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1/156. Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract.

    A case of allergic bronchopulmonary aspergillosis is presented. The only symptoms in this 24-year-old woman patient were those of recurrent nasal obstruction, including mucosal ulcerations, edema, and thick secretions within the nose. ( info)

2/156. Specific IgE to cross-reactive carbohydrate determinants strongly affect the in vitro diagnosis of allergic diseases.

    BACKGROUND: Cross-reacting carbohydrate determinants (CCDs) are antigenic structures shared by allergenic components from taxonomically distant sources. The case history of a patient with a great discrepancy between skin test and specific IgE results led us to investigate the role of these determinants in his specific case and in an allergic population. OBJECTIVE: We sought to determine the role of CCDs in causing false-positive and clinically irrelevant results in in vitro tests. methods: The involvement of CCDs was studied by specific IgE inhibition by using glycoproteins with a known carbohydrate structure. Direct and inhibition assays were performed by commercially available systems, in-house ELISA, and the immunoblotting technique. The binding to the periodate-oxidated carbohydrate structure of glycoproteins and allergenic extracts was also evaluated. A comparative study between skin test and specific IgE responses to the antigens studied was carried out in 428 consecutive allergic subjects. RESULTS: All the tests performed suggested that cross-reacting carbohydrate epitopes were the cause of false-positive specific IgE results in one of the commercial systems and the high reactivity in all the solid-phase in vitro tests. None of the cross-reacting carbohydrate allergens yielded a positive skin test response. Periodate treatment caused variable degrees of reduction of IgE binding to the different antigens studied, indicating that CCDs played a different role in each of them. About 41% of patients allergic to pollen had specific IgE for a glycoprotein, without a positive skin test response to the same molecule. CONCLUSIONS: CCDs must be taken into account when evaluating the clinical relevance of positive results in in vitro specific IgE assays, at least in the diagnosis of patients with pollen allergy. Commercial systems should be carefully assessed for the ability to detect specific IgE for carbohydrate determinants to avoid false-positive or clinically irrelevant results. ( info)

3/156. hypersensitivity pneumonitis among workers cultivating tricholoma conglobatum (shimeji).

    We report five cases of hypersensitivity pneumonitis among workers cultivating tricholoma conglobatum (shimeji). After having worked for 5 to 20 years, they began to notice symptoms of cough, sputum, and dyspnea. They were diagnosed as having a hypersensitivity pneumonitis based on clinical features, bronchoalveolar lavage and transbronchial lung biopsy. By the double immunodiffusion test, precipitating lines between shimeji spore antigen and sera were observed in all of the patients. By enzyme-linked immunosorbent assay, the antibody activities against shimeji and three species of fungi (cladosporium sphaerospermum, penicillium frequentans, and scopulariopsis species) were significantly higher in the sera of the patients than in those of normal subjects who were cultivating shimeji. Although it is not clear what causes this disease, these findings may be helpful in determining the specific antigen. ( info)

4/156. Respiratory allergy to mushroom spores: not well recognized, but relevant.

    BACKGROUND: Although basidiospores are a major component of the air spora in many parts of the world, their clinical significance as triggers of respiratory allergy has rarely been demonstrated. Therefore, the class of basidiomycetes as an aeroallergen is not well known. OBJECTIVE: To demonstrate a cause and effect relationship between respiratory allergy and basidiospores, we illustrate this case report of a 38-year-old housewife. methods: skin prick test, immunoblot, and active anterior rhinomanometry were used as diagnostic tools to verify specific reactivity of a pleurotus pulmonalis spore extract. Two atopic subjects served as controls. RESULTS: The skin prick test positive study subject reacted with subjective and objective signs including a significant drop of the FEV1 by nasal challenge at a concentration of 0.1 mg/mL of the pleurotus spore extract while both controls were negative even at a higher test concentration. IgE-immunoblot revealed several distinct bands in the serum of the pleurotus-sensitized subject. CONCLUSION: spores of pleurotus pulmonalis, a common mushroom of the fungal class of basidiomycetes, can cause specific, IgE-mediated acute rhinoconjuncivitis and asthma in sensitized individuals. ( info)

5/156. Allergic fungal sinusitis caused by Bipolaris (Drechslera) hawaiiensis.

