Ways to Reduce Allergies

How To Win Your War Against Allergies

How To Win Your War Against Allergies

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Allergy Relief

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Diagnostic Tests in Allergy

The Future of Allergy Testing The diagnosis of allergic diseases depends first and foremost on a careful medical history taken by a suitably experienced clinician. An allergy history concentrates on the relationship between the consistency of the patient's problems with allergic diseases and the likelihood that the problems are the result of allergen exposure. The clinical suspicion of allergic disease is enhanced when the patient demonstrates IgE specific for the allergen or allergens identified by the history. Ultimately, the diagnosis is confirmed by the patient's response to allergen avoidance or other therapeutic trials. Both skin tests and blood tests for allergen-specific IgE can be very useful in diagnosis when the strengths and limitations of each are understood and appropriately used by the clinician. Key Words Allergy diagnosis skin test antibodies serum test in vitro test. The concept of diagnostic testing in allergy has been confusing for many years. Although there are...

Natural History of Clinical Reactions to Food Allergy

In studies of infants with adverse reactions to cow's milk based formula, some of which were IgE-mediated and some not, 56 became milk tolerant by the age 1 yr, and 87 by the age of 3 yr. All the children with non-IgE reactions were clinically tolerant by age 3 compared with 75 with IgE-mediated milk allergy. Individuals who develop an allergic reaction at any age to peanuts, tree nuts, seeds, fish, or seafood are most likely to have a life-long risk to re-exposure to the specific food protein. Until recently, peanut sensitivity was felt to last at least 14 yr. Current studies have now shown that 20-25 of children originally allergic to peanut were able to tolerate this protein when orally challenged at a later time. Little is known about the true natural history of food allergy to tree nuts, seeds, fish, or seafood. However, these allergies have been assumed to represent a life-long risk, especially if the sensitivity is acquired as an adult. There are case reports of individuals who...

Management Of Food Allergy Or Intolerance

The management of proven or suspected food allergy usually consists of strict avoidance of that food. In some food-intolerance reactions, such as lactose intolerance, the reaction is quantitative, since small amounts of lactose sugar-containing foods can be tolerated. This is in contrast to the case of systemic anaphylaxis, in which food allergens in trace amounts can trigger a serious life-threatening event once the patient is sensitized and preformed IgE antibodies exist to that food. Long-term specific food avoidance may be a problem for patients, especially when they are away from home, while at school eating in the cafeteria, at a restaurant, or at a party. Some foods, like nuts and peanuts, are easily disguised in candies, bakery products, hors d'oeuvres, or salads or salad dressings. The cooking steam from food (e.g., fish or seafood) may precipitate a reaction for specifically sensitive individuals. Processed foods may not have detailed labeling to identify a dangerous food....

Has the incidence of latex allergy increased

In the general population the incidence of latex allergy may be decreasing because of improved recognition of at-risk groups, strategies to avoid latex exposure, and a decrease in latex-containing hospital products. However, in the health-care profession, the incidence is increasing. Standard (previously called universal) precautions have become an everyday practice for health care workers and latex products are an essential feature. The benefit of such practice is to protect these workers from exposure to viral illnesses such as human immunodeficiency virus, hepatitis B and C, and other communicable diseases. Patients are protected from each other as well.

What tests are available to diagnose and characterize a prior allergic reaction Should patients having a prior

Serum tryptase, a mast cell protease, will be elevated after both immunologic and nonimmunologic mast cell activation, so is probably of little value. In vitro tests such as the radioallergosorbent test (RAST) detect IgE antibodies and can be performed for specific drugs but are insensitive. In vivo testing such as skin prick and intradermal testing is of variable usefulness because many patients in the general population are also cross-sensitized to many drugs. For instance, over 9 of the general population will have a positive skin prick test to muscle relaxants. In regard to latex, there are so many proteins that usual skin testing may not identify the causative allergen. Furthermore, skin testing can induce a systemic reaction severe enough to require therapy Many authorities believe that the costs, risks, and limited information gained suggest that testing be undertaken only in unusual circumstances. One instance may be the individual suspected of occupation-related allergies.

Key Points Allergic Reactionsy

To prevent severe allergic reactions, it is important to identify patients at risk and to take a good history. 2. The major causes of anaphylactic reactions in the operating room are muscle relaxants, followed by latex allergy. 3. Concerning latex allergy, proper preparation of the operating room environment is critical. Schedule patients at risk as first cases. Latex and nonlatex-containing supplies should be clearly identified and the former avoided. Powdered gloves should be avoided. 4. The proper medications needed to adequately treat a reaction should it occur must be at hand. Treat allergic reactions aggressively. Accelerate epinephrine doses if needed. 5. It is important to recognize that health care workers are at increased risk for latex hypersensitivity. Avoid the use of powdered gloves wherever possible and be alert for the development of symptoms that might signify latex allergy. 6. Health care workers with type I latex allergy should have proper allergy identification and...

Allergies to Medications

Drug allergies arise from a complicated response by the immune system to a specific medication. A person usually goes through three stages when developing an allergy to a medication. First, he or she must be exposed to the drug by taking one or more doses. Next, the person's immune system identifies the drug as harmful and begins producing antibodies to fight it. Finally, the person takes another dose of the drug, and the allergy symptoms appear. The symptoms may appear immediately, within 1 to 2 hours, or within a few days to a week after taking the drug. Common symptoms of drug allergy include skin rash or hives, difficulty breathing, and itching. Severe drug allergies may cause seizures, loss of consciousness, or shock (see box below). If you have had a previous severe allergic reaction, you will need to carry an injecting device that contains epinephrine with you at all times, so you can inject yourself immediately if you have another allergic reaction. An injection of epinephrine...

National Institute Of Allergy And Infectious Diseases

Purpose The Division of Microbiology and Infectious Diseases (DMID) at the National Institute for Allergy and Infectious Disease (NIAID) supports drug discovery and development services for researchers. The purpose is to facilitate the translation of ideas, generated through basic research, into safe and effective drugs, vaccines, and diagnostics to control and prevent infectious diseases. Pre-clinical drug development services are focused only on therapeutics, and must fill a gap in the drug development pathway.

For Allergic Rhinitis and Food Allergy

For almost all patients with a tendency to develop anaphylactic reactions to foods, such as peanuts, egg proteins, wheat proteins, shellfish, and so on, there is not an effective prophylactic treatment other than strict avoidance of the foods containing the allergenic substances. Because severe allergic reactions to foods affect many young children, the fear of developing anaphylactic attacks resulting from accidental exposure to allergenic foods causes tremendous stress for both the young patients and their parents. Anti-IgE can substantially reduce the sensitivity to the problematic foods.

Unconventional Theories Of Allergy

The principal theories on which most of the unproven allergy practices are based are listed in Table 1. So-called allergic toxemia is the basis for a number of these practices. It is comprised of two mistaken components. It postulates that allergens are inherently toxic and that virtually any subjective symptom in the absence of objective evidence of pathology can be attributed to allergy. In fact, most allergens are nontoxic in the usual dosage and manner of exposure necessary to either induce or elicit an allergic reaction. The presence or absence of potential toxic properties of an allergen is irrelevant to its ability to evoke an allergic immune response. Furthermore, the manifestations of allergic illness result from inflammation and not toxicity. In contrast, proponents of allergic toxemia in its various forms diagnose this condition not in patients with allergic symptomatology, but rather in patients with multiple vague complaints that usually include fatigue, anxiety,...

Other Food Intolerance Reactions That May Be Confused With Allergy

One of the most common gastrointestinal problems that is confused with milk allergy is primary (and secondary) lactose intolerance. The pathogenesis of this reaction is described under Mechanisms. As pointed out, the problem with milk usually begins around age 7, but may start earlier in childhood if the child has had significant gastroenteritis. Then, for the rest of his or her life, ingestion of cow's milk is a problem. This sequence of events is different from that of the individual who is milk protein allergic in that the milk-allergic individual has trouble during early childhood and later is usually able to tolerate milk clinically. The triggering of headaches by vasoactive amines naturally or by food additives may occur with the foods listed in Table 3 and described under Mechanisms. Although the issue of allergy being involved in migraine headache pathogenesis has been long debated, it is rarely proven. In a few cases of patients with migraine headaches, chemical mediator...

Allergy Tests

Acute allergic reactions from insect stings result from IgE antibodies reacting with insect venoms. These antibodies are best detected by the immediate skin test reaction. Individual insect venoms yellow jacket, honeybee, white-faced hornet, yellow hornet, and wasp are commercially available for diagnostic skin tests. A positive skin test is defined as an immediate wheal-and-flare reaction occurring within 10 min after an intradermal skin test with venom doses up to 1.0 pm mL. Higher venom doses cause nonspecific irritative reactions. IgE antibodies in the serum can also be measured by the radioallergosorbent test (RAST). This in vitro test is more expensive and generally less sensitive than the simple immediate skin test. It is estimated that approx 20 of individuals with positive venom skin tests will not have a positive RAST. Thus, the RAST is not recommended for routine diagnosis unless a skin test cannot be performed. There have been isolated observations of people who have had...

