1/133. 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 = sensitivity (Clic here for more details about this article) |
2/133. tobacco allergy: demonstration of cross-reactivity with other members of solanaceae family and mugwort pollen.BACKGROUND: tobacco is a plant belonging to the solanaceae family. This plant is usually used as a contact insecticide for several infestations in some areas, such as the Canary islands. Allergy induced by inhalation of this plant is unusual. Identification of the potential allergen in growing areas is essential. OBJECTIVE: We report a patient with occupational sensitivity to an aqueous solution of cut tobacco whose clinical manifestations were rhinoconjunctivitis and urticaria. Past medical history was significant for seasonal allergic rhinoconjunctivitis to mugwort pollen and oral allergy syndrome with avocado. methods: Green tobacco and cured tobacco leaf extracts were prepared, skin prick tests were performed with green tobacco, cured tobacco leaf extracts, and certain aeroallergens. Conjunctival challenge test was carried out with green tobacco and cured tobacco leaf extract. serum-specific IgE against tobacco leaf was performed by commercial CAP. CAP inhibition experiments were carried out with tobacco and artemisia vulgaris. RESULTS: Skin prick tests and conjunctival challenge tests with green tobacco and cured tobacco leaf extracts were positive, as well as serum-specific IgE by CAP, indicating an IgE-mediated sensitization. CAP inhibition experiments were carried out and it was found that tobacco, mugwort pollen, and tomato extracts inhibited the binding of the patient's serum to solid-phase tobacco leaf. No inhibition was observed when alternaria, D. pteronyssinus, and potato were used as control inhibitors. Inhibition of immunoCAP to mugwort was obtained with mugwort and tobacco extracts and no cross-reactivity to D. pteronyssinus was shown. CONCLUSION: The results suggest that tobacco can induce IgE-mediated reactions that are mediated by the existence of common antigenic epitopes between tobacco and mugwort pollen. This allergy can be a hazard of employment in the agricultural areas.- - - - - - - - - - ranking = 1keywords = sensitivity (Clic here for more details about this article) |
3/133. urticaria from beer: an immediate hypersensitivity reaction due to a 10-kDa protein derived from barley.BACKGROUND: urticaria from beer has been reported in atopic patients. In these subjects, the skin-prick test positivity to and presence of specific serum immunoglobulin (Ig)E for barley malt, the basic ingredient used in brewing, suggested a type I hypersensitivity to barley component(s). OBJECTIVE: To identify the beer allergen(s) and to investigate the presence of related proteins in barley. methods: Three patients with urticaria from beer and other atopic people, some of them suffering from baker's asthma, were examined for both prick test sensitivity to and the occurrence of serum-specific IgE for partially purified proteins from beer. Allergen identification in beer, malt and barley was performed by immunoblotting. RESULTS: Skin-prick tests and detection of specific IgE by both solid-phase (RAST) and liquid-phase (AlaSTAT) assays demonstrated that the 5-20-kDa beer protein fraction contained the allergen. Immunoblot analysis with sera of patients with urticaria from beer showed that IgE bound only the 10-kDa protein band in beer and malt, whereas a main 16-kDa protein was revealed in barley in addition to a very faint 10-kDa band. With the serum of a patient suffering from baker's asthma no IgE binding bands were observed in beer, whereas specific IgE binding to several proteins, including a major 16-kDa component, were detected for both malt and barley. CONCLUSIONS: urticaria from beer is an IgE-mediated hypersensitivity reaction induced by a protein component of approximately 10 kDa deriving from barley. This allergen does not seem to be related to the major barley 16-kDa allergen responsible for baker's asthma. Because of the severity of the allergic manifestations to beer we recommend testing atopic patients positive to malt/barley and/or who exhibit urticarial reactions after drinking beer for their sensitivity to this beverage.- - - - - - - - - - ranking = 8keywords = sensitivity (Clic here for more details about this article) |
4/133. Allergic reactions to lignocaine.True allergic reactions to local analgesics are extremely rare. This case report illustrates the procedures adopted to manage a patient with a history of suspected allergy. A young woman was found to have a true type I hypersensitivity to lignocaine. Another routinely used local analgesic agent, prilocaine, was tested by the same methods and found to give no allergic response. Dental treatment was successfully completed using the latter and the patient advised to wear a medical alert bracelet.- - - - - - - - - - ranking = 1keywords = sensitivity (Clic here for more details about this article) |
5/133. Positive skin tests in late reactions to radiographic contrast media.In the last few years delayed reactions several hours after the injection of radiographic and contrast materials (PRC) have been described with increasing frequency. The authors report two observations on patients with delayed reactions in whom intradermoreactions (IDR) and patch tests to a series of ionic and non ionic PRC were studied. After angiography by the venous route in patient n degree 1 a biphasic reaction with an immediate reaction (dyspnea, loss of consciousness) and delayed macro-papular rash appeared, whilst patient n degree 2 developed a generalised sensation of heat, persistent pain at the site of injection immediately and a generalised macro-papular reaction after 24 hours. The skin tests revealed positive delayed reactions of 24 hours and 48 hours by IDR and patch tests to only some PRC with common chains in their structures. The positive skin tests are in favour of immunological reactions and may help in diagnosis of allergy in the patients.- - - - - - - - - - ranking = 0.056817316447342keywords = contrast (Clic here for more details about this article) |
6/133. Protamine allergy as a complication of insulin hypersensitivity: A case report.BACKGROUND: Although most patients receiving insulin produce insulin-specific IgE, significant allergic symptoms develop in very few of them. patients receiving neutral protamine Hagedorn (NPH) insulin are at increased risk for the development of protamine hypersensitivity. The case of a 19-year-old woman with insulin-dependent diabetes and regular and NPH insulin hypersensitivity is presented. OBJECTIVE: The purpose of this study was to determine whether desensitization to NPH insulin, as well as standard insulin desensitization, could control allergic symptoms in a patient allergic to both NPH and regular insulin. methods: The patient required insulin desensitization for severe urticaria, angioedema, and occasional wheezing resulting from her insulin dose. She underwent a standard protocol for insulin desensitization twice in a 2-month period, with persistence in her symptoms. She was found to have high protamine-specific, as well as insulin-specific, IgE levels, and because of her poor response to regular insulin desensitization, she was desensitized to both regular and NPH insulin. RESULTS: Dual desensitization resulted in marked improvement in her symptoms. The patient had recurrence of urticaria and angioedema a year and a half later, at which point the NPH was stopped and she was desensitized to regular insulin. She continued to receive regular insulin 4 times per day over the following 3 years with only occasional hives. CONCLUSION: patients with insulin allergy may not have complete resolution of their symptoms after standard desensitization, particularly those patients with concomitant protamine allergy. These patients may require protamine/NPH desensitization, an alternative insulin preparation, or both.- - - - - - - - - - ranking = 6keywords = sensitivity (Clic here for more details about this article) |
7/133. 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 = 6keywords = sensitivity (Clic here for more details about this article) |
8/133. Effective acute desensitization for immediate-type hypersensitivity to human granulocyte-monocyte colony stimulating factor.BACKGROUND: Granulocyte-monocyte colony stimulating factor (GM-CSF) is the treatment of choice for patients with life threatening neutropenias. Hypersensitivity to GM-CSF may lead to cessation of treatment. Acute desensitization is an alternative mode of managing drug hypersensitivity, especially when other common modes like substitution of offending drug or premedication with antihistamines and/or corticosteroids are not available or fail. CASE REPORT: A 42-year-old woman with a 17-year history of severe chronic mucocutaneous candidal infections became resistant to all common antifungal drugs. As her disorder was associated with defective functions of monocytes and granulocytes, GM-CSF treatment was started yielding a very good clinical effect. After a short period of treatment, however, the patient developed anaphylactic reactions which could not be abolished by preadministration of antihistamines and/or corticosteroids. Replacement of therapy by G-CSF caused identical hypersensitivity phenomena. methods: Prick skin tests with 100, 200, or 400 microg/mL of GM-CSF or G-CSF, using also negative and positive controls, were performed on the patient and three healthy control subjects. A positive local reaction was observed only in patient at the prick point of 200 microg/mL GM-CSF or 400 microg/mL G-CSF. Acute desensitization to GM-CSF was initiated adopting a protocol used for parenteral desensitization to penicillin. RESULTS: The patient tolerated the desensitization procedure very well and we could resume the administration of GM-CSF. For the past 30 months the patient has been treated uneventfully by subcutaneous administration of GM-CSF, 500 microg twice weekly, and is free of candidal infections. Skin prick tests were repeated 1 month postdesensitization and resulted in a very weak response to GM-CSF compared with the predesensitization response. CONCLUSIONS: Acute desensitization can be utilized in patients who develop drug hypersensitivity reactions to GM-CSF. As GM-CSF is a very unique agent and in most cases cannot be replaced by another one, acute desensitization may play a very important role in managing failure of GM-CSF treatment due to hypersensitivity reactions.- - - - - - - - - - ranking = 9keywords = sensitivity (Clic here for more details about this article) |
9/133. Delayed and immediate hypersensitivity reactions associated with the use of amalgam.Hypersensitivity to the constituents of dental amalgam is uncommon. When it occurs it typically manifests itself as a lichenoid reaction involving a delayed, type IV, cell-mediated hypersensitivity response. Rarely, a more acute and generalised response can occur involving both the oral mucosa and skin. We describe two cases that illustrate the presentation and management of these two types of reaction.- - - - - - - - - - ranking = 6keywords = sensitivity (Clic here for more details about this article) |
10/133. fever, rash and worsening of asthma in response to intravenous hydrocortisone.We describe a case of a hypersensitivity reaction to intravenous hydrocortisone in a 64-year-old female with asthma, and briefly review other cases.- - - - - - - - - - ranking = 1keywords = sensitivity (Clic here for more details about this article) |
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