1/14. Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits.BACKGROUND: latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant. OBJECTIVE: Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred. methods: A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an American-style fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed. RESULTS: In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific hevea species allergen similar to that of the foam layer sample. CONCLUSION: Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/14. Screening patients for latex allergies.PURPOSE: To review the reasons for the recent increase in latex allergies and the five possible routes of exposure to latex. DATA SOURCES: Selected review articles from print and electronic sources; author's clinical experience; case studies. CONCLUSIONS: latex allergies are now being documented in groups not previously considered to be at risk due to increased screening in primary care settings. IMPLICATIONS FOR PRACTICE: nurse practitioners should question about latex sensitivity, flag the charts of latex-sensitive clients, counsel those with a suspected latex sensitivity, refer those with known latex allergy to an allergist, and take the necessary precautions to move toward a latex-safe environment.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
3/14. cataract surgery for natural rubber latex allergic patients.The prevalence of reactions against natural rubber latex (NRL) is thought to be increasing in both the general public and healthcare workers. These can vary from mild benign skin reactions to bronchospasm, anaphylactic shock, and death. Difficulties exist for ophthalmic departments wishing to establish protocols in providing 'latex-free environments' for patients undergoing cataract surgery. Currently no legislation exists regarding the labelling of NRL-containing products in the United Kingdom with information on a product's NRL content provided by the manufacturer on a voluntary basis only. It is hoped this review article will act as a basic guide in the management of NRL-sensitive patients undergoing cataract surgery in the United Kingdom.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
4/14. Prolonged cardiovascular collapse due to unrecognized latex anaphylaxis.We present a case of a prolonged anaphylactic reaction that occurred in temporal relationship to the administration of cefazolin. Subsequent allergy testing was positive for latex and negative for cefazolin-both unexpected results. Our case illustrates that medications administered before the onset of anaphylaxis should not be assumed to be the causative allergen and that a latex allergy should be considered in the differential diagnosis. Because the etiology of an anaphylactic reaction cannot be immediately determined, patients experiencing intraoperative cardiovascular collapse should be treated in a latex-free environment. IMPLICATIONS: We describe a patient who experienced latex-induced intraoperative anaphylaxis. The event coincided with antibiotic administration, which prompted us to erroneously assume that the causative allergen was medication related. Allergy to latex must always be considered as a potential culprit of perioperative cardiovascular collapse.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
5/14. chlorhexidine anaphylaxis: case report and review of the literature.chlorhexidine is a widely used antiseptic and disinfectant. Compared to its ubiquitous use in medical and non-medical environments, the sensitization rate seems to be low. Multivarious hypersensitivity reactions to the agent have been reported, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions and photosensitivity reactions. An increasing number of immediate-type allergies such as contact urticaria, occupational asthma and anaphylactic shock have been reported. In the case report, we describe anaphylaxis due to topical skin application of chlorhexidine, confirmed by skin testing and sulfidoleukotriene stimulation test (CAST(R): cellular antigen stimulation test). The potential risk of anaphylactic reactions due to the application of chlorhexidine is well known, especially that application to mucous membranes can cause anaphylactic reactions and was therefore discouraged. The use of chlorhexidine at a 0.05% concentration on wounds and intact skin was so far thought to be safe. Besides our patient, only one other case of severe anaphylactic reaction due to application of chlorhexidine on skin has been reported. hypersensitivity to chlorhexidine is rare, but its potential to cause anaphylactic shock is probably underestimated. This review should remind all clinicians of an important potential risk of this widely used antiseptic.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
6/14. Anaphylactic shock to argas reflexus bite.anaphylaxis is a severe, life-threatening allergic reaction, affecting both children and adults. The occurrence of anaphylaxis is not as rare as generally believed (1.21% to 15.04% of the US population). Often the cause of this reaction remain unknown, mainly due to the difficulty in defining the outbreaking causes. Herein, we describe an interesting case of a patient, who developed an anaphylactic reaction after the bite of a pigeon tick. During the last 2 years, in wintertime, the patient often came to the emergency room for general rash and swelling, hypotension and tachycardia preceded by itching and general distress. Notably, the symptoms manifested themselves as night fell. In two particular occasions the patient reached the hospital in a state of shock. After another episode of general swelling, the patient was invited to examine her domestic environment. She brought us some parasites, collected at home, particularly on the bed. A morphological examination by entomologists proved these parasites to belong to argas reflexus (Arg.r.), one of the 31 species of soft ticks. The presence of specific IgE to a protein secreted by the Arg.r. salivary glands was in favour of immediate-type systemic reaction, as supposed by the clinical history.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