Drug Allergy Testing

Elective immediate reacting allergy skin testing is usually available only in the case of p-lactam antibiotic sensitivity, insulin sensitivity and with reactions to components of vaccines (e.g., egg, gelatin). It is available experimentally for papain sensitivity and suspected sensitivity to neuromuscular blocking agents. In vitro blood serum assays are available only to latex, p-lactam antibiotics (penicillin major determinant only) and papain (experimental). These in vitro assays are helpful, if positive. A negative test does not rule out sensitivity. At one time, in vitro cell-mediated drug lymphocyte transformation testing was available in some experimental laboratories. There is little or no current evidence regarding the value of this type of drug reaction testing. Drug allergy testing (skin testing in vitro studies) usually should be done by allergy-immunology specialists who are knowledgeable about the use and interpretation of such tests. Often investigation and management of...

Airborne Allergies

An allergy is an exaggerated or inappropriate response of the immune system to a substance that is harmless to most people. Substances that can cause such reactions are called allergens. Common allergens include pollen, dust particles, certain foods, insect venom, mold, and medications. Doctors think that the reason some people are allergic to a particular substance is because they have inherited a tendency to be allergic (although not necessarily to that particular substance). Being exposed to a potential allergen when the body's defenses are lowered or weakened such as during a viral infection seems to contribute to the development of an allergy. People with allergies are often sensitive to more than one allergen. During an allergic reaction, the immune system is responding to a false alarm. When a person comes into contact with an allergen, the immune system launches an inappropriate immune response by releasing large amounts of an antibody (a disease-fighting protein) called...

Allergies to Food

A food allergy is a reaction of the immune system to a food or food ingredient that most people find harmless. If you eat a food that produces an allergic reaction, your immune system responds by releasing numerous chemicals that cause allergic symptoms. A food allergy is different from a food intolerance, which does not trigger an immune response. A food intolerance (such as lactose intolerance, see page 266) usually arises from an enzyme deficiency and produces symptoms such as stomach cramps, gas, or diarrhea. Food intolerances are relatively common, but a true food allergy is rare, affecting only about 1 percent of the population. The most common foods that cause allergies in adults are fish and shellfish, eggs, and nuts such as peanuts, walnuts, and pecans. Symptoms of food allergy can include skin reactions such as hives or rashes, nasal congestion, asthma attacks (see page 245) in people who have asthma, and gastrointestinal problems such as nausea, gas, or diarrhea. Because...

Allergic Reactions

Drugs or their reactive metabolites can cause an allergic reaction in patients that may be due to either cell-mediated or antibody-mediated reactions. There are various clinical manifestations of hypersensitivity reactions Allergy status must always be confirmed and recorded before the administration of any drug, and patients should be informed of any potential signs or symptoms to watch out for if they are at risk of an allergic reaction.

Cat Allergy

Cats produce several potentially sensitizing allergenic proteins. However, the major allergenic protein, Fel d 1 is implicated in 85-95 of cat-sensitized patients. A single cat can produce 3-7 g day of this protein, which is secreted by sebaceous, salivary, and perianal glands. The skin and fur are thought to be the primary reservoirs, with the highest concentration of Fel d 1 found on the cat's face and neck. The function of Fel d 1 is unknown, although it may play a role in epithelial protection or pheromone regulation. Additional cat proteins that may elicit an IgE-mediated response include albumin and Fel d 3. Nearly 10-20 of allergic patients can develop sensitivities to these proteins in addition to Fel d 1. The production of Fel d 1 is greatly influenced by testosterone, so that male cats produce higher Fel d 1 than females. Castrated male cats produce less protein overall, but still enough to induce symptoms in sensitized patients. There is no evidence to suggest that either...

Dog Allergy

Standardized materials for diagnostic and research purposes have made studies on dog allergy difficult. Can f 1 seems to have similar properties to Fel d 1. It can be carried on both large and small particles. It can also become airborne quite easily and remain so for extended periods of time. Because of these similarities, the avoidance measures discussed for cat allergy are recommended for patients who are sensitive to dogs.

Identifying The Vascular Lesion

Despite its advantages, diagnostic catheter angiography is now almost never performed for evaluation of acute stroke in institutions that have access to modern CT and MR scanners. There are several reasons for this. Catheter angiography requires the presence of highly trained angiographers, technologists, and sometimes anesthesiologists, some of whom may not be immediately available at all times of the day. It is a relatively time-consuming technique, and it may unacceptably delay the initiation of therapy in the acute stroke patient. The iodinated contrast used for catheter angiography can result in nephrotoxicity and allergic reactions, which are discussed in the next section. Also, catheter angiography is a highly invasive and somewhat risky procedure. Complications may occur if atherosclerotic plaques are dislodged from the aorta during catheter passage or if small thrombi There are two widely used noncontrast-based MRA techniques time-of-flight (TOF) MRA and phase contrast (PC)...

Sources of antimicrobial use data

Within an institution, patient administration records may be readily available as an estimate of antimicrobial use. Theoretically, these records should exactly mirror drug use however, the accuracy of the records should be verified. For example, a dose of an antimicrobial may be charted, yet the drug is still not administered to the patient due to discovery of a drug allergy or difficulty in establishing venous access. In some cases, a partial dose might be administered before an adverse event (e.g., extravasation) is recognized. Although administration records have been difficult to obtain in many settings, increasing use of electronic medical record data may make this information more readily available.

Reactions to Venom Immunotherapy

Systemic Allergic Reactions Systemic allergic reactions resulting from VIT are relatively uncommon, as compared with reactions that follow other types of allergen immunotherapy. However, because of the possibility of such reactions, it is important that VIT, as with other allergenic extracts, only be administered in the setting in which personnel and equipment are available for treatment of an anaphylactic reaction. Following such a reaction, the venom dose is Large local reactions following VIT are more common. When other types of allergenic extracts are administered, doses are decreased and a smaller dose might be maintained to avoid such reactions. In the case of venom, however, it is necessary to administer a maintenance dose (50-100 pg) in order to assure protection from insect stings. Measures to minimize these local reactions include splitting the venom dose into two injection sites and the addition of a small amount of epinephrine, such as 0.05-0.1 mL, with the venom, a...

Antibacterial Agents Usually Attack Specific Targets

(Folate is necessary for nucleic acid synthesis.) Because mammalian cells do not make folate (humans get folate from the diet), human cells are not affected by inhibitors of folate synthesis. In the late 1930s, a sulfa craze broke out, and thousands of derivatives were made. Some formulations were dangerous and led to the founding of the Food and Drug Administration (see Box 3-2). Sulfa drugs played a central role in preventing wound infections during World War II. (American soldiers were issued sulfa powder and instructed to sprinkle it on open wounds.) Allergic reactions are one of the problems with sulfa drugs about 3 of the population experiences adverse reactions.

Suggested Reading

American Academy of Allergy, Asthma & Immunology, Inc. Pediatric Asthma Promoting Best Practice. American Academy of Allergy, Asthma, and Immunology, Milwaukee, WI, 1999. Lemanske RF Jr. RF, Green CG. Asthma in infancy and childhood. In Middleton E Jr, Reed CE, Ellis EF, et al., eds. Allergy Principles and Practice, 5th ed. St. Louis Mosby-Year Book, Inc., 1998 877-900. Liu A, Martinez FD, Taussig LM. Natural history of allergic diseases and asthma. In Leung DYM, Sampson HA, Geha RS, Szefler SJ, eds. Pediatric Allergy Principles and Practice. St. Louis Mosby, Inc., 2003 15

Sideeffects And Complications

Serious complications are extremely rare, but they do occur for example, paralytic poliomyelitis following the use of live attenuated polio vaccine, and encephalitis following yellow fever vaccination in infants. Note that it is important to adhere to the manufacturer's health authority's list of contraindications cited for each vaccine in question so that the risk of allergic reactions or other preventable complications can be minimized.

Implementation Of An Acute Stroke Team And Acute Stroke Protocols

The overwhelming prerogative, in thrombolysis for acute ischemic stroke, is the need for rapid, yet complete, evaluation of potential therapeutic candidates within the 3-hour treatment window. Time is the acute stroke clinician's worst enemy.33 The acute stroke protocol should begin at the first of point of contact with the healthcare system the call to an ambulance dispatcher. Stroke symptoms should be recognized and given high priority for dispatch. Emergency medical technicians (EMTs) should be trained to identify potential thrombolysis candidates in the field by recognizing signs of stroke,73,74 and several simple scales have been created for this purpose.75-78 Prenotification by the EMTs, before hospital arrival, allows time for notification of the acute stroke team and preparation of the CT scanner before patient arrival, and has been associated with fewer in-hospital delays in treatment.79,80 The initial evaluation, after arrival in the emergency department, should include a...

