Allergic Reaction Ebook

How To Win Your War Against Allergies

How To Win Your War Against Allergies

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Allergy Relief

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Diagnosis Of Drug Allergy

Simple patch skin testing is naturally most useful in diagnosing contact dermatitis, but it is unreliable for other allergies. Skin prick tests are helpful in specialist hands for diagnosing IgE-dependent drug reactions, notably due to penicillin, cephalosporins, muscle relaxants, thiopental, streptokinase, cisplatin, insulin and latex. They can cause anaphylactic shock. False positive results occur. Drug allergy, once it has occurred, is not necessarily permanent, e.g. less than 50 of patients giving a history of allergy to penicillin have a reaction if it is given again.

Allergy diets and pollutants

There is some objective evidence of greater sensitivity to allergens in CFS patients. Three studies reported that 50-77 per cent of CFS subjects demonstrate positive skin tests to a variety of allergens (Conti et al. 1996 Straus et al. 1988b). However, Mawle et al. (1997) found no laboratory evidence for the increased incidence of allergies in CFS patients, despite the fact that they reported more allergy-associated symptoms than did controls. Other studies have also found little association between reports of allergies in CFS and objective evidence of these allergies (Conti et al. 1996 Steinberg et al. 1996). A randomised controlled trial of the antihistamine Terfenadine showed no treatment effect for CFS patients, either with or without allergies (Steinberg et al. 1996). Yeast allergy is one of the most universally common - a fungus parasite of the gut normally kept in check by the immune system, but it can become systemic, or cause a skin infection. It causes leaky gut mucosa,...

Pseudoallergic Reactions

These are effects that mimic allergic reactions but have no immunological basis and are largely genetically determined. They are due to release of endogenous, biologically active substances, e.g. histamine and leukotrienes, by the drug. A variety of mechanisms is probably involved, direct and indirect, including complement activation leading to formation of polypeptides that affect mast cells, as in true immunological reactions. Some drugs may produce both allergic and Pseudoallergie reactions.

Allergies to Botulinum ToxinA

There are hardly any reports about hypersensitivity or allergic responses after aesthetic BNT treatments. LeWitt describes a persistent rash at the facial injection site (LeWitt et al. 1997). Cote reports about two cases of allergic reactions filed to the US FDA between 12 1989 and 5 2003 after use of BNT-A for cosmetic indications (Cote et al. 2005).

Treating Allergies at the Cell Membrane

Allergies represent overreactions of the immune system caused by exposure to foreign substances referred to as allergens. The inhalation of allergens, such as pollen, pet dander, and dust, can cause a variety of allergic responses, including itchy eyes, a runny nose, shortness of breath, and wheezing. Allergies can also be caused by food, drugs, dyes, and other chemicals. A variety of highly effective antihistamine drugs are available for the treatment of allergy symptoms. These drugs share the property of binding tightly to histamine H1 receptors, without eliciting the same effects as histamine itself. They are referred to as histamine H1 receptor antagonists because they prevent the binding of histamine to the receptors. The structures of Allegra (made by Hoechst Marion Roussel, Inc.), Claritin (by Schering-Plough Corp.), and Zyrtec (by Pfizer) are all shown at right.

Diet Allergies

Food sensitivity can develop at any age but is particularly common in infants and young children. About 7-10 of children exhibit food allergies during their growing years.1 Colic in babies may be caused by sensitivity to a food -a common allergen is the protein in cow's milk. Adults can also develop sensitivity reactions, particularly when the immune system is knocked off-balance by stress, illness, food additives, and poor nutrition. Food allergies are often difficult to identify. Although many diagnostic tests have been tried, none is entirely satisfactory. Elimination of suspected foods from the diet is the most direct and reliable method if one of the eliminated foods was causing the reaction, improvement will occur.1,4,14 Foods must be eliminated for at least 5 days (and often for 2-4 weeks) to allow time for their adverse effects to completely disappear. If improvement occurs, the eliminated foods should be rein- Because a food once caused a sensitivity reaction doesn't mean it...

