A case of latex allergy suspected drug allergy]

A 30-year-old female with paroxysmal supraventricular tachycardia (PSVT) underwent catheter ablation. About 30 minutes later, urticaria and dyspnea occurred suddenly. Blood pressure decreased to 62/41 mmHg, and she fell into the state of anaphylactic shock. She recovered within one hour following treatment. We initially suspected the onset of anaphylaxis was caused by either the local anesthetic or the intravenous antibiotic administered. Following thorough investigation (skin tests and challenge tests), we concluded that the anaphylaxis was not drug induced. Subsequently, we suspected latex allergy. Skin prick test showed a positive reaction to rubber gloves. The specific test for IgE antibody against latex was positive at 10.8 UA/ml. From these results, anaphylactic shock caused by latex (probably medical gloves) was diagnosed. Doctors should take preventive measures against latex allergy not only in operating rooms but also during minor treatments. It is possible that latex allergy is responsible for some cases of anaphylaxis of unknown origin.     

The national survey of immediate type of food allergy]

BACKGROUND: The actual conditions regarding immediate type food allergy have not been fully understood. Appropriate countermeasures have not been taken so far. The objective of our research is to identify the actual conditions of immediate type food allergy in Japan for the purpose of contributing to future practices. SUBJECT: We conducted a survey on the patients in collaboration with 2689 domestic hospitals which have pediatrics and more than 100 beds. We focused on these cases who presented with symptoms of allergy within 60 minutes of the intake of any offending food. RESULT: 60.4% of collaborators returned the questionnaire. We investigated 1420 cases in 498 hospitals. Average age of cases was 6.7+/-13.1 (Mean+/-SD). Ages not more than 8 years-old comprised 80.1% of the whole population. The most common offending foods were eggs, milk products, wheat, buckwheat, fish and fruits. In addition, offending foods varied depending on age. The clinical symptoms appeared at 24.2 minutes+/-19.4 minutes (Mean+/-SD) after the intake of offending foods. The most common clinical symptom was observed on the skin and respiratory organs. CONCLUSION: Based on the results of this study, the Ministry of Health, Labor and Welfare amended the ministerial ordinance concerning the allergy food labeling system. Five major offending foods (eggs, milk, wheat, buckwheat, and peanuts) were designated as ingredients to be specified on the label.     

The national survey of immediate type of food allergy]

There are not so many epidemiological data for food allergy in Japan due to lack of relevant investigation. Therefore we are to study the reality of the immediately type of food allergy by utilizing IgE and CAP-RAST data investigated in 1998 and 1999 by the Research Group of Public Welfare Ministry of Labor. The survey was conducted in cooperation with 2689 domestic hospitals which have pediatrics and more than 100 beds. We focused on patients who had the symptoms of allergy within 60 minutes after the intake of any offending food. The questionnaire was returned by 498 hospitals (collect rate 60.4%), which reported 1420 cases. We did not find clear relation between serum IgE and frequency of food allergy symptom and admission rate. On the other hand, we recognized that CAP-RAST had significant differences in the frequency of shock disease caused by the intake of milk products whereas there were no differences in any other major antigens. We concluded that both serum IgE value and CAP-RAST Class cannot indicate the severity of the immediate type of food allergy.     

A case of occupational contact urticaria and oral allergy syndrome due to seafood]

A 20-year-old woman was referred for evaluation after about 2 years of recurrent episodes of localized urticaria during handling of several kinds of raw fish in a sushi shop, where she had worked part-time for 2 years. She had also experienced allergic symptoms such as itching and swelling of her lips, generalized urticaria, laryngeal tightness, stridor and dyspnea immediately after ingestion of raw and cooked seafood, including sole, horse mackerel, sea eel and shellfish, over the previous 1 year before referral. Skin prick tests and blood test for specific IgE antibodies were positive for many kinds of seafood, including sole, horse mackerel, sea eel, eel, crab, and abalone, which belonged to different taxonomic phyla, including Chordata, Arthropoda, and Mollusca. A challenge with a piece of broiled sole induced swelling of the lips, obstruction of the larynx, difficulty with deglutition, and abdominal pain. In addition, serum-specific IgE antibodies to two major fish allergens, parvalbumin and collagen, were detected by ELISA, suggesting that allergic symptoms could be induced by many kinds of seafood in the present patient. She was therefore diagnosed with occupational contact urticaria and oral allergy syndrome due to seafood. At the time of this report, the present patient had been followed for one year and no reactions have occurred since she started to avoid the causative types of seafood.     

