Sulfasalazine allergy: fever, skin rash, hepatitis and T-lymphocytes

We describe a case of severe sulfasalazine allergy. Exacerbation of the symptoms occurred after unintentional rechallenge with co-trimoxazole, indicating that the reaction was triggered by the sulphonamide component. The clinical picture consisted of generalised adenopathy, hepatitis, high fever and a maculopapular skin rash. A bone marrow biopsy and skin biopsy both showed noncaseating granulomas. The white blood cell count rose to 90.10(9)/l with 40% atypical lymphocytes (plasmacytoid). They were identified by flow cytometry as activated T lymphocytes.     

Dutch College of General Practitioners' practice guideline can be more firm--the food allergy test does not exist

The diagnosis of food allergy begins with a detailed history. Food allergy causes reproducible symptoms with every exposure. If this pattern cannot be elicited from the history, food allergy is unlikely. Measurement of specific immunoglobulin E in serum is not useful in the diagnosis of food allergy because asymptomatic sensitisation is common. Oral food challenges are the gold standard of food allergy diagnosis; they should preferably be performed in a double-blind fashion.     

Iodine allergy--adverse reactions to contrast media

Essential of iodine allergy is not well-known in clinical practice and it might be combined with the adverse reactions of intravascular contrast media which contain iodine. Definition of iodine allergy should be cleared up because serum also contains iodine. One should make a difference between iodine allergy and adverse reactions of contrast media. Physiological role and occurrence of iodine in the organism was reviewed, moreover, allergic reactions caused by iodine-containing chemicals (iodine and tropomyosine allergy). The contrast medium types and their immediate and late reactions were considered together with the mechanism. According to the published data and author's own experience the iodine allergy should be considered as an iodine-protein complex allergy. The cause of adverse reactions of contrast media is the whole molecule and not the iodine content of it. No cross reaction can be observed between iodine and contrast media. Iodine allergy and contrast media reactions are entirely different phenomenons. It was referred to prevention and therapy, as well.     

Food allergy: nuts and tree nuts

Nuts are a well-defined cause of food allergy, which affect approximately 1 % of the general population in the UK and the USA. There do appear to be differences in the frequency of nut allergy between different countries because of different dietary habits and cooking procedures. For example, in the USA and France, peanuts are one of the most frequent causes of food allergy, but in other countries, it seems to be less common. Genetic factors, in particular, appear to play a role in the development of peanut allergy. While the majority of nut allergens are seed storage proteins, other nut allergens are profilins and pathogenesis-related protein homologues, considered as panallergens because of their widespread distribution in plants. The presence of specific IgE antibodies to several nuts is a common clinical finding, but the clinical relevance of this cross-reactivity is usually limited. Allergic reactions to nuts appear to be particularly severe, sometimes even life-threatening, and fatal reactions following their ingestion have been documented. Food allergy is diagnosed by identifying an underlying immunological mechanism (i.e. allergic testing), and establishing a causal relationship between food ingestion and symptoms (i.e. oral challenges). In natural history investigations carried out in peanut-allergic children, approximately 20 % of the cases outgrew their allergy or developed oral tolerance. The treatment of nut allergies should include patient and family education about avoiding all presentations of the food and the potential for a severe reaction caused by accidental ingestion. Patients and families should be instructed how to recognise early symptoms of an allergic reaction and how to treat severe anaphylaxis promptly.     

Food allergy: A manifestation of eating disorder?

Six patients presenting with long history of multiple food allergies producing subjective symptoms not typical of allergy are presented. The diagnosis of food allergy was considered spurious in each case, because purported association of food and symptoms is not reproducible. In these cases longstanding abnormal eating behavior and weight problems preceded the diagnosis of “food allergy” when weight reduction diets were not effective. Acceptance of this pseudodiagnosis is enhanced in patients with susceptibility to suggestion. In any patient with a history of multiple food “allergies” the possibility of an underlying disorder in eating or in weight control should be thoroughly investigated.     

