Allergy Testing Ebook
Abietic acid is probably the major allergen of colophony, along with dehydroabietic acid, by way of oxidation products. Its detection in a material indicates that allergenic components of colophony are present. Bergh M, Menne T, Karlberg AT (1994) Colophony in paper-based surgical clothing. Contact Dermatitis 31 332-333 Karlberg AT, Bergstedt E, Boman A, Bohlinder K, Liden C, Nilsson JLG, Wahlberg JE (1985) Is abietic acid the allergenic component of colophony Contact Dermatitis 13 209-215 Karlberg AT, Bohlinder K, Boman A, Hacksell U, Hermansson J, Jacobsson S, Nilsson JLG (1988) Identification of 15-hydroperoxyabietic acid as a contact allergen in Portuguese colophony. J Pharm Pharmacol 40 42-47 Acetaldehyde, as its metabolite, is responsible for many of the effects of ethanol, such as hepatic or neurological toxicity. A case of contact allergy was reported in the textile industry, where dimeth-oxane was used as a biocide agent in textiles and its degradation led to acetaldehyde. in...
Do you suspect that something you eat is causing those unusual symptoms you get from time to time Food allergies are relatively rare in adults. They most commonly occur in children, who usually outgrow them over time. Foods that most often cause a true allergic reaction in children include egg whites, shellfish, nuts, and milk. Some people are sensitive to certain foods but are not actually allergic to them because the food does not trigger an allergic reaction. Food preservatives called sulfites and flavor enhancers such as monosodium glutamate (MSG) can produce headaches and other symptoms. Some people get migraine headaches after consuming red wine, cheese, or chocolate. Talk to your doctor about any symptoms you may be experiencing that you think may be food-related.
By the time a child arrives in the otolaryngologist's office for evaluation of chronic sinusitis, someone in the family will have raised the issue that this is all due to allergy. In many situations, the nature of the rhinorrhea and congestion does resemble that seen in atopic patients. However, microscopic and immunologic analyses of the secretions are not consistent with what is seen in IgE-mediated rhinitis. Rather, the findings are those of acute infectious inflammation. Whereas some reports report a higher incidence of sinusitis in atopic children, concerns about reporting biases and biases in the allergy practices reporting such findings raise concerns about the validity of the reports. The primary risk factors for such disease are primarily related to exposure to other children, as in day care. The prompt response to effective antimicrobials also weighs against allergy being of primary importance. As a child grows beyond 3-5 years of age, the incidence of IgE-mediated disease...
Drug allergies arise from a complicated response by the immune system to a specific medication. A person usually goes through three stages when developing an allergy to a medication. First, he or she must be exposed to the drug by taking one or more doses. Next, the person's immune system identifies the drug as harmful and begins producing antibodies to fight it. Finally, the person takes another dose of the drug, and the allergy symptoms appear. The symptoms may appear immediately, within 1 to 2 hours, or within a few days to a week after taking the drug. Common symptoms of drug allergy include skin rash or hives, difficulty breathing, and itching. Severe drug allergies may cause seizures, loss of consciousness, or shock (see box below). If you have had a previous severe allergic reaction, you will need to carry an injecting device that contains epinephrine with you at all times, so you can inject yourself immediately if you have another allergic reaction. An injection of epinephrine...
Allergy is a specific, exaggerated immune response to a (usually harmless) foreign substance or antigen ( p. 94ff.). Allergens are antigens that induce allergies. Small molecules conjugated to endogenous proteins can also have antigenic effects. In this case, they are referred to as incomplete antigens or haptens. The heightened immune response to secondary antigen contact ( p. 94ff.) normally has a protective effect. In allergies, however, the first contact with an antigen induces sensitization (allergization), and subsequent exposure leads to the destruction of healthy cells and intact tissue. This can also result in damage to endogenous proteins and autoantibody production. Inflammatory reactions are the main causes of damage.
A long history of speculation exists concerning the association of multiple sclerosis (MS) with allergies. This idea was especially popular in the 1940s and 1950s. Many different allergic substances have been proposed over the years. Various food allergies have been implicated in MS. Some studies have found that MS is more common in areas with high intakes of dairy products or gluten-containing grains, such as wheat, rye, oats, and barley. As a result, the consumption of dairy products or gluten has been implicated in MS. Other proposed allergic foods have included yeast, mushrooms and other fungi, fermented products (such as vinegar), sugar, potatoes, red meat, fruits, vegetables, caffeine, and tea and other tannin-containing foods.
Allergy is one of the most common causes of problematic nasal mucosa edema48 and is implicated as a contributing factor in rhi-nosinusitis.49 Some investigators consider allergy in children the most important predisposing element in pediatric chronic rhi-nosinusitis,50'51 although its true role in this disease process is still under debate. Controlled studies comparing the incidence of sinusitis in allergic groups with nonallergic groups are very scarce, especially in pediatric populations. One study found no difference in the involvement of the sinuses of atopic children in comparison to nonallergic children with chronic nasal complaints.52 The same investigators showed the prevalence of rhinosinusitis to decrease after 8 years of age, and the prevalence of atopy to increase with age.52 Together, these findings suggest that allergy may not be a primary cause of chronic pediatric rhinosinusitis.44 Interestingly, however, the prevalence of rhinosinusitis in allergic children is higher...
An allergy is an exaggerated or inappropriate response of the immune system to a substance that is harmless to most people. Substances that can cause such reactions are called allergens. Common allergens include pollen, dust particles, certain foods, insect venom, mold, and medications. Doctors think that the reason some people are allergic to a particular substance is because they have inherited a tendency to be allergic (although not necessarily to that particular substance). Being exposed to a potential allergen when the body's defenses are lowered or weakened such as during a viral infection seems to contribute to the development of an allergy. People with allergies are often sensitive to more than one allergen. During an allergic reaction, the immune system is responding to a false alarm. When a person comes into contact with an allergen, the immune system launches an inappropriate immune response by releasing large amounts of an antibody (a disease-fighting protein) called...
A food allergy is a reaction of the immune system to a food or food ingredient that most people find harmless. If you eat a food that produces an allergic reaction, your immune system responds by releasing numerous chemicals that cause allergic symptoms. A food allergy is different from a food intolerance, which does not trigger an immune response. A food intolerance (such as lactose intolerance, see page 266) usually arises from an enzyme deficiency and produces symptoms such as stomach cramps, gas, or diarrhea. Food intolerances are relatively common, but a true food allergy is rare, affecting only about 1 percent of the population. The most common foods that cause allergies in adults are fish and shellfish, eggs, and nuts such as peanuts, walnuts, and pecans. Symptoms of food allergy can include skin reactions such as hives or rashes, nasal congestion, asthma attacks (see page 245) in people who have asthma, and gastrointestinal problems such as nausea, gas, or diarrhea. Because...
Assess for knowledge of factors related to attacks, past history of respiratory infections, and measures taken to maintain health of child. Assess health history of allergies in family members, what does or does not precipitate attack, and what behaviors result from the attack. Teach parents and child handwashing technique allow for demonstration.
The most frequent presenting symptoms of IP are nasal obstruction (64 to 78 ), followed by headache, epistaxis, facial pain, periorbital swelling, purulent rhinorrhea, chronic sinusitis, allergy, hyposmia, visual changes, and meningitis. Some patients are even asymptomatic. These signs and symptoms make IP difficult to distinguish from inflammatory dis-
The direct inoculation of antigen-expressing DNAs represents a powerful new approach to eliciting immune responses. The antigens are synthesized in transfected cells and obey the trafficking, modification, and antigen-presentation rules of eukaryotic cells. Very low levels of antigen expression (typically nanograms) induce both antibody and cytolytic T cell responses. This easy method of immunization may be used for testing the immuno-genicity of novel recombinant molecules and screening DNA libraries. Potential applications include the development of protective vaccinations, the control of tumors, and the manipulation of allergies and autoimmune disease. DNA-based immunizations readily raise polyclonal and monoclonal antibodies, invoke helper T cells (TH), and activate cytolytic T cells (Tc). The use of DNA for immunization also holds promise for basic studies on immune responses.