Bronchial Hyperresponsiveness

One of the absolute features of asthma is exaggerated nonspecific airway reactivity to a variety of irritating stimuli. Thus, asthmatics develop airway obstruction in response to natural exposures (cold air, exercise, irritating chemicals, laughing, and coughing) or to provocations in the laboratory (histamine, methacholine, cold air hyperventilation) (Table 9). Airway hyperresponsiveness is found universally in asthmatics, in a portion of subjects with chronic bronchitis, in some subjects with allergic rhinitis, and in 3-8 of otherwise normal subjects. There is a close correlation between the degree of increased responsiveness and disease severity patients with the most reactive airways often require oral CCSs for control, whereas milder degrees of abnormality predict the requirement for fewer medications. Hyperresponsiveness increases after allergen exposure, late-phase allergic reactions, viral infections (especially influenza-type infections), and ozone exposure. Conversely,...

Are there any illnesses or medical conditions that are associated with osteoporosis

Some illnesses, such as hyperthyroidism and Cushing's syndrome, increase the speed with which bone is broken down. Other illnesses, such as cystic fibrosis and celiac disease, interfere with bone formation by impeding the body's absorption or production of the nutrients needed for bone development. In fact, 3 to 4 of those with osteoporosis have gluten intolerance, the allergy to wheat that occurs in celiac disease. People with gluten intolerance cannot absorb the correct amount of calcium and Vitamin D from their intestines. One of the problems is that many people have minor symptoms and do not even know they have an allergy to wheat. Gluten intolerance can also occur later in life.

Pathophysiology And Specific

Mast Cell Mediators of Allergy Fig. 1. Mechanisms of allergic reaction Allergen is processed and presented to T-cells via dendritic cells or macrophages or B-cells. The T-cell response is regulated by a network of regulatory T-cells and by the concentrations of a variety of cytokines secreted by cells involved in the immune response. In allergy-prone subjects (atopic subjects), the tendency to produce IgE specific for the allergen is increased. The IgE is made by B-cells, which transform into plasma cells. The IgE is bound to mast cells and basophils via a high-affinity receptor for IgE. Upon subsequent exposure to allergen, the mast cells degranulate and release chemical mediators responsible for the early-phase reaction and recruit inflammatory cells, which are largely responsible for the late-phase reaction. The dashed arrow indicates that some of the mediators released or created by the mast cell during degranulation, particularly leukotrienes and kinins, contribute to the...

Your patient states that he was told he is allergic to Novocain which he received for a tooth extraction Should you

Allergy to local anesthetics is rare despite frequent use of local anesthetics. Less than 1 of adverse reaction to local anesthetics is true allergy. Most reactions labelled as allergy are probably one of the following vasovagal response, systemic toxicity, or systemic effects of epinephrine. True allergy would be suggested by history of rash, bronchospasm, laryngeal edema, hypotension, elevation of serum tryptase, and positive intradermal testing. Esters produce metabolites related to p-aminobenzoic acid and are more likely to produce allergic reactions than are amide local anesthetics. Allergic reactions following use of local anesthetics may also be caused by methylparaben or other preservatives in commercial preparations of local anesthetics. There is no cross-sensitivity between classes of local anesthetics. Therefore patients known to be allergic to ester local anesthetics could receive amide local anesthetics. Caution is still warranted in case the patient is...

Nonallergic Rhinitis with Eosinophilia

Described as suffering from perennial nasal congestion, rhinorrhea, sneezing, and pruritus but do not have specific IgE for allergens, an increase in total IgE, or a personal or family history of atopy. The nasal secretions contain eosinophils, which distinguishes this condition from other forms of PNAR. The lack of an atopic personal and family history in NARES makes an undefined allergy unlikely as the cause. The condition may be part of the spectrum of eosinophilic rhinitis and nasal polyposis. Subjects with aspirin triad (nasal polyps with eosinophils, asthma, aspirin sensitivity) experience eosinophilic rhinorrhea and nasal congestion prior to the development of nasal polyps, suggesting a spectrum of eosinophilic nasal disease (Fig. 4). However, most subjects with NARES do not develop aspirin triad.

Discuss the important features of the preoperative evaluation

The anesthesiologist should review the surgical diagnosis, organ systems involved, and planned procedure. Important features include personal interview, physical examination, and review of medical records. Important questions involve medications, drug allergies, substance abuse (e.g., cigarettes, alcohol, illicit drugs), review of systems, and prior anesthetic experience (i.e., history of difficult intubation, delayed emergence, malignant hyperthermia, prolonged neuromuscular blockade, or postoperative nausea and vomiting). From this evaluation the anesthesiologist decides if any preoperative tests or consultations are indicated and then formulates an anesthetic care plan.

Automated methodscomputerassisted prescribing

For 15 years, in the university hospital LDS of Salt Lake City, a computer program Clinical-decision-support has been in use for assisting clinicians with antimicrobial drug prescribing (Evans et al., 1986). Clinicians prescribe drugs with the help of a computer (Evans et al., 1998). The errors of prescribing are recorded and they allow a continuous evaluation of process parameters (allergies, dosages, costs . . .) and patient outcome parameters such as side effects, length of stay. The program is linked to microbiology laboratory results and provides alerts to identify patients with inappropriate therapy due to susceptibility mismatches (Pestotnik et al., 1996). The LDS pharmacy database has provided several evaluations of quality interventions in intensive care (Evans et al., 1998) and on the timing of surgical prophylaxis (Classen et al., 1992). A similar program, Computer-based expert system for quality assurance of antimicrobial therapy, which produces reports of the...

Regulators Of Lipid Mediators

LTD4 Antagonists - While definitive clinical evidence of a major role for the peptide leukotrienes in asthma allergy was not presented this year, many antagonists are in the clinic and expectations remain high. A perceptive overview of the area appeared recently (13). The orally active LTD4 LTE4 antagonist LY171883 (1) showed small beneficial effects on pulmonary function (increase in FEV,, decrease in use of broncho-dilators) in mild asthmatics given 600 mg. b.i.d. for six weeks (14). SKF 104353-Z2 (2) has been shown to block LTD,,- and antigen-induced bronchoconstrietion in asthmatics upon aerosol administration (15,16). Early clinical data for ICI 204219 (3) and MK-571 (4), previously known as L-660711, are now available after oral administration of 3 or i.v. infusion of 4, both drugs were effective blockers of aerosol LTD4 challenges (17, 18). The chemistry leading to the novel unsymmetrical dithioacetal unit present in 4 was described (19). Chemistry (20) and pharmacology (21,22)...

Symptoms And Signs

The incubation period is usually 2-3 weeks. Typically, the patient develops slight moderate fever some days before swelling of the salivary glands, mostly the parotid glands. In about 80 of the cases there is a bilateral swelling, appearing within an interval of one or several days. A continuous swelling involving the salivary glands, the jaw region and lateral aspects of the neck is not uncommon. The patient complains of oral dryness and painful chewing, and occasionally there is trismus. Oedema and redness around the opening of the Stensen's duct are frequently seen. Mumps that remains located symptomatically to the salivary glands is considered uncomplicated and recovery is usually complete within 1 week or less. Asymptomatic infections are common (at least 20-30 ), particularly in early childhood. Differential diagnosis. Mononucleosis or bacterial infections of oropharynx, sialoadenitis (anomalies of the glandular duct, immune deficiency), other viral infections of salivary glands...

Obtaining Informed Consent

Described in 0-1 of patients these can be treated with diphenhydramine. Rare cases of vasovagal syncope have been reported. Cardiovascular complications are reported with an incidence of one in 5300 patients and pulmonary complications one in 3800.Use in patients with known allergy to fluorescein sodium should be avoided, as there have been case reports of anaphylaxis.

Blepharoconjunctivitis

Blepharitis is inflammation of the eyelid margins that is most often misdiagnosed as an ocular allergy because it commonly causes conjunctivitis as well. Infection or seborrhea are common causes. As in patients with atopic dermatitis, the most important organism isolated from the lid margin is Staphylococcus aureus. Antigenic products and not the colonization itself are thought to play the primary role in the induction of chronic eczema of the eyelid margins. The symptoms include persistent burning, itching, tearing, and a feeling of dryness. Patients commonly complain of more symptoms in the morning than in the evening. This is in contradistinction to patients with dry eye syndromes, who complain of more symptoms in the evening than in the morning because of drying out of the tear film during the day. The crusted exudate that develops in these patients may cause the eye to be glued shut when the patient awakens in the morning. The signs of staphylococcal blepharitis include dilated...

Bacterial Conjunctivitis

Topical gentamicin and tobramycin are indicated if Gram-negative organisms are suspected or seen on Gram stain. It should be noted that all of these antibiotics have the potential to elicit an allergic reaction. A careful history for drug allergies, a time limit for therapy, and re-evaluation will minimize complications. Topical ciprofloxacin or ofloxacin offers coverage for a wide spectrum of infecting agents, but should be used only when there is the likelihood for therapeutic failure or the conjunctivitis is thought to be the result of multiple infecting organisms or Pseudomonas species. Treatment of inclusion conjunctivitis should be aggressive because there is the potential for the cornea to perforate in a short time. Both topical and systemic antibiotics should be used. The patient should be observed for other sexually transmitted diseases.