    Depending on the aggressiveness of the pathogen and a patient's immunocompetence, fungal polypoid pansinusitis or allergic fungal sinusitis (AFS) may be a life-threatening disease. Apart from the clinical findings, its diagnosis is based on the demonstration of mucinous material with abundant eosinophils in the paranasal sinuses (indicating an allergic process), cultivation of the causative pathogen and immunocompetence of the patient. In a 20-year-old immigrant Sudanese woman, AFS due to Bipolaris (Drechslera) hawaiiensis was diagnosed. Because of intracranial extension, the disease had led to erosion of the cranial base and orbit with amaurosis on the right side and focal epilepsy. In addition to endonasal microsurgical pansinus operations, local irrigation therapy with amphothericin B was accompanied by systemic treatment with itraconazole after in vitro cultivation of the pathogen and determination of its sensitivities. Interdisciplinary management included a combination of endonasal surgery with debridement of infected tissues and wide drainage of the sinuses without removal of skull bone or the dural lesion in addition to specific antimycotic treatment. Injury to adjacent anatomical structures must be avoided in any case to prevent systemic or possibly lethal dissemination of infection. ( info)

6/156. asthma due to kerosene exposure: three case reports.

    Three families comprising 6 adults and 3 children experienced prolonged exposure to kerosene vapour as a result of accidental domestic oil storage tank spills in 3 separate incidents. All were previously well but within 6 to 8 weeks, 3 children and one adult developed asthma which has persisted for more than 2 years. The 5 remaining adults developed upper and lower respiratory tract symptoms (but not asthma) and symptoms of conjunctival irritation. Levels of kerosene vapour were measured in all rooms in one household and were within accepted toxicological limits. kerosene vapour is not considered toxic. asthma caused by kerosene vapour is previously undescribed. ( info)

7/156. A case of allergy to globe artichoke and other clinical cases of rare food allergy.

    We describe herein four unusual clinical cases of rare allergy to foods in patients affected by allergic rhinitis and asthma. The patients were skin tested both with commercial food extracts and using prick-prick procedure with fresh foods. Total and specific IgE in serum were determined by REAST. Grapes, lupine seeds, black mulberry and artichoke resulted positive in the patients under study. This is the first time allergy to ingested artichoke has been described. ( info)

8/156. Allergy to iguana.

    BACKGROUND: Furry animals produce allergens that can cause allergic rhinitis and asthma. In contrast, scaly animals, such as lizards, are assumed not to be allergenic. OBJECTIVE: We sought to evaluate a 32-year-old man who complained of allergic rhinitis and asthma symptoms that occurred exclusively in his own home. He had dogs and cats at home but denied any increase in symptoms specifically associated with these pets. skin prick testing initially performed to 42 common aeroallergens, including cat, dog, and house dust mite, elicited negative results. He later reported that the symptoms were worse on exposure to his pet iguanas. methods: skin prick tests were subsequently performed to an extract made from scales from his pet iguana. Extracts were also prepared from several zoo reptiles. Immunoassays for IgE antibody, as well as IgE immunoblots, were performed by using these extracts and the patient's serum. RESULTS: The skin prick test result with the pet iguana scale extract was positive. The patient's serum contained IgE antibody to his own pet iguana and to a zoo iguana. CONCLUSION: Our patient's history, skin test results, and in vitro studies clearly demonstrate that he is allergic to iguana. physicians should be aware that such allergy to scaly pets may occur and should not restrict history taking to questions about furry pets. ( info)

9/156. Allergic granulomatous angiitis (churg-strauss syndrome) associated with allergic bronchopulmonary candidiasis.

    We describe a case of churg-strauss syndrome (CSS) associated with allergic bronchopulmonary candidiasis (ABPC). A 61-year-old man who had been given a diagnosis of ABPC based on serologic and radiographic findings experienced pain and purpuric rash on the left leg accompanied with motor weakness. The diagnosis of CSS was made from skin, nerve and muscle biopsies. Although immunosuppressant and prednisolone were administered and resulted in transient improvement, candidal pneumonia was suspected to have developed 60 days after the administration and the patient finally died of respiratory failure. To our knowledge, this is the first case of CSS associated with ABPC. ( info)

10/156. anaphylaxis to deer dander in a child: a case report.

    BACKGROUND: hypersensitivity to deer dander is rarely reported, with only 26 cases in the literature. Ours is the youngest reported case and the first reported case of anaphylaxis on exposure to a live deer. OBJECTIVE: Evaluation of a case of anaphylaxis in a young boy upon exposure to a deer. methods AND RESULTS: A 4-year-old boy experienced hives, swelling, and shortness of breath requiring epinephrine following a deer exposure. He had one mild reaction 5 days prior to his anaphylaxis with an indirect exposure. A deer dander extract was made from fur supplied by the patient's mother. IgE-mediated reactivity was positive for deer and cattle by both selective skin prick method and RAST results. CONCLUSION: hypersensitivity to wild animals can lead to life threatening anaphylaxis, even in children. Passive transfer of antigen may occur, but needs further investigation. ( info)
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