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

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Extra resources for Allergic Diseases: Diagnosis and Treatment

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Particle concentration increases with increasing wind speed, but in gusty winds these particles may be swept into the upper atmosphere, reducing ground exposure. In the cool, calm evening hours, these particles may resettle toward the ground, increasing exposure. Surprisingly, the brisk rainfall caused by thunderstorms does not reduce the airborne pollen and spore levels, while long periods of rainfall can act to scour these particles and reduce exposure. The aerodynamic characteristics of these particles play an important role in the degree and manner of exposure.

While growth in children may occur in spurts, change in growth velocity or decremental change in percentile should alert the physician to consider reasons for growth reduction with the knowledge that growth in atopic children is generally delayed. Clues to allergic propensity are often seen in the patient's face. Discoloration of the infraorbital skin or "allergic shiners" may imply nasal congestion and subsequent lymph stasis. Extension of the mid-face or adenoid facies in children with adenoid hypertrophy, an infraorbital crease or so-called Dennie's line, and a transverse crease along the lower half of the nose are frequent but are not absolute indicators of underlying allergy.

Extension of the mid-face or adenoid facies in children with adenoid hypertrophy, an infraorbital crease or so-called Dennie's line, and a transverse crease along the lower half of the nose are frequent but are not absolute indicators of underlying allergy. The eye examination is concerned principally with the state of the tarsal (lower lids) or palpebral (upper lids) and bulbar conjunctivae. Degree of injection is noteworthy. In vernal conjunctivitis and giant papillary conjunctivitis, the superior palpebral conjunctivae show papillary hypertrophy or "cobblestoning" and may be accompanied by a stringy, fibrinous secretion.

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