1/16. Severe food allergies by skin contact.BACKGROUND: Ingestion is the principal route for food allergens, yet some highly sensitive patients may develop severe symptoms upon skin contact. CASE REPORT: We describe five cases of severe food allergic reactions through skin contact, including inhalation in one. methods: The cases were referred to a university allergy clinic, and evaluation comprised detailed medical history, physical examination, skin testing, serum total and specific IgE, and selected challenges. RESULTS: These cases were found to have a strong family history of allergy, early age of onset, very high total serum IgE level, and strong reactivity to foods by skin prick testing or RAST. Interestingly, reactions occurred while all five children were being breast-fed (exclusively in four and mixed in one). CONCLUSIONS: Severe food allergic reactions can occur from exposure to minute quantities of allergen by skin contact or inhalation. food allergy by a noningestant route should be considered in patients with the above characteristics.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. The necessity for dual food intake to provoke food-dependent exercise-induced anaphylaxis (FEIAn): a case report of FEIAn with simultaneous intake of wheat and umeboshi.BACKGROUND: food-dependent exercised-induced anaphylaxis (FEIAn) is classified among the physical allergies. Many different food allergens have been reported, but the pathophysiology of FEIAn remains unknown. Furthermore, provocation tests with a suspected food do not always succeed in patients with FEIAn. OBJECTIVE: We sought to clarify and investigate causative foods and mechanisms of FEIAn in a 14-year-old boy. In addition, we tested in vivo and in vitro effects of cromolyn sodium in the same patient. methods: We used open challenge tests for the provocation of FEIAn and measured changes in plasma histamine levels and FEV1. In addition, we investigated the mechanism of FEIAn in this case with in vitro histamine release testing. RESULTS: The patient was diagnosed as having FEIAn by provocation testing with a simultaneous intake of wheat and umeboshi, but not when each food was eaten singly, followed by exercise. In addition, his plasma histamine level increased transiently and forced expiratory volume 1, expressed as a percentage change from baseline, decreased significantly. A synergistic effect on in vitro histamine release testing with 2 kinds of the causative foods was shown. Administration of cromolyn sodium proved to be effective on both the in vitro and in vivo tests. CONCLUSION: This is the first report of FEIAn provoked by the test with a simultaneous intake of 2 kinds of food. This case might in part explain negative challenge test results in patients with FEIAn.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/16. Sudden death associated with food and exercise.Exercised-induced anaphylaxis occurs in conjunction with significant physical exertion. anaphylaxis occurring when an individual exercise within a few hours of ingesting a particular food is an unusual variant. Cardiovascular symptoms can be the sole manifestation of exercise-induced food allergies, in which case death may mimic sudden cardiac death during physical exertion due to other pathologic causes. We report the sudden and unexpected death of an individual following the ingestion of hazelnuts and almonds, to which the individual was not previously known to be allergic. The decedent collapsed during vigorous dancing. The death was not associated with cutaneous or laryngeal manifestations of anaphylaxis. awareness of the variable manifestations of food-precipitated anaphylaxis is necessary to correctly establish the diagnosis. An elevated serum tryptase level may be indicative of an allergic reaction, and allergen-specific IgE levels may be used to confirm the particular antigen.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/16. A case of fatal biphasic anaphylaxis secondary to multiple stings: adrenalin and/or a longer observation time could have saved the patient?We report the case of an atopic male, 76 years old, with post-myocardial infarction ischaemic cardiopathy, arterial hypertension and a history of insect-sting induced large local reactions who died because of a biphasic anaphylaxis subsequent to multiple Vespid stings (about 15). Within approximately ten minutes after the stings he developed urticaria, extended erythema and hypotension (90/60 mmHg), measured by a family member. The objective physical examination by the emergency doctor at the patient's home revealed an orticarioid reaction and erythema of the back and neck, an unaffected respiratory apparatus and CNS, normal pupils, a pulse rate of 74, normal blood pressure ranging from 120/70 to 130/60 mmHg. The patient was administered antihistamine and corticosteroid through parenteral route. During the 45' observation period at the patient's home the urticaria subsided but not to completion. Approximately 40 minutes after the emergency doctor left, the urticaria reoccurred, angioedema of the neck and worsening asthenia developed. The patient died, despite attempts to resuscitate him by the emergency doctor that had been called out again. A post-mortem examination revealed generalised eodema of the lungs, brain, glottis, and bowels due to the severe characteristic systemic compromise of anaphylaxis. The Authors discuss whether an early use of adrenalin and/or a longer observation time could have saved the patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/16. exercise-induced urticaria and anaphylaxis.Five patients with exercise-induced anaphylactoid reactions are reported. Because of a growing interest in physical exercise and the severity of the symptoms it is important to recognize this condition, even though rare. All of our 5 patients had a history of urticaria and anaphylaxis in association with physical stress, but it seems difficult to induce anaphylactoid reactions under laboratory conditions. Two different clinical patterns could be distinguished in these patients. Three had the anaphylactoid form with signs of alternative complement pathway activation, while 2 patients had the variant form presenting first as cholinergic urticaria and progressing to angioedema and vascular collapse. The latter patients had elevated plasma histamine levels during challenge, but no sign of complement activation was observed. Our findings suggest differing pathomechanisms for these two forms.