The treatment prescribed is based on the acuity and severity of the symptoms. Some patients are treated pharmacologically with corticosteroids to relieve edema and analgesics to manage joint and GI discomfort. Allergy testing to identify the provocative allergen is usually performed. If the allergen is a food or medication, the patient needs to avoid ingesting the allergen for the rest of his or her life. Patients who are placed on corticosteroids or immunosuppressive therapy need an environment that protects them as much as possible from secondary infection. If the patient is on corticosteroids, monitor her or him for signs of Cushing's syndrome and the complications of corticosteroids, such as labile emotions, fluid retention, hyperglycemia, and osteoporosis.
Olopatadine hydrochloride Terfenadine Action Kinetics Compete with histamine at H1 histamine receptors (competitive inhibition), thus preventing or reversing the effects of histamine. First-generation antihista-mines bind to central and peripheral H1 receptors and can cause CNS depression or stimulation. Second-generation antihistamines are selective for peripheral H1 receptors and cause less sedation. Antihistamines prevent or reduce increased capillary permeability (i.e., decrease edema, itching) and bronchospasms. Allergic reactions unrelated to hista-mine release are not affected by antihistamines. Certain of the firstgeneration antihistamines also have anticholinergic, antiemetic, antipru-ritic, or antiserotonin effects. Clients unresponsive to a certain antihista-mine may regain sensitivity by switching to a different antihista-mine.
Current and past illnesses should be reviewed. Of importance in patients presenting with rash-like symptoms is the recognition of atopy (as manifest by hay fever or asthma) as this history is suggestive of atopic dermatitis. Inquiry regarding past allergic reactions to food or medications is essential. Any systemic condition that may suppress the immune system and thus predispose the patient to cutaneous infections or neoplasia (such as HIV and diabetes) should be questioned.
While susceptibility to anaphylaxis is increased among those who have inherited sensitivity to antigens, the genetic component has not been well defined. Over 20 genes have been associated with the development of allergy and mutations and of these, many passed on in families. Family studies indicate that if both parents suffer from allergies, the allergy risk in their offspring is 80 . Implicated genes include the IL-4, IL-4 receptor, cytokine, INF7, p-adrenergic receptor, 5 lipoxygenase, PHF1, TARC, and leukotriene C4 synthetase genes.
Anaphylactic shock can occur at any age and in both men and women, but women seem a little more susceptible than men. Individuals with food allergies (particularly shellfish, peanuts, and tree nuts) and asthma may be at increased risk for having a life-threatening anaphylactic reaction. People at the ends of the lifespan are most at risk. To prevent infants and children from experiencing severe allergic reactions, pediatricians carefully plan vaccines and diet to limit the risk of allergic reaction until a child's immune system is more mature. Severe food allergy is more common in children than in adults, but diagnostic contrast, insect stings, and anesthetics are more common in adults than in children. Teenagers with food allergies and asthma may be at high risk for an allergic reaction because they are more likely to eat outside the home and less likely to carry their medications. Older people also have a great risk of anaphylaxis, and their risk of death is high owing to the...
Provide a complete explanation of all allergic responses and how to avoid future reactions. If the patient has a reaction to a food or medication, instruct the patient and family about the substance itself and all potential sources. If the patient has a food allergy, you may need to include a dietitian in the patient teaching. Encourage the patient to carry an anaphylaxis kit with epinephrine. Teach the patient to administer subcutaneous epinephrine in case of emergencies. Encourage the patient to wear an identification bracelet at all times that specifies the allergy.
The medical history is obtained, including age, gravity, parity, last menstrual period, use and type of contraception, prior cervical cytology results, allergies, significant medical history including HIV status and history of any immunosuppressive conditions or medications, other medications, prior cervical procedures, and smoking history. If there is any possibility of pregnancy, a pregnancy test is obtained.
A limited number of studies have evaluated the possible role of allergies in MS. No well-designed studies exist to support any specific food or environmental factor as an allergic cause of MS. In addition, no studies have demonstrated that eliminating exposure to a certain presumed allergic agent is beneficial. It is interesting to note that people with MS actually appear to have fewer allergic problems than do those who do not have the disease. Recent information indicates that people with MS have nearly 70 percent fewer allergic symptoms and more than 80 percent fewer positive allergy tests than the general population. This appears to be a result of the underlying immune disorder that occurs in MS. In other studies, it appears that components of the immune system that are involved in allergies may play a role in MS. Specifically, mast cells, allergy-associated immune cells, are present in MS lesions in the central nervous system. In experimental allergic encephalomyelitis (EAE), the...
Allergy, histamine 1 receptor blockers, and the risk Oro AS, Guarino TJ, Driver R, et al. Regulation of disease susceptibility decreased prevalence of IgE-mediated allergic disease in patients with multiple sclerosis. J Allergy Clin Immunol 1996 97 1402-1408. Robbie-Ryan M, Brown M. The role of mast cells in allergy and autoimmunity. Curr Opin Immunol 2002 14 728-733. Tang L, Benjaponpitak S, DeKruyff RH, et al. Reduced prevalence of allergic disease in patients with multiple sclerosis is associated with enhanced IL-12 production. J Allergy Clin Immunol 1998 102 428-435.
Positive contrast CTE in 29-year-old male with Crohn's disease with allergy to iv contrast. a Coronal reformat showed low-grade small bowel obstruction with sharp transition point (black arrowhead). The cause of the obstruction was a long segment of fibrostenosis (arrows). b Sagittal reformat showed enteric fistula (white arrowheads). In view of fi-brostenosis, patient was not treated with inflix-imab (inhibitor of tumor necrosis factor-alpha)
The CT.h4S cells are a derivative of the CT.4S mouse cell line. These cells can be obtained by contacting Dr. W.E. Paul, Laboratory of Immunology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892. CT.h4S cells proliferate in response to human IL-4. The protocol for measuring human IL-4 is similar to the assay for IL-2 (see Alternate Protocol 1) exception that the cells are exquisitely sensitive to the absence of IL-4 and the initial incubation period is 24 hr longer (see Support Protocol 5 for instructions regarding maintenance of CT.h4S cells).
IFN-sensitive L929 fibroblasts (see critical parameters) Murine interferon reference standards IFN-a, IFN-P, IFN-y, and IFN-aP (available from Dr. C. Laughlin, National Institute of Allergy and Infectious Diseases, Bethesda, MD) Vesicular stomatitis virus (VSV Indiana strain see caution, step 9) Supplemented Earles balanced salt solution (EBSS), 4 C 5 (v v) formalin
Secondly, chemicals or their metabolites can act by the immune system. This means they interfere with the response mediated by the specific antigen receptors of B and or Tcells. Chemicals may be recognized as antigen and elicit immune responses, or they may directly or indirectly change self antigens and thus break tolerance. It is generally accepted by now that T cells are the major players in xenobiotic-induced autoimmunity and allergy. Chemicals acting by the immune system lead to sensitization and a memory response. Memory lymphocytes can expand and mediate a stronger immune response on second contact with the chemical, even if it occurs long after the first contact. Adverse immune reactions of this type may lead to allergy or autoimmunity.
Murine dendritic cells, either freshly prepared or derived by culture of bone marrow cells with IL-4 and GM-CSF, express IL-18 mRNA. Human dendritic cells derived from human PBMC constitutively express IL-18 mRNA and produce mature IL-18 (Stoll et al., 1998). Epidermal cells, particularly keratino-cytes, can secrete IL-18 with IL-12, in response to the stimulation with contact allergen (Stoll et al., 1997). However, keratinocytes do not have caspase-1 under normal conditions, suggesting that IL-18 secretion by keratinocytes might be induced in a caspase-1-independent manner, presumably by extracellular protei-nase 3.