Metabolism And Inactivation

Earlier insulin preparations contained a large number of protein contaminants thought to be immunogenic and hence the cause of lipodystrophy, insulin allergy and sometimes antibody-mediated insulin resistance in many patients. Monocomponent (MC)-insulin and human insulin are virtually free of these peptides and are therefore very rarely accompanied by the above-mentioned immunological side effects. In this respect, however, human insulin offers only a little advantage over MC-insulin although human insulin is the least immunogenic (Gyimesi and Ivanyi, 1989 Zenobi, 1991). One disadvantage of human insulin is that about 20 of patients treated with it experience a change in hypoglycaemia symptoms during the course of their illness. While autonomic symptoms become weaker or disappear, patients have to react to neuroglycogenic symptoms which normally remain constant. However, the incidence of hypoglycaemic events does not change during treatment with human insulin (Zenobi, 1991). 6.4...

Keratoconjunctivitis Sicca

Keratoconjunctivitis sicca is a dry eye syndrome commonly associated with an underlying systemic autoimmune disorder such as Sjogren's syndrome, rheumatoid arthritis, or HIV infection. However, it must be included in the differential of ocular allergy, especially in perimenopausal and postmenopausal women. Tear production decreases with age 60 fewer than at the age of 18. The eye produces approx 400 drops of tears per day. It is characterized by an insidious and progressive lymphocytic infiltration into the main and accessory lacrimal glands. Patients initially complain of a mildly injected eye with excessive mucus production. Symptoms include a gritty, sandy feeling in the eyes compared to the itching and burning feeling many patients complain of with histamine release into the eye. As the cornea becomes involved, a more scratchy and painful sensation as well as photophobia may appear. The corneal epithelial injury can be detected with punctuate staining with fluorescein. The...

Ophthalmic Procedures And Testing

Primary health care providers should also be familiar with some ophthalmic procedures and test to assist in completing detailed and thorough history and physical examination in order to assist them in confirming a diagnosis of ocular allergy. More importantly, these various tests help to differentiate between the many disorders that mimic allergic disorders of the eye. Ocular provocation testing can be likened to skin testing of the eye. Known quantities of specific allergen are instilled onto the ocular surface, and the resulting allergic response is measured. This technique is commonly performed by allergists in a research study, especially in the assessment of new drugs against ocular allergies.

Classification And Etiological Considerations

Thus, when a child or an adult has an isolated event of a short duration of urticaria, the clinician must attempt to identify a specific cause or exposure. In the child, typical allergens causing acute urticaria include medications such as antibiotics. A common inciting group is penicillin or other p-lactams regularly used for respiratory tract infections. Food is another common cause of acute urticaria in children, with the leading allergens being derived from egg, milk, soy, peanut, or wheat. In adults, foods more commonly encountered that result in allergic urticaria include shellfish and tree nuts (walnuts, hazelnuts, pecans, etc.). Virtually any food can result in an allergic reaction. However, historical evidence will usually reveal that a particular food resulted in the outbreak of hives shortly after ingestion. In addition, repeated ingestion of that food will result in repeat episodes of acute urticaria. One should be very suspicious of an individual who believes that he or...

Skin Anomalies Pathological Noninfective

Classically this condition is the end-result of intense, chronic pruritus that results from repetitive rubbing or scratching. The skin responds by thickening and the increase in skin markings is referred to as lichenification. This occurs mostly in individuals with a history of allergies, eczema, hay fever or asthma. They have sensitive and easily irritated skin.

Table 1 Examples of Potentially Serious Medication Errors and Possible Prevention Strategies

Prescription Allergy Accurate assessment and recording of allergies * All prevention strategies should have system redundancy (e.g., allergies checked by physician, pharmacist, and nurse), ongoing system analysis for possible improvements and evaluation of system failures, ongoing educational efforts materials (including ease of access to medication information), and fostering of interdisciplinary communication.

Historical Perspective

Since 1880 when Blackley 3 inoculated his own skin with different pollen extracts, the diagnosis of type I allergy has generally been established by provocation tests with extracts prepared from putative natural allergens. Almost a century later, shortly after the discovery of IgE antibodies 4 , the radioallergosorbent test (RAST) was developed 5 . The RAST and its derivatives are based on the detection of sIgE antibodies directed against a number of different (genuine and cross-reactive) allergen components present in the natural allergen extract. The inherent complexity, variability, and instability of natural allergens and the considerable variation between individual sensitization profiles complicate the correct interpretation of extract-based test results. For example, it has repetitively been demonstrated that ubiquitous structures such as profilins and cross-reactive carbohydrate determinants (CCD) present on glycoproteins of plants and hymenoptera venom can result in a...

Microarray The Technique

The microarray technique for CRD enables sIgE testing in a multiplex format and allows the simultaneous measurement of many IgE clones 35, 36 . The major advantage lies in the potential to investigate large numbers of allergens in parallel, detecting sIgE abundance, functionality, and interaction concerning numerous allergenic determinants using only minute amounts of serum (i.e., in children). However, this random testing'' generates a high amount of not necessarily clinically relevant information. Interpretation personalized to each individual patient using history and skin prick testing is still necessary. Also adequately powered trials are required before this technique can be introduced into daily clinical practice. Fig. 1. Component-based allergy diagnosis by microarray incubation of allergen chips with 20 l serum allows allergen-specific IgE antibodies to bind to spotted allergen components. Analysis of fluorochrome-labeled anti-IgE antibodies using a confocal laser scanner....

Clinical Experience with CRD Using Microarray

Since its introduction in the field of allergy diagnosis 16 , only a few papers have been published on the application of CRD testing by micro-array. In the pioneer study by Hiller et al., 94 purified allergen components were analyzed (78 recombinant and 16 natural) representing the most prevalent inhalant allergens such as pollen (trees, grasses, weeds), food, mites, molds, mammalian allergens (epithelia, serum proteins, saliva proteins), hymenoptera venom, insects, and natural rubber latex in sera of 20 (generally multisensitized) patients but only one healthy control individual. It was demonstrated that the clinical sensitivity was well reflected by the IgE reactivity pattern to the microarrayed allergen components from the respective sources. However, no strict association between the fluorescence intensity as measured in the microarray-based system and the magnitude of wheal reactions in the skin test was demonstrated. In a comparative study between the microarray using...

Hand Eruptions In Health Care Workers

When health care workers develop hand eczema, the reactions may or may not be related to gloves. Similar to any other hand eczema, management requires avoidance of irritants, and it requires a search for possible allergy to rubber chemicals in latex gloves (especially thiuram and carbamates), contact urticaria to latex proteins, and occasionally to rubber chemicals or cornstarch in glove powder and rarely to other gloves. We gen erally test persons to the rubber chemicals with a patch test to rubber chemicals for both 20-30 min (for contact urticaria to rubber chemicals) and the standard 48-h application for contact dermatitis. We also test to gloves other than latex, as well as formaldehyde, glutaraldehyde, and contents of soaps to which they are exposed, for example, chlorhexidine, cocamidopropyl betaine, the standard patch test series, and other preservatives used in soaps and shampoos, including parachlorometaxylenol, quaternium-15, and other preservatives. A RAST test can be...

Benzoic acid derivatives

PGD2 is the major cyclooxygenase product formed and secreted by activated mast cells during allergic reactions. However, the lack of suitable antagonists for its receptors, CRTH2 and DP, has limited progress toward elucidating the role that PGD2 plays in allergic diseases. The recent discovery of potent and selective antagonists for CRTH2 and DP receptors, coupled with the genetic analysis of DP and CRTH2 function using KO mice, as well as the discovery of selective agonists

Problems not confined to obstetrics

85 ALLERGIC REACTIONS Most severe reactions on the labour ward are caused by drugs, especially antibiotics, intravenous anaesthetic drugs (particularly suxamethonium) and oxytocin. Some well-recognised cross-reactions exist, e.g. up to 10 of individuals with true penicillin allergy are also allergic to cephalosporins. Allergy to amide local anaesthetic drugs is rare but has been reported, as has allergy to preservatives used in local anaesthetic and other drug preparations. Non-steroidal anti-inflammatory drugs and paracetamol often cause rashes but these are usually mild following brief oral rectal courses, although severe reactions have been reported following intravenous administration. Reactions may also follow administration of gelatine intravenous fluids and blood. Latex allergy has become an increasing problem amongst both medical staff and patients, driven by an increase in the wearing of gloves because of concern about transmission of blood-borne infection and the ubiquitous...

