1/5. Occupational asthma and IgE sensitization to cellulase in a textile industry worker.BACKGROUND: Although there have been a few reports of occupational asthma due to cellulase in several occupational settings, this is the first case of cellulase-induced occupational asthma in an employee working in the textile industry. Its pathogenetic mechanism remains to be further clarified. OBJECTIVE: It is important to alert physicians to the possibility of occupational asthma caused by cellulase in workers of the textile industry. methods AND RESULTS: The patient had atopy and strong positive responses to cellulase extract on skin prick tests. Bronchoprovocation test showed an early asthmatic response to cellulase extract. serum specific IgE and specific IgG4 antibodies to cellulase were detected by enzyme-linked immunosorbent assay (ELISA). In order to further characterize the allergenic component of the extract, sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. Eight IgE binding components ranging from 6 to 97.5 kD were detected within the cellulase extract. CONCLUSION: These findings suggest that inhalation of cellulase can induce IgE-mediated bronchoconstrictions in employees working in the textile industry.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Case report of an aviator with a single episode of altered consciousness due to hymenoptera hypersensitivity.This case is presented to: a) emphasize the importance of a careful history, including interviewing witnesses and considering a complete differential diagnosis when evaluating aviators with a history of an episode of altered consciousness; and b) demonstrate an appropriate use of literature review, subspecialty consultations, and U.S. Air Force Aeromedical Guidelines to arrive at an aeromedical disposition for an unusual case. A military aviator experienced an episode of syncope/near syncope, initially felt to be caused by a primary seizure or an arrhythmia. Subsequent thorough evaluation included careful history taking, extensive interviewing of witnesses, subspecialty consultations, review of appropriate literature and deliberation by a board of experienced military aeromedical physicians. Cardiac and neurologic diagnoses were considered but careful history and witness interviews revealed that the aviator had sustained an insect sting just minutes before the episode. Evaluation by allergy specialists, including skin testing, identified him as being hypersensitive to hymenoptera stings. A diagnosis of hypersensitivity reaction to a hymenoptera sting was determined to be the cause of the altered consciousness episode. review of the literature revealed that immunotherapy for hymenoptera sensitivity reduces the risk of future anaphylaxis to only 1-2% after maintenance dose is achieved. Consideration of the risk of future events and the success of rush immunotherapy resulted in a recommendation for a waiver to return the aviator to unrestricted flying duties. The importance of diligent history taking must never be forgotten. In this aviator it led to the correct diagnosis and definitive therapy. In addition, appropriate consideration of the literature and knowledge of outcome rates allowed a return to unrestricted flying for this aviator. If the original diagnosis of seizure or arrhythmia had been accepted, this aviator would have been disqualified without waiver and a valuable flying asset would have been lost.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. dermatitis due to sulfites in home permanent preparations. Part II.Irritant contact dermatitis to sulfite hair preparations most commonly occurs when users do not follow instructions. Allergic eczematous reactions are very rare; immediate urticarial reactions seem to occur principally in patients with asthma. Pretesting should be done in such patients in a physician's office where medication for the treatment of shock or asthma is available.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. 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 = physician (Clic here for more details about this article) |
5/5. Adverse reactions associated with midline catheters--united states, 1992-1995.The midline catheter is a peripherally inserted 6-8-inch catheter that may be used in patients requiring intermediate duration (i.e., several weeks) of physiologically compatible intravenous (IV) therapy. Unlike conventional short peripheral IV catheters, the midline catheter does not require changes every 48-72 hours. Midline catheters can be inserted at the bedside by a trained health-care worker, in contrast to subclavian, jugular, or femoral central venous catheters, which require insertion by a physician (often in an operating or procedure room) and usually are associated with more serious complications. Since 1990 (1), the food and Drug Administration (FDA) has received reports of acute hypersensitivity-like reactions temporally associated with insertion of midline catheters made from Aquavene (Landmark, Menlo Care, Menlo Park, california), an elastomeric hydrogel material that becomes hydrated and expands after catheter insertion (FDA, unpublished data, 1995; 1). This report describes four episodes of such reactions during 1992-1995, including one in a patient in a home-health-care setting (patient 1) and three among patients at a large university-affiliated hospital (patients 2-4).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |