BACKGROUND:Tropomyosin has been described as cross-reacting allergen between mite, cockroach and shrimp.METHODS:In 13 patients with asthma and/or rhinitis sensitized to mite and/or German cockroach and presenting urticaria, oral allergy syndrome or angio-edema upon eating shrimp and/or crab, we measured specific IgE to mite, cockroach, crab and shrimp tropomyosin.RESULTS:Ten patients had specific IgE to tropomyosin from mite, 8 from shrimp, 6 from crab and 5 from cockroach. AST inhibition tests indicated that mite allergen is a primary sensitizer and is cross-reacting with shrimp, crab and cockroach allergens.CONCLUSION:Tropomyosin could be the cross-reacting allergen relevant for clinical symptoms to mite, cockroach, shrimp and crab.
It is the first case reported of delay hypersensitivity due to polydioxanone (PDS II).
The currently proposed guidelines and consensus for asthma include Peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) as two criteria to classify asthma severity. The report between these functional data and clinical classification degrees has been evaluated in 153 asthmatic patients. Concordance between functional evaluation and clinical degree has been found only for moderate persistent asthma but not for intermittent or mild persistent asthma. These results suggest that the correlation between clinical evaluation and lung function proposed in the guidelines must be reevaluated.
Products of the sea are important source of food. Increase in consumption, due to their nutritive value has also led to a great frequency of reactions, including those that are immunologically mediated. Although hypersensitivity reactions to sea products are often easy to identify and can be confirmed by specific in vitro and in vivo tests, some patients can only be diagnosed by double-blind provocation test against placebo (DBPCFC). An atypical or incomplete clinical history suggests, always, contamination with toxins and/or parasites such as Anisakis. Crossed reactivity between different sea products is frequent. However, there are clinical differences between allergy to molluscs, crustaceans and fishes. From precise evaluation of the reactions to sea produce, will result a reduced and reasoned suppression from this type of allergens at food levels.
The ambrosia (Ambrosia artemisiifolia L.) has been announced in Switzerland for more than 100 years. During the last decade, signs of an increased presence of the ambrosia and its pollen appear in the south-west of Switzerland, in particular in Geneva. Aerobiologic measurements make it possible to highlight the importance of the transport of pollen by the winds since the area of Lyon, where the ambrosia is abundant. It also bring elements making it possible to detect a local production of pollen in the Geneva area, where several invaded fields were discovered with the autumn 2001. A multidisciplinary group was created in Geneva and it attempts to prevent as far as possible probable invasion of the ambrosia.
Allergy to pseusoephedrine seems to be rare and has been described as responsible of urticaria, contact dermatitis, fixed non-pigmenting erythema or pseudoscarlatina. We report the case of a male patient who presented a recurrent erythema after administration of different treatments including pseudoephedrine. A cutaneous biopsy was compatible with erythema multiform. Patch tests confirmed the diagnosis of allergy to pseudoephedrine but resulted in a reappearance of symptoms.
Infection with respiratory syncytial virus is frequent but most often benign. The serious forms of the illness, which make necessary hospitalisation or care in an intensive Care Unit, appear in infants of less than 6 weeks and especially in those with underlying pathologies, prematurity, congenital cardiopathies or chronic respiratory illnesses. Palivizumab (SYNAGIS) is mouse humanized monoclonal antibody which is used for prevention by monthly injections before and during the epidemic period. In a pivotal study performed on 1502 infants aged less than 6 months and former prematures of less than 36 weeks gestational age (GA) or aged less than 2 years and preventing a bronchopulmonary dysplasia, 1002 infants received 5 monthly injections, compared with 500 infants treated with placebo. There was a significant reduction of 55% risk of hospitalisation with VRS infections in the treated group, but no significant reduction in the number of stays in intensive care or deaths. The recommendation in France now is to use SYNAGIS in children aged less than 6 months, born with or GA of less then 32 weeks or aged less than 2 years and presenting a bronchopulmonary dysplasia. Questions remain on the cost-benefit ratio of this treatment and the favourable effects of this treatment in children who carry other chronic pulmonary or cardiac pathologies.