Definitions and Classifications

Adverse reactions to foods can be divided into two major groups food allergy, which depicts an immunological, usually involving IgE, reaction to a food and food intolerance, which involves all other adverse reactions, some of which are the result of unknown mechanisms, but none of which involves immune reactions (Table 1). Recently, revision of these commonly accepted definitions has been suggested in Europe, as follows adverse reactions to food would be termed food hypersensitivities, food intolerances would be Food allergy IgE-mediated reactions, called nonallergic food hypersensitivities, and either food hypersensitivities or food allergy would be simply known as food allergy. This chapter is based on the previously accepted terms generally used in the United States. Other terms that are occasionally used to describe types of food intolerance include food toxicity or food poisoning, idiosyncratic reaction, and pharmacological reactions to foods. Food toxicity may be the result of...

Management options

It is important that mothers with a previous history of severe allergic reactions are identified antenatally. Wherever possible, the previous anaesthetic record should be obtained and a plan for her care documented. Management of the known allergic case includes a general state of readiness and awareness as well as the obvious avoidance of any known allergens. Latex allergic patients may be identified from the history in most cases by asking about food allergies and skin reactions after exposure, e.g. rubber gloves, condoms, etc. If patients have had a previous severe reaction where the allergen is unknown, pretreatment with H - and H2-antagonists + steroids should be considered, although whether this should be routinely done if the allergen is known and can be avoided is controversial. Routine screening of all women by using skin or blood testing is generally not indicated, since precautions should be taken on the basis of a strong history even if testing produces negative results.

Incidence and Prevalence

The incidence of food intolerance reactions greatly exceed food allergies in all age groups. Only some food intolerance reactions resemble allergic reactions. One well-documented study of 480 consecutively born infants found that the incidence of adverse reactions to foods confirmed by double-blind, placebo-controlled food challenge (DBPCFC) during the first 3 yr of life was 8 . In three well-done studies involving infants (United States, Sweden, Denmark), the incidence of allergic and intolerance reactions to cow's milk protein was found to be 2 . The prevalence of peanut allergy in the United States and United Kingdom is estimated to be between 0.5 and 1 of the general population. Recent evidence from studies on the Isle of Wright would indicate that the prevalence of peanut sensitivity is increasing, as much as three times (1989 1996), perhaps as a result of more exposure there of susceptible individuals to peanuts Recent telephone surveys in the US have indicated that the...

Mechanisms Of Allergic And Allergiclike Intolerance Reactions To Foods And Food Additives

Food Allergy Most cases of allergic reactions to foods are a result of type I immune reaction involving IgE antibody directed to that food. As with other allergic reactions, the susceptible person must be first exposed to the food protein, usually intermittently over time, before sensitization occurs. This process involves the development of IgE antibody to that specific food protein. Oral allergy syndrome are the effector cells of allergy and contain either preformed chemical mediators or are able to facilitate formation of other mediators in the immediate tissue around the cell once stimulated. Re-exposure to the same food protein results in chemical mediator release or formation in the tissue, which causes the clinical allergy signs and symptoms. Proven Food Allergy in Infants The most likely foods involved in allergic reactions in children below the age of 2 in the United States are Atopic dermatis and the eosinophilic gastroenteropathies are felt to represent, at least in part,...

Food Additive Intolerance Reactions

Allergic reactions have been reported to occur to the preservative sulfites (and SO2), sodium benzoate, butylated hydroxyzole (BHA), butylated hydroxytylene (BHT), the sugar substitute aspartame, artificial colors (especially yellow, red, and blue), and the flavor enhancer monosodium glutamate (MSG). The symptoms of principal concern are urticaria and asthma. In most cases, even if it is proven that the food additive is involved in the clinical symptoms, the exact mechanism of the reaction is unknown. In sulfite-induced asthma, the principal mechanism is believed to be the inhalation of SO2 as sulfite-containing foods are chewed in the mouth. In addition, a small number of individuals have been identified who have a sulfite oxidase enzyme deficiency, which prevents metabolism of this preservative and could result in high blood levels. In a few cases of documented urticarial reactions to color, histamine and prostaglandin increase has been found in the urine after specific food allergy...

Gastrointestinal Reactions Involving Food

A wide variety of signs and symptoms involving the gastrointestinal tract could be attributed to a food allergy. However, most are not specific, and the possible causes for most of these signs and symptoms are multiple. Itching and swelling of the mouth, however, are certainly suggestive of an allergic reaction as in the OAS. Infants who have formula intolerance can develop vomiting, have diarrhea, or simply have blood loss in the stool. Some individuals simply fail to thrive. Allergy and Gastrointestinal (GI) Food Reactions Most GI reactions to diet are not a result of food allergy. Milk protein allergy intolerance usually occurs in infants. Food protein anaphylaxis (allergy) occurs within minutes to 2 h after food ingestion and almost always includes urticaria with or without GI symptoms. The fi ndings of eosinophils on GI biopsy is suggestive but not diagnostic of food allergy. In studies, 30-42 of infants with gastroesophageal reflux were found to have eosinophilic infiltrates in...

Pulmonary Reactions Involving Food

Rhinitis and or asthma-like symptoms (wheezing, respiratory distress) occur as part of systemic anaphylaxis to foods. It has been shown in studies of children with atopic dermatitis who are allergic to foods that after specific food avoidance, followed by DBPCFC 2 wk later, one-third are likely, upon challenge, to develop respiratory symptoms, such as rhinitis or asthma, along with exacerbation of their skin rash. Other than these two situations, isolated rhinitis after food ingestion as a result of allergy is rare. The estimated prevalence of food allergy induce asthmatic reactions is also low (26 ) except in those with documented food anaphylaxis or concurrent atopic dermatitis (up to 24 ). From studies in the United Kingdom, there appears to be an increase risk (5- to 10-fold) of future respiratory allergy (rhinitis or asthma or both) in infants who have an allergy to eggs or egg and milk, especially if they have eczema.

Brain Microarray Studies

The first microarray analysis of MS brain tissue was conducted on a single 46-year-old male patient 128 . Acute white matter plaque tissue was contrasted with normal-appearing white matter to determine differentially expressed genes between the samples. Sixty-two differentially expressed genes (out of more than 5,000 genes surveyed) were identified, including several genes related to the brain or inflammation. In a follow-up paper, Whitney et al. 129 compared the gene expression from lesions in two MS patients and brains of EAE mice with normal-appearing white matter using a microarray consisting of 2,798 human genes. They found that the myelin basic protein gene was under expressed in the MS lesions as compared to normal white matter, indicating that the oligodendrocytes in the lesions were not properly functioning or dead. One interesting upregulated gene that was upregu-lated in both the MS lesions and the EAE brains was arachidonate 5-lipoxygenase. The product of this gene is...

Infant Formula Substitution

A particular problem exists for infants who are allergic or intolerant to conventional cow's-milk-based formula. Although some individuals who are allergic and have urticaria can use a soy-based formula substitute, any child with a gastrointestinal problem should be given a casein protein hydrolysate infant formula. Table 8 lists the substitute infant formulas available commercially in the United States for milk allergy. Nutramigen or Alimentum is usually preferable to Pregestimil in the United States. An elemental amino acid formula should be tried in the few infants who are very sensitive to cow's milk protein and cannot tolerate casein hydrolysate formula. And the two amino-acid-based infant formulas available in the United States are Neocate and Ele Care . Prevention of allergy has been attempted in infants born to allergic parents by the use of special diets. Studies have compared the use of 1. Dietary restriction in the mother in the last trimester (of a diet devoid of...

Antimicrobial Cycling Programs Reported In The Literature

Antimicrobial cycling has potential as a method to decrease antimicrobial resistance rates because of its theoretical ease of implementation. In reality, 100 compliance with the cycling regimen is extremely difficult to achieve. In the published trials of antimicrobial cycling, as much as 50 of antimicrobial use was off cycle because of concerns over resistance, allergies, medication side effects, and use of antimicrobials in accordance with national guidelines (15,29,30). Possibly as a consequence of poor adherence to antimicrobial cycling regimens, antimicrobial cycling studies have produced conflicting results.

Introduction Definitions

Drug allergy is a common term often used to depict any unexpected and unwanted event or effect that occurs when an individual is taking a specific drug or therapeutic agent. A better, overall term to describe these circumstances would be an adverse reaction to a drug (Table 1). These reactions can be further classified into either drug allergy (reactions resulting from an immunological mechanism) or drug intolerance (reactions resulting from nonimmunological or unknown mechanisms). Some reactions closely resemble allergic reactions and are termed allergic-like or pseudo-allergic. This includes anaphylactoid reactions that clinically resemble anaphylaxis, since in both situations chemical mediator release or activation is responsible for these symptoms. Some idiosyncratic reactions to drugs can be confused with drug allergy.