Vaccination-associated anaphylaxis in adults: Diagnostic testing ruling out IgE-mediated vaccine allergy

Re-vaccinations in patients with a history of anaphylaxis after vaccine injection have to be avoided because of the potential risk of recurrent anaphylaxis. However, without diagnostic work-up vaccine allergy remains a presumption and necessary vaccinations may be unjustified withheld. In the last 7 years all patients referred to our allergy clinic with a diagnosis of vaccination-induced anaphylaxis were subjected to allergologic diagnostic procedures to identify IgE-mediated allergy. We evaluated 38 patients with a history of vaccination-associated anaphylaxis. The diagnostic procedure included skin testing and challenge tests, i.e. re-vaccination with the suspected vaccine. In all 38 patients negative skin tests and tolerated challenge tests ruled out IgE-mediated allergic anaphylaxis to vaccine components. Diagnostic testing after suspected vaccination-induced anaphylaxis should be performed to rule out IgE-mediated allergy to the incriminated vaccine and its constituents and to enable future vaccinations with the tested compounds. Therefore, a history of anaphylaxis after vaccination may not be an absolute contraindication for re-vaccination.     

Prevalence of food allergy: an overview

At present the only cure for food allergy is to avoid eating the food responsible for the allergy. Thus, food allergy or food hypersensitivity is a disease that is not only of concern to the individual who is affected but also to those involved directly and indirectly in supplying and preparing food for the food-allergic individual, and its impact on society should be evaluated on this basis. It is generally assumed that questionnaire-based studies vastly overestimate the prevalence of food hypersensitivity. The reported perceived prevalence of food hypersensitivity varies from 3.24% to 34.9%, which may be explained partly by the difference in reporting lifetime prevalence compared with point prevalence. However, of more importance is the apparent inverse correlation between response rate and prevalence (the higher the response rate, the lower the perceived prevalence). The three most-recent prevalence studies on food hypersensitivity (one on perceived food hypersensitivity and two on confirmed food hypersensitivity) all report estimates for prevalence of approximately 3%, but their criteria for including subjects as being positive are not identical, although they do overlap. Furthermore, because of differences in methodology there is no definitive information to indicate whether the prevalence of food allergy is increasing. However, the high prevalence of pollen-related food allergy in younger adults in the population suggests that the increase in pollen allergy is also being accompanied by an increase in pollen-related food allergy.     

维生素D与儿童食物过敏的研究进展

近年来,食物过敏的发生率呈逐年上升趋势,婴幼儿为其高发人群,故应引起家长和儿科医生的广泛重视。目前,食物过敏的病因及其发病机制尚不明确,但最新研究发现,维生素D(VitD)与儿童食物过敏存在密切相关性,因其可影响人体免疫系统的调节作用。但目前国内外关于VitD与儿童食物过敏的相关资料研究较少,本文就VitD与食物过敏的流行病学及发病机制的最新研究进展作一综述。     

Proguanil-sulphonamide for malaria prophylaxis

There are few safe, effective chemoprophylactic regimens for preventing Plasmodium falciparum infection in south-east Asia. In two randomized placebo-controlled trials, combinations of proguanil and sulphonamide were tested for chemoprophylactic activity in schoolchildren, aged 6-15 years, living near the Thai-Burmese border. Proguanil at an equivalent adult dose of 200 mg/d was combined with sulphafurazole (= sulfisoxazole) at 25 mg/kg/d or sulphamethoxazole at 25 and 10 mg/kg/d. Combinations of daily proguanil/sulphafurazole and proguanil/sulphamethoxazole were equally effective (greater than 75%) against both falciparum and vivax malaria when the sulphonamide component was used at 25 mg/kg/d. Proguanil and sulphamethoxazole at 10 mg/kg/d was ineffective. Approximately 1% of the children had sulphonamide-related skin rashes which resolved when treatment stopped. Proguanil/sulphonamide is a possible alternative chemoprophylactic regimen in areas with multiple drug-resistant P. falciparum.     

Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis

Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects. Of 25 immunocompromised patients receiving alternative prophylaxis in whom nocardiosis developed, 16 subsequently tolerated TMP/SMX treatment. Clinicians should consider TMP/SMX allergy evaluation and rechallenging to assess patient tolerance.     

Cow's milk allergy: a critical review.

Foods which are ingested frequently, and cow's milk in particular, are a common cause of delayed-in-onset allergy. Difficulty in diagnosing milk allergy is encountered because: (1) skin tests are unreliable; (2) the symptoms of milk allergy are frequently delayed in appearing, thereby obscuring their connection with the previously ingested food; (3) when such symptoms do appear, they often fail to suggest allergy as etiologic; and (4) the offending antigen may be present in a milk product not obviously associated with milk per se such as sherbet or cheese. Contrary to common belief, most milk (and other food) allergy is not reagin (IgE) mediated. Milk allergy is not confined to infancy, but is frequently seen in children and adults, often persisting as an allergy which had supposedly been "outgrown." Since milk allergy is often a familial disorder, its presence in a patient can assist the physician in possibly discovering it in other members of the family. A two or three-week trial elimination of milk, in conjunction with written dietary instructions for the patient, is presently the only reliable diagnostic procedure.     