The authors report a patient who presented 4 times a systemic urticaria with arthralgias and fever treated by corticosteroids with efficacy. Wild hop (Humulus lupulus) was finally proved to be the causal factor. H.L. belongs to the cannabinaceas family. Hop dermatitis in hop workers population is the main widely described clinical manifestation. Rhinitis, conjunctivitis, asthma are rare as soon as contact urticaria. IgE-anti Hop induced allergies are described in the literature. However, in some cases of reactions to hop the mechanisms are uncertain: toxicity--possible role of lupuline--or immunoallergic processus with immunocomplexes (IC) (with increased IC in serum) and systemic urticaria such as in our observation.
A hydrolysate of proteins is considered to be adapted to treatment of allergy to cow's milk proteins when it is tolerated by 90% of allergic children. This suggestion implies that 10% of the children who are allergic to cow's milk proteins do not tolerate the preparations based on hydrolysates of proteins and presupposes the case of intolerance or allergy henceforth widely reported. The diagnosis must mention before the existence or the persistence in an infant fed with a hydrolysate of proteins of non-specific clinical signs often attached to more frequent pathologies, such as gastro-oesophageal reflux or colic. Substitution of a hydrolysate by another is one alternative, but the level of residual peptides of protein hydrolysates explains only the cases of severe allergy, the child may show reactions to these residual epitopes. The alternative is use of a formulation based on amino-acids, which allows diagnosis by an elimination-provocation test of protein hydrolysate. An elementary formulation based on amino-acids may permit to await the period of acquisition of tolerance.
Food allergy to cow's milk proteins (APLV) is frequently found in young infants. Treatment is by starting an elimination diet. Different substitution products have been proposed: soya milk, partial hydrolysate of the proteins of lactoserum, powdered casein hydrolysate, hydrolysed soya and pork collagen. Allergic reactions to soya milk, hydrolysates of lactoserum proteins, powdered casein hydrolysates and hydrolysates of soya have been described. The study that we present evaluates the effect on the natural development of these allergies of a formula based on amino-acids (Neocate) in 26 patients who presented a syndrome of multiple allergies one of which was a food allergy to milk. Twenty-five of them had a severe atopic dermatitis, isolated (14 cases), or associated with gastro-intestinal troubles (6) break in the growth curve (5), anaphylactic reactions (2), one asthma (1). One child had a chronic diarrhoea associated with a weight plateau. Evaluation 2 or 3 months later showed a significant improvement of the atopic dermatitis. Return of the stature-weight growth was noted in 4 children from 5, the check in one was reported as due to a initially unrecognised allergy to gluten. The recovery of the APLV was shown by double-blind oral provocation test in 20/23 children between 11 and 37 months (22 +/- 9). Duration of administration of Neonate was between 6 to 19 months (12 + 5) months. This study confirmed the beneficial effect of the amino-acid formula on weight gain, gastro-intestinal troubles and development of atopic dermatitis. The level of recovery of APLV of 86% at the age of 2 years is better than that reported in the syndrome of multiple food allergies of 22%. The influence of this diet on the development of other food allergies remains to be evaluated.
Desloratadine, the active metabolite of loratadine, is a new antihistamine. Because of its anti allergy properties, desloratidine has an affinity for histamine receptors 25 to 100 times greater to those of the usual antihistamines, coupled with a capacity to inhibit the production of pro-inflammatory mediators. When evaluated in healthy volunteers, the half life of desloratadine has been estimated at 27 hours, which is comparable with a night time length of action. Many clinical studies made with patients suffering with allergic rhinitis or chronic idiopathic urticaria have shown a rapid symptom reduction, lasting 24 hours after first taking. This action was correlated with an improvement in socio-professional activity, sleep and quality of life in general. In patients suffering from allergic rhinitis, rhinomanometry showed a significant improvement in nasal congestion by desloratadine. The clinical advantages of desloratadine on antihistamines taken previously were measured in a study made on almost 48,000 patients, of whom 91% found its efficacity satisfactory. By its powerful action, coupled with an excellent tolerance profile, desloratadine represents a real therapeutic advance for allergic patients.