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/16. Case report: 30-yr-old female with exercise induced anaphylaxis.This case describes a 30-yr-old white female who presented with a 2-wk history of pruritic rash with exercise. This rash occurred with each bout of exercise and was accompanied by one episode of light-headedness. A bicycle ergometer exercise challenge resulted in a fine wheal and flare rash of the trunk and upper extremities that was associated with symptomatic hypotension. She was diagnosed with exercise induced anaphylaxis, and initial treatment with hydroxyzine was instituted. Side effects from the drug were poorly tolerated, and she was switched to inhaled cromolyn sodium. She had noted resolution of her symptoms while she took cromolyn as recommended. Two months after her initial presentation, she also began to experience the same rash with hot showers. exercise induced anaphylaxis is a well-described form of physical allergy that may be underdiagnosed. As the fitness boom continues and clinicians see more exercising patients, it will be important to recognize and understand this condition. It is a true anaphylactic reaction and, as such, certainly has the potential for significant morbidity and mortality.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/16. Systemic anaphylaxis induced by physical exertion: a case report.anaphylaxis is a systemic reaction which can be very dangerous in many patients. In addition to the most common antigens (drugs, venoms, foods), physical exercise can provoke anaphylaxis in the sensitized patients. The mechanism of this reaction is still unknown. In this report, we describe a case of exercise-induced anaphylaxis in a 25 year old female who had experienced two syncopal attacks during strong physical activity. On other occasions she had noticed that prolonged work would cause urticaria, pruritus and numbness. During hospitalization, on two occasions a treadmill stress test induced bronchial spasm, urticaria and hypotension. We believe that the association of urticaria and anaphylaxis would suggest the possible presence of a vasoactive substance released from the mast-cells and basophil leucocytes.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |
8/16. Celery-dependent exercise-induced anaphylaxis.food-dependent exercise-induced anaphylaxis, first reported in 1983, is a subtype of exercise-induced anaphylaxis. A case of celery-dependent exercise-induced anaphylaxis is reported. The presentation and management of these and other exercise-related physical allergies, including classic and variant cholinergic urticaria, is reviewed. As the prevalence of strenuous physical activity increases, it is important for emergency physicians to recognize unusual, but potentially serious, complications of exercise.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
9/16. The occurrence of multiple physical allergies in the same patient: report of three cases.The syndromes of idiopathic anaphylaxis, exercise-induced anaphylaxis, and other physical allergies are well described as separate entities. This article describes the combination of these problems in the same patient. Two patients with idiopathic anaphylaxis are described. One also has exercise-induced anaphylaxis, and one also has exercise-induced bronchospasm and exercise-induced urticaria and angioedema. A third patient with exercise-induced anaphylaxis, idiopathic urticaria, angioedema, cholinergic urticaria, and dermatographism is described.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
10/16. Urticarial and anaphylactoid reactions following ethanol intake.Ingestion of ethyl alcohol may be associated with a number of adverse reactions. Apart from toxicological effects, intolerance syndromes occur, which are caused by genetic or acquired defects in alcohol metabolism and are manifest clinically as flushing. In addition to these abnormalities, rare cases of generalized urticaria and anaphylactoid reactions after ingestion of ethyl alcohol have been reported, the pathogenesis of which is still a matter of debate. We describe three patients who presented with recurrent generalized urticaria, which developed within minutes of consumption of small amounts of ethyl alcohol. Common causes of chronic recurrent urticaria were excluded by case history, physical examination and laboratory investigations, and by comprehensive allergy testing. All patients produce positive prick tests with acetic acid, and developed urticaria after oral challenge with small amounts of highly purified ethyl alcohol. The symptoms are most probably caused by an intolerance to ethyl alcohol or its metabolites, whereas an allergy sensu strictu seems unlikely.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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