1/12. Cockroach allergy and asthma in a 30-year-old man.A growing body of evidence has implicated allergens derived from cockroaches as an important environmental factor that may aggravate asthma in sensitized persons. We present the case of a 30-year-old man with asthma and a cockroach allergy. Allergy skin testing confirmed hypersensitivity to cockroach extract, and a home visit revealed visual evidence of infestation and the presence of Bla g 1 German cockroach allergen in vacuumed dust. As is typical of patients with a cockroach allergy and asthma, multiple factors in addition to cockroach allergen appeared to aggravate the patient's asthma. A multimodality therapeutic regimen, which included medications as well as cleaning of the home, integrated pest management, and professional application of chemical controls, resulted in substantial clinical improvement. The pathophysiology, epidemiology, and clinical features of cockroach-allergic asthma are reviewed, and an approach to diagnosis and management is suggested.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/12. Management of the latex hypersensitive patient in the endodontic office.This case report documents the treatment of an endodontic patient who experienced a type 1 hypersensitivity reaction to latex. The dental, medical, and environmental aspects of treating latex allergic patients are reviewed. Because gutta-percha and latex rubber are similar compounds, the possible cross-reactivity of these materials is discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/12. Occupational IgE-mediated allergy to tribolium confusum (confused flour beetle).BACKGROUND: We report on IgE-mediated allergy in a worker caused by tribolium confusum (confused flour beetle). These beetles lived in the "old" flour to which he was exposed in his work. CASE REPORT: A 35-year-old, nonatopic mechanic in a rye crispbread factory developed rhinitis, conjunctivitis, and asthmatic symptoms, as well as urticaria on his wrists, lower arms, hands, neck, and face, during the maintenance and repair of machines contaminated by flour. This flour had been in and on the machines for a long time, and it contained small beetles. The patient did not suffer any symptoms when handling fresh, clean flour. RESULTS: Skin prick tests with standard environmental allergens, storage mites, enzymes, flours, and molds were negative. A prick test with flour from the machines gave a 10-mm reaction. An open application of the same flour caused urticarial whealing on the exposed skin. Prick tests with fresh flour from the factory were negative. A prick test with minced T. confusum from the flour in the machines gave a 7-mm reaction. histamine hydrochloride 10 mg/ml gave a 7-mm reaction. Specific serum IgE antibodies to T. confusum were elevated at 17.2 kU/l. Prick tests with the flour from the machines were negative in five control patients. CONCLUSIONS: The patient had occupational contact urticaria, rhinitis, conjunctivitis, and asthmatic symptoms from exposure to flour. His symptoms were caused by immediate allergy to the beetle T. confusum. Immediate allergy to this beetle has rarely been reported in connection with respiratory symptoms, but it may be more common. Contact urticaria from this source has not been reported before.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/12. 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) |
5/12. All that drains is not infectious otorrhea.It has been said that, 'All that wheezes is not asthma.' Thus, is also so of otorrhea. Bacterial infection most often causes otorrhea which, in turn, generally responds to treatment with ototopical antimicrobial therapy. When it persists, non-infectious etiologies must be considered. Although allergic causes of otorrhea have been described in the literature, inhalant environmental allergens (Type I Allergy) causing eustachian tube dysfunction or ototopical drops, most notoriously neomycin containing formulations, causing contact dermatitis are those usually mentioned. Further, most reports of contact allergic reactions of the ear have involved the external auditory canal skin or pinna and have been attributed to non-medicinal triggers like shampoos and metals used in ear rings. A search of the literature failed to reveal a reported case of recurrent or chronic otorrhea without cholesteatoma due to an allergic reaction to the components of a tympanotomy tube (TT). Such a case is presented here.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/12. Case report of latex aerosolization from a transesophageal echocardiogram machine.Aerosolized natural rubber latex proteins produce latex sensitization and can cause acute allergic reactions in susceptible individuals. The objective of this study is to describe measures that should be taken to ensure a latex-safe hospital environment. A case of latex-induced anaphylaxis prompted a survey of air quality in acute care areas of a major tertiary health care center that had eliminated the use of powder-free latex gloves years earlier. Six air samples were collected using pre- and postcalibrated sampling pumps operating at 2.7 L/minute. Samples were collected in duplicate on three-piece 37-mm Teflon filters in open-faced cassettes and tested for latex allergen by inhibition immunoassay. All samples had less than the detection limit > 5 ng/m3 for aerosolized latex except for the echocardiogram suite where the transesophageal echocardiogram machine was located. After thorough cleaning of the suite and echocardiogram machine, subsequent air sampling showed no detectable latex aerosolization particles. Follow-up investigation to discover the source of contamination revealed that the department performing routine maintenance on the echocardiogram equipment used powdered latex gloves obtained outside the hospital. Employees who are latex allergic may experience symptoms even in an environment of powder-free, nonlatex gloves. The site was a contaminated transesophageal echocardiogram machine. Institutional policies should be in place to monitor employee complaints and address allergic reactions to latex.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