Figure a shows two oval, basophilic granulated mast cells from connective tissue of the greater omentum. As single cells, but more frequently in small groups, mast cells occur particularly often in the vicinity of small vessels (see Fig. 148). Mast cells (diameter 6-12 im) contain a rounded nucleus. Their cytoplasm is loaded with basophilic, metachromatic granules. Paul Ehrlich (1877) interpreted these as alimentary storage granules (Ehrlich's mast cells). Mast cells synthesize, store and extrude the acid and sulfatized glycosami-cu noglycan heparin, the biogenic amines serotonin (only rat and mouse) and 5 histamine, also two additional factors, which play a role in anaphylactic reactions. Histamine is released in large amounts during allergic reactions. It cu causes a widening of the capillaries.
In general, there are few contraindications to salicylic acid chemical peeling. Salicylic acid peels are well tolerated in all skin types (Fitz-patrick's I-VI) and all racial ethnic groups. General contraindications include salicylate hypersensitivity allergy unrealistic patient expectations active inflammation dermatitis or infection at the salicylic acid peeling site acute viral infection pregnancy and isotretinoin therapy within 3-6 months of the peeling procedure. The author has performed more than 1,000 salicylic acid peels without observing any evidence of salicylate allergy hypersensitivity following a salicylic acid peel.
Very small amounts of mercury are released from amalgam in teeth in the form of solid mercury and mercury vapor. It is claimed that the mercury released from amalgam damages the immune system and nervous system and thereby causes MS and other diseases. In addition, it has been proposed that disease is caused by harmful allergic reactions to the mercury or to the electrical currents generated by mercury. The presumed mercury toxicity is termed mercury hypersensitivity, mercury sensitivity, mercury toxicity, and micromercurialism. Electricity generated by mercury is called electrogalvinism or oral galvanism.
I understand that there is a small risk of developing permanent darkening after the proce-dure.There is a rare chance that the peel could cause undesirable pigment loss at the treated site, the condition being treated could worsen after the peeling procedure,or a scar could de-velop.In addition,there is a small chance that a bacterial infection could develop, or the peel could also trigger a flare of a pre-existing Herpes infection at the treated site. In addition, there have been uncommon cases of allergic reactions to salicylates (the active peel ingre-dient).The benefits and side effects of the procedure have been explained to me in detail.All of my questions have been answered. I have no allergies to salicylic acid.
Not enough is known yet about the prevalence of food allergies and intolerances. Estimates vary widely and are unreliable. It is not easy to diagnose a food allergy and to identify the food component provoking the allergic reaction. The same holds for food intolerance. In Chapter 14, the different types of food allergy and food intolerance and the associated problems are discussed.
In general, in developed countries food safety is adequate. However, it should be noted that the information on the (chronic) toxicity of natural food components is insufficient. Further, a number of important health problems such as cardiovascular disorders, diabetes, osteoporosis, obesity, allergy, and cancer are believed to be related to nutrition. Nutritional interventions could drastically reduce the incidence of these diseases.
Action Kinetics Fewer sedative effects. tv2 25 hr. Time to peak effect 3-9 hr. Duration 4-25 hr. Uses Allergic rhinitis (oral). Par-enterally to treat allergic reactions to blood or plasma adjunct to treat anaphylaxis uncomplicated allergic conditions when PO therapy is not possible or is contraindicated. Contraindications Use in neonates.
Native to the northern part of South America, the cashew's likely center of origin is semi-arid northeast Brazil. The nut is at the apex of the fruit or apple, a fleshy and enlarged fruit stalk. The fruit is sweet-tasting and eaten raw or as juice or jam. Early Portuguese navigators found that the Indians valued both the nuts and fruit and soon after took the crop to India, the East Indies, and Africa. The Spanish probably took it to Central America and the Philippines. It remained a smallholder crop for the next 300 years in Asia and Africa. It is now a significant plantation crop in international trade, ranking third after almonds and hazelnuts. The main producer is Mozambique. The shell or pericarp of the nut contains an oil rich in phenols (similar to those found in poison ivy) that cause severe allergic reactions. The shells are therefore heated and removed from the nut before they enter trade.
And will continue to be debated until a group of alloplastic materials are developed that satisfy the basic needs of the ideal implant. A suitable implant must be biocompatible, strong, and elastic. The material should be completely inert, incapable of inducing inflammation or allergy, noncarcinogenic, resistant to mechanical strain, easily modified for shaping, and sterilizable.
High anaphylaxis risk Nonselectives block cat-echol's ability to reduce mast cell degranulation in patients with atopic allergies. Hypoglycemia All -blockers mask sympathetic response to hypoglycemia and interfere with gluconeogenesis glycogenolysis. Withdrawal Rebound increased heart rate and elevated blood pressure on abrupt withdrawal can precipitate MI and CVA.
The acute toxicity of BHA is relatively low. Its oral LD50 in rats is 2.5 to 5 mg kg body weight. Owing to many years of use without adverse effects (except for a few cases of allergic reactions), BHA was given the Generally Recognized As Safe (GRAS) status by the US Food and Drug Administration. In the early 1980s, experimental data became available on the induction of tumors by BHA in rodents (rats, hamsters, and mice). Changes such as hyperplasia, papillomas, and carcinomas were observed in the forestomach (an organ that is absent in man). These changes were time- and dose-dependent (Figure 9.3).
Toxicity Gastrointestinal (nausea, vomiting, diarrhea) allergic manifestations CNS Allergy 5 manifest penicillin sensitivities local pruritus, asthma 1 develop ana-phylaxis. Treatment O2, epinepherine-nor-epinepherine, P2-agonists, steroids, H1- and H2-blockers, theophylline, fluids. Consider glucagon for severe hypotension. CNS Seizures due to inhibition of GABA-to-receptor binding. Treatment benzodi-azapines barbiturates.
Cytokines and growth factors are widely used terms which describe a diverse group of soluble proteins and peptides that play a key role in the regulation of a number of physiological processes, including regulation of both innate and acquired immune responses to foreign and self-antigens, microbial pathogens, and cancer cells. These polypeptides, which include established cytokines and chemokines, and growth factors, including hormones and other soluble mediators, operate at extremely low concentrations to modulate the biological and molecular functions of cells, tissues, and or entire organ systems. Cytokines and growth factors typically mediate interactions between cells via direct and indirect mechanisms regulating various immune and physiological processes. This regulation can occur either locally through cell-cell interactions within a specific tissue microenvironment or systemically via circulating cytokines in a fashion similar to that observed in hormone-mediated responses....
Aller-Chlor, Allergy, Chlo-Amine, Chlor-Trimeton Allergy 4 Hour, Chlor-Tripolon M (OTC), Extended-release Tablets Chlor-Trimeton 8 Hour and 12 Hour (OTC), Injectable Chlorpheniramine maleate (Rx) Classification Antihistamine, alkyla-mine type Uses PO Allergic rhinitis. IM, SC Allergic reactions to blood and plasma and adjunct to anaphylaxis therapy. Adults and children over 12 years 5-40 mg for uncomplicated allergic reactions 10-20 mg for amelioration of allergic reactions to blood or plasma or to treat anaphylax-is. Maximum dose per 24 hr 40 mg.
Diphenolmethane derivatives (p. 177) were developed from phenolphthalein, an accidentally discovered laxative, use of which had been noted to result in rare but severe allergic reactions. Bisac-odyl and sodium picosulfate are converted by gut bacteria into the active colon-irritant principle. Given by the enteral route, bisacodyl is subject to hydrolysis of acetyl residues, absorption, conjugation in liver to glucuronic acid (or also to sulfate, p. 38), and biliary secretion into the duodenum. Oral administration is followed after approx. 6 to 8 h by discharge of soft formed stool. When given by suppository, bisacodyl produces its effect within 1 h.