The phenologic observations carried out in Switzerland since 1951 show a clear tendency to the earlier appearance of the spring phases of development of the vegetation during last decades. As these phases are strongly influenced by the temperature, these results reinforce the hypothesis according to which the climatic reheating in progress strongly influences the development of the vegetation. The flowering and the release of the pollen of the plants allergens are significant phenologic phases for human health. Modifications in their dates of manifestation lead to a displacement of the periods of allergic risk. The analysis of the aerobiologic data of the Swiss stations over one duration of more than 20 years showed that the species which flower in winter and in spring were subject to the influence of the soft winters of the years 1990 to 2000. In certain areas the pollen of birch, for example, is nowadays waited on average 3 weeks earlier than 20 years ago, whereas the pollen of ash appears with one month in advance. The phenologic and aeropalynologic studies thus prove sensitive witnesses of the climatic change in progress. This last intervenes like an indirect but significant component of human health, in particular when the field of the allergies is considered.
INTRODUCTION:What impact does the use of new drugs and latex gloves it have on the frequency and the severity of peri-anaesthetic anaphylactoid reactions? Does the evolution of in vitro techniques does represent a progress in the imputability of the substances at the origin of the shock?THE METHODS:They include the letter from the anaesthetic doctor, the questioning by the allergologist, skin tests (Pricks, IDR) with the anaesthetic substances and the latex according to the GERAP protocol and the biologic tests (Human Basophilic Degranulation test (TDBH), Radio ImmunoAssay (RIA), leukotrienes E4 assay (LTC4), Flow Cytometry (CMF)).THE RESULTS:386 patients were explored (289 women and 88 men, mean age 41.5 years). The muscle relaxants are the first cause of anaphylaxis 77%. Muscle relaxants cross allergy is found in 55.1%. The Latex, tested since 1989 with Allerbio and Stallergenes extracts, is responsible for 25 shocks with one death and 15 with grade III or IV. Preventive antibiotherapy, since consensus meeting of 1992, seems responsible of 17 accidents. 116 TDBH, 216 RIA, 17LTC4 and 47CMF. TDBH are made concordant with skin tests in 48.2% against, 71.2% for the RIA.CONCLUSION:The experience of 17 years of allergo-anaesthetic consultation confirms the first row for the muscles relaxants for the target of anaphylactic shock, but the imputability of Vecuronium and Rocuronium increases to the detriment of the Suxamethonium. The Latex is in the second row, but the target questioning, the systematic use of Prick tests and "latex free" surgery room limit its increase which should change down. The antibiotherapy occupies the third row and might increase. 54 accidents have remained unexplained.
BACKGROUND:Studies have shown that allergens are very important sensitizing agents in patients with asthma. Respiratory disorders such as asthma and allergic rhinitis are common in the United Arab Emirates, (UAE).OBJECTIVES:The aim of this study was to investigate the relationship between allergen specific IgE antibodies and skin test reactivity in patients with asthma in hot climate and desert Arabian country.DESIGN:A hospital-based prospective study conducted.SETTING:Tawam Teaching Hospital, Al-Ain, UAE.PATIENTS:327 adult patients recruited with respiratory, dermatologic and ophthalmologic diseases of suspected allergic origin who attended Tawam Teaching Hospital of Faculty of Medicine, Al Ain, UAE, during three years from 1996 to 1998.METHODS:Skin Prick Test (SPT) and radioallegosorbent tests (RAST) were performed on 327 patients for common allergens. The blood sample was taken for measuring specific IgE concentration.RESULTS:There were 327 UAE patients of whom 117 (35.8%) were males and 210 (64.2%) were females. The population sample had a higher prevalence of diagnosed asthma among females (48.1%) than in males (36.7%). Skin prick testing showed that 244 patients (74.6%) had positive results, and 83 patients (25.4%) were found to be skin test negative. 44% had a positive family history of asthma. The twelve most common reactions in the United Arab Emirates were: Mesquite (45.5%), Grass Mix (40.7%). Cottonwood (33.1%), Bermuda Grass (31.3%), Kochi (25.8%), Acacia (25.6%), Alfalfa (22.9%), Chenopodium (19.6%), Date palm (13.8%), Cockroach (14.7%), house dust (11.9) and Dust mite (9.5%). Total IgE level (> 100 kU/l) was strongly associated with history of wheeze (p = 0.019), asthma (p = 0.01) and allergic rhinitis (p < 0.0001), atopy (p < 0.0001) and the presence of specific IgE antibodies to grass pollen (p < 0.0001), mite (p = 0.008) and cockroaches (p = 0.025).CONCLUSION:The present study revealed that hypersensitivity to pollens, house dust, dust mite and cockroach was common. The family history, environment, and airborne allergens are identified to be risk factors for asthma and other allergic diseases in Arabian Gulf Countries.
