1/11. A case of jellyfish sting.Jellyfish sting may result in a wide range of symptoms from common erythematous urticarial eruptions to the rare box-jelly induced acute respiratory failure. In taiwan, with the increasing frequency of international travel, cases of jellyfish sting to foreigners are on the rise. We report a case of jellyfish sting with the rare presentation of painless contact dermatitis. A 38-y-o man accidentally stepped on a sea urchin with his right foot during scuba diving in a beach in thailand. Traditional therapy with vinegar was applied on the lesion. However, when he returned to taiwan, erythematous patches on the left thigh with linear radiations to the leg were discovered. The skin lesions had bizzare shapes and showed progressive change. No pain or numbness was noticed. Jellyfish stingwas suspected, topical medications were applied, and the patient recovered without complication. Jellyfish stings usually result in a painful erythematous eruption. In this case, though the lesion involved a large surface, there was no pain. delayed diagnosis of jellyfish sting was due to the atypical presentation and the physician's unfamiliarity to the Thai jellyfish sting. awareness to the wide spectrum of jellyfish sting symptoms should be promoted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Allergic reactions to isosulfan blue during sentinel node biopsy--a common event.BACKGROUND: Sentinel lymph node (SLN) dissection in the management of high-risk melanoma and other cancers, such as breast cancer, has recently increased in use. The procedure identifies an SLN by intradermal or intraparenchymal injection of an isosulfan blue dye, a radiocolloid, or both around the primary malignancy. methods: At the time of selective SLN mapping, 3 to 5 mL of isosulfan blue was injected either intradermally or intraparenchymally around the primary malignancy. From October 1997 to May 2000, 267 patients underwent intraoperative lymphatic mapping with the use of both isosulfan 1% blue dye and radiocolloid injection. Five cases with adverse reactions to isosulfan blue were reviewed. RESULTS: We report 2 cases of anaphylaxis and 3 cases of "blue hives" after injection with isosulfan blue of 267 patients who had intraoperative lymphatic mapping by the procedure described above. The 2 patients with anaphylaxis experienced cardiovascular collapse, erythema, perioral edema, urticaria, and uvular edema. The blue hives in 3 patients resolved and transformed to blue patches during the course of the procedures. CONCLUSIONS: The incidence of allergic reactions in our series was 2.0%. As physicians expand the role of SLN mapping, they should consider the use of histamine blockers as prophylaxis and have emergency treatment readily available to treat the life- threatening complication of anaphylactic reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Montelukast-induced generalized urticaria.OBJECTIVE: To report a case of generalized urticaria induced by montelukast treatment. CASE SUMMARY: A 28-year-old man with allergic rhinitis and moderate persistent asthma developed generalized urticaria 5 days after the initiation of montelukast and inhaled fluticasone. Symptoms disappeared within one day after suspension of both drugs. Two months later, after the resumption of montelukast and fluticasone, the patient developed generalized urticaria and eyelid angioedema, which were successfully treated with intravenous betamethasone, achieving complete remission within hours. After 2 days, the patient resumed inhaled fluticasone only and continued this therapy for several months without any adverse reaction. DISCUSSION: We attributed the adverse reaction to montelukast because of the temporal relationship between use of montelukast and urticaria, the absence of other identified causative factors and other explanations for allergic reactions, and the positive dechallenge and rechallenge. The Naranjo probability scale showed a probable relationship between skin manifestations and montelukast treatment. CONCLUSIONS: The use of antileukotrienes is increasing in asthma therapy. In cases of generalized urticaria in asthmatic patients undergoing montelukast therapy, physicians should be aware of a potential adverse reaction to this drug.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Recurrent, localized urticaria and erythema multiforme: a review and management of cutaneous anthrax vaccine-related events.The October 2001 domestic anthrax attacks affected 22 people, resulting in 5 fatalities. The added global terrorist threats have created an increasing need for homeland protection, as well as protection of our widely deployed forces battling terrorism. It is now relevant for physicians to be familiar with both clinical anthrax and adverse vaccine-related events associated with the resumption of the anthrax vaccine program. Dermatologists played a lead role in the initial response to the anthrax attack. We must be the lead providers most familiar with the cutaneous reactions that may be seen with the preventive vaccination. This article reviews the latest recommended evaluation and management of anthrax vaccine adverse events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Monoclonal gammopathy in association with allergic disorders of the skin and respiratory tract.Monoclonal gammopathy is a condition characterized by the abnormal proliferation of a single clone of plasma cells, which produces a homogeneous monoclonal protein. It has been reported to occur in association with urticaria in the context of Schnitzler's syndrome and also has been observed to occur in angioedema with acquired C1 esterase inhibitor deficiency. We report 11 cases of monoclonal gammopathy presenting to practicing allergists (>2.5% of those screened) primarily in association