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1/33. Effective acute desensitization for immediate-type hypersensitivity to human granulocyte-monocyte colony stimulating factor.

    BACKGROUND: Granulocyte-monocyte colony stimulating factor (GM-CSF) is the treatment of choice for patients with life threatening neutropenias. Hypersensitivity to GM-CSF may lead to cessation of treatment. Acute desensitization is an alternative mode of managing drug hypersensitivity, especially when other common modes like substitution of offending drug or premedication with antihistamines and/or corticosteroids are not available or fail. CASE REPORT: A 42-year-old woman with a 17-year history of severe chronic mucocutaneous candidal infections became resistant to all common antifungal drugs. As her disorder was associated with defective functions of monocytes and granulocytes, GM-CSF treatment was started yielding a very good clinical effect. After a short period of treatment, however, the patient developed anaphylactic reactions which could not be abolished by preadministration of antihistamines and/or corticosteroids. Replacement of therapy by G-CSF caused identical hypersensitivity phenomena. methods: Prick skin tests with 100, 200, or 400 microg/mL of GM-CSF or G-CSF, using also negative and positive controls, were performed on the patient and three healthy control subjects. A positive local reaction was observed only in patient at the prick point of 200 microg/mL GM-CSF or 400 microg/mL G-CSF. Acute desensitization to GM-CSF was initiated adopting a protocol used for parenteral desensitization to penicillin. RESULTS: The patient tolerated the desensitization procedure very well and we could resume the administration of GM-CSF. For the past 30 months the patient has been treated uneventfully by subcutaneous administration of GM-CSF, 500 microg twice weekly, and is free of candidal infections. Skin prick tests were repeated 1 month postdesensitization and resulted in a very weak response to GM-CSF compared with the predesensitization response. CONCLUSIONS: Acute desensitization can be utilized in patients who develop drug hypersensitivity reactions to GM-CSF. As GM-CSF is a very unique agent and in most cases cannot be replaced by another one, acute desensitization may play a very important role in managing failure of GM-CSF treatment due to hypersensitivity reactions.
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2/33. cyclophosphamide type I hypersensitivity in systemic lupus erythematosus.

    cyclophosphamide is an important immunosuppressive agent in the treatment of many rheumatic diseases. urticaria and anaphylaxis to intravenous cyclophosphamide (i.v. CYC) have been reported in patients with haematological and solid organ malignancies. This is the first report in the rheumatology literature of a type I hypersensitivity reaction following monthly i.v. CYC. An 18-year-old girl with systemic lupus erythematosus (SLE) developed generalized urticaria (without concomitant angioedema or anaphylaxis) following i.v. CYC. She had previously developed life-threatening angioedema following a respiratory tract infection. She successfully completed regular pulse i.v. CYC with pre-medication with anti-histamine. In the absence of a severe type I hypersensitivity reaction and other suitable immunosuppressive agents, i.v. CYC may be safely continued with pre-medication and careful monitoring during each infusion.
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3/33. latex hypersensitivity reactions despite prophylaxis.

    Latex rubber hypersensitivity represents a significant problem facing the medical, surgical, radiologic, and dental professions. As a tertiary care center, the Childrens Hospital of philadelphia has a large population of patients with spina bifida and complex genitourinary anomalies; a number of these children have latex rubber allergy, which may first present as intraoperative anaphylaxis. Although there is no substitute for complete antigen avoidance, all medical products containing latex rubber may not have suitable alternatives. Therefore, we have formulated a protocol to prevent perioperative reactions through the use of prophylactic medications and the limitation of latex exposure. This regimen includes steroids, antihistamines, and bronchodilators when indicated. In four children, prophylaxis failed perioperatively because of parenteral infusion of latex rubber proteins.
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4/33. Risks of BCG intralesional therapy: an experience with melanoma.

    A nearly fatal allergic reaction to intratumor BCG injections was associated with a complete remission of recurrent malignant melanoma. Clinical course and histologic sections suggested both anaphylactic and Arthus reactions. The occurrence of reactions at BCG injection sites as well as at uninjected sites of tumor suggests common BCG and melanoma antigens. The management of events involved in this often fatal postimmunotherapy complication involves the early administration of parenteral fluids, antituberculous therapy, antihistamines, and possible steroids. The prophylactic use of antihistamines and an in-hospital administration of intralesional BCG immunotherapy are strongly suggested. In the future, prophylactic INH may prove to be both therapeutically efficacious and protective against infectious complications.
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keywords = histamine
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5/33. Occupational rhinoconjunctivitis and asthma by exposure to lathyrus sativus flour.

