long term airways this study that, within the control group effects of salmeterol have revealed no worsening Department of (selected from the population of asth-of bronchial hyperreactivity.9 Similarly most, [6][7][8][9][10]

In 47 atopic subjects, skin-prick testing to 10 common allergens was performed, and specific IgE to the same allergens was assessed by the multi-allergosorbent chemiluminescent assay (MAST-CLA). Overall agreement between the tests was 66.4% for conventionally positive skin tests (weal diameter greater than or equal to 3 mm), rising to 78.5% when a positive skin test was defined as having a weal diameter greater than or equal to 5 mm. Agreement between the tests was statistically significant for all allergens except Alternaria. A history was obtained from each subject of the presence or absence of allergic symptoms on exposure to cats, and whether there was a history of grass pollen allergy. MAST-CLA testing for specific IgE to cat dander predicted a history of cat allergy with an efficiency of 74.5%, while a positive MAST-CLA test for Cocksfoot grass predicted a history of grass pollen allergy with an efficiency of 85.1%. Similar results were obtained on skin testing for these allergens. We conclude that MAST-CLA gave results comparable to those obtained by skin-prick testing, and correlated equally well with the history of allergic symptoms.