1/163. The treatment of bovine collagen allergy with cyclosporin.BACKGROUND: Bovine collagen is currently the most common substance used in soft-tissue augmentation. Although patients should undergo routine skin testing for allergy to bovine collagen prior to treatment, hypersensitivity reactions may rarely still occur. Previously, there have been no reliable methods of treatment for these reactions, and physicians could only reassure patients that the reaction would slowly disappear. OBJECTIVE. The use of oral cyclosporin in a patient with hypersensitivity to bovine collagen was evaluated. methods: A patient with an allergic reaction to implanted bovine collagen was started on cyclosporin 175 mg p.o. bid (5 mg/kg/day) after no improvement was seen after treatment with oral and topical steroids. The cyclosporin was started on Day 23 of the allergic reaction. RESULTS: Improvement in the itching and redness was noted by Day 28 of the allergic reaction, and complete clinical resolution of the allergic reaction was noted on Day 41. On Day 47, the cyclosporin was stopped without recurrence of symptoms. The patient did not experience side effects from cyclosporin, and her blood pressure and renal function remained normal. CONCLUSION: This case report shows that oral cyclosporin A may be a safe and effective treatment for bovine collagen hypersensitivity.- - - - - - - - - - ranking = 1keywords = red (Clic here for more details about this article) |
2/163. latex allergy in an orthognathic patient and implications for clinical management.A 19-year-old girl with mild asthma had had 16 months of orthodontic treatment as part of the joint orthodontic/orthognathic approach to her 9.5 mm overjet. At the time of banding her second molars she developed latex protein allergy as a reaction to the operator's non-sterile powdered latex gloves. She also gave a history of allergy to other substances as well as of eczema. The patient was confirmed as allergic to latex protein by radioallergosorbent test (RAST) for IgE, requiring precautions be taken during further orthodontic procedures as well as during the subsequent orthognathic surgery for the underlying Class II skeletal pattern.- - - - - - - - - - ranking = 1keywords = red (Clic here for more details about this article) |
3/163. Prehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia.INTRODUCTION: epinephrine overdoses in children have been associated with supraventricular tachycardia. myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients. CASE REPORT: We report a case of ventricular dysrhythmias and myocardial ischemia in a 5-year-old boy who received 10 times the recommended dose of subcutaneous epinephrine. Prehospital providers administered the epinephrine, believing it was part of a "high-dose" epinephrine protocol. DISCUSSION: There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.- - - - - - - - - - ranking = 1keywords = red (Clic here for more details about this article) |
4/163. Demonstration of reactivity to airborne and food allergens in cutaneous vasculitis by variations in fibrinopeptide a and other blood coagulation, fibrinolysis and complement parameters.In a 32-year-old woman and a 40-year-old man with cutaneous vasculitis, etiological allergic responses to foods and airborne allergens were found. During provocation tests, observations were made on blood levels of fibrinopeptide a(FPA) and coagulation factors, fibrinogen degradation products (FDP) and serum complement components. skin biopsies were taken for microscopic and immunofluorescence analysis. In case 1, anaphylactoid allergy to milk and reaginic and anaphylactoid hypersensitivity to grass pollens were found. Dermal provocations with grass pollens gave arthralgia, hematomas, serum C3 fluctuation, factor vii reduction and fibrinolysis. During peroral milk challenge, transient increases in FPA and FDP levels were observed before symptoms appeared. In case 2, anaphylactoid hypersensitivity responses to bacteria, animal danders, foods and pollens were found. Two inhalations with sheep-wool extract resulted in a typical skin eruption. The first also gave an early reduction of C3 and then FPA liberation. Nasal birch-pollen test gave an increase of FPA in the latent period and then typical nodules. At least no low molecular weight FDP were detected during provocations. In patients with vasculitis reactions to exogenous allergens, FPA and FDP estimations after provocations may discriminate harmful from innocuous allergens and reveal individual response patterns in coagulation and fibrinolysis systems.- - - - - - - - - - ranking = 3keywords = red (Clic here for more details about this article) |
5/163. Occupational asthma caused by champignon flies.BACKGROUND: Occupational bronchial asthma in mushroom (champignon) workers is unusual, although reports on it appeared in 1938 and 1951; we have not found any others since those dates. Here we report the case of a 52-year-old man who works as a champignon cultivator. He suffered rhinoconjunctivitis and asthma attacks whenever he entered the champignon culture caves. We studied flies as a possible antigen source. We collected these insects from the growing sites in order to identify them, and then prepare an extract; the samples turned out to be of two families of insects of the order diptera, 98% from the Phoridae family (Brachycera suborder) and 2% from the Sciaridae (Nematocera suborder). methods: skin prick tests, conjunctival provocation tests, serum specific IgE, specific IgE-binding fractions in immunoblotting, and monitoring of PEFR (at work and off work) were performed. RESULTS: IgE-mediated hypersensitivity to these flies was demonstrated by skin prick test, conjunctival provocation test, serum specific IgE, and IgE-binding fractions in immunoblotting. Monitoring of PEFR both at work and off work showed a clear relationship between symptoms, or fall in PEFR, and the workplace. CONCLUSIONS: We report the case of a patient suffering from asthma and rhinoconjunctivitis caused by hypersensitivity to fly proteins.- - - - - - - - - - ranking = 3keywords = red (Clic here for more details about this article) |