Most information about our surroundings is gathered by the eye, which is literally a 'window' for the brain. With an aging population, the prevalence of sight-threatening ocular diseases continues to increase. Thus, for instance, more than 70 million people suffer from glaucoma worldwide.1-3 Visual impairment caused by diabetes affects up to 90 of diabetics over 10 years of age. Likewise, pathological dry eye and ocular allergic conditions afflict 100 million patients worldwide, and age-related macular degeneration (AMD) is the leading cause of blindness among the elderly, affecting up to 28 of patients after the seventh decade of life.2 Consequently, the discovery and development of therapeutic products for the treatment of these various ocular diseases is of paramount importance, and is being actively pursued within the pharmaceutical industry.1-3
Erythromycin suppresses advancement of the ribosome. Its action is predominantly bacteriostatic and directed against gram-positve organisms. For oral administration, the acid-labile base (E) is dispensed as a salt (E. stearate) or an ester (e.g., E. succinate). Erythromycin is well tolerated. It is a suitable substitute in penicillin allergy or resistance. Azithromycin, clarithromycin, and roxithromycin are derivatives with greater acid stability and better bioavailability. The compounds mentioned are the most important members of the macrolide antibiotic group, which includes josamycin and spiramycin. An unrelated action of erythromycin is its mimicry of the gastrointestinal hormone motiline ( f interprandial bowel motility).
A wide range of physical and psychological problems have been observed among victims even several years after the earthquake. These problems were mainly related to stressful experiences and conditions of the victims. However, other environmental factors and direct physical damage also played an important role. For example, hypertension among victims could be caused by several causes such as salty instant food, stressful living conditions, and nightmares. It will take a long time to obtain data on such possible effects of the earthquake as those on the psychosocial development of children, and those on the immune function (and on the incidence of allergy, cancer, etc.).
The causes are generally eustachian tube obstruction secondary to mucosal edema due to infection (sinusitis, nasopharyngitis) or allergy extrinsic pressure on the cartilaginous portion of the eustachian tube due to hyperplasia of glandular or lymphoid tissue or, rarely, due to tumors malfunction of the tubal muscles as in children with cleft palate, or malformation of the tube itself as in Down's syndrome. Other factors that may contribute include bacteriologic, immunologic, genetic, socioeconomic status, seasonal variation, as well as lack of transmission of specific immunoglobulins in non-breast-fed infants. All these factors cause tubal dysfunction or occlusion leading to negative middle ear pressure due to oxygen absorption by the mucosa of the middle ear cleft. Normally, the tendency of the tubal walls to collapse at the level of the isthmus can be overcome by an increase in the nasopharyngeal pressure. A negative middle ear pressure up to -25 mm Hg can be thus corrected. On the...
Baker, Monosodium L-glutamate-induced asthma, in J. Allergy Clin. Immunol. 80, 530-537, 1987. Hattevig, G., Kjellman, N.I.M., and N. Sigurs B. Bjorksten, and N.I.M. Kjellman, Effect of maternal avoidance of egg's, cow's milk and fish during lactation upon allergic manifestations in infants, in Clin. Exp. Allergy 19, 27-32, 1989. James, J.M., A.W. Burks, Food hypersensitivity in children. Curr. Opin. Pediatr. 6, 661-667, 1994. Kagnoff, M.F., Immunology of the digestive system, in Johnson, L.R., (Ed.), Physiology of the GastroIntestinal Tract. Raven Press, 1987. Metcalfe, D.D., Food allergens, in Clin. Rev. Allergy 3, 331-349, 1985. Sampson, H.A., Mechanisms in adverse reactions to food. The Skin. Allergy 50 (20 Suppl.), 46-51, 1995. Simon, R.A. and D.D. Stevenson, Adverse reactions to sulfites, in Allergy, Principles and Practice, Middleton et al, (Eds.), St. Louis, C.V. Mosby Company, 1988. Stevenson, D.D., R.A. Simon, W.R. Lumry and D.A. Mathison,...
John's wort include stomach complaints, fatigue, and especially allergic reactions (photodermatitis). Most authorities warn strongly that Hypericum extracts should not be taken alongside other anti-depressants doing so can result in a syndrome called serotonin syndrome.
For some patients iron supplements are ineffective. We do not know why some people fail to absorb supplementary iron. These patients may require intravenous iron. The kind of intravenous iron formerly used in the United States, iron dextran, caused death in approximately 0.7 percent of patients due to allergic reactions, making its use very dubious however, iron sucrose, which has been used safely in Europe for decades, is now available here. So is ferric gluconate, another form of intravenous iron.
Clinical applications include preoperative suppression of thyroid secretion according to Plummer with Lugol's solution (5 iodine + 10 potassium iodide, 50-100 mg iodine d for a maximum of 10 d). In thyrotoxic crisis, Lugol's solution is given together with thioamides and p-blockers. Adverse effects allergies contraindications iodine-induced thyrotoxicosis.
Ephedra sinica represents one of the oldest medicinal plants in China, where it is known by the name of ma huang. It is estimated that its use began 4,000 years ago, particularly in northern China and Mongolia. Ephedra was used in ethnomedicine as a stimulant, to increase perspiration, and as an anti-inflammatory. In the Chinese school of medicine, a preparation called mimahuang, containing roasted honey and chopped dried aerial parts of this species, is claimed to be an effective treatment for flu and respiratory tract inflammations. Ephedra, which contains ephedrine and similar alkaloids, has been used extensively in the ancient pharmacy as an antihistaminic in the treatment of asthma and as a natural decongestant. It has become a very popular ingredient in herbal combinations for allergies and hay fever. Since it is a central nervous system stimulant and increases the metabolism and increases body temperature, it has been used to control weight and to help prevent sleep, and by...
Spyker-Cranmer et al. (1982) report that the female offspring of dams treated with chlordane throughout gestation show a profound deficit in contact hypersensi-tivity response (CHR) to a contact allergen, oxazolone, at both 0.16 and 8.0 mg kg doses, while male offspring show a significant decrease at the 8.0 mg kg dose at 100 days of age. Thus, females appear to be sensitive to lower doses of chlordane. Only after recent reanalysis of the CHR data (Spyker-Cranmer et al. 1982), in light of the gender effects noted in more recent studies (Blyler et al. 1994), were these dose-gender differences in the response revealed. Additional CHR analysis, using either an intermediate 4.0 mg kg dose or a higher 16.0 mg kg dose, showed significant differences with either dose at 100 days of age in both genders (Barnett et al. 1985). Neither gender demonstrated any significant defect in their humoral immune response (anti-sheep erythrocyte SRBC plaque-forming cells PFC ) at either the 0.16 or 8.0 mg...
Parenteral therapy Iron dextran (Imferon) is the preferred medication for intramuscular injections. Pregnant and elderly patients with severe iron deficiency anemia may be given total-dose intravenous infusions of iron dextran in a sodium chloride solution, after a small test dose is given to gauge any allergic reaction.
Safety - good hygienic design prevents the contamination of the product with substances that would adversely affect the health of the consumer. Such contamination could be microbiological (e.g. pathogens), chemical (e.g. lubricating fluids, cleaning chemicals) and physical (e.g. glass). Prevention of contamination of products with potentially allergenic agents through proper cleaning, etc., is also important.