A case of allergy to cow's milk hydrolysate

We here report a girl, now 3 years old, who has suffered from severe food allergy since her first year of life. She was strongly allergic to cow's milk, and had high levels of IgE antibody (AB) to casein (210 kU/I), beta-lactoglobulin (43 kU/I), and alpha-lactalbumin (23 kU/l) at 12 months of age. In addition, at the same age, she showed positive (2-4+) skin prick reactions to both unboiled and boiled formulas (Profylac, Nutramigen, and Neocate), besides being positive in RAST to Nutramigen (0.6 kU/l). During the first 3 years, IgE Ab levels against casein and Nutramigen increased to 310 and 1.6 kU/l, respectively. Furthermore, at 3 years of age, she had positive RAST to 14 of 15 tested food allergens, being negative only to codfish. Assessment of eosinophil-related markers revealed high total eosinophil count, increased eosinophil activity, and a low ratio of interferon (IFN)-gamma:IL-5, indicating enhanced IL-5 production. The food allergy was correlated to poor weight gain and increasing problems with atopic allergy in the airways.     

The time course of biological and immunochemical allergy states induced by anisakis simplex larvae in rats

Oral infection by Anisakis simplex third stage larvae (L3) frequently gives rise to an allergic response. To comprehend the allergic and immune responses induced by L3, we investigated the kinetics of specific antibody isotype expression and the time course of biological and immunochemical allergy states using sera prepared from rats orally infected with L3 twice, with an interval of 9 weeks between infections. Biological and immunochemical allergy states were analysed by RBL-2H3 exocytosis and by indirect ELISA for IgE, respectively. The peak IgM at reinfection (RI) was comparable or similar to that at primary infection (PI) both in levels analysed by indirect ELISA and in antigen recognition analysed by Western blot. IgG1 and IgG2a levels were higher and showed accelerated kinetics after RI vs. after PI. However, the level of IgG2b was substantially lower than that of IgG2a. Peak immunochemical and biological allergy states for RI were higher and were reached faster than those for PI. The peak biological allergy state was observed at 1 week postreinfection and this occurred sooner than that for the peak immunochemical allergy state found at 2 weeks postreinfection. Our analysis of the relationship between specific IgE avidity and biological allergy state did not show any meaningful correlation. These results suggest that the allergic response induced by L3 oral infection is predominantly caused by reinfection and that this is accompanied by an elevated IgM level, which further suggests that the biological allergy state might not be related to specific IgE avidity.     

A case of fallow deer allergy

We report the case of a 25-year-old housewife, a native of Mexico City, with rhinitis and asthma induced by exposure to fallow deer in an animal park close to her home. In the literature, we could find only one previous case. The patient presented a polyvalent IgE sensitization in prick skin tests and RAST to several animals' dander and epithelia, but RAST inhibition experiments showed a cross-reactivity only between fallow deer and horse allergen extracts.     

Inhalant allergy following occupational exposure to blowflies

An allergic reaction, provoked by exposure to the blowfly Lucilia cuprina and shown to be IgE-mediated, occurred in a subject employed in an entomological research laboratory. The subject's serum, and sera from three other asthmatic patients with IgE antibodies to blowfly extracts, also reacted with extracts from the screw-worm fly (Chrysomya bezziana). Results suggested that antigens from the two species share immunological cross-reactivity. Cross-reactions also exist between the different developmental stages of both species. Allergic reactions to inhaled insect allergens may not be uncommon in the Australian community.