Rhinitis is characterized by nasal congestion, rhinorrhea, sneezing, and/or posterior nasal drainage. It affects a significant portion of the population and presents a large burden economically and on quality of life. Rhinitis is broadly characterized as allergic and nonallergic, of which nonallergic rhinitis may be divided into inflammatory and noninflammatory etiologies. The inflammatory causes include nonallergic rhinitis with eosinophilia, postinfectious, and rhinitis associated with nasal polyps. The noninflammatory causes include idiopathic nonallergic (vasomotor) rhinitis, medication-induced rhinitis, hormone related (e.g., pregnancy), and systemic disease related. Allergic rhinitis is classified as intermittent or persistent and mild versus moderate-severe. The nasal mucosa is extremely vascular; parasympathetic stimulation promotes an increase in nasal cavity resistance and nasal gland secretion, whereas sympathetic stimulation leads to vasoconstriction. The diagnosis of rhinitis begins with a directed history, particularly noting pattern, chronicity, and triggers of symptoms. Examination of the nasal cavity with attention to appearance of the septum and inferior turbinates is recommended. Skin testing for aeroallergens is helpful in demonstrating the presence or absence of immunoglobulin E antibodies and to differentiate nonallergic from allergic rhinitis. Treatment includes patient education, irritant or allergen avoidance, and pharmacotherapy. Medications used for the treatment of rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, intranasal anticholinergic agents, oral decongestants, and leukotriene receptor antagonists. When used in combination, an intranasal antihistamine spray and nasal steroid provide greater symptomatic relief than monotherapy. Allergen immunotherapy is the only disease-modifying intervention available for allergic rhinitis.

Acute severe asthma, formerly known as status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy. It is a medical emergency that requires immediate recognition and treatment. Albuterol in combination with ipratropium bromide in the emergency department (ED) has been shown to decrease the time spent in the ED and the hospitalization rates. The benefits of ipratropium are not sustained after admission to the hospital. 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 to 12 hours. Viral respiratory infections are a common trigger for acute asthma; other causes include medical nonadherence, allergen exposure (especially pets and mold [e.g., Alternaria species]) in individuals who are severely atopic, nonsteroidal anti-inflammatory exposure in patients with aspirin allergy, irritant inhalation (e.g., smoke, paint), exercise, and insufficient use of inhaled or oral corticosteroids. The patient's history should focus on the acute assessment of asthma control and morbidity, including current use of oral or inhaled corticosteroids; the number of hospitalizations, ED visits, intensive care unit admissions, and intubations; the frequency of albuterol use; the presence of nighttime symptoms; activity intolerance; current medications; exposure to allergens; and other significant medical conditions. Severe airflow obstruction may be predicted by accessory muscle use, difficulty speaking, refusal to recline < 30°, a pulse of >120 beats/min, and decreased breath sounds. 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 of >90% are reassuring, although CO2 retention and a low partial pressure of oxygen may be missed.

Asthma specialist care was infrequent among this pediatric ED population, consistent with the sub-optimal chronic asthma care we observed. Prospective trials should further investigate if systematic referral to asthma specialists during/after an ED encounter would improve asthma outcomes.

In recent years, examining dietary patterns has become a more common way of investigating potential associations between diet and adverse health outcomes. The New Nordic Diet (NND) is a potentially healthy and sustainable dietary pattern characterized by foods that are locally available and traditionally consumed in the Nordic countries. The diet has been typically examined in adult populations, and less is known about compliance to the NND from infancy throughout childhood. In the current study, we therefore aimed to develop and describe child age-specific NND scores. This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway (MBRN). We have previously developed a NND score for the maternal diet during pregnancy, and the development of the child diet scores was based on the rationale of this score. Food frequency data from n = 89 715 at child age 6 months, n = 76 432 at 18 months, n = 58 884 at 3 years, and n = 35 978 at 7 years were used to construct subscales in accordance with the maternal diet score. Subscales were composed of responses to a selection of food and drink items or other questions and were dichotomized by the median, yielding four age-specific diet scores where the possible scoring ranged from 0 to 6 at 6 months and 3 years and from 0 to 9 at 18 months and 7 years. The developed scores will be used to examine associations with childhood overweight and cognitive and mental development in future studies.

Unproved methods and controversial theories in the diagnosis and management of allergy/immunology are those that lack scientific credibility. Some definitions are provided for perspective, as in chronic medical conditions, frequently nonscientifically based treatments are developed that can have a profound psychological effect on the patients in the absence of objective physical benefit. Standard practice uses methods of diagnosis and treatment used by reputable physicians in a particular subspecialty or primary care practice, with the understanding that diagnosis and treatment options are consistent with established mechanisms of conditions or diseases. Conventional medicine (Western or allopathic medicine) is that which is practiced by the majority of physicians, osteopaths, psychologists, registered nurses, and physical therapists. Complementary medicine involves diverse practices or products that are used with the practice of conventional medicine, such as using acupuncture in addition to opioids for pain relief. Alternative medicine implies use of complementary practices in place of conventional medicine. Unproved and controversial methods and theories do not have supporting data, validation, or sufficient scientific scrutiny, and they should not be used in the practice of allergy/immunology. Some examples of unproven theories about allergic/immunologic conditions include allergic toxemia, idiopathic environmental intolerance, and toxic disease from indoor molds. Unconventional diagnostic methods for allergic conditions include cytotoxic tests, provocation-neutralization, electrodermal diagnosis, applied kinesiology assessments, chemical analysis of body fluids, and serum immunoglobulin G (IgG) or IgG4 testing. Unproven treatments and intervention methods for allergic/immunologic conditions include acupuncture, homeopathy, halotherapy, and autogenous urine injections.