Cases reported "Urticaria"

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11/97. Drug-induced solar urticaria due to tetracycline.

    Solar urticaria is an uncommon disorder characterized by pruritus, erythema and whealing commencing within minutes of exposure to ultraviolet (UV) and visible light, and generally resolves in a few hours. We describe a 28-year-old woman who developed pruritus and erythema 5 min after sun exposure while on tetracycline for treatment of perioral dermatitis. Phototesting elicited urticarial reactions in the UVA, UVB and visible spectra. Repeat phototesting after cessation of tetracycline was negative. This report documents the first case of solar urticaria induced by tetracycline.
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12/97. Occupational IgE-mediated allergy to tribolium confusum (confused flour beetle).

    BACKGROUND: We report on IgE-mediated allergy in a worker caused by tribolium confusum (confused flour beetle). These beetles lived in the "old" flour to which he was exposed in his work. CASE REPORT: A 35-year-old, nonatopic mechanic in a rye crispbread factory developed rhinitis, conjunctivitis, and asthmatic symptoms, as well as urticaria on his wrists, lower arms, hands, neck, and face, during the maintenance and repair of machines contaminated by flour. This flour had been in and on the machines for a long time, and it contained small beetles. The patient did not suffer any symptoms when handling fresh, clean flour. RESULTS: Skin prick tests with standard environmental allergens, storage mites, enzymes, flours, and molds were negative. A prick test with flour from the machines gave a 10-mm reaction. An open application of the same flour caused urticarial whealing on the exposed skin. Prick tests with fresh flour from the factory were negative. A prick test with minced T. confusum from the flour in the machines gave a 7-mm reaction. histamine hydrochloride 10 mg/ml gave a 7-mm reaction. Specific serum IgE antibodies to T. confusum were elevated at 17.2 kU/l. Prick tests with the flour from the machines were negative in five control patients. CONCLUSIONS: The patient had occupational contact urticaria, rhinitis, conjunctivitis, and asthmatic symptoms from exposure to flour. His symptoms were caused by immediate allergy to the beetle T. confusum. Immediate allergy to this beetle has rarely been reported in connection with respiratory symptoms, but it may be more common. Contact urticaria from this source has not been reported before.
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13/97. Occupational generalised urticaria and allergic airborne asthma due to anisakis simplex.

    anisakis simplex (AS), a fish and cephalopodes parasite, may cause allergic reactions in humans on eating and/or handling contaminated fish. We present a case of occupational hypersensitivity to AS in a woman employed in a frozen-fish factory. She showed both generalised urticarial rash and asthmatic symptoms after work place exposure. All these symptoms immediately disappeared after work place exposure was ceased. The presence of a positive skin prick test and high specific IgE values confirmed a hypersensitivity to anisakis. This is the first case reported of both occupational generalised urticaria and allergic airborne asthma due to AS in the same patient. We suggest that AS could be an important cause of occupational asthma and/or urticaria in the fish industry.
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14/97. Localized heat urticaria: a clinical study using laser Doppler flowmetry.

    We studied the pathophysiology of localized heat urticaria using laser Doppler flowmetry (LDF) in two patients with this rare disease. In heat challenge tests, performed with different challenge times and temperatures, a heat stimulator with a thermoregulated metal disc was utilized. Immediately after removal of the heat source, cutaneous blood flow (CBF) changes in the tested sites were monitored with LDF. In both patients the increase in (CBF) took place at some intervals after a heat challenge, synchronous with the start of the urticarial response. This interval, or the latency time (LT), showed distinct inverse proportion to the intensity of heat stimuli and was prolonged by effective treatments, such as application of antihistamines and repeated heat exposure by LDF. Therefore, the time of latency might be regarded as a good indicator of the severity of illness and therapeutic effectiveness, and thus might reflect the relationship between the degree of heat stimuli and the releasing process of chemical mediator(s) in patients with localized heat urticaria (LHU).
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15/97. Severe food allergies by skin contact.

    BACKGROUND: Ingestion is the principal route for food allergens, yet some highly sensitive patients may develop severe symptoms upon skin contact. CASE REPORT: We describe five cases of severe food allergic reactions through skin contact, including inhalation in one. methods: The cases were referred to a university allergy clinic, and evaluation comprised detailed medical history, physical examination, skin testing, serum total and specific IgE, and selected challenges. RESULTS: These cases were found to have a strong family history of allergy, early age of onset, very high total serum IgE level, and strong reactivity to foods by skin prick testing or RAST. Interestingly, reactions occurred while all five children were being breast-fed (exclusively in four and mixed in one). CONCLUSIONS: Severe food allergic reactions can occur from exposure to minute quantities of allergen by skin contact or inhalation. food allergy by a noningestant route should be considered in patients with the above characteristics.
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16/97. Opiate-sensitivity: clinical characteristics and the role of skin prick testing.