Getting Ready The Approach to the Interview

Before seeing the patient, review his or her medical record, or chart. The purpose of reviewing the chart is partly to gather information and partly to develop ideas about what to explore with the patient. Look closely at the identifying data (age, gender, address, health insurance), the problem list, the medication list, and other details, such as the documentation of allergies. The chart often provides valuable information about past diagnoses and treatments however, you should not let the chart prevent you from developing new approaches or ideas. Remember that information in the chart comes from different observers, and that standardized forms reflect different institutional norms. Moreover, the chart often fails to capture the essence of the person you are about to meet. Data may be incomplete or even disagree with what you learn from the patient understanding such discrepancies may prove helpful to the patient's care.

Red Cell Modification

Changes in composition and storage characteristics of the components as well as significant increases in costs (Table 2.2). Some of the commonly used procedures include leukocyte reduction to remove excess white blood cells that may cause alloimmunization and febrile reactions, gamma irradiation to inactivate contaminant lymphocytes responsible for transfusion-associated graft-versus-host disease, washing to remove plasma and plasma proteins that may cause allergic reactions, and cryopreservation for long-term storage of rare blood types. Any modification or manipulation that results in interruption of the closed container of a blood component (such as washing and some methods of degly-cerolization or thawing) will affect the component's expiration date. Once the closed seal is broken, refrigerated storage is limited to 24 hours.

Side Effects and Contraindica

Are similar to those of taxol itself. The drug, however, is administered in polysorbate 80 rather than cremophor, so allergy is more commonly to the drug itself and can be severe. Poor liver function greatly enhances patient sensitivity to docetaxel. Severe fluid retention can also be observed. Patients are often administered corticoids before being exposed to docetaxel to assist in their tolerance of the drug. Myelotoxicity is potentially severe, so blood cell counts should be monitored. The toxicity of docetaxel is exaggerated when liver disease is present (319).

Principal Clinical Manifestations And Treatment

These are probably the commonest type of drug allergy. Reactions may be generalised, but frequently are worst in and around the external area of administration of the drug. The eyelids, lips and face are usually most affected. They are usually accompanied by itching. Oedema of the larynx is rare but may be fatal. They respond to adrenaline (epinephrine) (i.m. if urgent), ephedrine, Hj-receptor antihistamine and adrenal steroid. Note that preventive self-management is feasible where susceptibility to anaphylaxis is known, e.g. in patients with allergy to bee- or wasp-stings. The patient is taught to administer adrenaline i.m. from a prefilled syringe (EpiPen Auto-injector, delivering adrenaline 300 micrograms per dose). 6b. Granulocytopenia (type II, but also pseudoallergic) sometimes leading to agranulocytosis, is a very serious allergy which may occur with many drugs, e.g. clozapine, carbamazepine, carbimazole, chloramphenicol, sulphonamides (including diuretic and hypoglycaemic...

Antibody Based Therapeutics

During the early days of monoclonal antibody use, their therapeutic uses were limited caused by immunogenicity in humans, because thev were murine antibodies that induced human antimouse antibodies, leading to allergic reactions and reduced efficacy (59). After the discovery of murine antibodies in 1975, the next generations of antibodies were chimeric in nature with 66 human and 34 mouse produced through genetic engineering. During the 1980s and early 1990s, complementarity-determining region (CDR) grafting and veneering techniques were established, which reduced the mouse portion of the sequence to less than 10 . Lately, genetically engineered transgenic mice that can be used for production of humanized antibodies have been developed. The technology uses the standard hybridoma techniques to produce fully humanized antibodies (59).

Objective findings and the patients perspective

Theories of CFS which incorporate biological, psychological and social aspects of the illness have evolved in the past few years. However, it is difficult to appreciate these without first exploring the findings which have emerged from each of these fields. This chapter provides an overview of the progression of CFS research in the biomedical field. We have already seen that the re-emergence and popularity of CFS centred on the acknowledgement of the organic nature of the condition. The initial enthusiasm for viral theories has to a large extent been superseded by immunological and central nervous system (CNS) or brain hypotheses of the disorder. Ideas about pollutants and allergies still abound in the popular CFS literature, while investigators are forming new hypotheses such as CFS being a disorder of sleep, breathing problems, or low blood pressure. The evidence for each of these hypotheses is briefly reviewed together with examples of patients' ideas and beliefs about the various...

