1/12. asthma and rhinitis induced by exposure to raw green beans and chards.BACKGROUND: Although the vast majority of IgE-mediated allergic reactions to foods occurs through ingestion, a few cases of unexpected allergic reactions to foods may occur through the exposure to airborne food allergen particles. methods: case reports. skin prick tests and serum-specific IgE (CAP-FEIA) were used to identify specific IgE antibodies. bronchial provocation tests were performed to determine the clinical relevance of inhaled exposure to raw and cooked green beans and raw chards. After demonstrating specific reactivity to them, SDS-PAGE and immunoblotting of raw and cooked green beans were carried out to identify relevant antigens. RESULTS: Three women developed bronchial asthma and rhinitis after exposure to raw green beans, and one of them also when exposed to raw chards. All women tolerated ingestion of green beans. patients reported multiple episodes while handling these vegetables for cooking activities. Allergy to green beans and chards was demonstrated by skin testing and serum-specific IgE. Bronchial challenge test with these allergens showed positive responses to raw, but not cooked, green beans and chards. Oral food challenges with green beans (raw and cooked) and chards were negative in all patients. In order to further characterize the allergenic components of these extracts, SDS-PAGE and electroblotting studies were also performed. Immunoblots of raw and cooked green beans extract showed two IgE-binding bands with apparent molecular weights of 41.1 and 70.6 kD. Interestingly, a 47-kD IgE-binding protein was detected only in raw green bean extracts. CONCLUSIONS: We report three patients who developed asthma and rhinitis caused by exposure to raw, but not to cooked, green beans and chards in a non-occupational environment. Only minor differences of IgE reactivity between nitrocellulose-blotted raw and boiled green bean extract were found.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/12. A 4-year-old girl with manifestations of multiple chemical sensitivities.Multiple chemical sensitivities (MCS) syndrome, also known as idiopathic environmental intolerance, is a controversial diagnosis that encompasses a wide range of waxing and waning, subjective symptoms referable to more than one body system and provoked by exposure to low levels of chemicals, foods, or other agents in the environment. Although MCS has been studied extensively, a unifying mechanism explaining the illness remains obscure, and clinicians are divided as to whether such a medical entity exists separately from psychosomatic syndromes. MCS is an adult diagnosis; there is little reference to pediatric cases in the scientific literature. In this case from the Pediatric environmental health Subspecialty Unit at boston's Children's Hospital, I present the case of a preschool child who had suffered from milk allergy and poor weight gain as an infant, and then later developed asthma, allergic symptoms, sinusitis, headaches, fatigue, and rashes precipitated by an expanding variety of chemicals, foods, and allergens. I review definitions, mechanisms, diagnostic strategies, and management, and discuss some uniquely pediatric features of MCS as illustrated by this case.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
3/12. Occupational asthma caused by exposure to cooking lobster in the work environment: a case report.A 25-year-old male chef developed symptoms of cough, wheezing, and dyspnea following repeated exposure to cooking lobster in his work environment. skin prick tests to lobster, mixed shellfish, haddock, cod, oysters, and clams were strongly positive. skin prick tests to other routine antigens were negative except for alternaria fungal spores. Bronchial inhalation of aqueous lobster extract resulted in an isolated early asthmatic response.- - - - - - - - - - ranking = 5keywords = environment (Clic here for more details about this article) |
4/12. Atopic disease in childhood.A child with atopy produces IgE antibodies after exposure to common environmental allergens. The atopic diseases (eczema, asthma and rhinoconjunctivitis) are clinical syndromes each defined by a group of symptoms and signs. Not all children with atopy will have atopic disease or develop symptoms after exposure to an allergen. Both genetic and environmental factors determine the development of atopic disease. The presence of specific IgE antibodies to environmental allergens is determined with skin prick or radioallergosorbent testing in children with atopy. Test results should be interpreted in the context of the clinical history and further investigations (eg, allergen avoidance or challenge). Management of atopic disease is frequently symptomatic, but it is important to avoid identified allergen triggers. immunotherapy may be considered in selected school-age children with severe rhinoconjunctivitis. Preventing atopic disease in high-risk infants and hindering progression of disease in children with established disease are the areas of active research.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
5/12. 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 = 2keywords = environment (Clic here for more details about this article) |
