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11/22. IgE-mediated inhalant allergy against human corticotropin-releasing hormone.

    A 25-year-old female developed IgE-mediated sensitization against human recombinant corticotropin-releasing hormone (CRH) with symptoms of allergic rhinoconjunctivitis and bronchial asthma. The occupational allergy was proved by positive skin prick test, bronchial provocation, dose-dependent histamine release, RAST measurements with CRH allergen (RAST class 3) and RAST inhibition. Using the immunoblot technique, a single allergen band with a molecular weight of less than 14.4 kD in the range between the isoelectric point 5.2 and 5.7 was detected for the CRH extract. Since no endocrinological and behavioral disorders were found, increased CRH-specific IgE was not able to influence the regulatory control of this neuropeptide. After 18 months of avoiding the occupational CRH exposure allergen-specific histamine release and RAST were negative.
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keywords = exposure
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12/22. Inhalant allergy following occupational exposure to blowflies.

    An allergic reaction, provoked by exposure to the blowfly Lucilia cuprina and shown to be IgE-mediated, occurred in a subject employed in an entomological research laboratory. The subject's serum, and sera from three other asthmatic patients with IgE antibodies to blowfly extracts, also reacted with extracts from the screw-worm fly (Chrysomya bezziana). Results suggested that antigens from the two species share immunological cross-reactivity. Cross-reactions also exist between the different developmental stages of both species. Allergic reactions to inhaled insect allergens may not be uncommon in the Australian community.
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ranking = 1221.6859340927
keywords = occupational exposure, exposure
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13/22. Nasal allergy to avian antigens.

    This study describes the case of a patient who developed symptoms of rhinoconjunctivitis on exposure to budgerigars and parrots. An IgE-mediated allergy to budgerigar, parrot and pigeon antigens was demonstrated using both in-vivo challenge tests (skin and nasal provocation tests) and in-vitro investigations (radio-allergo-sorbent test, histamine release test). The study shows that the development of nasal disease can be associated with allergy to avian antigens.
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14/22. Occupational allergic rhinitis reaction to psyllium.

    We report studies that document a specific rhinitic reaction that developed as a result of occupational exposure to a psyllium-based powdered laxative. This nurse had a nonatopic family history, personal evidence of atopy (skin test reactions to pollen, cat dander, and house dust), and a significant elevation of antipsyllium IgE. Measurements of nasal and lower airway resistance documented only nasal obstruction to brief inhalational challenge to the laxative. Symptomatic relief was achieved with prior treatment with cromolyn. We suggest that nasal airway challenge can document and assess treatment for occupational rhinitis.
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ranking = 305.17148352317
keywords = occupational exposure, exposure
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15/22. The specificity of the lymphocyte transformation test in a patient with hypersensitivity reactions to pyrazolone compounds. A 10-week follow-up study before and after rechallenge.

    To evaluate the specificity of the lymphocyte transformation test (LTT) in the diagnosis of drug allergy we studied over 71 days an atopic woman with a past history of frequent adverse reactions to pyrazolone drugs. Rechallenge with the incriminated substances aminophenazone (aminopyrine) and propyphenazone was carried out on Days 11 and 31 respectively. An immediate type of hypersensitivity reaction was seen after 100 mg aminophenazone, while 100 mg of propyphanozone led to a serum sickness-like syndrome. We found two specifically sensitized lymphocyte populations using either the pure substance or sera containing metabolite in cell cultures. Stimulatory responses with indices ranging between 3 and 6 were seen 3-4 days after exposure, and the tests remained positive in both instances for 3-4 weeks. Specific sensitization was proven by positive skin tests and by a small but distinct lymphocyte proliferative response before challenge. Several lymphocyte function tests were performed over a period of 53 days and revealed a large fall in pokeweed mitogen-induced immunoglobulin synthesis and an increase in suppressor cell activity after rechallenge with aminophenazone. We conclude that the proliferative response observed in the presence of the offending drug is due to the activation of T memory cells and therefore highly suggestive of a true allergic reaction.
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16/22. The role and allergenic importance of storage mites in house dust and other environments.

