1/40. Galvanic urticaria.A variety of environmental stimuli, such as vibration, ultraviolet radiation, and exposure to water, are recognized as causes of "physical urticaria." A medical student, participating in a demonstration of a galvanic device used in the treatment of hyperhidrosis, demonstrated urticaria in response to this galvanic stimulation.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/40. Contact urticaria from rice.A 30-year-old man with atopic dermatitis had had erythema and itching of the hands after washing rice in water, though he had always eaten cooked rice without problems. Handling test with water used to wash regular rice was performed on abraded hands, and produced urticarial erythema after several minutes. Applications of water used to wash allergen-reduced rice were negative for urticarial reaction. Prick test with water used to wash regular rice was . However prick test reaction with water used to wash allergen-reduced rice was . histamine-release test of regular rice-washing water was grade 3 and that of allergen-reduced rice grade 1. In immunoblotting analysis with regular rice washing water, there were no bands with this patient. These results suggest that the allergen responsible for contact urticaria in this patient might be water-soluble, heat-unstable, and not contained in allergen-reduced rice.- - - - - - - - - - ranking = 8keywords = water (Clic here for more details about this article) |
3/40. Contact urticaria caused by heat-sensitive raw fish allergens.patients allergic to fish usually present with skin reactions after handling raw fish. Less frequently, these reactions are seen without symptoms after oral intake, often in chefs and food handlers. We have attempted to explain the skin selectivity of such reactions in a 36-year-old woman with contact urticaria after handling raw fish. We obtained aqueous extracts of raw and cooked fish (sole and hake) for in vivo (prick test) and in vitro (SDS-PAGE, IgE Immunoblot) tests. Prick-by-prick test, 20-min closed patch test, rub test with fresh and cooked fish (sole, hake and cod) and specific IgE (CAP-system) to sole, cod and hake were performed. The strength of positive reaction to raw fish was greater than to cooked fish on both prick and prick-by-prick testing. Rub tests showed positive responses only to raw fish. Specific IgEs to sole (45 KU/l), hake (66.9 KU/l) and cod (18.7 KU/l) were obtained. IgE immunoblot recognized 3 antigens of 25, 48, 56 kDa in raw sole and 1 of 42 kDa in raw hake extracts. No IgE binding was observed with the cooked extracts or control sera. Our findings strongly suggest a Type-I hypersensitivity to fish. Immunoblot analyses demonstrated a loss of specific IgE binding to cooked extracts. We have reported a case of contact urticaria caused by heat-sensitive raw-fish allergens in a patient who probably became sensitized via the cutaneous route.- - - - - - - - - - ranking = 0.12350782565845keywords = intake (Clic here for more details about this article) |
4/40. Familial aquagenic urticaria associated with familial lactose intolerance.Aquagenic urticaria is a rare disorder characterized by the occurrence of pruritus and wheals after temporary contact with water. The familial occurrence of aquagenic urticaria over 3 generations is reported here in association with familial lactose intolerance, a condition in which the enzyme lactase encoded on chromosome 2, is deficient. In two patients, a young man and his mother, we verified the appearance of pruritic hives 5 to 10 minutes after contact with water of any temperature. Other types of physical urticaria were absent, and mastocytosis was excluded by extensive laboratory investigations; lactose intolerance was confirmed in both patients by H(2)-exhalation test. In these patients the clinical symptoms did not respond to antihistamines or UV-radiation therapy. Four other members of the family had wheals from water contact, two of whom had lactose intolerance. Two other members had lactose intolerance only. Although the association of aquagenic urticaria with lactose intolerance may be coincidental, attention is drawn to the fact that the 2 conditions, known to be familial, may coexist in the same family, possibly based on an association of gene loci.- - - - - - - - - - ranking = 3keywords = water (Clic here for more details about this article) |
5/40. Anaphylactic shock to oysters and white fish with generalized urticaria to prawns and white fish.Because seafood consumption is moderate-to-high in spain, allergic reactions to seafood such as fish, crustacea and mollusc are fairly frequent. The clinical features of these reactions depend on the implicated species and whether the reaction is provoked by ingestion, handling or vapor inhalation. Because different species have common antigenic structures, cross-sensitization is frequent, especially between crustaceans and molluscs. Contamination of fish by nematodes (anisakis) may produce severe reactions.We report the case of a female patient with no personal or family history of allergy who experienced two episodes of anaphylactic shock: the first occurred immediately after eating oysters and the second after ingestion of white fish. The patient also developed generalized urticaria provoked by crustacean (prawns) and white fish. The results of skin prick tests were negative for fish, shellfish, crustacean and oysters while in vitro tests were positive for oyster, prawns, anisakis, ascaris and echinococcus, although stool samples and gastric endoscopy were negative.- - - - - - - - - - ranking = 0.49699874797541keywords = consumption (Clic here for more details about this article) |