The most significant adverse effect of insulin therapy is hypoglycemia. This is especially the case for treatment of T1DM, but is also true for T2DM. Insulin allergy and lipoatrophy were commonly seen with the use of animal insulin before 'pure' and biosynthetic preparations became available. Both reactions are now rare, but can be seen, probably because there is some degradation during storage and or with depot injection into tissues that can induce an immune response. Weight gain commonly occurs following improved glycemic control with insulin therapy. In the UKPDS, individuals receiving insulin therapy had an average weight gain of 4.0 kg over the course of the study.81
(incidence up to 5 ), with manifestations ranging from skin eruptions to anaphylactic shock (in less than 0.05 of patients). Known penicillin allergy is a contraindication for these drugs. Because of an increased risk of sensitiza-tion, penicillins must not be used locally. Neurotoxic effects, mostly convulsions due to GABA antagonism, may occur if the brain is exposed to extremely high concentrations, e.g., after rapid i.v. injection of a large dose or intrathecal injection. Cephalosporins (C). These -lac-tam antibiotics are also fungal products and have bactericidal activity due to inhibition of transpeptidase. Their shared basic structure is 7-aminocepha-losporanic acid, as exemplified by cephalexin (gray rectangle). Cephalo-sporins are acid stable, but many are poorly absorbed. Because they must be given parenterally, most including those with high activity are used only in clinical settings. A few, e.g., cepha-lexin, are suitable for oral use. Cephalo-sporins are...
Encephalomyocarditis (EMC) virus (ATCC VR 129B) Human interferon reference standards (available from Dr. C. Laughlin, National Institute of Allergy and Infectious Diseases, Bethesda, MD) Human diploid fibroblast (FS-4 Havell and Vilcek, 1972), trisomy 21 human line (GM2504 Preble et al., 1982), or human lung carcinoma line (A549 ATCC CCL 185)
IgE-mediated allergic reactions (p. 72) involve mast cell release of histamine (p. 114) and production of other mediators (such as leukotrienes, p. 196). Resultant responses include relaxation of vascular smooth muscle, as evidenced locally by vasodilation (e.g., conjunctival congestion) or systemically by hypotension (as in anaphylactic shock) enhanced capillary permeability with transudation of fluid into tissues swelling of conjunctiva and mucous membranes of the upper airways ( hay fever ), cutaneous wheal formation contraction of bronchial smooth muscle bronchial asthma stimulation of intestinal smooth muscle diarrhea. 1. Stabilization of mast cells. Cromolyn prevents IgE-mediated release of mediators, although only after chronic treatment. Moreover, by interfering with the actions of mediator substances on inflammatory cells, it causes a more general inhibition of allergic inflammation. It is applied locally to conjunctiva, nasal mucosa, bronchial tree (inhalation), intestinal...
Bacterial and viral infections are both unlikely ever to lead to eosinophilia except in a few patients with scarlet fever, mononucleosis, or infectious lymphocytosis. The second most common group of causes of eosinophilia are allergic conditions these include asthma, hay fever, and various dermatoses (urticaria, psoriasis). This second group also includes drug-induced hypersensitivity with its almost infinitely multifarious triggers, among which various antibiotics, gold preparations, hydantoin derivatives, phenothiazines, and dextrans appear to be the most prevalent. Eosinophilia is also seen in autoimmune diseases, especially in scleroderma and panarteritis. All neoplasias can lead to paraneoplastic eosinophilia, and in Hodgkin's disease it appears to play a special role in the pathology, although it is nevertheless not always present. Elevated Basophil Counts. Elevation of segmented basophils to more than 2-3 or 150 1 is rare and, in accordance with their physiological role in the...
The fact that sodium hypochlorite is not a sensitizer is a significant advantage that sodium hypochlorite solutions have over some other topical antiseptics. To clarify sensitization potential, Hazelton Laboratories examined 1.1 sodium hypochlorite solution using a standard test for predicting sensitization or allergic reactions, the Guinea Pig Maximization Test 46 . This test consisted of dermal and intradermal application of various concentrations of test solutions of sodium hypochlorite as an induction dose, followed 2 weeks later by a challenge dose of sodium hypochlorite solution. No reaction to the challenge dose was observed with sodium hypochlorite. The author concluded
Identifying and minimizing the factors that predispose to fistula formation helps improve the chance of successful wound healing. Since most fistulae are associated with a wound infection, appropriate antibiotic coverage is essential. Studies by Johnson et al. and more recently by Weber et al.5 show a marked decrease in wound infection rates with appropriate antibiotic administration. For maximum efficacy, one dose should be given preoperatively so that antibiotics are in the circulation before the skin incision is made. The spectrum of coverage should include oral anaerobes as well as aerobic gram-positive and negative bacteria, including Staphylococcus aureus. We favor the standard combination of cefazolin and metronidazole, and reserve clindamycin for patients with penicillin allergy. Although ampicillin with sulbactam and single coverage with cefuroxime (second-generation cephalosporin) or cefotaxime (third-generation cephalosporin) have been found effective, we do not routinely...
In a few cases, however, UGTs enhance the toxicity of their substrates. This is the case with some nonsteroidal anti-inflammatory drugs (NSAIDs). The resulting ester glucuronides can undergo acyl migration, i.e., the intramolecular transesterification from the C1 hydroxy group of the glucuronic acid to the C2 hydroxy group and further to the C3 and C4 hydroxy groups. This can lead to the formation of a free aldehyde group at C1, which can react with primary amino groups in proteins generating Schiff's bases. Amadori rearrangement can then lead to a stable protein adduct, which may give rise to allergic reactions, a well-known drug toxicity of some NSAIDs. Glucuronic acid conjugation can also result in enhanced genotoxicity. Aromatic amines, including important human carcinogens, are metabolized by CYPs (preferentially CYP1A2) to aromatic hydroxylamines. Glucuronidation of these leads to the formation of a (moderately good) leaving group, which after being cleaved off leaves behind a...
Only one MR study using gadolinium and MR angiography revealed superiority over CT. The advantage of MRI is thought to be in the area of small tumors, which do not alter the contour of the gland 25 . At present, CT is the modality of choice in the work-up of suspected pancreatic disease and MRI appears to be a problem solving modality. MRI may be helpful in cases where clinical suspicion of disease is very high but results with MDCT are negative or equivocal. In addition, when choosing an imaging modality, one has to take into account the fact that with MDCT, imaging of the pancreas, including preparation, takes a small fraction of the time needed for a complete MRI of the pancreas. Overall, MR of the pancreas should be considered in patients (1) with elevated serum creatinine, allergy to iodine contrast, or other contraindications for iodine contrast administration (2) with prior CT imaging who have focal enlargement of the pancreas with no definable mass (3) whose...
Action Kinetics Concentrated insulin injection (500 U mL). Depending on response, may be given SC or IM as a single or as two or three divided doses. Not suitable for IV administration because of possible allergic or anaphylactoid reactions. Uses Insulin resistance requiring more than 200 units insulin day. Contraindications Allergy to pork or mixed pork beef insulin (unless client has been desensitized). Special Concerns Use with caution during lactation. Additional Side Effects Deep secondary hypoglycemia 18 24 hr after administration.
Clinical studies of pets are limited. No large, well-designed studies have been undertaken of pet ownership in people with MS. In other conditions, early studies indicated that pet ownership improved bereavement, lowered the use of medical services, decrease the risk of allergies and asthma in children, decreased the risk of heart disease, and increased survival rates from heart attacks. However, subsequent studies did not support these findings. In children, pet ownership does appear to decrease absenteeism from school.
Medicinal treatments for hemophilia B began in 1954 with the isolation of antihemophilic factors of bovine and porcine origin, although severe allergic reactions were common with these treatments 37 . The subsequent development of cold-insoluble cryoprecipitate and PCC in 1965 dramatically changed the treatment of hemophiliacs. The most significant advance came in the 1970s with the development of lyophilized concentrates of FVIII (for hemophilia A) and FIX (for hemophilia B), which have transformed the life of many hemophiliacs 4,6 .
Use of the ophthalmic solution Transient stinging and burning following instillation, ocular irritation, allergic reactions, superficial ocular infections, superficial keratitis. Drug Interactions Ketorolac may T plasma levels of salicylates due to i plasma protein binding. How Supplied Injection 15 mg mL, 30 mg mL Ophthalmic solution 0.5 Tablet 10 mg
Thyrotoxicosis can be controlled more quickly than with thionamides using solutions of saturated potassium iodine (SSKI or Lugol's solution 1-3 drops t.i.d.) which blocks the release of stored hormones. Side effects of iodine are uncommon and include acneiform eruptions, fever, coryza, and salivation 99 . Severe and fatal allergic reactions to iodine have also been observed 99 .