哈尔滨市香坊区学龄儿童牛乳蛋白过敏状况调查

目的了解儿童牛乳蛋白过敏(cowmilk protein allergy,CMPA)现状,为CMPA的防治和致敏食物的监管提供科学依据。方法以自编问卷、皮肤点刺试验、德国敏筛试纸实验作为初步诊断依据,对哈尔滨市5840名6～10岁学龄儿童进行筛查,分析牛乳蛋白过敏的影响因素。结果在有效答卷5720份中,自诉牛乳蛋白过敏的学生196例,其中47例皮肤点刺实验、德国敏筛试纸均呈阳性,CMPA发生率为0.82%。牛乳蛋白过敏多为皮疹,其次为胃肠过敏。除对牛乳蛋白过敏外,同时也对其他食物过敏。喂养方式、其他食物过敏情况、父母过敏情况是CMPA发生的影响因素。结论应采取母乳喂养、推荐食用低致敏婴儿配方粉等综合措施预防和治疗CMPA。     

Review of latex allergy.

BACKGROUND: Allergy to latex has become an increasing concern to many patients and health care providers. Health care providers should become aware of this problem and develop strategies for treatment and prevention. METHODS: We searched MEDLINE from 1990 to 1998 for the topics of latex allergy using the key words "latex" and "allergy." Other sources were found from back-referencing these references and from the Internet. RESULTS: Latex allergy is emerging as a clinical and occupational health problem. Understanding the clinical and immunologic features, which range from dermatitis to anaphylaxis, can provide the basis of preventive and therapeutic strategies. CONCLUSION: The clinician should be able to recognize latex allergy and educate patients about the potential hazards of latex-containing products. Providers can develop a plan for protecting patients and health care staff from latex exposure as well as treating allergic reactions when they occur.     

Dental surgeons with natural rubber latex allergy: a report of 20 cases.

Latex allergy is becoming a major occupational health issue and dental surgeons are at risk from becoming sensitized to natural rubber latex. A study was conducted to investigate risk factors and glove-related symptoms reported by dentists with natural rubber latex allergy. Twenty dentists, who had undergone serological or dermatological testing for a Type I allergy to latex, were identified from a questionnaire survey. Risk factors investigated were: gender, years in clinical practice, exposure to latex gloves, atopic history and food allergy. The majority of dentists (75%) gave an atopic history. Glove-related adverse reactions ranged from cutaneous to systemic manifestations. All twenty dentists reported itching of the hands in response to latex gloves. One respondent was unable to continue in dental practice because of her glove-related allergies; nineteen dentists were able to continue by using synthetic, non-latex gloves.     

Molecular diagnosis in cat allergy

Domestic cats represent one of the most common sources of indoor allergens. All over the world, many households own cats, whose allergens are persistent and widespread. Cat allergy itself is frequent, and its symptoms vary from rhinoconjunctivitis to life-threatening asthma. In vitro diagnosis using precision medicine allergy immunoassays is important because natural cat dander extracts may differ in quality and quantity of some of the individual allergen components and other molecules. In the component-resolved diagnosis of cat allergy, singleplex and multiplex specific immunoglobulin (Ig) E assays include use of the cat-specific major allergen, secretoglobin Fel d 1 (as a species-specific molecule), other allergen components (such as lipocalins Fel d 4, cross-reacting with other animal similar molecules, and Fel d 7, present in small quantities in natural extracts), and serum albumin Fel d 2 (related to the cat-pork syndrome). IgA Fel d 5 and IgM Fel d 6 are not available as allergen components in the current commercial IgE immunoassays, but they may impair the in vitro diagnostic evaluation of cat allergy because galactose-α1,3-galactose is an IgE-binding epitope of these native feline allergens. The benefits of molecular-based cat allergy diagnosis are continually evaluated, as the role of recombinant allergen components already known is detailed and new other molecules of interest may be discovered in the future.     