6/12. Food and chemicals as environmental incitants.Susceptibility to environmental incitants such as air, food and water components is becoming an increasingly recognized health problem. These sensitivities and reactions can induce a spectrum of symptoms affecting smooth muscle, mucous membranes and collagen in the respiratory, gastrointestinal, genitourinary and vascular systems. These reactions may be mistaken for hypochondriasis, but actually are due to reactions to foods and chemicals found in the patient's home and work environments. Careful clinical histories should alert the nurse and physician, who can confirm suspicions by eliminating and challenging the patient with potentially offending agents under controlled circumstances.- - - - - - - - - - ranking = 6keywords = environment (Clic here for more details about this article) |
7/12. Environmentally triggered cardiac disease.Twelve highly selected patients with non-arteriosclerotic cardiac arrhythmias and/or chest pain refractory to medication and having symptoms related to smooth muscle sensitization were studied in a rigidly controlled, relatively fume- and particle-free environment. The majority of signs and symptoms cleared in 10 patients without medication while under environmental control, and in 10 of the 12 patients all arrhythmias were reproduced with controlled, repeated individual-blind and double-blind incitant challenges. blood abnormalities occurred in the complement and T-lymphocyte systems.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
8/12. Food-induced (allergic) arthritis. Inflammatory arthritis exacerbated by milk.Suggestive, but largely unproven, observations have associated arthritis with environmental antigens, including foods. We studied a patient with inflammatory arthritis in a prospective, "blinded," controlled fashion to determine whether her symptoms were associated with food sensitivities. This 52-year-old white woman with 11 years of class I, stage I, active disease, had symptomatic exacerbations allegedly associated with meat, milk, and beans. We observed an increase in symptoms following an unblinded food challenge and then studied her in our clinical research unit. On her normal diet for 6 days, she averaged 30 minutes of morning stiffness, 9 tender joints, 3 swollen joints, 87% subjective assessment (100% = best possible), and 89% examiner assessment. While she was fasting (3 days) or taking Vivonex (2 days), we noted no morning stiffness, tender joint score of 1, swollen joint score of 0, and assessments of 100% (P less than 0.05 versus normal diet). She was then nourished with Vivonex for 33 days without difficulty and challenged in a blinded fashion at mealtimes with lyophilized foods placed into opaque capsules. Four milk challenges (equivalent to greater than or equal to 8 ounces per meal) produced up to 30 minutes of morning stiffness, 14 tender joints, 4 swollen joints, subjective assessment of 85%, and objective assessment of 80% (P less than 0.05 versus fasting-Vivonex), peaking 24-48 hours postchallenge. Placebo and other foods (lettuce and carrots) were without effect.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/12. Disturbed children: the role of food and chemical sensitivities.A wide range of longlasting patterns of symptoms may result from individual sensitivity to substances in the environment such as foods, chemicals, dusts and pollens. Behaviourally disturbed and learning disordered children are common. Their numbers may be increasing and certainly they make great demands on parental understanding and courage as well as on professional judgement and time. A number of case studies are presented which suggest that the difficulties encountered by a significant number of these children have much to do with idiosyncratic responses to foods and additives. This hypothesis requires careful research study at an early date for if validated it will have far reaching implications for the assessment and management of disturbed, delinquent and learning disordered children. Perhaps not enough attention has been paid to the role of biological and environmental factors in the development of children's problems. Certainly recent research has begun to provide support for the concept of environmental (ecologic) illness.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
10/12. Food-induced and occupational asthma due to barley flour.BACKGROUND: occupational exposure to inhalant allergens may induce asthma but the presence of asthma after the ingestion of the allergen is rarely reported. OBJECTIVE: To clarify the clinical relevance of every identified allergen in a patient with respiratory symptoms after exposure to feeding stuffs and cereal flours in his work environment and after ingestion of beverages made of these cereal grains. methods: Case report. skin prick tests and serum-specific IgE (CAP-FEIA-fluoroenzymeimmunoassay) were used in order to identify specific IgE antibodies. bronchial provocation tests were performed as an aid in determination of clinical relevance of occupational exposure to the patient's asthma. RESULTS: A 50-year-old man developed bronchial asthma both after exposure to feeding stuffs and flours and after ingestion of beverages made of cereal flours. Allergy to storage mites (Lepidoglyphus destructor), house dust mites (dermatophagoides pteronyssinus and farinae), and barley and corn flours were demonstrated by skin testing and serum-specific IgE. Bronchial challenge tests with every allergen showed no response except for an immediate response to barley flour. The most relevant clinical feature was an immediate asthmatic response developed after oral provocation with either barley-made beer or barley flour itself which indicates IgE-mediated, food-induced bronchial asthma (sulfite sensitivity was ruled out). CONCLUSION: In some particular cases, barley flour may induce bronchial asthma through inhalational and oral routes due to an IgE-mediated mechanism.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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