with dermatologic disorders, i.e., urticaria, angioedema, and nonspecific dermatitis, but also with allergic respiratory disorders, i.e., allergic rhinitis, chronic sinusitis, and asthma. Most of the patients with dermatologic manifestations had respiratory disorders as well, three with chronic sinusitis. To our knowledge, these are the only such cases reported in patients with urticaria or angioedema in the absence of Schnitzler's syndrome or C1 inhibitor deficiency or in association with chronic sinusitis, allergic rhinitis, or asthma. Monoclonal gammopathy, angioedema, urticaria, allergic respiratory disorders, and sinusitis could be linked through antigenic stimulation as a trigger, either infectious, as in chronic sinusitis; self-antigens, as in autoimmunity; or the monoclonal gammopathy itself, causing idiotype-anti-idiotype immune complexes and inflammatory disease. The allergist, dermatologist, otolaryngologist, and primary care physician should all maintain a high index of suspicion for the occurrence of monoclonal gammopathy in the "allergic" population. serum protein electrophoresis and/or serum immunofixation are useful screening tools. When monoclonal gammopathy is found, the presence of light chains in the urine should be assessed and the patient should be referred for prompt hematology-oncology evaluation with periodic monitoring for the development of plasma cell dyscrasias. Additional prospective study is necessary to determine the true prevalence of monoclonal gammopathy in the population presenting to the practicing allergist.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Urticarial contact dermatitis in food handlers.OBJECTIVE: To show that prick testing (using fresh samples of the food suspected from the patient's history) and not only patch testing is the appropriate investigation in selected cases of hand dermatitis in patients who spend considerable time handling foods (for example, catering workers, cooks). SETTING: The Contact and Occupational dermatitis Clinic at the Skin and Cancer Foundation, a tertiary referral centre in Sydney. patients: Fourteen patients with hand dermatitis present for an average of 6.17 years referred by dermatologists and occupational health physicians. INTERVENTIONS: Patch and prick tests were performed for each patient. RESULT: In all patients prick tests identified the food allergens. seafood was the most common allergen giving positive results in 10 patients. patch tests did not identify any of the food allergens. Of the 14 patients nine were followed up and seven of these had been forced to change their career direction. CONCLUSION: Prick testing is the appropriate investigation in selected cases for the diagnosis of urticarial contact dermatitis in food handlers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. pancytopenia, rash and fever caused by diethylstilbestrol used for prostate cancer.pancytopenia, rash, and fever developed in a 66-year-old man being treated for metastatic prostate cancer with diethylstilbestrol (DES). Only the withdrawal of DES resulted in the prompt resolution of symptoms, signs, and laboratory manifestations. Both immunologic and endocrinologic mechanisms are implicated and must be considered by physicians using DES for the palliative management of prostate cancer.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. 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) |
9/11. Chronic urticaria associated with bacterial infection. A case of dental infection.In most cases of chronic urticaria, a specific etiology cannot be determined. This should not discourage the physician from continuing to search for its underlying cause. infection has long been considered a cause of urticaria, although the incidence is probably low when all other common causes are considered. A case of chronic urticaria of five years duration, which was associated with chronic extensive dental infection and periodontal disease, is presented to show the importance of infection as a trigger mechanism of urticaria.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Familial cold urticaria: a father and daughter with typical clinical and laboratory features.BACKGROUND: Familial cold urticaria is a rare, autosomally dominant disease of interest to physicians treating urticarial-type diseases. OBJECTIVE: To describe two patients, a father and daughter with the characteristics of this disease and review the features that differentiate it from other cold-induced syndromes. methods: Both patients underwent a cold room challenge, a lesional skin biopsy, and an ice-cube test, P-K test and extensive laboratory studies pre- and post-cold-room challenge. RESULTS: A careful history revealed winter outbreaks of erythematous, nonpruritic lesions occurring hours after cold air exposure since early childhood. Systemic symptoms included burning, chills, and arthralgias rather than the anaphylactic symptoms associated with acquired urticarias. Cold room challenge induced "non-urticarial" lesions after a delay of one-half to two hours. Lesional biopsy demonstrated polymorphonuclear infiltration with increased eosinophils. ice-cube tests and P-K tests were negative, and laboratory studies were remarkable only for a rise in leukocytes and erythrocytic sedimentation rate after positive challenge. Abnormal serum proteins were not found. CONCLUSION: Familial cold urticaria is an inherited disease with distinct characteristics that distinguish it from acquired cold urticarias and other cold-induced syndromes. Most importantly, lesions occur with a delay after exposure to cold air and are not urticarial. Anaphylactic symptoms do not occur and abnormal serum proteins are not found.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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