Isolation and characterization of proteic allergens in refined peanut oil

Allergic reactions to peanut oil are very much debated, even if the responsibility of peanut oil has been evoked in several cases of adverse reactions, including death related to severe asthma. The aim of the present study was to investigate the presence of allergenic proteins in peanut oil. Proteins were extracted from commercial refined peanut oil, with a relative content in the order of 0.1–0.2 μg per g of oil, and molecular sizes ranging from 14 up to 76 kDa in SDS-PAGE. Eight protein bands were systematically observed in crude, neutralized and refined oils, with a molecular mass ranging from ≈ 14 to 76 kDa, including one at 18 kDa which was identified by Western blot performed with serum from two allergic patients. The protein extract gave positive IgE-RIA with patient sera, positive in vitro leucocyte histamine release tests and positive skin-prick tests in allergic patients. The allergenic protein was purified by HPLC and [¹²⁵I] iodide-labelled. It had an isoelectric point at 4.5 in isoelectrofocusing. In conclusion, we have demonstrated the presence of allergenic proteins in crude and refined peanut oil. These proteins are the same size as two allergens previously described in peanut protein extracts.     

Allergic shock to latex and ethylene oxide during surgery for spinal bifida

Few studies have examined the possible adverse effects that epidural injection of depot corticosteroid preparations may have on meningeal membranes and nervous tissue. Thirty-six healthy adult white rabbits received 0.3 ml/kg epidural injections of either lactated Ringer's solution (negative control group), 1% lidocaine containing methylprednisolone acetate (study group), or normal saline containing talc (positive control group). Animals were killed either 4 or 10 days after injection and stained sections of the spinal cord and meningeal membranes were examined by light microscopy. In all animals that received either lactated Ringer's solution or lidocaine with methylprednisolone acetate, microscopic examination of specimens taken from the L5-L6 interspace revealed no white cell infiltrates and no fibroblastic activity. All animals that received epidural injections of normal saline containing talc had marked infiltration of tissue macrophages in the epidural space. There was no thickening of the meningeal membranes or nerve roots in any animal. The complete lack of inflammatory changes and meningeal thickening demonstrated in this pilot study helps to confirm the safety of methylprednisolone acetate when injected into the epidural space.     

Identifying the carotid 'high risk' plaque: is it still a riddle wrapped up in an enigma?

The selection of patients for many vascular interventions has largely been based on the severity of luminal narrowing. However, histological data from the coronary and carotid circulations suggest that other plaque features such as inflammation and fibrous cap thickness may be more important in predicting future thrombo-embolic events. This paper reviews the available evidence for identifying carotid atheroma at high risk of being associated with clinical events. Despite a large number of imaging and biomarker studies, 'presenting symptoms' remains the most clearly identified risk predictor for ischaemic stroke in patients with carotid stenosis. At present, no imaging modality or plasma biomarker has clearly identified a high risk sub-group of asymptomatic carotid stenoses for which the benefit of carotid intervention is comparable to that of symptomatic atherosclerosis. Emerging developments in MRI, transcranial Doppler and scintigraphic imaging hold some promise for the future. However, the multiple mechanisms and sites determining ischaemic stroke occurrence in association with atherosclerosis suggests that systemic therapies are likely to be the most powerful modality in the management of asymptomatic disease.     

Le risque histaminique et anaphylactique de l''atracurium

The histamine releasing potential of atracurium was assessed by testing skin reactivity in ten patients who had previously suffered from a preanaesthetic anaphylactoid accident, but in whom the diagnosis of anaphylaxis had not been confirmed. Atracurium was injected intradermally in increasing concentrations so as to determine the reactivity level, comparing it in the same patient with that due to d-tubocurarine and alcuronium given in the same way. Skin tests with histamine and 48/80 were also carried out at the same time. When a positive reaction was obtained with atracurium, the injection was repeated 4 h after, the patient having taken 50 mg hydroxyzine p.o. The results showed that the skin reactivity level with d-tubocurarine was obtained with 1 in 100 dilution and with atracurium 1 in 10, with nine patients out of ten reacting positively. Alcuronium is the least histamine releasing drug, as it gave rise to a positive reaction in only two patients at a dilution of 1 in 10. Histamine release due to atracurium was greatly reduced by giving hydroxyzine. The allergizing potential was also studied in six other patients who had a tone anaphylaxis to a muscle relaxant and in whom crossed anaphylaxis was being tested for. All the commercial muscle relaxants together with atracurium were tested, even though none of the patients had ever received this last. Anaphylaxis was confirmed when the intradermal reaction was positive with a dilution of 1 in 1,000 and beyond. These tests showed that five patients out of the six had a crossed anaphylaxis, and one of these five was sensitive to all four muscle relaxants (atracurium included).(ABSTRACT TRUNCATED AT 250 WORDS)     