    We report the case of a 42-year-old non-smoking man, who had worked as a carpenter for 6 years and who reported a history of rhinorrhea, paroxysmal sneezing, nasocular pruritus, lacrimation, wheezing and dyspnea attacks while preparing a mixture to seal the junctures between wooden panels. Allergy study consisted of skin prick testing (SPT) to inhalants, foods and lathyrus sativus flour (LSF) extract, specific bronchial provocation test with LSF extract, cytological analysis of sputum, specific IgE antibodies against LSF, and histamine releasing test with dilutions (1:5, 1:25, 1:125, 1:625) of LSF. The results demonstrated occupational rhinoconjunctivitis and asthma due to LSF exposure. We provide a review of published reports to date.
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keywords = histamine
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6/33. Latex-vegetable syndrome due to custard apple and aubergine: new variations of the hevein symphony.

    An increasing number of vegetables with crossreactions to latex are being described in patients with latex-vegetable syndrome. We present two of these vegetables, custard apple linked in two previous cases with latex sensitisation, and aubergine, that had not been described up to now in patients with latex sensitisation. The diagnosis of both cases was based on the clinical history, positive skin prick test (SPT) and specific IgE to the offending vegetables, as well as to positive SPT and specific IgE levels to latex and the major fruits involved in the latex-fruit syndrome (avocado, banana, and chestnut). Further, crude extracts from latex, custard apple and aubergine, as well as the purified allergens Hev b 6.02 and Prs a 1 were used in in vitro and in vivo assays: IgE immunodetection, histamine release (HRT) and basophil activation (BAT) tests and skin prick tests. In case 1, both purified Hev b 6.02 and Prs a 1 induced positive responses in skin prick tests, high levels of basophil activation and histamine release. Specific IgE immunodetection uncovered a reactive band of 45 kd in the crude custard apple extract, which was also recognized by anti-chitinase monospecific antibodies. The serum from patient 1 also detected Prs a 1 in immunodetection. Hev b 6.02 produced positive skin responses and showed high biological activity in HRT and BAT in the case of patient 2. However, Prs a 1 was reactive neither in SPT nor in IgE immunodetection. In fact, no band was detected using the serum of patient 2 in avocado or aubergine extracts. By contrast, Prs a 1 reached high values of basophil activation and over 10% of histamine release in case 2.
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keywords = histamine
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7/33. Clinical report and investigation of a patient with localized heat urticaria.

    Localized heat urticaria is a rare disorder, in which the nature of the mediator is not fully established. We report the case of a 41-year-old woman with the condition, dependent upon mast cell integrity, in which histamine was demonstrated as the dominant, if not sole mediator. Non-sedative antihistamines conferred some therapeutic benefit, but subsequent sequential desensitization has enabled her to lead a full and active life again.
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keywords = histamine
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8/33. Allergy to limpet.

    Allergy to mollusk has rarely been described. The limpet, belonging to Phylum mollusca, is one of the most frequent mollusks in the Canary islands, as in all warm maritime regions. We report two cases of atopic patients who developed anaphylactic reactions after ingestion of this mollusk. Type I hypersensitivity to limpet antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, and histamine release test to cooked limpet extract. The controls did not react to any of these tests. Allergic activity was only found with a cooked limpet extract; this suggests that the offending antigen/s may have been released by cooking this food.
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keywords = histamine
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9/33. Systemic allergic reaction to pine nuts.

    This case report describes a systemic reaction due to ingestion of pine nuts, confirmed by an open, oral provocation test. Skin prick testing with the aqueous allergen revealed an immediate positive prick test, and histamine release from basophil leukocytes to the aqueous allergen was demonstrated. radioallergosorbent test demonstrated specific IgE antibodies to pine nuts. In a review of medical literature, we found no reports of either oral provocation tests confirming a systemic reaction due to ingestion of pine nuts or demonstration of specific IgE antibodies.
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keywords = histamine
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10/33. Occupational asthma caused by guar gum.

    Some vegetable gums have been reported to cause asthma. We describe three subjects who were exposed at work to guar gum, which is derived from the outer part of Cyanopsis tetragonolobus, a vegetable that grows in india. The first subject worked for a pharmaceutical company; the second and third subjects worked at a carpet-manufacturing plant. All three subjects developed symptoms of rhinitis and asthma after the onset of exposure to guar gum. All subjects were atopic and demonstrated mild bronchial hyperresponsiveness to inhaled histamine at the time they were observed. Skin prick tests demonstrated an immediate skin reaction to guar gum. All three subjects had high levels of serum IgE antibodies to guar gum. Specific inhalation challenges in which the three subjects were exposed for short intervals (less than or equal to 4 minutes) to powder of guar gum elicited isolated immediate bronchospastic reactions in two subjects and a dual reaction in the other subject.
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