Cocamide DEA Coconut Oil Fatty Acids Diethanolamide NNbis2Hydroxyethyl Coco Fatty Acid Diethanolamide Cocoyl
Fowler JF Jr (1998) Allergy to cocamide DEA.Am J Contact Dermat 9 40-41 Kanerva L, Jolanki R, Estlander T (1993) Dentist's occupational allergic contact dermatitis caused by coconut diethanolamide, N-ethyl-4-toluene sulfonamide and 4-tolydietahnolamine. Acta Derm Venereol (Stockh) 73 126-129 Pinola A, Estlander T, Jolanki R, Tarvainen K, Kanerva L (1993) Occupational allergic contact dermatitis due to coconut diethanolamide (Cocamide DEA). Contact Dermatitis 29 262-265
Sulfonamides structurally resemble p-aminobenzoic acid (PABA), a precursor in bacterial DHF synthesis. As false substrates, sulfonamides competitively inhibit utilization of PABA, hence DHF synthesis. Because most bacteria cannot take up exogenous folate, they are depleted of DHF. Sulfonamides thus possess bacteriostatic activity against a broad spectrum of pathogens. Sulfon-amides are produced by chemical synthesis. The basic structure is shown in (A). Residue R determines the pharma-cokinetic properties of a given sulfon-amide. Most sulfonamides are well absorbed via the enteral route. They are metabolized to varying degrees and eliminated through the kidney. Rates of elimination, hence duration of effect, may vary widely. Some members are poorly absorbed from the gut and are thus suitable for the treatment of bacterial bowel infections. Adverse effects may include, among others, allergic reactions, sometimes with severe skin damage, displacement of other plasma protein-bound drugs...
In most respects, clinical performance (biologic and mechanical) is more important than cost. Biologic properties that can be evaluated include gingival irritation, recurrent caries, plaque retention, and allergies. Mechanical properties include wear resistance and strength, marginal fit, ceramic bond failure, connector failure, and tarnish and corrosion. cyanide, and hydrofluoric acid. Consequently, restrictions have been imposed on their shipping and use. For instance, asbestos in casting ring liners and uranium salts in dental porcelain are no longer used. There is also concern25 for the possible health hazards (see Chapter 19) associated with alloys containing nickel and beryllium. Although no definite conclusions can be drawn, appropriate safety precautions are advisable when grinding these alloys. Filtered suction units and appropriate barriers (masks) should be used. The ADA26 requires nickel-containing alloys to carry a precautionary label stating that...
TREATMENT The key to treatment is to determine the underlying cause since urticaria is always present secondary to an underling immunologic process. Elimination of the inciting factor is curative. Allergy testing may be useful for recurrent cases. In acute urticaria, an etiology is found 20 to 30 of the time and most commonly includes drugs, food or food additives, intravenous radio-opaque contrast medium, hymenoptera stings, infections, or systemic inflammatory diseases. Marked emotional tension may precipitate or exacerbate the condition. Cold, pressure, and sunlight may trigger urticaria in rare familial or sporadic cases. Often, however, the cause cannot be determined. Cold compresses often give relief. Use of subcutaneous epinephrine injection may be necessary for hypotension or airway involvement. In chronic cases the etiology is found in less than 5 of cases.
The marketing of all pharmaceuticals in the United States is regulated by the Code of Federal Regulations for Drugs, 21 CFR, Chapter 1, Sub-chapters C and D. Biological products which include all vaccines, antibiotics, hormones, human blood or blood-derived products, immunoglobulin products, products containing intact cells, fungi, viruses or virus pseudotypes, proteins produced by cell culture or transgenic animals and animal venoms synthetically produced allergenic products and drugs used for bloodbanking and transfusion are further regulated by the Code of Federal Regulations for Biologies, 21 CFR, Chapter 1, Subchapter F. While the fundamental issues regarding safety and efficacy of biopharmaceuticals are essentially the same as those for conventional pharmaceutical agents, the complexity of biotechnology products has necessitated
Evolution into cutaneous T-cell lymphoma was observed in four patients with long-standing chronic contact dermatitis (11) present for up to 15 years before clinically and histologically verified mycosis fungoides occurred. Contact allergy was confirmed in these cases by patch testing with sensitization against nickel, potassium dichromate, and formaldehyde. These observations may suggest that at least in some cases, CTCL may be caused by chronic antigenic immunostimulation (12).
Mature T lymphocytes of the CD8 or CD4 classes bear a T cell receptors (TCR) that are specific for a molecular complex consisting of a major histocompatibility complex class I or II (MHC class I or II) molecule bound to a unique self or foreign peptide. Until recently, methods for monitoring the T cell immune response to a viral or tumor antigen were restricted primarily to functional assays based on limiting dilution analysis, because the lack of specific molecular reagents to identify clonal T cells obviated approaches to identify and enumerate specific T cells. The development of efficient methods to express and refold MHC class I molecules with synthetic peptides in vitro has been coincident with the identification of specific protein sequences that provide the substrate for enzymatic biotinylation. This combination has led to the development of a straightforward method for generating synthetic TCR ligands, making them tetravalent to provide increased avidity (despite the...
The initial evaluation of patients with chronic otitis media should include a thorough otologic and general medical history. The otologic history must include careful documentation of symptoms and previous treatment, both medical and surgical. The general medical history should include documentation of potential predisposing factors including upper respiratory allergy, smoking, diabetes mellitus, and possible immunologic compromise.
Otolaryngol Head Neck Surg a day. Humidification may also be a simple means by which to moisturize sinonasal mucosa, thin nasal secretions, and facilitate mucociliary transport. Care must be taken, however, to minimize potential fungal overgrowth in the humidifier, as this may actually worsen or precipitate rhinosinusitis. Mucolytic agents such as guaifenesin serve to thin mucus, potentially reducing stasis and promoting clearing of secretions. Their efficacy in children has not been established in rhinosinusitis. Antihistamines are inappropriate in chronic rhinosinusitis unless allergy is involved.44 empirical broad-spectrum b-lactamase-resistant antibiotic, 5 days only of a topical decongestant at initiation of therapy, daily saline nasal irrigations and nasal steroid sprays, antihistamines in patients with positive allergy profiles, room humidification, and judicious use of mucolytics if they afford symptomatic benefit to the patient. In addition,...
The snail species most often used for maintaining Schistosoma mansoni is Biomphalaria glabrata. Several detailed reviews have described the maintenance features of this snail for the most efficient production of the parasite (Bruce et al., 1971 Lewis et al., 1986 Liang et al., 1987). For the investigator interested in developing an S. mansoni life cycle, the NIH maintains a supply contract whereby uninfected snails and S. mansoni-infected snails and mice can be obtained free of charge. Contact the Parasitology and International Programs Branch of the National Institute of Allergy and Infectious Diseases (NIAID) at (301) 496-2544.
Some deaths in the dental chair are attributed to allergic reactions to the drugs given, principally local anesthetics. There is controversy as to the validity of this etiology, however. True allergic reactions to a local anesthetic or a substance used as a preservative or stabilizer in the local anesthetic are probably extremely rare.20,21 Most so-called allergic reactions are probably overdoses of the local anesthetic caused by an intravascular injection of the drug, due to failure to aspirate after placement of the needle injection of large doses of a local anesthetic into a highly vascular area or unusually rapid absorption.20,22 This last cause is aided by the fact that local anesthetics by themselves are vasodilators that enhance absorption in vascular areas.