6/40. Localized heat urticaria in a patient is associated with a wealing response to heated autologous serum.We report a case of localized heat urticaria in a 71-year-old woman who developed weals and loss of consciousness after taking a bath. Exposing her skin to heat at 40 degrees C or immersing her hands in water at 40 degrees C produced urticarial lesions and increased her plasma histamine level. Desensitization with hot water improved her symptoms and normalized her plasma histamine level after heat challenge. An intracutaneous injection of her serum produced no reaction, while an injection of her serum that had been heated at 40 degrees C for 15 min induced a weal flare response. Further examination revealed that the weal-inducing activity of her heated serum remained for at least for 6 h and that treatment of her serum at 60 degrees C for 2 h did not abrogate its weal-inducing activity. These findings indicate that certain materials in her serum that are activated by heat are responsible for the development of her anaphylactic and urticarial reactions and that these reactions may be mediated by histamine.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
7/40. anaphylaxis to proton pump inhibitors.proton pump inhibitors (PPI) are widely used for the treatment of peptic ulcer, but cases of anaphylactic reactions have rarely been described. We present a patient who experienced an episode of urticaria 30 minutes after oral intake of an omeprazole capsule.skin prick tests to omeprazole, pantoprazole and lansoprazole were positive. Challenge test with lansoprazole was carried out and within 45 minutes the patient developed urticaria, facial edema, vomiting, and hypotension. Oral challenge with other imidazole derivatives (ketoconazole, cimetidine, metronidazole) were carried out with good tolerance.serum tryptase levels determined 3 hours after the adverse reaction to lansoprazole were elevated. Specific IgE to PPI were not detected by an enzyme-linked immunosorbent assay technique.The clinical findings, positive skin prick test to PPI and elevated serum tryptase levels suggest that an IgE-mediated mechanism was implicated in the reactions to both omeprazole and lansoprazole. skin prick tests may be a useful tool for detecting patients sensitized to PPI.An experimental protocol was used to detect specific IgE antibodies against PPI, which may explain RAST negativity.The previous findings suggest that cross-reactivity between PPI exists, but not with other imidazoles.- - - - - - - - - - ranking = 0.12350782565845keywords = intake (Clic here for more details about this article) |
8/40. Aquagenic urticaria.Aquagenic urticaria is a rare form of physical urticaria characterized by small follicular wheals with an erythematous flare upon exposure to water. We describe typical lesions in a seven-year-old boy with aquagenic urticaria, cholinergic urticaria, and symptomatic dermatographism, who responded to treatment with ultraviolet B and oral antihistamines.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
9/40. Scombroid poisoning. A report of seven cases involving the Western Australian salmon, Arripis truttaceus.OBJECTIVE: To present the clinical findings of scombroid poisoning due to ingestion of the Western Australian salmon, Arripis truttaceus, occurring in two separate outbreaks involving seven patients. Both outbreaks occurred in March and the fish had been caught in South Australian waters. CLINICAL FEATURES: Onset of symptoms in all patients occurred within half an hour of ingestion of the affected fish. The clinical syndrome included erythema and urticaria of the skin, facial flushing and sweating, palpitations, hot flushes of the body, headache, nausea, vomiting and dizziness. The fish implicated in one outbreak was noted to have a peppery taste. The diagnosis of scombroid poisoning was confirmed by the presence of the clinical syndrome, and by demonstration of high histamine levels in the cooked fish. INTERVENTION AND OUTCOME: Two patients had minor symptoms which had resolved before seeking medical advice. Another two patients had mild symptoms which disappeared after two hours of observation and required no specific treatment. Three patients had evidence of major toxicity which was successfully treated with parenterally administered promethazine. One of the three patients with major toxicity required overnight admission and repeated doses of promethazine to eradicate her symptoms. No patient had symptoms for longer than 12 hours. CONCLUSION: Scombroid poisoning is caused by ingestion of fish which has accumulated scombrotoxin during spoilage. The toxin is heat stable and has been identified as histamine. The clinical presentation closely resembles an acute allergic reaction. This similarity in symptoms may result in the diagnosis of scombroid poisoning being missed by clinicians. patients with the symptom complex may be incorrectly informed that they are allergic to the fish species. diagnosis is clinical and can be confirmed by analysis of the histamine content of the fish. Treatment is with antihistamines, however major toxicity may require the same aggressive management as acute anaphylaxis.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
10/40. Allergy to banana in a 5-month-old infant.Food proteins can sensitize the infants via different sources. A 5-month-old boy suffered three episodes of generalized urticaria 20 min after the ingestion of a fruit puree containing apple, banana and orange. skin testing showed positive results to banana and chestnut. Other tests were negative. The value of specific immunoglobulin e (Pharmacia CAP-FEIA, Uppsala, sweden) to banana was 58 KU/l, to orange was 9.7 KU/l, to chestnut was 5.6 KU/l and to latex was 1.6 KU/l. Orange, apple and latex products were well tolerated. He never had eaten chestnut. The parents rejected a banana challenge test. The route of sensitization in our case might be via placenta, breast-milk, and inadvertent oral intake of food or even via inhalation. An early frequent exposure to banana allergens was considered a possibility factor for the development of banana sensitization. We found that the banana consumption during pregnancy and lactation by the mother of our patient was greater than usual. It is not frequent to find so high levels of sensitization to any fruit in first year of life. In our case, latex, chestnut and orange sensitizations did not seem to be clinically relevant. However, latex and foods known to cross-react with banana antigens should be given to banana-sensitive individuals with great caution.- - - - - - - - - - ranking = 0.62050657363386keywords = consumption, intake (Clic here for more details about this article) |
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