    skin tests were performed on 210 patients with house dust allergy and bronchial asthma or perennial rhinitis using extracts of dermatophagoides pteronyssinus and of four storage mites most commonly found in house dust in the United Kingdom--Acarus siro, Tyrophagus putrescentiae, Lepidoglyphus (formerly Glycyphagus) destructor and Glycyphagus domesticus. The results of the skin tests were related to certain occupations and living conditions of the patients which could have exposed them to storage mites and some patients were included because their environment seemed especially likely to expose them to these species in order to assess the importance of these conditions. D. pteronyssinus was the most potent of the mite allergens and provoked the largest number of positive tests but a proportion of the storage mite species gave skin reactions which were larger or as large as those of D. pteronyssinus. No significant statistical correlation was found between reactions to D. pteronyssinus and any storage mite but highly significant correlations were found between some storage species. The frequency and strength of reactions to these species were unexpectedly high in view of their irregular occurrence and relative scarcity in house dust. It is suggested that sensitisation to these species occurs through exposure either to localised sources of infestation overlook during the random collection of floor or bedding dust or to infested materials encountered at work or other activities or to infested food or bedding of certain domestic pets. It is concluded that allergy to storage mites is more important and widespread that hitherto realised and is a considerable occupational hazard in farming communities and to those in occupations handling infested materials. Storage mites may also be important allergens for those living in very damp houses where the growth of moulds may encourage the development of Glycyphagus domesticus or other mites.
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17/22. Allergy to coriander. A case report.

    After 3 years of occupational exposure to powdered coriander - a spice - a woman developed respiratory symptoms of immediate hypersensitivity. skin tests, nasal and bronchial challenge tests and the RAST were positive to coriander. Column chromatography, enzymatic digestion of the fractions and skin testing suggested that the allergen is a protein.
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ranking = 305.17148352317
keywords = occupational exposure, exposure
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18/22. proteins: chymopapain and insulin.

    We studied clinical and immunologic aspects of the reactions to two newly introduced drugs, chymopapain and human recombinant deoxyribonucleic acid insulin (HI), in patients demonstrating allergies to one of these two drugs. We then used this information to improve our ability to diagnose and prevent chymopapain allergy and to further our understanding of systemic insulin allergy and its management. Of the patients who were sensitive to chymopapain, one had severe anaphylaxis to intradisc injection while the other had rhinitis, asthma, and urticaria with occupational exposure. The latter demonstrated cutaneous reactivity to papain; the former refused skin testing. Both demonstrated immunoglobulin (Ig) E and IgG to chymopapain as measured by enzyme-linked immunosorbent assay. We have prospectively skin tested 61 patients with chymopapain. Sixty-one patients have had negative skin tests and have tolerated the intradisc injection of chymopapain without incident. We are continuing our prospective skin test study in order to identify a population at risk for allergy to chymopapain. Two patients with systemic allergic reactions to animal insulin have at least as much cutaneous reactivity and IgE and IgG antibodies to HI as to porcine insulin. A large local reaction occurred during an attempt to desensitize one of them to HI; the patient was subsequently desensitized without difficulty to porcine insulin, to which she was less skin reactive. We conclude that HI will not eliminate insulin allergy in patients with systemic allergy to animal insulin and that such patients will continue to require the usual therapeutic measures for insulin allergy.
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ranking = 305.17148352317
keywords = occupational exposure, exposure
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19/22. Occupational asthma caused by cedar urea formaldehyde particle board.

    Two carpenters developed asthma and rhinitis related to occupational exposure to a cedar urea formaldehyde (CUF) particle board. One patient developed nasal and chest symptoms and an equivocal early asthmatic response after CUF sawdust exposure, but not after spruce or western red cedar sawdust exposure; possible late asthmatic response may have been inhibited by beclomethasone treatment. The other patient developed marked nasal and chest symptoms and a dual asthmatic response after CUF exposure, but not after spruce or cedar exposure. Both patients developed increased bronchial responsiveness to inhaled histamine, which persisted for at least six days in the first patient, and which was associated with increased asthmatic symptoms of days' to weeks' duration in both. A previously unexposed asthmatic patient, with more markedly hyperreactive bronchi, developed no symptoms, no change on spirometric testing, and no change in histamine response after CUF exposure. Specific IgE antibodies directed against formaldehyde-human serum albumin conjugate could not be demonstrated using the radioallergosorbent test. This investigation documents the occurrence of occupational asthma caused by urea formaldehyde used as a bonding agent in particle boards. Absence of a response in a previously unexposed, more severe asthmatic patient suggests specific sensitization to some component of the urea formaldehyde resin complex had developed.
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ranking = 310.17148352317
keywords = occupational exposure, exposure
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20/22. Nasal peak-flow-rate recording is useful in detecting allergic nasal reactions--a case report.

    Serial nasal peak-expiratory-flow-rate recordings have been used to detect changes in nasal patency. A hospital nurse with allergy to latex showed a marked decrease in nasal flow when exposed to latex gloves in a challenge test and in her work environment. We propose using the method as a diagnostic tool for allergic rhinitis in occupational and other exposure situations in which nasal blockage is a prominent symptom.
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keywords = exposure
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