Broad Spectrum Penicillins

Of their use rather than to their innate risk of causing the disease (this is probably highest for the injectable cephalosporins). Ampicillin and its analogues have a peculiar capacity to cause a macular rash resembling measles or rubella, usually unaccompanied by other signs of allergy. These rashes are very common in patients with disease of the lymphoid system, notably infectious mononucleosis and lymphoid leukaemia. A macular rash should not be taken to imply allergy to other penicillins which tend to cause a true urticarial reaction. Patients with renal failure and those taking allopurinol for hyperuricaemia also seem more prone to ampicillin rashes. Cholestatic jaundice has been associated with use of co-amoxiclav even up to 6 weeks after cessation of the drug the clavulanic acid may be responsible.

HCN as a Biological Pacemaker

As encouraging as these initial successes were, there are significant drawbacks with adenoviral gene delivery. Since the plasmid is not incorporated into the genome, the effect is transient, rarely lasting more than 6 weeks. Second, there is also the risk of allergic reaction, which has limited adenovi-ral approaches in prior clinical trials for other disease processes. Alternative viruses from the retroviral family are incorporated into the genome but come with an increased associated risk of neoplasia. In 2004 Potapova et al. (2004) employed an altogether different approach to deliver the HCN genes to the cardiac syncytium. They took human mesenchymal stem cells (hMSCs) and incorporated the same HCN2 gene by electroporation. After demonstrating high levels of expression of an If-like current in the transfected hMSCs, they injected one million of these transfected cells into the left epicardium and studied the animals 3-10 days later in the same manner described for viral delivery....

Special Drugs For Urinarytract Infections

Nitrofurantoin, a synthetic antimicrobial, is active against the majority of urinary pathogens except pseudomonads. It is well absorbed from the gastrointestinal tract and is concentrated in the urine (t' 2 1 h) but plasma concentrations are too low to treat infection of kidney tissue. Excretion is reduced when there is renal insufficiency, rendering the drug both more toxic and less effective. The main use of nitrofurantoin is now for prophylaxis. Adverse effects include nausea and vomiting (much reduced with the macrocrystalline preparation) and diarrhoea. Peripheral neuropathy occurs especially in patients with significant renal impairment, in whom the drug is contraindicated. Allergic reactions include rashes, generalised urticaria and pulmonary infiltration with lung consolidation or pleural effusion. It is safe in pregnancy, except near to term because it may cause neonatal haemolysis, and it must be avoided in patients with glucoses-phosphate dehydrogenase deficiency (see p....

Tubulointerstitial nephritides

An association with tubulointerstitial nephritis and nephrotic syndrome has also been occasionally reported for penicillin amoxicillin-induced nephropathy 53 . Several reports have analyzed T-cells in penicillin-induced allergy. It was shown that 1) CD4+ T-cells specific for penicillin may be derived from the skin of patients and produce mainly IL-5, some of them being perforin positive with a cytolytic potential 54 2) P-lactams specific clones may be obtained only from patients with adverse drug reactions the clones were Th2

Chronic Eosinophilic Leukemia Hypereosinophilic Syndrome

Myeloproliferative hypereosinophilic diseases are defined by a persistent (> 6 months) unexplained eosinophilia greater than 1.5 X 109 L, a hypercellular bone marrow with eosinophilia, and tissue damage. They are discriminated from idiopathic hypere-osinophilic syndrome by the presence of tissue damage, although this may indeed be artificial as tissue damage may be subclinical or occur in the future. While investigating these patients, a reactive cause of eosinophilia such as allergies, parasitic infections, and other malignancies (e.g., on detection of phenotypi-cally abnormal T lymphocytes56) should be assiduously excluded. Eosinophil morphology varies from normal to include abnormalities such as degranulation, cytoplasmic vacuolation, hypolobulation, or hyperlob-ulation. The presence of Chronic eosinophilic leukemia (CEL) is suggested by increased proportion of blasts, hepatosplenomegaly, raised serum tryptase, vitamin B12, and a cytogenetic abnormality. In some patients the...