Psychopathology masquerading as food allergy

Three patients who presented with vague symptoms previously diagnosed as food allergy are reviewed. No evidence for allergy to foods was found in any of the patients. Two were depressed with psychotic thinking and the third had moderately severe anxiety with depression. All three improved following psychiatric diagnosis and intervention. One was treated with antidepressant and one with antidepressant-antipsychotic medication. All three maintained improvement two years later. The diagnosis of food allergy must be based on showing a direct relationship between the inciting food and the immunologically mediated reaction. Anxiety and depression may masquerade as food allergy. Evidence of psychopathology should be present to make such a diagnosis.     

Early Introduction of Allergenic Foods and the Prevention of Food Allergy

The increasing prevalence of food allergies is a growing public health problem. For children considered high risk of developing food allergy (particularly due to the presence of other food allergies or severe eczema), the evidence for the early introduction of allergenic foods, and in particular peanut and egg, is robust. In such cases, the consensus is clear that not only should such foods not be delayed, but that they should be introduced at approximately 4 to 6 months of age in order to minimize the risk of food allergy development. The early introduction of allergenic foods appears to be an effective strategy for minimizing the public health burden of food allergy, though further studies on the generalizability of this approach in low-risk populations is needed.     

Occupational allergy to laboratory animals: employer practices

Occupational asthma from exposure to laboratory animals has recently been recognized as a compensable prescribed disease in Britain. Current American employer attitudes and policies regarding laboratory animal allergy were surveyed by questionnaire and the findings compiled from 155 institutions. Laboratory animal allergy was reported as a workplace disease of animal house employees by 108 facilities (70%), with rat and rabbit exposure the most frequent cause. While 103 of 155 animal research facilities required a preemployment medical examination, only six of these included hypersensitivity screening. Applicants for jobs involving animal contact were rarely disqualified because of an allergic history. A uniform policy regarding the problem of allergy to laboratory animals in U.S. animal facilities is not presently apparent.     

Nahrungsmittelallergien im Kindesalter

IgE-mediated immediate type reactions are the most common form of food allergy in childhood. Primary (often in early childhood) and secondary (often pollen-associated) allergies can be distinguished by their level of severity. Hen’s egg, cow’s milk and peanut are the most common elicitors of primary food allergy. Tolerance development in hen’s egg and cow’s milk allergy happens frequently whereas peanut allergy tends toward a lifelong disease. For the diagnostic patient history, detection of sensitization and (in many cases) oral food challenges are necessary. Especially in peanut and hazelnut allergy component-resolves diagnostic (measurement of specific IgE to individual allergens, e.?g. Ara h 2) seem to be helpful. In regard to therapy elimination diet is still the only approved approach. Patient education through dieticians is extremely helpful in this regard. Patients at risk for anaphylactic reactions need to carry emergency medications including an adrenaline auto-injector. Instruction on the usage of the adrenaline auto-injector should take place and a written management plan handed to the patient. Moreover, patients or caregivers should be encouraged to attending a structured educational intervention on knowledge and emergency management. In parallel, causal therapeutic options such as oral, sublingual or epicutaneous immunotherapies are currently under development. In regard to prevention of food allergy current guidelines no longer advise to avoid highly allergenic foods. Current intervention studies are investigating wether early introduction of highly allergic foods is effective and safe to prevent food allergy. It was recently shown that peanut introduction between 4 and 11  months of age in infants with severe atopic dermatitis and/or hen’s egg allergy (if they are not already peanut allergic) prevents peanut allergy in a country with high prevalence.     

Occupational skin diseases among the nurses in the region of Lódź

We examined 223 nurses from the Lód? region, referred to the Nofer Institute of Occupational Medicine in 1995-99 because of suspected occupational dermatoses. The diagnosis of contact allergy was based on the positive results of patch tests, and immediate allergy to common allergens and latex on the results of prick tests, as well as on the determinations of specific IgE antibodies. Contact allergy was diagnosed in 66.4% of nurses. The most frequent sensitisers were quaternary ammonium compounds (benzalkonium) (23.8%), nickel (21.5%) and formaldehyde (20.6%); allergy was somewhat less frequently caused by thimerosal (14.3%), fragrances (12.1%), glutaraldehyde (10.8%), cobalt (9.9%), thiurams (6.7%) or glyoxal (4.9%). Allergy to rubber was diagnosed in 40 patients (17.9%), including 25 cases of immediate allergy to latex, 8 cases of contact dermatitis from thiuram rubber curing accelerators, and 7 cases of mixed allergy. It has been concluded that the contact with disinfectants (40.8% of allergic nurses), metals (30.9%) and rubber (17.9%) was the most frequent source of allergy in this group of medical personnel.