    BACKGROUND: The value of skin prick testing in opiate-sensitive individuals is uncertain as opiates cause non-specific weals by direct degranulation of mast cells. OBJECTIVE: To define whether skin prick test (SPT) responses to opiates in opiate-sensitive individuals are different to those seen in the normal population and to describe the clinical characteristics of this group of subjects. methods: The SPT responses of eight opiate-sensitive subjects to morphine 10 mg/mL, pethidine (meperidine) 50 mg/mL and papaveretum 15.4 mg/mL at four different concentrations (undiluted, 1/10, 1/50 and 1/100) were compared with the responses of 100 (32 atopic) non-opiate-sensitive control subjects. Four of the opiate-sensitive subjects had a clinical history of asthma, rhinitis or urticaria on occupational exposure to morphine. One subject developed urticaria with codeine, one developed urticaria and asthma with morphine and diamorphine and two subjects reacted to intravenous papaveretum with anaphylaxis or urticaria. Five out of the eight cases had opiate sensitivity confirmed by single-blind placebo-controlled oral challenge. RESULTS: Skin prick tests to all three opiates were not significantly different when the eight opiate-sensitive subjects were compared with either the entire normal control group or the subgroup of 47 definite opiate-tolerant controls that had previously received opiates for clinical indications. Furthermore, there were no significant differences in size of opiate SPT responses between atopic and non-atopic control subjects. In the control subjects, there was a positive correlation in SPT weal size between the three opiates. CONCLUSION: Skin prick testing is not useful in the diagnosis of opiate sensitivity and placebo-controlled challenge should be considered.
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keywords = occupational exposure, exposure
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17/97. Occupational contact urticaria caused by airborne methylhexahydrophthalic anhydride.

    Acid anhydrides are low-molecular weight chemicals known to cause respiratory irritancy and allergy. Skin allergy has on rare occasions been reported. A total of 3 subjects with occupational exposure to methylhexahydrophthalic anhydride (MHHPA) and hexahydrophthalic anhydride (HHPA) from an epoxy resin system were studied to evaluate the nature of their reported skin and nose complaints (work-related anamnesis, specific IgE, contact urticaria examinations, and ambient monitoring). Using a Pharmacia CAP system with a HHPA human serum albumin conjugate, specific IgE antibody was detected in serum from 1 (33.3%) out of the 3 workers. One unsensitized worker displayed nasal pain and rhinorrhea only when loading liquid epoxy resins into the pouring-machine (2.2 mg MHHPA/m3 and 1.2 mg HHPA/m3), probably being an irritant reaction. Two workers had work-related symptoms at relatively low levels of exposure (geometric mean 32-103 microg MHHPA/m3 and 18-59 microg HHPA/m3); one complained of only rhinitis, and the other was sensitized against HHPA and displayed both rhinitis and contact urticaria (the face and neck). The worker's skin symptoms were evidently due to airborne contact, since she had not had any skin contact with liquid epoxy resin or mixtures of MHHPA and HHPA. These urticaria symptoms were confirmed by a 20-min closed patch test for MHHPA, but not by that for HHPA. The causative agent was considered to be MHHPA, although the specific IgE determination to MHHPA was not performed.
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18/97. Allergic contact urticaria and rhinitis to roe deer (Capreolus capreolus) in a hunter.

    Roe deer (Capreolus capreolus) is one of the most common game mammals in europe, where hundreds of thousands people are exposed to this animal. Despite this fact, we are aware of only two cases of allergy to roe deer published until recently, one case of allergic rhinoconjunctivitis and asthma and the second of contact urticaria. We describe another case with co-existing allergic contact urticaria and rhinitis in a 55-year old male professional hunter. The symptoms were provoked only by exposure to roe deer, and there were no other past or present allergic diseases. Specific IgE was found to following animal allergens: cow dander (CAP class 5), goat epithelium and horse dander (each CAP class 4), dog epithelium, dog dander and swine epithelium (each CAP class 2). Skin prick tests have shown positive reaction only to cow epithelium ( ). Because of lack of deer dander allergen for specific IgE and skin tests, we have confirmed the causal relationship between exposure to roe deer and allergy using the rub test with roe deer's fur. There was a clearly positive urticarial reaction on the patient's skin accompanied by nasal itch, sneezing and rhinorrhea. No reaction was seen in a control person. We surmise that the positive tests with cow epithelium seen in this patient may result from a cross-reactivity to deer allergens. We conclude that although occupational allergies to roe deer seem to be rare, such possibility should be always considered among people having contact with these animals.
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19/97. An unusual acute urticarial response following microdermabrasion.

    BACKGROUND: Microdermabrasion is widely performed in a number of clinical settings, including medical offices, salons, and spas. This procedure is generally regarded as safe and easy to perform. OBJECTIVE: To determine if latex exposure caused an acute urticarial response following microdermabrasion in a latex-allergic patient. methods: The patient was prick tested to saline and histamine controls, latex, and sterile medical grade 100 m aluminum oxide crystals that had been passed through the microdermabrader. RESULTS: The strongly positive latex prick test confirmed latex allergy in our patient. Negative prick testing to aluminum oxide crystals that had passed through the microdermabrader make it unlikely that the patient was exposed to latex via this system. CONCLUSION: physicians need to carefully evaluate patients who are considering microdermabrasion and appreciate that unexpected serious complications can occur.
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20/97. Successful treatment of solar urticaria by extracorporeal photochemotherapy (photopheresis)--a case report.

    Solar urticaria is characterized by erythema and whealing immediately after exposure to ultraviolet radiation and/or visible light. We report about a patient with severe solar urticaria, who was highly sensitive to both UVA radiation and visible light with a Minimal urticaria Dose (MUD) of 7 J/cm2 UVA. Management of this patient was extremely difficult because standard treatment with oral antihistamines, hardening with UVA, UVB, visible light or oral PUVA and even oral cyclosporin A were completely ineffective. We therefore decided to perform extracorporeal photochemotherapy (photopheresis, ECP). After nine treatment cycles with photopheresis the MUD increased from 7 J/cm2 UVA before treatment to 22 J/cm2 UVA. This hardening effect was associated with a significant decrease of the frequency and severity of whealing and the accompanying symptoms (pain, fatigue, pruritus). CONCLUSION: photopheresis might be of some benefit in selected patients with otherwise intractable solar urticaria.
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