Anaesthetist's responses to patients' self-reported drug allergies

Background. Patients with drug allergies are commonplace inanaesthetic practice. We investigated the incidence and natureof drug ‘allergies’ reported by surgical patientsattending a hospital pre-admission clinic, and went on to ascertainto what degree drug allergies recorded in the records influenceddrug prescribing during the patients’ hospital stay anddetermine whether any adverse events occurred in relation todrug prescribing in this population. Methods. Patients attending for anaesthetic assessment at aPre-Admission Clinic over a 30 week period were questioned concerningdrug allergies. Medical records of these patients were thenexamined after their hospitalization to assess medications prescribedduring that period. Results. Of 1260 patients attending the Pre-admission clinicduring the study period 420 (33.4%) claimed to have a totalof 644 individual drug ‘allergies’. The most commonagents implicated were antibiotics (n=272), opioid analgesics(n=118) and NSAIDs (n=62); the most common form of these reactionswere dermatological (n=254) and nausea and vomiting (n=124).There were 41 self-reports specifically of anaphylaxis and afurther 61 where there was significant respiratory system involvement. Conclusions. The majority of the self-reported allergies werein fact simply accepted adverse effects of the drugs concerned.The patients’ reported drug ‘allergy’ historywas generally well respected by anaesthetists and other medicalstaff. There were 13 incidents, mainly involving morphine, wherepatients were given a drug to which they had claimed a specificallergy. There were 101 incidents in 89 patients where drugsof the same pharmacological group as that of their allergicdrug were used. There were no untoward reactions in 84 patientswho had claimed a prior adverse reaction to penicillin who weregiven cephalosporins. There were no sequelae from any otherevents. While anaesthetists generally respected patients self-reported‘allergies', more attention needs to be paid to the accuraterecording of patients’ events and a clear distinctionshould be made both in medical records and to the patient betweentrue drug allergy and simple adverse drug reactions.     

Ecological studies on Culex tritaeniorhynchus as a vector of Japanese encephalitis

In the Republic of Korea, light-trap assessments and collections from cows and pigs after sunset were highly successful in monitoring the seasonal abundance of C. tritaeniorhynchus, the primary vector of Japanese encephalitis. The dates and duration of the population peaks at semirural suburbs of Seoul and Pusan were markedly different from those at a rural rice-growing site. The main breeding sites in these three areas were, respectively, swamps, marshes, and ricefields. The overall adult densities were the lowest at the rice-growing site where agricultural pesticides were extensively used. A short period of man—vector contact occurred at each study site at low densities when the natural population was at its peak. These vector monitoring techniques, coupled with information on antibodies in swine, represent a simple but valuable surveillance system.     

Surface membrane changes of T cells induced by syngeneic tumour cells. I. Formation and uptake of complexes of Ig and tumour antigens by T cells.

A large dose of tumour cells (10(7)) from two different tumours produced a significant increase of Ig-bearing spleen cells 6 h after intraperitoneal administration in syngeneic mice, like conventional antigens previously tested. Incubation of normal spleen cells in serum taken 6 h after administration of tumour cells reproduced in vitro the changes observed in the spleen cell population of the serum donors, demonstrating the presence of a cytophilic Ig, which was shown to be taken up by T cells. Serum collected 6 h after tumour cell inoculation contains also a 4S factor which can generate in vitro cytophilic Ig for T cells in the presence of a foreign soluble protein or tumour antigen. Extracts obtained from tumours cells, which were shown to contain tumour antigens, were labelled with 125I and mixed with the 4S factor and normal 7S Ig. Upon fractionation of the mixture, high molecular weight material containing radioactivity and 7S Ig were eluted in the void volume, well ahead of the position of both the tumour cell preparation and the 7S Ig. This material contained Ig cytophilic for splenic T cells and it is likely that it represents cytophilic complexes of Ig and tumour antigens. It is postulated that the cytophilic Ig detected in the serum of animals 6 h after injection of a large number of tumour cells represents cytophilic complexes of Ig and tumour antigens formed through the mediation of a soluble factor.