Factors That Influence Incidence

There are probably less adverse drug reactions in children and the elderly. Drug-induced skin rashes are reported to be one-third higher in females. Individuals who have a severe reaction to one drug (e.g., p-lactam antibiotics) may be at increased risk for reactions to other antibiotics. Children of parents with a confirmed reaction to a p -lactam antibiotic have more risk that the general population to develop reaction to p-lactam antibiotics. Although being allergic or atopic does not increase the risk of development of an allergy to p-lactam antibiotics, it may increase the risk of having an anaphylactoid reaction to RCM exposure. A maculopapular (toxic) rash due to amoxicillin ampicillin is more likely to occur when the patient treated with this drug has an Epstein-Barr virus infection (acute infectious mononucleosis). Both drug allergies (e.g., to p-lactam antibiotics) and drug intolerance reactions (e.g., systemic or skin reactions to may types of therapeutic agents) are more...

Lipid Rafts in immune Cell Signaling

Introduction - The cells of the immune system express a variety of receptors that allow the system to recognize and respond to the universe of foreign pathogenic organisms including viruses, bacteria and parasites. An important class of immune receptors are the multi-chain immune recognition receptors or MIRRs that include the antigen receptors on the two major classes of lymphocytes, namely, B cells (the B cell receptor or BCR) and T cells (the T cell receptor or TCR) (1). Another important MIRR family member, the high affinity receptor for IgE, or FceR1, is expressed on mast cells and basophils and plays a key role in allergic immune responses. The engagement of the MIRRs by their multivalent ligands, either soluble antigens for the BCR, peptide fragments of antigens bound to Major Histocompatibility Complex (MHC) molecules for the TCR and complexes of antigen bound to IgE antibodies for the FcsRI, leads to the initiation of tyrosine-kinase based signaling cascades that ultimately...

Should a penicillinallergic patient receive cephalosporins

Although penicillin is the most common cause of anaphylaxis in the general population, interestingly only about 10 to 20 of patients reporting a penicillin reaction have a well-documented allergy, and numerous complaints such as gastrointestinal symptoms or rashes of nonimmunologic origin are labeled allergy. An oft-quoted statistic is that there is an 8 to 10 risk of cross-sensitivity between penicillin and cephalosporins because they share a p-lactam ring, but this is now disputed. In earlier times this may have been true, possibly because earlier generations of cephalosporins contained trace amounts of penicillin. Some authorities believe cephalosporins are safe to be administered to penicillin-allergic patients as long as these patients have not experienced a prior anaphylactic reaction or have a documented positive skin test for penicillin. However, a 1995 review by Anne et al (1995) found that penicillin-allergic patients were three times as...

What are the implications of occupational latex exposure

Currently about 70 of all allergic reactions are reported in health care workers, and it is estimated that 3 to 12 of this group have developed some degree of latex sensitivity. The majority of allergic reactions are probably caused by inhalational exposure from latex particles adhering to the powder of powdered gloves. Since signs and symptoms may be very nonspecific (puffy eyes, nasal congestion, sneezing, wheezing, coughing, hoarseness), the connection may not be made to an occupational exposure. Workers who develop hand dermatitis or have an atopic history may be at increased risk. It is important to note that, although sensitization may occur at work, severe allergic manifestations may occur while these workers are receiving medical care. The key to the protection of health care workers is to reduce work-related exposure (Stop the Sensitization ). The use of nonpowdered latex or latex-free gloves is probably the most important intervention. Maintaining good skin care is also...

Rafts As Potential Targets Of Therapies

The observations that lipid rafts play an important role in immune cell signaling suggests that they may provide new targets for treatment of autoimmune diseases and allergy and to block organ rejection in transplantation. To provide such opportunities the molecular mechanisms by which rafts function to facilitate MIRR signaling will need to be delineated in detail. Nonetheless, even in the absence of Glucocorticoids (GCs) are a class of cholesterol-derived steroids produced by the hypothalamic-pituitary-adrenal axis that have significant immunosuppressive and anti-inflammatory effects on the immune system (69). GCs inhibit T cell responses and consequently, GCs have been widely prescribed in the treatment of autoimmunity, allergy and inflammatory disease and in the prevention of graft rejection. The primary targets for the action of GCs appear to be intracellular receptors that alter nuclear gene transcription. However, recent evidence indicates that GCs alter both the lipid...

Computer Assisted Decision Support Programs

Support programs have been designed to provide real-time integrated patient and institutional data including culture and susceptibility results, laboratory measures of organ function, allergy history, drug interactions, as well as cumulative or customized location-specific antibiogram data, and cost information. They provide therapeutic choices for clinicians and allow for the incorporation of clinical judgment by overriding suggestions. Autonomy is preserved while insuring that important variables in the choice of antimicrobial therapy are considered. This topic is covered in depth by Pestotnik in this book.

Messaging Technical Standards and Technical Architecture

A variety of clinical terminology standards exist in healthcare, giving meaning to raw data and allowing for semantic interoperability. Systematized Nomenclature of Medicine (SNOMED) (20) clinical terms are one example of a clinical reference terminology that provides for semantic interoperability. SNOMED is the most comprehensive international and multilingual clinical reference terminology available in the world. SNOMED serves as a taxonomy for a specific set of concepts (e.g., organisms, allergies, device procedures, symptoms, and so on) with unique meaning the current core terminology contains over 357,000 healthcare concepts. Other examples of terminology standards include LOINC (Logical Observation Identifiers Names and Codes) (21) and RxNorm (22). Table 3 is a summary of key standards and the organizations responsible for developing and maintaining them (23). Without strict adherence to standards it is unlikely that CDSS will function properly and satisfy the first design...

Sedation and Psychomotor and Cognitive Impairment

Perhaps of singular importance regarding the distinction between subjective drowsiness and the objective ability to perform is that in children. It has been shown that the learning capacity of allergic children may suffer during the allergy season, and that a firstgeneration sedating antihistamine (although improving allergy symptoms) may actually worsen performance. On the other hand, the use of a nonsedating antihistamine will, presumably by controlling symptoms without affecting performance, enhance learning ability in children.

Empiric Treatment of Group I VAP

Recommended therapy consists of monotherapy with ampicillin-sulbactam, lev-ofloxacin, moxifloxacin, ciprofloxacin, ceftriaxone, or ertapenem. Combination therapy is not needed in this group of patients (Fink et al. 1994). The choice between these drugs is based on resistance patterns, especially among S. pneumoniae, H. influenzae, and E. coli. The increase in penicillin resistance in S. pneumoniae is well documented however, the predominant use of quinolones for treatment of severe pneumonia is followed by emergence of resistance. Quinolones are recommended for patients with p-lactam allergy and, as alternatives, aztreonam or

Uncomplicated Gonococcal Infections

Azithromycin 2 g as a single oral dose has demonstrated an efficacy of 99.2 (95 CI 97.2-99.9 ) for urogenital and rectal infections, and treatment efficacy of 100 for pharyngeal infection (95 CI 82.3-100 ) but is not recommended because of expense, frequency of gastrointestinal intolerance, and concerns regarding rapid emergence of resistance, as evidenced by the increase in azithromycin MICs documented since 1999 in the United States and internationally (103,104). Treatment with 1 g of azithromycin is insufficiently effective and is not recommended. Azithromycin remains a treatment option in patients with documented severe allergic reactions to beta-lactams.

Primary Thromboprophilaxis in aPLPositive Patients

Thus, low-dose aspirin (75 mg day) is considered as a logical prophylaxis in individuals with persistently positive aPL and or unequivocally positive LA tests in case of aspirin allergy or intolerance, other antiaggregant drugs should be considered. Prothrombotic factors should be avoided (i.e., smoking, estrogen-containing oral contraceptive pills) and or treated (i.e., hypertension, hypercholesterolemia, diabetes mellitus) in all patients. Furthermore, high-risk situations (such as surgery, long-haul travel) should be covered with subcutaneous heparin prophylaxis.

Bronchospasm and Severe Bronchitis A Real Chokehold on Ventilation

Provides a strong allergic reaction to some inhaled substance - such as dust or pollen. Mild-to-moderate bronchoconstriction is a normal protective reflex response when a person accidentally inhales some poisonous or irritating substance (such as second-hand cigarette smoke). The bronchoconstriction is protective, in that it allows less of the inhaled substance to flow down into the alveoli.

IgE Receptor Crosslinking And Activation Of Apcs

As previously mentioned, DCs play a critical role in the regulation of TH cell responses via the secretion of various soluble factors and the expression of membrane associated co-stimulatory molecules. Since interaction of allergen with surface bound IgE-FceRI complex results in the release of inflammatory mediators and upregulates the production of various cytokines, it is conceivable to assume that FceRI could be a key molecule which connects IgE-mediated allergic reaction and the preferential induction of TH2 type T-cell activation, as observed in AD patients (17).

Box 1211 Adverse Effects of Antibiotics

Data collected between 2004 and 2006 showed that more than 140,000 persons per year in the United States visited emergency rooms (ERs) due to adverse reactions from antibiotics, accounting for 20 of ER visits for all prescription drug-related side effects. Because only 16 of all prescriptions were for antibiotics, antibiotics are not safer than the average drug. Antibiotics differ from other drugs with respect to the type of adverse effect Almost 80 of the antibiotic adverse effects are for allergic reactions, which cannot be reduced by limiting prescription errors. (Allergic reactions may not be easily predicted.) For other drugs, ER visits are usually for overdose or medication errors, not for allergic reactions. Data for several drugs are shown in Table 12-4.