Guideto Further Reading

Friedman P S 1998 Allergy and the skin. 11 Contact and atopic eczema. British Medical Journal 316 1226-1229 treatments for cutaneous warts systematic review. British Medical Journal 325 461 64 Greaves M W, Sabroe R A 1998 Allergy and the skin. 1 Urticaria. British Medical Journal 316 1147-1150

Penicillin and Other Antibiotics

A problem with widespread antibiotic use is that pathologic bacteria eventually mutate so that they are immune to the antibiotic's effects. Thus, penicillin, which was first discovered by Alexander Fleming in the United Kingdom in 1928, went into large-scale production in time for World War II. But it is no longer effective against many bacterial infections. Patients in developed countries where antibiotics have been used extensively for years often harbor bacteria that have mutated into penicillin-resistant strains. In addition, penicillin is inherently ineffective against many strains of bacteria, and causes severe allergic reactions in some patients. Because of these problems, derivatives of penicillin have been introduced to the market. For example, cephalosporins were primarily developed to address the rashes and other allergic problems associated with penicillin.

Structural Determinants of Potassium Channel Blockade and Drug Induced Arrhythmias

Nerability of some patients to life-threatening rhythm disturbances. This maybe due to an underlying propensity stemming from inherited mutations or polymorphisms, or structural abnormalities that provide a substrate allowing for the initiation of arrhythmic triggers. A number of pharmacological agents that have proved useful in the treatment of allergic reactions, gastrointestinal disorders, and psychotic disorders, among others, have been shown to reduce repolarizing K+ currents and prolong the Q-T interval on the electrocardiogram. Understanding the structural determinants of K+ channel blockade might provide new insights into the mechanism and rate-dependent effects of drugs on cellular physiology. Drug-induced disruption of cellular repolarization underlies electrocardiographic abnormalities that are diagnostic indicators of arrhythmia susceptibility.

Generic For Chloralodol

And dependence and their danger in overdose. Chloral hydrate (3) (see Table 5.5) seems the least problematic with relatively low abuse potential it is still used as an alternative to benzodiazepines. The adverse effects include gastric irritation, light headedness, ataxia, nightmares, excitement, confusion, allergic reactions, and skin rash. It also causes drowsiness and motor incoordination therefore, chloral hydrate should not be used concomi-tantly with other CNS depressant drugs such as alcohol. The adverse effects of ethchlorvynol (4) (see Table 5.5) are similar to those of

Chemotherapy Regimens Mopp and MOPP derivatives

Approached 2.5 in the NCI series and 1.5 in smaller studies.47 Hematologic toxicities, although reversible, were sometimes fatal, as hematopoietic growth factor compounds were not available at that time. Vincristine-associated neuropathy was clinically relevant with doses more than 2 mg. Procarbazine was associated with severe emesis, and a type I allergic reaction in rare cases.

Physiological Effects Of Glucocortioids

Glucocorticoids inhibit inflammatory and allergic reactions. They do this by stabilizing the lysosomal membranes, inhibiting the release of proteolytic enzymes, and by increasing capillary permeability. This in turn reduces dia-pedesis of leukocytes. Glucocorticoids also reduce the number of circulating lymphocytes, monocytes, eosinophils, and basophils. The decrease in the number of basophils accounts for the fall in blood histamine levels and the reduction of the allergic response. There is also an increase in the number of inflammatory cells (neutrophils) caused by a decrease in the migration from the capillaries and an accelerated release from bone marrow. Glucocorticoids also inhibit the ability of neutrophils to marginate to the vessel wall. In addition, they cause impairment of the lymph nodes, thymus, and spleen that directly leads to decreased antibody formation.