Choc anaphylactoïde mortel chez un malade traité par bêta-bloquants

The occurrence of an anaphylactoid shock in a patient treated with beta-adrenergic blocking agents during a long time prior to surgery constitutes a high risk because beta-receptors are refractory to adrenergic substances and compensatory mechanisms are obtunded. The shock is characterized by severe hypotension and bradycardia, both resistant to adrenaline. These signs were observed in a patient treated with metoprolol for hypertension several months prior to surgery. The intravenous injection of an iodine containing contrast medium during general anaesthesia was followed by a lethal anaphylactoid shock resistant to adrenaline, atropine and isoprenaline. The treatment of the shock needs, besides adrenaline, massive vascular filling, high doses of beta-agonists and glucagon.     

Risk factors in anaphylactoid reactions to muscle relaxants. A retrospective study of 103 cases of shock

A homogeneous series of 103 cases of shock due to muscle relaxants has been used to identify the risk factors in anaphylactoid shocks due to either true anaphylaxis or to non-specific histamine release. Clinical atopy (asthma) and sub-clinical atopy as shown up by skin tests with mites and pollens, as well as a history of IgE-dependent drug allergy, were present with a significantly greater frequency in the history of patients presenting with anaphylaxis. Abnormal histamine release and reactivity to histamine, as assessed by skin tests with 48/80 and histamine, were often found in those patients who presented with non-specific histamine release induced by muscle relaxants. Whatever the mechanism for the shock, the frequency of spasmophilia was increased. A history of non-immunological intolerance to acetyl salicylic acid and other non-steroid anti-inflammatory drugs was more often found than in the reference drugs was more often found than in the reference population. However, 25% of the patients studied did not have any of these risk factors. Several possibilities of preventing anaphylactoid reactions are given, if one or more of these risk factors are found in the history: a better choice of anaesthetic drugs, in the light of previous anaesthetic protocols, the relief of anxiety by appropriate premedication, antihistamine premedication and the prevention of bronchospasm.     

Food-dependent exercise-induced anaphylaxis--update and current data

Exercise-induced anaphylaxis (EIA) is defined as the onset of allergic symptoms during, or immediately after, exercise, the clinical signs being various degrees of urticaria, angioedema, respiratory and gastrointestinal signs and even anaphylactic shock. Food-dependent exercise-induced anaphylaxis (FDEIA) introduces food in the syndrome and is revealed by a chronological sequence in which food intake, followed by exercise, induces symptoms after a varying period. When the food intake and the exercise are independent of each other, there are no symptoms. FDEIA is not very frequent. Identifying the culprit food allergen depends on the patient's eating habits. Crustaceans and wheat flour are the two commonest but others foods can be implicated. The patho-physiology of FDEIA has not been clearly established but it appears to result from degranulation of mast cells. As with food allergy, FDEIA diagnosis is based on interview, skin and biological tests and challenge. For the clinical signs of allergy, antihistamines, corticosteroids and epinephrine may be administered. Prophylaxis aims to prevent a recurrence; the patient should be given an emergency kit to deal with any recurrent episode. After the food allergen has been identified, it should be avoided for at least 4 to 5 hours before any exercise.     

Simultaneous dislocation of the radial head and distal radio-ulnar joint. A case report

Isolated dislocation of the distal radio-ulnar joint and isolated dislocation of the radial head in adults are not common injuries. A simultaneous dislocation of the radial head and distal radio-ulnar joint with no other injury seems to be extremely rare since only one report was found in the English literature. A similar case, but with some differences in presentation and treatment is reported.