The decisionmaking process in prescribing antibiotic therapy

In the decision-making process for prescribing antibiotic therapy it is important to review scientific literature and guidelines issued from specialty societies. It is also important to consider other factors such as adverse drug reactions, allergies, pharmaco-economics, pharmacodynamics, pharmacokinetics, previous antibiotic therapy, treatment failures, and compliance issues. Primary care physicians are being increasingly challenged to take good care of our patients despite demands to keep costs down, get the patient well, and have prescribing habits profiled. In countries where government agencies subsidise drugs, prescribers are required to prescribe only what is listed in their formulary.

Interventional Radiology Therapeutic Angiography

Rapidly bleeding sites can be localized and treated by angiography if bleeding continues at the time of the exam. Disadvantages of this method include the requirement for availability of skilled interventional radiologists on very short notice, the need to move an unstable patient from the intensive care unit to a fluoroscopy unit, risks of contrast media allergic reactions or nephrotoxicity as a consequence of prolonged or repeated studies, and inherent complications of the invasive procedure.

IgE in Mast Cell and Basophil Sensitization

Mast cells in tissue and circulating basophils in the blood are the two primary cell types sensitized by allergenic molecules to release inflammatory mediators. In nearly all human subjects, these cells express in a resting state on the surface a high density of high-affinity IgE.Fc receptors (also referred to as type I IgE.Fc receptors, FcsRI), which are almost entirely occupied by IgE. The cells are armed and irritable. When allergenic molecules (antigens) contact the mast cells or basophils, they are bound by FcsRI-bound IgE specific for the allergen molecules. Because an allergenic protein has multiple antigenic sites, the binding by IgE causes the crosslinking of the IgE and hence the aggregation of the underlying FcsRI to almost instantaneously trigger the cells to release the contents of the granules via exocytosis.

Use of antimicrobials in food animals and their impact on public health

The use of antimicrobials in food-producing animals can lead to emergence of resistant bacterial strains, allergic reactions in animals and humans, and other adverse effects depending on the compound (Aarestrup et al., 2001 Tollefson and Flynn, 2002). Bacteria from animals may reach the human population by many routes. Drug-resistant bacteria of animal origin, such as E. coli and Enterococcus spp. can colonise the intestine of humans (Wegener et al., 1997). Heavily exposed individuals like slaughterhouse workers, food handlers, and farmers feeding antimicrobials to animals have a higher frequency

The Unique Binding Properties of Therapeutic AntiIgE

Antibodies specific for human IgE can bind to IgE, which is already bound by FcsRI and hence can crosslink IgE and sensitize mast cells and basophils even better than allergenic proteins. The anti-IgE therapeutic products can bind to free IgE specifically with high affinity they cannot bind to and sensitize basophils isolated from even the most sensitive human subjects they cannot bind to the IgE already bound by the low-affinity IgE.Fc receptors (also referred to as type II IgE.Fc receptors, or FcsRII, or CD23) on the surface of B-cell lines.

AntiIgE Works for Different Allergens and Different Symptoms

Allergic patients are sensitive to their distinctive sets of allergens. However, the cellular and molecular processes leading to the generation of IgE, the sensitization of mast cells and basophils, and the manifestation of symptoms are the same. In contradistinction to specific allergy immunotherapy, anti-IgE is nonspecific.

Elimination Diets and Diet Supplements

Cluded that most research shows no credible evidence for the effectiveness of such diets in treating ADHD. He did note that such diets may be helpful for a small subset of children who have specific food allergies, but there is no evidence that children with ADHD have any greater incidence of such food allergies than children in the general population.

For Pediatric Patients

Are known to be associated with allergy, much higher than that (about 70 ) for adults. This is probably partly because as the asthmatic disease protracts additional immune factors, expanded inflammatory reactions, and tissue damage may gradually obscure the allergic etiology in some of the asthma cases. If so, it may require anti-IgE to work over a much longer time to allow secondary immune mechanisms to wind down and achieve an improvement.

Other Uses Such as Atopic Dermatitis and Venom Sensitivity

Insect allergy is of particular interest because the process of therapeutic desensitiza-tion is itself fraught with danger. Although not suggested for long-term therapy, a short-term partial disarming of the anaphylactic potential with anti-IgE might allow a safer means of treatment progression.

Potential Benefits Of Environment Control

Two events occur prior to the development of symptoms in allergic patients. First, the individual has to become exposed and sensitized to a particular allergen with production of allergen-specific immunoglobulin E (IgE). This IgE may become affixed to mast cells that are present throughout the body, but are most prominent at mucosal surfaces. The second event is re-exposure to that allergen, stimulating the mast cells to release their inflammatory mediators and triggering many of the symptoms attributed to allergy. Currently, a primary focus of research is to advance the understanding of why some patients become sensitized to allergens and others do not. The complex interplay between genetics and environment plays a key role in determining an individual's susceptibility to allergy. Environmental factors such as exposure to allergen, endotoxin, infections, and foods during infancy seem to be important in the development of the immature immune system. This suggests that there is a...

Abarelix Anticancer [68

This phenomenon is observed in 4-33 of patients receiving a GnRH agonist. A GnRH antagonist such as abarelix acts by direct inhibition of LH and FSH secretion, which avoids the initial surge in serum testosterone concentrations. Abarelix is a decapeptide, and it is prepared by a typical coupling cycle for peptide synthesis using Boc-amino acids and a methyl-benzhydrylamine (MBHA) resin. Abarelix has high binding affinity for GnRH receptor (Kd 0.1 nM). Following intramuscular administration of a 100 mg dose, abarelix is absorbed slowly with a Cmax of 43.4 ng mL observed approximately 3 days after the injection and has a half-life of about 13 days. The apparent volume of distribution is over 4000 L, suggesting extensive distribution. Abarelix has high protein binding (96-99 ), and it is primarily metabolized via hydrolysis of peptide bonds. Following a dose of 15 mg kg in humans, approximately 13 of abarelix is recovered unchanged in the urine, with no...

Other Animal Exposures

It is likely that nearly every animal can produce proteins to which individuals could become sensitized if adequately exposed. There are documented cases of allergy to numerous mammals ranging from rodents such as rats and mice to large animals such as horses or cows. Sensitization can also occur to pets such as gerbils, hamsters, guinea pigs, or rabbits. Typically, the urine from these animals contains allergenic proteins that can easily become aerosolized. Therefore, allergic patients should avoid contact with contaminated bedding and avoid cleaning the cages of these animals. Although it is relatively easy to reduce one's exposure to such small caged pets, natural exposure to mouse or rat allergen is more common than we would like to think.

Fungal Allergen Avoidance

With detergent, and then cleaned with an antifungal agent such as chlorine bleach. Condensation-collection pans should be checked to ensure proper drainage and lack of obstruction to avoid pooling of water. Simple steps such as these can be quite helpful in the treatment or prevention of indoor mold growth. Although studies have yet to be done on the clinical effectiveness of mold avoidance, removal of clearly mold-contaminated materials is important, as these are potential triggers for severe allergy and asthma.

Characteristics of staff authorised to take responsibility for the supply or administration of medicines under Patient

Clinical condition - The PGD is applicable to any patient (male or female) who has been diagnosed with genital candidiasis. Genital candidiasis is a fungal infection and is commonly caused by the species Candida albicans. In women the sites of infection may include the vulva, vagina and the urethra, and in men the most common sites include the glans, prepuce and urethra. Signs and symptoms are variable. Women may complain of a thick white vaginal discharge, pruritus, soreness, erythema, dysuria and dyspareunia. Fissuring may be apparent on the vulva. Men may present with a visible rash on the glans and they may also complain of pruritus and dysuria. Diagnosis is confirmed either clinically, microscopically (by wet and dry slide) or by culture media. Inclusion criteria - symptomatic patients who have had Candida diagnosed clinically and or microscopically, and symptomatic patients who have had Candida diagnosed on culture. Exclusion criteria - this includes female patients who have...

Roger W Fox md and Richard F Lockey md

Treatment of Allergic Reactions Medications and Equipment Future Trends in Immunotherapy Suggested Reading Allergen immunotherapy is appropriate and effective treatment in patients who have symptoms of allergic rhinitis and or allergic asthma with natural exposure to allergens and who demonstrate specific IgE antibodies (by skin tests or in vitro tests) to relevant allergens. Allergen immunotherapy is medically indicated in patients with respiratory allergies when symptoms are not controlled adequately by pharmacotherapy and avoidance measures, or when there is a need to avoid adverse effects of pharmacotherapy or a wish to reduce long term use of pharmacotherapy. Randomized, double-blind, placebo-controlled studies show that immunotherapy is effective for the treatment of allergic rhinitis and or asthma. in patients with moderate to severe respiratory allergies, immunotherapy should be considered. Key Words Aeroallergens vaccine immunotherapy pollen mites danders molds allergic...