Professional allergists have made a compendium of data of specific IgE compared with clinical diagnosis. The data allow the establishment of curves of diagnostic probability and future following of patients according to the clinical plan of skin tests and assay of specific IgE.
Capillary leakage Syndrome (CLS) is a rare clinical syndrome, that was first described in 1960, characterized by acute episodes of generalized edema, hemoconcentration, hypoproteinemia and monoclonal gammopathy, in the vast majority of cases. We describe a 39-year-old man with anasarca, bilateral pleural and pericardial effusions, ascites and diffuse alveolo-intersticial edema. Clinical and laboratory findings were consistent with an acute episode of CLS. Treatment with prednisone, furosemide and aminophylline was started, which lead to a gradual improvement in 48 hours. Pathophysiologically there is an increase in capillary permeability with the extravasation of fluid and plasmatic proteins to the extravascular space that can lead to hypovolaemic shock. In the second phase there is a reentry of the fluid overload leading to pulmonary edema. The etiology of this hyperpermeability still remains unclear. The role of cytokines has become central in the comprehension of pathophysiology of CLS. Adhesion molecules are probably also involved in the genesis of capillary leakage. CLS treatment remains empirical. However, at present it seems that the association of steroids with furosemide, aminophylline and terbutaline are capable of controlling the clinical manifestation of the acute episodes in most cases. To our knowledge no prophylatic therapy has clearly proven its efficacy. There are only a few series analyzing the long-term evolution of patients with CLS. Further studies are necessary with the objective to collect enough patients with CLS to observe natural history of the disease and evaluate the efficacy of empiric treatments.
We report the case of an HIV-infected woman, who presented with chronic and productive cough without sign of hypersensitivity (fever, cutaneous eruption, gastrointestinal disorders), while taking abacavir. All complementary exams being negative, the involvement of abacavir has been suspected. So the drug was stopped leading to a rapid disappearance of cough. It is the first report of chronic cough with abacavir apart of a context of hypersensitivity reaction.
The results of assay of IgE can only be expressed by a very imprecise system of classes. Quantification of the measurement of IgE by the method of the CAP-system of prognosis of allergic patients. Expression of IgE by a measurement of intensity of fluorescence allows the establishment of a decent curve for each allergen. It makes a method of predictive evaluation of risk of the allergy pathology for each allergen. It significantly improves the sensitivity, since it allows detection of IgE at levels less than 0.35 KUA/l. Thus it gives a considerable improvement for the clinician at the level of diagnosis avoiding the "gold standard" provocation test in allergy diagnosis as well at the level of prognosis.
The place of trophallergens in the allergy investigation of asthmatic children is controversial. Asthma is only rarely the isolated manifestation of food allergy. The clinical history is essential for research of the associated signs that reveal a food allergy. In the absence of these associated signs, the presence of a positive test for trophallergens only rarely reflects a true food allergy, of which the presence can only be assured by a double blind oral provocation test. In addition, in nurslings, the presence of a positive skin test to a trophallergen indicates atopy in the infant, but is only a mediocre predictive factor of eventual asthma, in the absence of an associated clinical allergy.
The role of Candida species in allergic diseases is briefly reviewed pointing out the more common forms of cutaneous and respiratory allergy where Candida can be implied, the current laboratory diagnostic methods and the possible effectiveness of Candida immunotherapy in selected patients.