Currently, approximately 16 approved antimicrobials may be used for the treatment of otitis media.23 The recommended first line antibiotic for treatment of otitis media continues to be amoxicillin.24'25 In situations of treatment failures or drug allergy to amoxicillin, other antimicrobials should be considered. In cases where agents which have high activity against b-lactamase-producing H. influenzae and M. caterrhalis-effective antimicrobials include amoxicillin and clavulanate potassium, cefixime, cefpodoxime proxetil, and cefuroxime axetil. In cases in which resistant Pneumococcus is suspected or has been diagnosed, high-dose amoxicillin may be beneficial with doses ranging from 60 to 90 mg kg day. This regimen may also be used in combination with amoxicillin shill clavulanate. Obviously, without tympanocentesis, it is difficult to obtain a true diagnosis of the bacteriologic agents in any specific case of otitis media. Unfortunately, tympanocentesis continues as a rather invasive...
Other medical modalities recommended for the treatment of otitis include corticosteroids, administered orally or intra nasally 33-36 antihistamines and or decongestants. Although there is evidence that orally administered corticosteroids may help clear chronic middle ear effusion, there is no evidence that this provides a long-term benefit in patients with chronic otitis media with effusion.35 In addition, there is the risk of potential side effects from utilization of cortocosteroids. Intranasal steroids may play a role in patients with chronic middle ear effu-sion.36 However, there is no evidence of efficacy in the treatment of acute otitis media. Antihistamine decongestant preparations have been used in the past for treatment of otitis media with effusion. However, there is no evidence that this accelerates clearance of middle ear effusion and there appears to be no role for these medications in the treatment of acute otitis media.37 In children who have significant symptoms of...
Three case control studies have investigated the possibility of an environmental etiology for MF. The first recorded a high incidence of allergies, of fungal, and viral infections and found a higher than expected proportion of patients in the petrochemical, textile, metal, and machine industries in the United States (17). A second study from Scotland failed to confirm these observations, but recorded a higher incidence than expected of atopic diathesis in MF patients (18). The third study from the United States failed to confirm any differences in occupational environmental exposure but noticed an increased rate of other malignancies including skin cancers (19).
Promote expediency in treatment if a reaction occurs may prevent an allergic reaction. Prevent development of latex allergy prevent allergic reaction in those who are already sensitized. Promotes screening of all patients which may prevent severe allergic reactions in otherwise low-risk patients.
A second category includes those related to the anesthesia, whether local or general. Most anesthetic-related deaths are caused by human error, with the most common problems related to ventilation. An intra-operative death could be caused by as simple a mistake as inserting the intubation tube into the esophagus. There may be unrecognized extubation, disconnection from the ventilator, or inadequate ventilation. There may be allergic reaction to the anesthetic agent (rare) or contamination of the gas being administered. In some instances, due to mix-ups in bottled gases, the wrong gas is administered. The patient may develop malignant hyperthermia.38 This is usually associated with the use of halogenated anesthetics and succinycholine. The individual usually has a genetic predisposition, but this condition may not occur every time anesthesia is administered. The onset of signs can be insidious or fulminant, with a rapid rise in body temperature, tachycardia, arrhythmias and skeletal...
Uses Systemic Vascular failure in shock, shock-like states, drug-induced hypotension or hypersensitiv-ity. To maintain BP during spinal and inhalation anesthesia to prolong spinal anesthesia. As a vasoconstrictor in regional analgesia. Paroxysmal SVT. Nasal Nasal congestion due to allergies, sinusitis, common cold, or hay fever. Ophthal-mologic 0.12 Temporary relief of redness of the eye associated with colds, hay fever, wind, dust, sun, smog, smoke, contact lens. 2.5 and 10 Decongestant and vasoconstrictor, treatment of uveitis with posterior synechiae, open-angle glaucoma, refraction without cyclople-gia, ophthalmoscopic examination, funduscopy, prior to surgery. Contraindications Severe hypertension, ventricular tachycardia. Special Concerns Use with extreme caution in geriatric clients, severe arteriosclerosis, bradycardia, partial heart block, myocardial disease, hyperthyroidism and during pregnancy and lactation. Nasal and ophthalmic use of phenylephrine may be systemically...
Asthma is an inflammatory disease of the peripheral airway, and several groups have been able to demonstrate an association of asthma severity with TH2 polarization in peripheral blood (Fingerle-Rowson et al. 1998 Gately et al. 1998 Humbert et al. 1997 Nurse et al. 1997). Involved in this polarization is the TH2 cytokine IL-10, but this anomalous interleukin should be considered a regulatory cytokine more than a promoting cytokine because of its inhibitory effects on allergic reactions (Figure 14.1). IL-10 has been shown to induce long-term hyporesponsiveness of allergen-specific CD4+ T cells and to decrease mast cell numbers in addition to inhibiting the production of eosinophils (Akdis et al. 1998 Borish 1998 Mackay and Rosen 2001). Moreover, IL-10 has been shown to inhibit eosinophil survival and IL-4-induced IgE synthesis (Takanaski et al. 1994), and in an animal model, IL-10 was shown to inhibit the late-phase response and the influx of eosinophils and lymphocytes after allergen...
Respiratory sensitization is often characterized by episodes of wheezing, coughing, and chest tightness.102 The condition can be severe and sometimes fatal.103 The mechanisms by which chemicals can induce this adverse response are uncertain, but are assumed to be immune mediated with some pharmacological and neurological involvement. Currently there are no accepted, well-validated in vitro or in vivo models for the detection of respiratory sensitizers.85 However, preliminary work by Dearman and co-workers has shown, for a limited number of respiratory sensitizers at least, that these chemicals all elicit a response in the LLNAused for the detection of allergic contact dermatitis.104'105 Therefore, the suggestion can be made that chemicals that do not cause ACD will be unlikely to cause respiratory sensitization. However, there are significant differences between the mechanisms of these adverse effects that mean that not all contact allergens will necessarily be respiratory allergens.85
Experimental studies have shown that peripheral blood mononuclear cell sensitivity to allergens exists at birth (Kondo et al. 1992 Prescott et al. 1998 Warner et al. 1994 reviewed in Warner and Warner 2000). In particular, specific allergen-induced responses can be measured in the peripheral blood mononuclear cells as early as 22 weeks into gestation (Jones et al. 1996). Moreover, events after birth are believed to modify the developing immune response in newborns allergens, infections, diet, and gut microbial flora have all been implicated in the development, or not, of subsequent allergy (Warner and Warner 2000). The impact of diet on the development of allergies in newborns is now being recognized. The health benefits cited for breastfeeding include a reduction in childhood asthma (Oddy et al. 2002) and may be directly tied to gut microbial flora (Bjorksten et al. 1999 Holt et al.
2 to 3 months of pregnancy is associated with much less birch pollen reactivity of the offspring than occurs if the exposure was between 3 and 6 months' gestation (Van Duren-Schmidt et al. 1997). As the authors of that study pointed out, of particular relevance is that IgG transfer across the placenta is maximal during the latter few months of pregnancy, so maternal fetal interactions may be playing a major role in this case. Moreover, other studies have shown that children are at increased risk for allergy to seasonal allergens if born shortly before the relevant pollen season, when protective maternal (and presumably fetal) IgG antibodies would be at their lowest levels (Jenmalm and Bjorksten 2000). It will be particularly interesting to learn from future studies if there is a concomitant increase in risk for the development of asthma, since many of the same allergens are involved.
Ask the patient to describe normal and unusual exercise and activity patterns. Determine if the patient has had localized joint swelling, pain, and restricted movement and which joints have been affected. Ask if the pain has affected sleeping patterns. Establish a history of repetitive joint stress or trauma. Determine if the patient has either a congenital musculoskeletal condition that might have caused the tendinitis or a history of rheumatic disease. Determine if the patient has allergies to specific corticosteroids or local anesthetics, which are sometimes prescribed for tendinitis.