7/12. Sensitization to horse allergens without apparent exposure to horse. Report of two cases.It has been well established that occupational exposure to horses increases the risk of allergic sensitization to horse hair, on the contrary very few data have been published in individuals without direct contact with horses. We describe two cases of severe respiratory symptoms triggered by a single direct exposure in two patients with only 4-5 previous short contacts with horses during the entire their life, since they live in urban area of Naples. Cutaneous and serological diagnostic tests showed significant sensitization to horse dander other than some common inhalant allergens. Our report suggests that, in already (but unaware) horse-sensitized patients, the last direct contact with a horse has triggered severe respiratory symptoms. Passive carriage of horse allergen by the clothes of individuals in contact with horses/horse environments or a cross-reactivity between horse allergen (a lipocalin) and the major allergens (also lipocalins) of several furred animals are likely to explain our findings. Some other considerations can be derived by the clinical observation. First, it is likely that allergic sensitization to horse allergens could be more frequent than expected also in subjects without direct exposure to horse because of living in urban areas. Secondly, individuals suspected to be highly atopic or those already sensitized to some pet dander should be tested by SPTs/radio-allergo-sorbent test before the introduction of a pet indoors or, in the case of a big animal as the horse, a direct horse contact/entering into environments containing a horse.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
8/12. The late asthmatic response.Since LARs are associated with increases in airways reactivity, their significance may go well beyond the increase in symptoms due just to the allergen exposure. This is especially true since the increase in non-specific airways reactivity can last for weeks after a single exposure to allergen. Every effort should be made to search for possible allergic triggers in patients suspected to have LARs. Careful attention to historical information and skin test reactivity are critical in this evaluation. In situations where this approach is not revealing and where serious concerns remain about potential environmental triggers, a bronchial challenge to the suspected antigen can be considered. Since the nonspecific airways reactivity in patients with LAR may possibly be due to inflammation in the airways, the potential risk of transient induction of airways inflammation must be carefully weighed against the value of information that can be obtained from this procedure. Bronchial challenge should be performed only in an inpatient setting by experienced personnel under the supervision of a physician. A full explanation of the potential risks and benefits of this type of evaluation must be given to the patient and family. Treatment is primarily directed at allergen avoidance with use of a prophylactic drug, such as cromolyn sodium, when allergen avoidance is not possible.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/12. Transfer of latent atopy by bone marrow transplantation? A case report.A previously healthy 8-year old girl was diagnosed with acute myelogenous leukemia, and, while she was in first remission, she received a bone marrow transplant from her atopic brother. Studies 1 to 2 years after transplantation revealed that the marrow recipient had a specific-IgE production of donor-type pattern, indicated by the similar skin prick test results and RAST scores in the donor and recipient demonstrating allergy to animal dander and house dust. The recipient's own immunity had been destroyed by the preparative regimen for marrow transplantation, and no lymphoid cells of host origin could be found after transplantation in the chromosome analysis. A sensitization of the recipient to animal dander after transplantation was very unlikely because no animal contacts were present, and the chronic liver graft-versus-host disease of the patient additionally suggested a delayed immunologic recovery. The case history suggests that atopy can be transferred by bone marrow transplantation from donor to recipient. A possible mechanism appears to be a passive transfer not only of lymphoid precursors but also of mature memory cells within the bone marrow inoculum. The donor memory B cells are presumably capable of starting specific-IgE production when the cells are stimulated in the host environment by factors still unknown.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/12. Deliberate hymenoptera sting challenge as a diagnostic tool in highly selected venom-allergic patients.BACKGROUND: Open environment and working conditions close to abundant insects of the order hymenoptera should be avoided as much as possible by patients allergic to hymenoptera venom who do not receive venom immunotherapy. After having experienced accidental field re-stings not resulting in a systemic reaction, some of these patients may be willing to resume normal life and working habits. Since venom-specific IgE usually remains elevated in these patients, repeated skin tests or RASTs are not helpful in identifying disappearance of their venom allergy. OBJECTIVE: The purpose of this study was to evaluate the usefulness of deliberate live sting challenge as a diagnostic tool in highly selected venom-allergic patients who had initially refused venom immunotherapy. methods: Two cases are reported of bee venom-allergic patients who had previously refused venom immunotherapy and subsequently experienced honeybee field re-stings not resulting in systemic reactions. Two to three years later, their skin tests remained positive for bee venom. A third patient allergic to Vespa orientalis who had negative skin tests to all available venoms was denied venom immunotherapy due to lack of proper commercial venom. Because none of the patients was receiving venom immunotherapy the military service personnel concluded they still had venom allergy and rejected them from the highly prestigious service. All three patients were anxious to confirm the disappearance of their venom allergy and we used deliberate live sting challenges for that purpose. RESULTS: Two to three years after their initial systemic reactions live sting challenges were well tolerated by the three patients. They felt free to resume their normal life habits and were allowed to begin military service without further limitations. CONCLUSION: Deliberate insect stings using appropriate safety precautions should be considered a diagnostic tool in selected allergic patients who do not receive venom immunotherapy but in whom a reliable history of negative field re-stings can be obtained despite positive skin tests and in those who continue to have inconclusive venom skin tests.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
| | Next -> |