Indications For Allergen Immunotherapy

Controlled clinical studies demonstrate that allergen immunotherapy is effective for patients with respiratory allergies (Table 1). Immunotherapy is specific for the allergen administered, and the content of the treatment vaccine is based on the patient's history and allergy test results. In general, the very young (< 5 yr old) and elderly patients (> 65 yr old) are not candidates for immunotherapy. The very young patient with respiratory allergic diseases usually responds favorably to environmental control and pharmacotherapy, and an uncooperative child is not the ideal candidate for allergen injections. Theoretically, the young patient may benefit the most by immunotherapy by altering the natural course of a chronic disease. The elderly patient rarely requires immunotherapy for the management of rhinitis and or asthma. The optimal duration of immunotherapy to achieve the best therapeutic response remains unknown however, studies indicate that 3-5 yr of immuno-therapy is adequate...

How should opioids be given Are some opioids better than others

Meperidine has the highest incidence of allergic reactions in addition, its first metabolite, normeperidine, can accumulate and cause central nervous system excitation, including seizures. Normeperidine accumulation is dose dependent and more common in patients with renal impairment. Consequently meperidine has been removed from many hospital formularies and replaced with better opioid alternatives. Morphine has an active metabolite (morphine-6-glucuronide) that is analgesic and has a longer half-life than morphine. This metabolite can be useful in many cases because it allows a slow, sustained increase in analgesia. However, in patients with decreased renal function, the accumulation of an active metabolite may lead to increased side effects, including increased risk of respiratory depression. Fentanyl acts more rapidly than morphine or hydromorphone and has no active metabolites. It is a safer choice for patients with impaired renal or liver function. Hydromorphone also has no...

Working together to grow libraries in developing countries

In this first volume for the new decade, an array of interesting topics is presented. This volume leads off with an interesting review on the identification of potential biomarkers in vulnerable atheromatous plaques. Rupture of these plaques is associated with a host of coronary artery syndromes including myocardial infarction and stroke. The second review explores the unique relationship of haptoglobin polymorphism and its functionally distinct phe-notypes in vaccination, as well as susceptibility or resistance to common infection. The role of bilirubin as a physiological antioxidant is presented in the next chapter in support of its reported protective role in prevention of cardiovascular morbidity and mortality. The oxidation theme is continued in the next chapter as the role of NAD(P)H oxidase is investigated as the major source of superoxide in vascular cells and myocytes. The importance of this key enzyme in the pathophysiology of coronary artery disease is elucidated. The next...

Experience with the Microarray at the University of Antwerp

Excema Iga Deficiency

When discriminating between sensitization and genuine allergy, traditional IgE assays have repeatedly been demonstrated to be of limited value. Therefore, in order to assess the potential of the microarray in discriminating between clinically relevant and irrelevant sIgE antibodies, we conducted several evaluations. In a first study 37 we evaluated whether CRD by microarray could constitute a reliable instrument in the diagnosis of applemediated oral allergy syndrome (OAS) in birch pollen-allergic patients (Figs. 2 and 3). Although the recombinant form of the major apple allergen Mal d 1 (Malus domesticus) was absolutely discriminative between OAS patients and healthy control individuals (Fig. 2), it offered no advantage over conventional ImmunoCAP for rMal d 1 and failed to discriminate between sensitization and real allergy 46 . However, we observed that birch pollen-allergic patients without OAS to apple display a broader sensitization to classical inhalant allergens than birch...

Causes Of Bronchial Asthma Allergic Asthma

About 90 of asthmatics between the ages of 2 and 16 yr are allergic, 70 less than 30 yr are allergic, and about 50 of patients older than 30 yr are concomitantly allergic (Table 2). Thus, coincidental allergies are far and away the most common underlying condition associated with the development of asthma. One should suspect allergy as a contributing factor when (1) there is a family history of allergic diseases, (2) the clinical presentation includes seasonal exacerbations or exacerbations related to exposures to recognized allergens, (3) there is concomitant allergic rhinitis or other allergic disease, (4) a slight-to-moderate eosinophilia is present (300-1000 mm3) or eosinophilia in the sputum is observed, or (5) the patient is less than 40 yr old. Skin testing can be used to confirm immunoglobulin (Ig)E directed against incriminated allergens but does not establish a cause-and-effect relationship. Thus, patients may have a positive skin test but not have clinical symptoms of...

Theophylline Toxicity

Theophylline Toxicity Signs

The combination of seizures and cardiorespiratory arrest leads to the most disastrous consequences of theophylline intoxication. Individuals who are resuscitated and survive show signs of severe anoxic brain injury, much like those who have been resuscitated after drowning or strangulation. A meta-analysis of 12 studies with theophylline and 9 with caffeine showed no effect of either drug on behavior or cognition in children and adolescents. Concern about the effects of theophylline on behavior, particularly learning, was raised in a study by Rachelefsky and coworkers however, there were many commentaries and critiques of this study. Furukawa and associates, in two studies of theophylline in asthmatic children, also interpreted their results to suggest that theophylline may impair learning and behavior. It is of interest that one important abnormal finding in their initial report was not substantiated in their second study. Creer and McLoughlin, after a critical review of the subject,...

Contact Dermatitis of the Eyelids

In contradistinction to ocular allergy, which is predominantly associated with the activation of mast cells, contact dermatitis is predominantly a lymphocytic delayed type of hypersensitivity reaction involving the eyelids. Because the eyelid skin is soft, pliable, and thin, contact dermatitis of the eyelids frequently causes the patient to seek medical attention for a cutaneous reaction that elsewhere on the skin normally would be of less concern. The eyelid skin is capable of developing significant swelling and redness with minor degrees of inflammation. Contact allergy is a common cause of eyelid dermatitis in particular, and the allergens may reach the skin in many different ways. Common sources for allergenic sensitizers are topical pharmaceutical products (antibiotics, corticosteroids), cosmetics (fragrance components, preservatives, emulsifiers, hair-care and nail products), metals (nickel), rubber derivatives, resins (e.g., epoxy resin), and plants. Also, latex allergy...

How Does One Recognize Contact Dermatitis

Poison Ivy Streaking

Eczema that fails to heal with treatment should make one suspect contact dermatitis. Those subspecializing in contact dermatitis see this regularly. Sometimes the original problem is no longer present, and the patient proves to be allergic to a cosmetic lotion or topical medication that he or she applied to soothe the original dermatitis (Figs. 8 and 9). Sometimes a typical medication pattern is seen, with eczema spreading around lesions from the applied substance and fewer lesions at the periphery where less has been applied. In some cases of milder sensitivity, and especially corticosteroid allergy, one may see the original condition unchanged, but refusing to heal. 6. There is often a previous history of contact allergy or irritation. For example, one might look for contact dermatitis to an aminoglycoside in a nurse with previous allergy to neomycin. 7. A known allergy, irritation, or predisposing condition is present. Atopics of all types typically are susceptible to certain...

How Does One Manage A Patient With Suspected Contact Dermatitis

Remove the patient from all possible contact sources in the involved area. Of course, in some situations (e.g., clothing dermatitis), this is not possible. However, all white polyester textiles are seldom a problem, and such materials are a good substitute. Many women are reluctant to omit wearing makeup, but they are much more receptive when shown the potential for developing additional allergy (meaning they will have difficulty eventually finding products they will tolerate) if not removed from a source of allergic contact dermatitis.

Allergic Contact Dermatitis

Substances that can trigger allergic contact dermatitis include nickel or nickel-plated items, rubber, hair dyes, and cosmetics such as perfumes and lotions. (Some people are allergic to the chemicals used to preserve cosmetics, while others are allergic to the fragrances used in these products.) Rubber can cause a more serious allergic reaction that goes beyond a simple rash. Some people who are allergic to rubber (including the latex rubber used in rubber gloves) experience itchy, watery eyes and, in some cases, shortness of breath that could lead to anaphylactic shock (see page 383), a potentially fatal allergic reaction. Chromium contained in cement, leather, paints, and antirust products also can produce allergic contact dermatitis. Rashes produced by plants such as poison ivy, poison oak, and poison sumac also are considered allergic contact dermatitis. People who are sensitive to poison ivy, oak, and sumac also may be allergic to the oils contained in mango skins and cashew nut...

Osteonecrosis Avascular Necrosis or Aseptic Necrosis

Rheum Dis Clin North Am 32(3) 509-522 Amigo MC, Garcia-Torres R, Robles M, Bochicchio T, Reyes PA (1992) Renal involvement in primary antiphospholipid syndrome. J Rheumatol 19(8) 1181-1185 Asherson RA, Cervera R (2007) Pulmonary hypertension, antiphos-pholipid antibodies, and syndromes. Clin Rev Allergy Immunol 32(2) 153-158