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11/33. Basophil histamine release. A study in allergy to suxamethonium.

    A patient who suffered a severe hypotensive episode after induction of anaesthesia, was subsequently found to show positive skin-test responses to suxamethonium. Investigation revealed that suxamethonium induced basophils from the patient to release histamine to an extent comparable to that found after exposure to anit-IgE. basophils from control subjects showed no such response. Basophil histamine release may offer a useful approach to the investigation of adverse drug reactions.
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12/33. Occupational sensitivity to Alphitobius diaperinus (Panzer) (lesser mealworm).

    Alphitobius diaperinus is an important beetle in the grain and poultry industries. We evaluated three individuals with work-related symptoms of asthma, rhinitis, conjunctivitis, urticaria, and angioedema on exposure to the insect. Prick skin tests with extracts prepared from the larval, pupal, and adult life stages were positive in all three patients. Specific IgE antibodies to these extracts were demonstrated by RAST or radioimmunoassay. RAST and radioimmunoassay inhibition confirmed the specificity of IgE binding and further demonstrated immunologic cross-reactivity between the three life stages. Peripheral blood leukocytes from two of the individuals demonstrated significant histamine release when they were compared with cells from nonexposed atopic and normal control subjects. The proteins in the extracts of each life stage were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. More than 30 protein bands were detected in each of the extracts; however, the patterns of separation were different for each life stage. After immunoblotting and autoradiography, IgE-binding proteins were recognized by sera from all three individuals in the larval extract at 90 kilodaltons (kd), in the pupal extract at 90, 64, and 38 kd, and in the adult extract at 84 kd. Additionally, several other proteins were identified as being allergenic in some of the patients. We conclude that these three patients developed IgE-mediated sensitivity to A. diaperinus antigens as the result of occupational exposure. To our knowledge, this is the first description of sensitivity to this grain beetle.
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13/33. 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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14/33. Systematic approach to diagnosis and management of biphasic insulin allergy with local anti-inflammatory agents.

    In this report, we present a patient with a rarely encountered form of biphasic insulin allergy refractory to a conventional desensitization procedure. We describe a systematic approach to this clinical problem with a set of insulin preparations containing antihistamine and/or corticosteroid to verify the type of hypersensitivity reaction and identify treatment options. The approach taken here may be of use for patients with similar conditions who require insulin for adequate diabetic management but who would otherwise be forced to discontinue insulin because of allergic reactions.
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keywords = histamine
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15/33. Three cases of hemodialysis-associated hypersensitivity reactions.

    According to the united states food and drug administration, untoward reactions to capillary hemodialyzers occur at a rate of 3.5 of every 100,000 dialyzers sold. Allergic symptoms immediately after initiation of dialysis consist of burning retrosternal pain, sensation of diffuse heat, cold perspiration, periorbital and facial edema, flushing, laryngeal stridor, bronchial hypersecretion, hypotension, bradycardia, and loss of consciousness. In 1982 Popli et al. reported four patients suffering from such allergic manifestations; three were successfully managed after being taken off dialysis. These investigators thought that inadequate rinsing of cuprammonium cellulose capillary dialyzers was responsible for the reactions, and recommended rinsing the blood compartment with 2 liters of normal saline, and the dialysate compartment with 10 liters of dialysate, both in a single-pass fashion over 20 minutes. Nichols and Platts (1982) (3) reported 15 patients with urticaria, severe bronchospasm, and shock occurring immediately after the blood had been returned from the dialyzer. These authors suggested that the sterilizing agent, ethylene oxide (ETO), was responsible. Poothullil et al. (1975) (4) described a patient with pruritus, severe dyspnea, and hypotension during dialysis. On the basis of a positive skin prick test (dermal reaction to ETO-exposed human albumin) and of antigen-induced histamine release from peripheral leucocytes, these workers suggested that ETO was responsible for the allergic reactions. Marshall et al. (1984) (5) reported that 8.9% of hemodialysis patients had positive skin tests to ETO and that 12.1% were ETO-radioallergosorbent test (RAST) positive.(ABSTRACT TRUNCATED AT 250 WORDS)
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keywords = histamine
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16/33. Cholinergic urticaria: acetylcholine-receptor-dependent immediate-type hypersensitivity reaction to copper.

    A patient with cholinergic urticaria syndrome was found to have an unusually large number of muscarinic cholinergic receptors in the urticarial sites. The amplification of these receptors may account for her heightened sensitivity to acetylcholine discharge following exercise, heat, and emotion. The acetylcholine presumably acts directly on the mast-cell membrane to initiate histamine release and thereby punctate urticaria. In addition, an otherwise occult sensitivity to copper was detected with a 48 h contact patch test to the metal followed by an exercise challenge. Under these conditions, the patch test site developed hives after the autonomic stress stimulus of exercise but showed nothing on conventional patch testing before exercise. Such "cholinergic patch testing" is recommended for the demonstration of other examples of antigen enhancement of acetylcholine-mediated reactions.
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keywords = histamine
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17/33. Occupational allergy in horticulture: demonstration of immediate-type allergic reactivity to freesia and paprika plants.

    patients A and M developed allergic symptoms when working in a greenhouse with paprika plants and freesia plants, respectively. The possible involvement of an IgE-mediated mechanism was investigated with the skin prick test, radioallergosorbent test (RAST) and the histamine release test (HRT). Paprika flower, leaf and stem extract released 58, 47 and 43% of the total amount of histamine from washed leukocytes of patient A. In serum A IgE antibodies against paprika leaves and flowers could be demonstrated by RAST (11% binding of 125I-anti-IgE added). Freesia flower and stem extract released 46 and 43% histamine, respectively, from washed leukocytes of patient M. In the RAST, specific IgE antibodies against freesia flowers and stems were found in serum M (37% binding of 125I-anti-IgE added).
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18/33. Immediate hypersensitivity to seminal fluid and atopic dermatitis.

    A woman with atopic dermatitis experienced anaphylactic episodes following intercourse with her husband, with subsequent exacerbations of her atopic dermatitis. Skin testing and an in vitro leukocyte histamine release assay established the diagnosis of immediate hypersensitivity to her husband's seminal fluid; delayed hypersensitivity to seminal fluid could not be demonstrated. Antigen was found in the seminal fluid of nonrelated men. Radioallergosorbent testing detected the presence of circulating IgE antibodies specific for seminal plasma protein. immunotherapy with seminal plasma may have limited the severity of a subsequent reaction. serum from the husband and nonrelated men also contained antigen that provoked histamine release from the patient's leukocytes in vitro. The antigen in serum was associated with the globulin fraction and had a temporal relationship to ejaculation, appearing within 12 hours of ejaculation and disappearing within four days.
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keywords = histamine
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19/33. Immediate adverse reaction to aminophylline.

    We present a patient who experienced an immediate adverse reaction following intravenous administration of aminophylline. Skin prick, intradermal, and patch tests, RAST and indirect ELISA assays with aminophylline, theophylline and ethylenediamine were negative. A positive histamine release test was found only with ethylenediamine. Single-blind placebo-controlled challenges were positive with aminophylline and negative with theophylline. Our results suggest the reaction was a type I hypersensitivity reaction to ethylenediamine, but a nonimmune mechanism could not be excluded.
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keywords = histamine
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20/33. Occupational sensitization to Plasmopara viticola.

    Molds of the class of oomycetes are of allergologic importance in special cases. However, probes are not commercially available for diagnostic purposes. Our case report is based on the medical history of a greenhouse worker who had atopic syndrome. He handled pure cultures of defined fungi and plants. A sensitization to pseudo mildew growing on grapevine (Plasmopara viticola) was found. Skin prick test and histamine release test results were positive when extract of P. viticola was used. Detection of IgE reactivities against pseudo mildew via binding tests, Western blot analysis, and isoelectric focusing immunoblot confirmed the diagnosis. To our knowledge these results demonstrate for the second time a sensitization to oomycetes.
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