1/262. Sight-threatening acute orbital swelling from peribulbar local anesthesia.Severe allergic reactions to peribulbar local anesthesia are extremely rare. A 70-year-old woman presented with acute orbital swelling and optic nerve dysfunction after a peribulbar local anesthetic injection. The patient was treated with acute orbital decompression as well as intravenous antibiotics and methylprednisolone; she made a good recovery. An allergy, probably to lignocaine, was the most likely cause. Urgent recognition and treatment of this condition may prevent potentially serious visual consequences.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
2/262. cholestasis and liver cell damage due to hypersensitivity to erythromycin stearate--recurrence following therapy with erythromycin succinate.erythromycin is a frequently used antibiotic in patients with atypical respiratory infection and/or an allergy to penicillin. We report the case of a young woman who developed severe cholestasis and jaundice following treatment with erythromycin stearate. Two years later her general practitioner prescribed erythromycin succinate for pharyngitis. She experienced a severe second episode of jaundice and malaise. Different esters of erythromycin have been introduced to reduce side effects such as allergic reactions to erythromycin. The findings in our patient underline the fact that hypersensitivity is caused by the erythromycin molecule, independent from the type of esterification. Because of these side effects newer makrolides should be given preference over erythromycin.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
3/262. 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 = allergy (Clic here for more details about this article) |
4/262. Evidence of anaphylaxy after alteplase infusion.BACKGROUND AND PURPOSE: Although alteplase, a recombinant tissue plasminogen activator (tPA), is structurally identical to endogenous tPA and therefore should not induce allergy, single cases of acute hypersensitivity reactions have been reported. Until now, specific antibodies against alteplase were not detected in blood samples obtained in these patients. CASE DESCRIPTION: We report an anaphylactic reaction in a 70-year-old white female who was treated with intravenous alteplase for thrombolysis of acute ischemic stroke 160 minutes after onset of a right-sided hemiparesis. Thirty minutes after infusion of alteplase had been started, the patient suffered acute severe sinus tachycardia and hypotension, followed by cyanosis and loss of consciousness. The alteplase infusion was stopped, and following antiallergic therapy, tachycardia and hypotension resolved within 1 hour. The hemiparesis remained unaltered, but additional harm resulting from the hemodynamic complication was not observed. serum samples analyzed with a radioimmunoprecipitation assay were negative for total antibodies to alteplase, but in a subsequent ELISA, both samples were positive for IgE antibodies to alteplase. CONCLUSIONS: The detection of specific IgE antibodies reactive with alteplase in this patient could provide the first evidence of an anaphylactic-type reaction to alteplase in man. Because previous exposure to alteplase can be excluded, the results suggest that this patient had preexisting antibodies that were cross-reactive with one or more epitopes of alteplase and therefore precipitated the anaphylactic-type reaction.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
5/262. 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 = allergy (Clic here for more details about this article) |
6/262. Allergy to local anaesthetic: the importance of thorough investigation.A case report is presented which highlights the importance of a good history in arriving at the correct diagnosis in cases where allergy to local anaesthetic is suspected. Management of the patient is discussed and the topic of 'adverse reaction' briefly reviewed.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
7/262. anaphylaxis after thrombin injection of a femoral pseudoaneurysm: recommendations for prevention.After the injection treatment of a femoral pseudoaneurysm, an anaphylactic reaction occurred in a patient undergoing hemodialysis who previously had repeated exposure to thrombin. Before injecting bovine thrombin in patients with a history of prior exposure, we recommend that they undergo skin prick testing to detect possible allergy.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
8/262. Photosensitivity to lomefloxacin. A clinical and photobiological study.Photosensitivity is an uncommon but characteristic side effect of quinolones, with a variable incidence for the different drugs. Several cases, considered either phototoxic or photoallergic, have been described with lomefloxacin use. During the last 4 years we studied 8 patients (mean age 69.4 years) with eczematous or acute sunburn-like lesions in photo-exposed areas, after taking lomefloxacin for a period of one week to several months. After drug withdrawal and systemic and/or topical corticosteroids, lesions cleared within one week to two months, with dischromia in one patient. Six to eight weeks thereafter, a photobiological study was performed. Minimal erythema dose (MED) for UVA and UVB were normal and photopatch tests with lomefloxacin, ofloxacin, ciproflaxacin and norfloxacin, tested at 1%, 5% and 10% in petrolatum and irradiated with 5 and 10 J/cm2 UVA were negative in 7 patients and 20 controls. Patient 1 had a positive photopatch test with lomefloxacin. One patient, who inadvertently reintroduced the drug before photopatch testing, developed a sharply limited erythematous reaction at 48 h in all irradiated areas, without aggravation at the sites of the quinolones patches. Our patients illustrate the polymorphism of clinical photosensitivity to lomefloxacin and represent the largest series in which photobiological studies have been performed. As in previous reports there are arguments favouring photoallergy, but phototoxicity appears to be the main mechanism of photosensitivity to quinolones, particularly in older patients with concomitant diseases and long-term use of the drug.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
9/262. Tattoo allergy in patients receiving adjuvant radiotherapy for breast cancer.tattooing is routinely employed prior to radiotherapy treatment but allergies to tattoos are rare. New information on the incidence of tattoo allergy at St George Hospital is presented with details of two clinical cases. The literature on tattoo allergy has been unable to estimate the incidence of allergic reaction to tattoos because the total number of patients treated is unknown and not all patients were followed up. Our radiation oncology population for the first time has provided a known denominator, but wide confidence intervals prevent an accurate estimate of the incidence. Salient issues about tattoo allergy are highlighted based on a review of the published literature from 1966 to 1998.- - - - - - - - - - ranking = 7keywords = allergy (Clic here for more details about this article) |
10/262. steroids used to desensitize penicillamine allergy in Wilson disease.patients with Wilson disease require life-long treatment and penicillamine is the drug of choice. We present a 14-year-old boy with Wilson disease who developed hypersensitivity reaction 2 days after starting penicillamine therapy. His symptoms included fever, maculopapular rash and lip edema. The allergic reaction disappeared when penicillamine was discontinued, but relapsed after reinstituting penicillamine at a lower dose. Desensitization was attempted by introducing steroid therapy, the dose of 0.7 mg per kilogram per day of prednisolone for 2 days, then penicillamine was successfully tolerated. Subsequent tapering of the daily prednisolone dose was performed till it was discontinued one month after treatment began. We suggest that concomitant use of steroid and penicillamine should be used for the treatment of patients who develop penicillamine intolerance.- - - - - - - - - - ranking = 4keywords = allergy (Clic here for more details about this article) |
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