6/163. Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes: report of a case and literature review.Tetrasodium and/or tetrapotassium pyrophosphate (Ppi) is the anticalculus component of most tartar control dentifrices on the market today. While pyrophosphates alone are not responsible for hypersensitivity reactions, several modifications which may lead to adverse oral manifestations may occur when pyrophosphates are added to a dentifrice. First, tetrasodium pyrophosphate in a dentifrice forms a slightly alkaline solution upon oral use which could irritate oral membranes. Second, increased concentrations of flavoring agents, known to be sensitizers, are needed to mask the strong bitter taste of pyrophosphates. Third, increased concentrations of detergents, capable of producing hypersensitivity reactions, are necessary to allow the pyrophosphates to become soluble in the dentifrice. Fourth, a pre-existing condition of reduced salivary flow may augment hypersensitivity to tartar control toothpastes. While pyrophosphates have been approved as additives in dentifrices, these compounds along with the increased concentrations of flavorings and detergents and their higher intraoral alkalinity are strongly implicated as the causative factor in certain hypersensitivity reactions.- - - - - - - - - - ranking = 1keywords = red (Clic here for more details about this article) |
7/163. thalidomide-induced toxic epidermal necrolysis.Toxic epidermal necrolysis (TEN) is a severe dermatologic disorder associated with mortality of up to 30%. Withdrawal of the causative agent is crucial in its management. Although thalidomide-induced dermatologic disorders rarely were reported before thalidomide was administered to patients positive for the human immunodeficiency virus, hypersensitivity reactions including rash are the agent's major dose-limiting toxicities in this population. As it is prescribed for other immunosuppressed patients, such as those with malignancies, the frequency of dermatologic reactions (including TEN) may increase. A 62-year-old woman developed TEN after approximately 5 weeks of thalidomide therapy for the treatment of a glioblastoma.- - - - - - - - - - ranking = 1keywords = red (Clic here for more details about this article) |
8/163. Immunological and in-vivo neurological studies on a benzoic acid-specific T cell-derived antigen-binding molecule from the serum of a toluene-sensitive patient.T-cell-derived antigen-binding molecules (TABMs) specific for benzoic acid were isolated from the serum of a toluene-sensitive patient. The resulting purified TABMs (BA-TABMs) did not contain immunoglobulin g and were associated with the cytokine transforming growth factor-beta (TGF-beta). BA-TABMs bound to benzoic acid conjugated to human serum albumin (BA-HSA), as well as to other chemicals conjugated to human serum albumin-including dinitrophenol and oxazolone. The binding of BA-TABMs to the conjugated chemicals increased the level of detectable TGF-beta, and a similar effect was observed with the unconjugated chemicals, benzoic acid and 2,4-dinitrophenol glycine. The increase in TGF-beta was critically dependent on the ratio between BA-TABMs and the conjugated or unconjugated chemicals; the increase was optimum at intermediate concentrations and absent at low and high concentrations. The authors used an established animal model in vivo and demonstrated that TGF-beta enhanced the inflammatory response induced by the release of neuropeptides from sensory nerves; this enhancement occurred in a dose-dependent manner. The BA-TABMs also enhanced this neurogenic inflammatory response in a dose-dependent manner, and this effect was blocked by anti-TGF-beta antibody. When the authors added either BA-HSA or benzoic acid, the effect of BA-TABMs on neurogenic inflammation was further enhanced at intermediate concentrations of antigen and was unaltered or reduced at higher concentrations. TABMs specific to particular chemicals, as a result of their association with cytokines (e.g., TGF-beta), may be implicated in symptom production in chemically sensitive patients.- - - - - - - - - - ranking = 3keywords = red (Clic here for more details about this article) |
9/163. hypersensitivity reactions following laminaria placement.laminaria tents are commonly placed intracervically prior to elective termination of pregnancy. Three women, each of whom had undergone at least one previous abortion in which a laminaria was utilized, developed hypersensitivity reactions following laminaria placement. The reactions included urticaria, angioedema and respiratory distress. All responded to removal of the laminaria and administration of either diphenhydramine, prednisone, inhaled bronchodilators or subcutaneous epinephrine. One of the women subsequently underwent skin testing and was positive to laminaria. patients undergoing laminaria placement may manifest a Type I reaction, IgE-mediated sensitivity. Providers should counsel patients with histories of multiple previous laminaria insertions about this possibility, have alternative methods of cervical dilation available, and be able to promptly recognize and treat reactions when they occur.- - - - - - - - - - ranking = 1keywords = red (Clic here for more details about this article) |
10/163. Immunologic evaluation of dental patient with history of hypersensitivity reaction to sodium hypochlorite.A 12-year-old girl, with a previous history of bronchial reaction and contact dermatitis to sodium hypochlorite, was referred for root canal treatment. Complete immunologic evaluation revealed a mild hypersensitivity condition, as it was assessed by the RAST investigation to different allergens and the DTH reactivity expressed though migration inhibition test. The absence of a serious immunologic disregulation in the patient's immunologic profile justified the term 'non-allergic hypersensitivity' to sodium hypochlorite to describe the condition.- - - - - - - - - - ranking = 1keywords = red (Clic here for more details about this article) |
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