7/14. Clustered sensitivity to fungi: anaphylactic reactions caused by ingestive allergy to yeasts.BACKGROUND: Respiratory allergy to environmental molds is relatively common, and fungal allergen-specific reactivity seems to cluster in certain persons. However, generalized reactions caused by ingested fungi have seldom been described. OBJECTIVE: To describe a mold-sensitized patient who developed multiple anaphylactic reactions after ingesting a yeast preparation widely used by the food industry as flavoring in, for example, powdered and ready-made sauces. methods: skin prick tests and serum IgE tests were performed with inhalant and food allergens, including molds and yeasts, 2 pasta sauces consumed by the patient, individual sauce ingredients, and a food-quality yeast extract. radioallergosorbent test inhibition was used for specificity studies. RESULTS: skin prick and serum IgE test results were positive to several molds (cladosporium herbarum, alternaria alternata, aspergillus fumigatus, and penicillium notatum), baker's yeast (saccharomyces cerevisiae), malassezia furfur, and champignon and to the 2 pasta sauces, the yeast ingredient, and a food-quality yeast extract. radioallergosorbent test inhibition studies confirmed that the sauces contain cross-reacting yeast and mold allergens. CONCLUSIONS: This patient has a clustered sensitization to fungi characterized by allergy to environmental fungal allergens and to yeast extracts used in the food industry. yeasts should be considered as possible ingestive allergens in mold-allergic patients.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/14. Evaluation of systemic allergy in a jet aviator.Cholinergic urticaria and exercise-induced anaphylaxis (EIA) are related conditions. Cholinergic urticaria is caused by a rise in body core temperature and usually results in pruritus, skin lesions and, rarely, in serious respiratory and cardiovascular compromise. EIA can result in a cardiovascular compromise and syncope. Ingestion of certain foods may be associated with EIA. A 41-year-old jet pilot complained of 3-month onset of pruritus and urticaria during treadmill exercise. On one occasion, after a routine exercise bout, albeit with pruritus and urticaria, he experienced two short episodes of syncope. Treatment with a nonsedating H1-receptor antagonist was started. He underwent a unique challenge test that we designed. This included passive warming as well as exercising in a hot (temperature of 40 degrees C at 40% humidity) environment. After passing this test uneventfully, the pilot was returned to jet flight with a copilot and, subsequently, to full active duty.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
9/14. Environmentally induced cholinergic urticaria and anaphylaxis.Although urticaria is generally an uncomfortable condition, it is usually considered to be relatively benign. Recent evidence indicates that numerous environmental stimuli can initiate cholinergic urticaria, and severe systemic manifestations may be associated with the onset of the urticaria. exercise-induced anaphylaxis is a specific life-threatening reaction that has been documented to occur very unpredictably in susceptible individuals with cholinergic urticaria. The occurrence of severe hypotension, syncope, or laryngeal edema poses specific limitations to optimum performance should it occur in individuals employed in critical occupations. Although treatment with appropriate medications is generally effective in control of symptoms, these medications frequently have side effects not tolerable in high-risk situations. Four cases of U.S. air Force aircrewmen referred to the USAF School of Aerospace medicine for aeromedical evaluation illustrate the spectrum of problems that can be associated with cholinergic urticaria. exercise history should always be carefully evaluated in all individuals who present with urticaria.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
10/14. anaphylaxis after laboratory rat bite: an occupational hazard.Workers exposed to laboratory animals are at risk of developing asthma, rhinitis, angioedema, conjunctivitis, and urticaria. Approximately one in five scientists and technicians handling small animals will develop laboratory animal allergy symptoms within three years of employment, many of whom will have severe symptoms requiring a change of occupation. Individuals suffering from allergy to environmental allergens, such as pollen and ragweed, are more likely to develop allergic reactions to animals, and are more likely to develop asthma. We report a case of life-threatening anaphylaxis secondary to a rat bite in a laboratory research director with known allergies to rat urinary protein. While rodent bites are common in research settings, such severe reactions are extremely rare.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
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