Active maternal smoking has been shown to be associated with many complications of fetal development, and several studies consistently link respiratory tract effects, the development of allergy, and impaired lung function in school-age children with maternal smoking (Cook and Strachan 1999 Lodrup Carlsen and Carlsen 2001 National Academy of Sciences 2000). Fetal exposure to ETS in utero differs both qualitatively and quantitatively from exposure of young children to airborne ETS. It must be emphasized that these types of studies are difficult to interpret because most mothers who smoke during pregnancy also continue to smoke after a child is born (National Academy of Sciences 2000). Having said that, however, at least one study has found a stronger influence of in utero exposure than exposure encountered postnatally (Hu et al. 1997). Although maternal smoking clearly negatively impacts the respiratory health of offspring, the effects of ETS on the development of allergy and asthma are...
A major drawback of transdermal delivery systems is the potential for localized irritant and allergic cutaneous reactions. At the earlier stages of formulation development, it is, therefore, important to evaluate both drugs and excipients for their potential to cause irritation and sensitization (see Chapters 10 and 11). This is true for all transdermal systems, but especially for those that may stay in place for prolonged periods. The degree of primary and chronic irritation, and the potential to cause contact allergy, photoirritation, and photoallergy should be determined. Normally, the drug and excipients are initially separately evaluated for contact irritation and sensitization in animal models before evaluation in human subjects. It must, however, be emphasized that animal data are often not predictive of the human situation. Evaluation of skin irritation and delayed contact hypersensitivity should
Beginning in 2006, IBM's active workforce, as part of their health benefits, will have access to a personal health record (PHR) application. With the new benefit, participating IBM employees in the United States will be able to input and manage information about their medications, allergies, medical histories, test results, and more. In addition, they may also create PHRs for eligible family members. The personal health record is protected by federal HIPAA privacy and security regulations. The new PHR feature is envisioned as one building block of a larger on-line health information resource that offers content tailored to personal needs and is designed to help participants actively manage their health. The long-term goal for such an electronic health record sytem is to make patient data securely available to health care providers such as hospitals and emergency personnel when and where the information is needed.
Besides gastrointestinal problems and allergy, adverse effects particularly involve the CNS (confusion, hallucinations, seizures). Since they can damage epiphyseal chondrocytes and joint cartilages in laboratory animals, gyrase inhibitors should not be used during pregnancy, lactation, and periods of growth.
Stepwise Summary of Assessment Management and Management of Uncomplicated Chronic Pediatric Rhinosinusitis
Step 2 Evaluation for predisposing factors and concomitant diseases, with treatment of positive findings Allergy atopy Immune deficiency Cystic fibrosis Ciliary dyskinesia Enviromnent (smoking, day care) Gastroesophageal reflux 26. Shapiro G, Furukawa C, Pierson W, et al. Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. J Allergy Clin Immunol 1986 77 59-64 27. Gungor A, Corey J. Pediatric sinusitis a literature review with emphasis on the role of allergy. Otolaryngol Head Neck Surg 1997 116 4-15 39. Ramsey B, Richardson M. Impact of sinusitis in cystic fibrosis. J Allergy Clin Immunol 1992 90 547-552 51. Sharpe M, Furukawa C, Bierman C, et al. Allergic patients have more frequent sinus infections than nonallergic patients (abstract). J Allergy Clin Immunol 1992 751 332 54. Abdulrazzaq Y, Bener A, DeBuse P. Association of allergic symptoms in children with those in their parents. Allergy 1994 49 737-743 55. Williams P, Dolen W, Koepke J, et...
This substance is one of the strongest primary skin irritant known, and a universal contact allergen. Occupational dermatitis has been reported, but current use is decreasing or performed with completely closed systems. DNCB is sometimes used for topical treatment of alopecia areata, severe warts, and cutaneous metastasis of malignant melanoma.
Testing with the material as is under occlusion is absolutely contra-indicated because of high irritancy. A semi-open test might be indicated in cases with a high suspicion of contact allergy, particularly when resins are involved and testing with the standard and supple mentary series remains negative. The main allergen in cement is potassium dichromate, which is present in the standard series. Fast-curing cements contain epoxy resins, which are increasingly recognized as major allergens in the construction industry but also in other industrial areas (painting, metal, electronics, and plastic). The epoxy resin of the standard series is insufficient to detect all cases of relevant epoxy resin allergies, as has been shown by a large German multicenter study 8 . Sometimes acrylic resins may also be present.
Dimethylaminopropylamine is an aliphatic amine present in amphoteric surfactants such as liquid soaps and shampoos. It is present as a residual impurity thought to be responsible for allergy from cocamidopropylbetaine. It is structurally similar to diethyl-aminopropylamine. It is also used as a curing agent for epoxy resins and an organic intermediate in chemical synthesises (ion exchangers, additives for flocculants, cosmetics and fuel additives, dyes and pesticides). Patch test has to be carefully interpreted, since the 1 aqueous solution has pH 11 (personal observation). Angelini G, Foti C, Rigano L, Vena GA (1995) 3-Dimethylaminopropyl-amine a key substance in contact allergy to cocamidopropylbetaine Contact Dermatitis 32 96-99 Kanerva L, Estlander T, Jolanki R (1996) Occupational allergic contact dermatitis from 3-dimethylaminopropylamine in shampoos. Contact Dermatitis 35 122-123 Speight EL, Beck MH, Lawrence CM (1993) Occupational allergic contact dermatitis due to...
Conde-Salazar L, Del-Rio E, Guimaraens D, Gonzalez Domingo A (1993) Type IV allergy to rubber additives a 10-year study of 686 cases. J Am Acad Dermatol 29 176-180 Conde-Salazar L, Guimaraens D, Villegas C, Romero A, Gonzalez MA (1995) Occupational allergic contact dermatitis in construction workers. Contact Dermatitis 35 226-230 Kiec-Swierczynska M (1995) Occupational sensitivity to rubber. Contact Dermatitis 32 171-172 Von Hintzenstern J, Heese A, Koch HU, Peters KP, Hornstein OP (1991) Frequency, spectrum and occupational relevance of type IV allergies to rubber chemicals. Contact Dermatitis 24 244-252
Nitroglycerin is an explosive agent contained in dynamite, and an antianginal and vasodilator treatment available in systemic and topical forms. It is a well known irritant agent in dynamite manufacture. It can also cause allergic reactions in employees of explosives manufacturers, and in the pharmaceutical industry. Transdermal systems are the main source of iatrogenic sensitization. Nitroglycerin can cross-react with isosorbide dinitrate. Aquilina S, Felice H, Boffa MJ (2002) Allergic reactions to glyceryl trini-trate and isosorbide dinitrate demonstrating cross-sensitivity. Clin Exp Dermatol 27 700-702 Kanerva L, Laine R, Jolanki R, Tarvainen K, Estlander T, Helander I (1991) Occupational allergic contact dermatitis caused by nitroglycerin. Contact Dermatitis 24 356-362 Machet L, Martin L, Toledano C, Jan V, Lorette G,Vaillant L (1999) Allergic contact dermatitis from nitroglycerin contained in 2 transdermal systems. Dermatology 198 106-107
Tixocortol 21-pivalate is a 21-ester of tixocortol, widely used in topical treatments. It can induce severe allergic contact dermatitis. This corticosteroid is a marker of the allergenic A group that includes molecules without major substitution on the D cycle (no C16 methylation, no C17 side chain). A short-chain C21 ester is possible. Molecules are cloprednol, cortisone, fludrocortisone, fluoro-metholone, hydrocortisone, methylprednisolone, methylpred-nisone, prednisolone, prednisone, tixocortol, and their C21 esters (acetate, caproate or hexanoate, phosphate, pivalate or trimethyl-acetate, succinate or hemisuccinate, m-sulfobenzoate). tixocortol. Ann Dermatol Venereol 129 348-349 Lepoittevin JP, Drieghe J, Dooms-Goossens A (1995) Studies in patients with corticosteroid contact allergy. Understanding cross-reactivity among different steroids. Arch Dermatol 131 31-37
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