Cases reported "Hypersensitivity, Delayed"

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1/25. Fibroin allergy. IgE mediated hypersensitivity to silk suture materials.

    Delayed-type hypersensitivity with granulomatous lesions to silk sutures is rather rare. Yet, braided silk sutures often act as a non-immunologic foreign-body and cause a granulomatous inflammatory reaction years after surgery. We report here a case of recurrent granulomas with remarkable infiltration of eosinophils that may have resulted from an IgE-mediated hypersensitivity reaction to silk fibroin, a component of the braided silk suture. Under normal circumstances exposure to fibroin is rather rare. Therefore, the present patient may have developed this reaction to the silk sutures used in a previous surgery.
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keywords = exposure
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2/25. Polymorphic light eruption occurring in common variable hypogammaglobulinaemia, and resolving with intravenous immunoglobulin therapy.

    A 55-year-old woman with a past history of lower respiratory tract infections presented with a photosensitive eruption. Polymorphic light eruption (PLE) was diagnosed on the basis of the temporal relationship to sun exposure and the diagnosis was supported by positive monochromator irradiation tests in the ultraviolet A wavelength spectrum. Investigation of the patient's immune status identified low levels of all immunoglobulin (Ig) subtypes consistent with common variable hypogammaglobulinaemia. Intravenous Ig replacement therapy, instituted to minimize risks from bacterial infections, was commenced and over the ensuing months resulted in a complete resolution of the PLE. PLE is considered to represent a type IV hypersensitivity reaction directed against a cutaneous autoantigen induced by exposure to ultraviolet light. In PLE, nonspecific immunomodulatory mechanisms of intravenous Ig may be active, such as a reduction in the synthesis of cytokines and a blockage of the IgG Fc receptors on macrophages.
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ranking = 2
keywords = exposure
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3/25. Occupational allergic airbone contact dermatitis and delayed bronchial asthma from epoxy resin revealed by bronchial provocation test.

    Diglycidyl ether of bisphenol A (DGEBA) epoxy resins belong to the most common causes of occupational allergic contact dermatitis. DGEBA has on rare occasions caused occupational asthma. Here we present a patient who first developed occupational allergic contact dermatitis (ACD) caused by a single accidental exposure to DGEBA. Then, on continued occupational exposure to DGEBA, the patient developed occupational asthma from DGEBA, in addition to ACD. A bronchial provocation test with DGEBA caused a 36% drop in the peak expiratory flow, reflecting a delayed type of occupational asthma. This bronchial provocation test caused a strong dermatitis of the exposed skin of the face, in accordance with airborne ACD from DGEBA.
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ranking = 481.13177027266
keywords = occupational exposure, exposure
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4/25. Cryptococcal osteomyelitis and cellular immunodeficiency associated with interleukin-2 deficiency.

    We describe an unusual example of cellular immunodeficiency associated with interleukin-2 deficiency in an otherwise healthy 15-year-old boy who had isolated cryptococcal osteomyelitis of the scapula at 10 years of age. His previous medical history was remarkable only for prolonged, severe varicella infection at 6 years of age. He had persistent moderate lymphopenia, anergy, and absent lymphocyte blastogenic responses to mitogens, antigens, or monoclonal T cell antibodies. Subnormal blastogenic responses were seen after exposure to high concentrations of phorbol esters. Immunoglobulin levels and specific antibodies were normal. The patient has been in good health since treatment of his osteomyelitis. However, his lymphocyte blastogenic responses to mitogens have remained absent during 4 years of observation; investigation of the cause revealed a specific interleukin-2 deficiency resulting from defective generation of interleukin-2 messenger ribonucleic acid. Secretion of interleukin-1 by monocytes was normal, suggesting that the abnormal blastogenic response and interleukin-2 production were due to a problem intrinsic to T lymphocytes. The generation of messenger ribonucleic acid for interleukin-4 was not affected. interferon-gamma was produced at subnormal levels. The addition of recombinant interleukin-2 restored lymphocyte blastogenic responses and increased the expression of interleukin-2 receptors. The clinical findings and immunologic abnormalities present in this patient differ from other primary and secondary immunodeficiencies associated with interleukin-2 deficiency. Thus our observations in this patient extend the spectrum of immunodeficiencies associated with abnormalities in the production of this important cytokine.
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5/25. Unusual reactions to insect venoms.

    A variety of unusual, unexpected reactions have been described that occur in a temporal relationship to venom exposure, primarily insect stings. An immunologic mechanism appears responsible for reactions such as serum sickness and late onset allergiclike symptoms. In all probability, allergic mechanisms are responsible for the renal and neurologic symptoms and the delayed hypersensitivity type reactions. The mechanisms for the fatigue and malaise following venom injections and the most unusual areas of extensive erythema following venom skin tests are not known.
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6/25. Churg-Strauss angiitis. Arguments favoring the responsibility of inhaled antigens.

    A 27-year-old man presented with relapsing vascular limb purpura, pulmonary infiltrates and cranial nerve palsies occurring after exposure to pigeons. A lung biopsy specimen showed Churg-Strauss angiitis. Actinomycetes were observed in pneumocytes. The circumstances preceding clinical manifestations and pathologic findings favored the diagnosis of pulmonary vasculitis as a consequence of inhaled antigen. Recovery was obtained after treatment with prednisone, cyclophosphamide, and plasma exchanges.
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7/25. Late asthmatic reaction in a hairdresser, due to the inhalation of ammonium persulphate salts.

    Persulphate salts are among the various chemical substances that can cause occupational diseases in hairdressers. We present the case of a 21 year-old female who worked in a hairdressing salon for five and a half years. Five years prior to consultation, she presented with rhinitic symptoms and wheezing dyspnea which were related with her working environment. The routine laboratory examinations carried out on the patient were found to be normal. Among the various allergic exams performed there was an elevated total IgE. The provocation test with histamine was positive at the concentration of 10 mg/ml, demonstrating mild bronchial hyperreactivity. The test of bronchial exposure to ammonium persulphate was positive with bronchospasm 3-4 hours after this test. With a prior inhalation of betamethasone we were able to block this reaction, but with disodium cromoglycate we were able to block it only partially. We conclude that the patient presented with late onset bronchial asthma due to sensitivity to ammonium persulphate. It has to be pointed out that this patient was a rare case as generally persulphate salts choose to invade and affect the skin. The rarity of this pathology is reflected by the scarce bibliography on this subject.
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keywords = exposure
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8/25. Hypochlorite sensitivity in man.

    observation of an individual with immediate-type reaction following exaggerated dermal exposure to hypochlorite-containing cleaning products prompted review of similar hypersensitivity reactions attributed to hypochlorite or other highly reactive chemicals. This review confirms isolated incidences of hypochlorite sensitivity of the delayed type (allergic contact dermatitis), as well as immediate-type reactions from inhalation or topical challenge of sensitized individuals. We conclude that it is possible that excessive and prolonged exposure to hypochlorite may in some cases result in irritation and damage to the skin. This potentially gives rise to altered proteins which in rare cases may cause hypersensitivity. This reaction is common to other reactive small molecules with a strong irritant action.
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ranking = 2
keywords = exposure
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9/25. Significant changes in nonspecific bronchial responsiveness after isolated immediate bronchospecific reactions caused by isocyanates but not after a late reaction caused by plicatic acid.

    Although late bronchospastic reactions after exposure to antigenic and sensitizing agents usually significantly alter bronchial responsiveness to histamine or methacholine, presumably by causing bronchial inflammation, isolated immediate bronchospastic reactions do not induce such changes. We studied three subjects who demonstrated different patterns of reaction. The first individual was diagnosed as having occupational asthma to red cedar. This was confirmed by specific inhalation challenges that resulted in late bronchospastic reaction. No significant changes in the provocative concentration of histamine causing a 20% fall in FEV1 (PC20) were found 1 day after this reaction. Two weeks later, serial assessments (five and six, respectively) of PC20 histamine were recorded on control days and up to 48 hours after exposure to plicatic acid, which caused a late bronchospastic reaction with a maximum fall of 37% in FEV1. No significant changes in PC20 were found; the maximum variations on control days were 0.36 to 0.74 mg/ml, and on active days, from 0.37 to 0.59 mg/ml. By contrast, two other subjects, who demonstrated isolated immediate reactions after exposure to diphenylmethane diisocyanate, had significant changes in PC20 histamine and methacholine, in one subject from 3.1 mg/ml to 0.6 mg/ml 8 hours after exposure, and in the other subject, from 61.0 to 7.4 mg/ml 7 hours after exposure, with recovery during the next few days. These examples demonstrate that the pattern of nonspecific bronchial responsiveness after immediate and late bronchospastic reactions can be different from what has previously been described. Immediate bronchospastic reactions may lead to bronchial hyperresponsiveness, whereas late asthmatic reactions do not always induce changes in bronchial responsiveness.(ABSTRACT TRUNCATED AT 250 WORDS)
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ranking = 5
keywords = exposure
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10/25. Delayed flare-up reactions caused by jellyfish.

    Four patients had a recurrence of cutaneous lesions 1 week after being stung by jellyfish. Three patients had flare-up lesions after only one exposure to jellyfish. All of the recurring lesions were vesicular erythema, and the histological findings of case 3 corresponded to that of allergic contact dermatitis.
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ranking = 1
keywords = exposure
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