1/13. The treatment of bovine collagen allergy with cyclosporin.BACKGROUND: Bovine collagen is currently the most common substance used in soft-tissue augmentation. Although patients should undergo routine skin testing for allergy to bovine collagen prior to treatment, hypersensitivity reactions may rarely still occur. Previously, there have been no reliable methods of treatment for these reactions, and physicians could only reassure patients that the reaction would slowly disappear. OBJECTIVE. The use of oral cyclosporin in a patient with hypersensitivity to bovine collagen was evaluated. methods: A patient with an allergic reaction to implanted bovine collagen was started on cyclosporin 175 mg p.o. bid (5 mg/kg/day) after no improvement was seen after treatment with oral and topical steroids. The cyclosporin was started on Day 23 of the allergic reaction. RESULTS: Improvement in the itching and redness was noted by Day 28 of the allergic reaction, and complete clinical resolution of the allergic reaction was noted on Day 41. On Day 47, the cyclosporin was stopped without recurrence of symptoms. The patient did not experience side effects from cyclosporin, and her blood pressure and renal function remained normal. CONCLUSION: This case report shows that oral cyclosporin A may be a safe and effective treatment for bovine collagen hypersensitivity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Allergic reaction to spinal cord stimulator.OBJECTIVE: The objective was to report on the possibility of allergic reaction to the components of a spinal cord stimulator. DESIGN: We describe a severe allergic reaction after the insertion of a spinal cord stimulator in a patient with complex regional pain syndrome type 1. SETTING: The patient was being followed in an office-based pain management practice. PATIENT: The patient is a 41-year-old woman with complex regional pain syndrome type 1, posttrauma. Intervention: Insertion of a cervical and lumbar spinal cord stimulator. OUTCOME MEASURES: The outcome measures were a numerical scale of pain intensity and the ability to perform the activities of daily living. RESULTS: Adequate pain control complicated by allergic reaction. CONCLUSIONS: There exists a possibility that a patient may experience an allergic reaction to spinal cord stimulator components. Recognition of such contact sensitivity is important for physicians implanting such devices. patients may be misdiagnosed as having infections, which can delay appropriate management; definitive diagnosis can be confirmed with a patch test. Treatment consists of removal of such devices.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. The "Peter Pan" syndrome and allergy practice: facilitating adherence through the use of social support.The complexity of care of some patients in an allergy-immunology practice may be increased by behavioral abnormalities of the patients. Facilitating adherence through the use of social support may be the most effective treatment strategy for some of the most difficult of these patients. We report three patients whose medical management problems were alleviated largely because of the participation of their support system. All three patients were stabilized because of the acceptance of responsibility and support of the physician by the designated member of the patient's support system. The range of social support used to manage nonadherent patients ranged from directly providing instructions to a family member to the consistent presence of a spouse or companion at multiple clinical visits. In all cases, the success in management was attributed largely to the presence of a support system.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. burning mouth syndrome.A critical component of the dental hygiene process of care is assessment of the oral and general health conditions of clients. Some clients present with burning and painful sensations in the oral cavity in the absence of any noticeable disease. This condition has been referred to as burning mouth syndrome (BMS), an often complicated condition. Various local, systemic, and psychological factors have been linked with BMS, but its etiology is not fully understood. Yet as many as one million people are affected by it in the united states, and it is an increasingly-common problem in the aging population. Middle-aged women, mostly postmenopausal, are diagnosed with symptoms seven times more frequently than men. Careful diagnosis and treatment are necessary to alleviate the symptoms of this condition. Referral to a physician is warranted in some cases. The purposes of this course are to review the etiologic factors and clinical implications related to this condition and to discuss appropriate dental hygiene interventions. Collaboration among the client, dental hygienist, dentist, and physician provides for interdisciplinary actions that can lead to palliation of symptoms and evaluation of the possible underlying factors contributing to the condition.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/13. latex anaphylaxis in an obstetrics and gynecology physician.latex anaphylaxis caused by surgical gloves developed in a physician with a history of urticaria to latex. Standard therapy with epinephrine and fluids was effective. latex allergy should be included in the differential diagnosis for anaphylaxis in a patient or a physician.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
6/13. Clinical holistic medicine: developing from asthma, allergy, and eczema.This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/13. Late diagnosis of tree nut and sesame allergy in patients previously sensitized but tolerant to peanut.BACKGROUND: Recent studies have indicated that tolerance to peanut can occur in patients with a history of peanut allergy. Tree nut and sesame allergies have been reported to occur at increased incidence in patients with peanut allergy. Although the coexistence may be simply due to a predisposition to food allergy in these individuals, cross-reactivity has been demonstrated between peanut and tree nuts and between peanut and sesame seed. OBJECTIVE: To describe 3 patients previously sensitized but tolerant to peanut who were subsequently diagnosed as having either tree nut or sesame allergy. methods: All the patients had a clinical history of peanut sensitivity and underwent follow-up peanut skin testing to commercial extracts using a bifurcated needle followed by a graded peanut challenge. One patient had a previous positive radioallergosorbent test reaction to sesame and underwent a graded sesame challenge. RESULTS: All the patients had negative peanut challenge results. Two patients subsequently had exposure to tree nuts at home and had systemic reactions and positive skin test reactions to the incriminated tree nut. One patient had a positive challenge reaction to sesame. CONCLUSION: Demonstration of tolerance to peanut may falsely reassure patients and physicians that patients no longer need to avoid tree nuts or sesame. Tree nut and sesame allergies can exist or develop in patients despite the development of tolerance to peanut.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. Clinical ecology in the workplace.The field of clinical ecology is based on a putative diagnosis of "environmental illness," applied to persons who have multiple symptoms and are believed to be sensitive to numerous items in the environment. Increasingly this diagnosis is being used by workers for an occupational disability claim. medical records of 90 workers claiming work-related "environmental illness" were reviewed. The majority were women. They worked in a variety of occupations with no unifying feature of the type of work or the claimed causative exposure. Symptoms were multiple and unaccompanied by objective clinical findings. Careful review of medical records showed that most had their symptoms before the claimed occupational exposure. Examining physicians who were not clinical ecologists invariably arrived at other diagnoses, usually psychiatric. This retrospective review lends no support to the clinical ecology concept of "environmental illness."- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. Workers with multiple chemical sensitivities: psychosocial intervention.Treatment of MCS, an illness characterized by reaction to a multiplicity of factors coming from within the patient and from the social and physical environment, must incorporate multiple types of help, all directed toward supplying what these patients require. Medical, psychiatric, and social work treatment are all significant and all different, with overlap in several areas. As in all practice in the medical setting, the overall function of the social worker is to enable the MCS patient to make use of what the physician has to offer by supporting the patient's capacity to cope with the social and emotional impact of his/her illness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. Allergic sino-orbital mycosis. A clinical and immunologic study.We present a case of pansinusitis with orbital involvement associated with an allergic response to the fungus Curvularia (Cochliobolus) lunata. Key elements to the diagnosis included a predominant eosinophilic response of the sinus mucosa, the presence of a characteristic mucoid exudate containing fungal hyphae, peripheral blood eosinophilia, serum precipitins against C lunata, elevated serum total and Curvularia-specific IgE and IgG concentrations, and immediate cutaneous reactivity to C lunata antigen. This report suggests that an exaggerated allergic response should be considered in the pathogenesis of pansinusitis. The presence of fungal hyphae in sinus mucosal specimens should alert the physician to the possibility of this disease. Sinus fungal cultures, as well as thorough immunologic evaluation, of such patients is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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