Adverse Effects Of Herbal Therapy

Allergic reactions are generally of this type. The third type of adverse event results from effects of the agent, which develop during long-term courses of therapy, such as hypokalemia and HT associated with prolonged-administration glycyrrhizin therapy (30,31). Fourth, unexpected and delayed side effects, such as teratogenicity or carcinoge-nicity, may occur. For example, extracts of sassafras root have been shown to increase the likelihood of hepatocellular carcinoma in laboratory animals (32).

Dental And Medical Assessments Review of Dental History

At the vers least, the review should include past restorative, periodontal, and other dental treatment head and neck cancer and its treatment allergies, oral hygiene care techniques tobacco and alcohol use and any difficulties or problems associated with dental treatment. In addition, the dental history should review past injuries, the individual's perception ol past and future dental treatment outcomes, the fluoride status ol the drinking water (bottled, well, community), and the type of toothpaste used (fluoride versus nonfluoride). The medical history should be detailed and include a careful review of past and current medical and mental conditions including allergies and invasive procedures. I he review should focus on a careful evaluation of systemic diseases and disorders, particularly those that in tluencc dental treatment such as bleeding disorders and use of anticoagulants, diabetes, heart valve problems certain cardiovascular conditions, stroke, artificial joints and use of...

Hypersensitivity Reactions

Tissue damage is caused by inflammatory mediators, (histamine, prostaglan-dins, leukotrienes, and platelet activating factor) released from mast cells and basophils following antigen binding to cell bound IgE. These substances induce increased vascular permeability, vasodilatation, and smooth muscle contraction, either locally or systemically, depending on the site of antigen exposure. Contact allergens generally produce localized skin responses, but systemic exposure can often produce immediate life-threatening pathology (Fig. 13.3). Because pre-existing antibodies are obligatory for immediate hypersensitivity reactions, primary exposure to an antigen cannot trigger this type of response.

Rebound Adrenocortical Insufficiency

Type B (Bizarre) reactions will occur only in some people. They are not part of the normal pharmacology of the drug, are not dose-related and are due to unusual attributes of the patient interacting with the drug. These effects are predictable where the mechanism is known (though predictive tests may be expensive or impracticable), otherwise they are unpredictable for the individual, although the incidence may be known. The class includes unwanted effects due to inherited abnormalities (idiosyncrasy) (see Pharmacogenetics) and immunological processes (see Drug allergy). These account for most drug fatalities.

Drug Management Of Some Allergic States

Hyposensitisation, by subcutaneous injection of graded and increasing amounts of grass and tree pollen extracts, is an option for seasonal allergic hay fever due to pollens (which has not responded to anti-allergy drugs), and of bee and wasp allergen extracts for people who exhibit allergy to these venoms (exposure to which can be life threatening). If it is undertaken facilities for immediate cardiopulmonary resuscitation must be available due to the risk of anaphylaxis.

Idiosyncratic Unpredictable Hepatotoxicity

Prospective information in the foreseeable future. It does seem likely that patients with strong family or personal histories of allergic diatheses are at increased risk for developing allergies to drugs. However, because the actual development of such allergies is infrequent, specific drugs are not contraindicated for such patients, unless they have convincing histories of prior allergy to the same or related drugs.

Guide To Further Reading

New England Journal of Medicine 338 239-247 Irwin R S, Madison J M 2000 The diagnosis and management of cough. New England Journal of Medicine 343 1715-1721 Kay A B 2001 Allergy and allergic diseases. New England Journal of Medicine 344 30-37 (part I) 109-113 (part 2) Poole P J, Black P N 2001 Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease. British Medical Journal 322 1271-1274 Rees P J, Dudley F 1998 Oxygen therapy in chronic

Targeting Cd52 On Hcl Cells With Alemtuzumab

CD52 is a 12-amino-acid glycoprotein that is present on lymphocytes at up to 450,000 sites cell.48'49 It is also present on monocytes, macrophages, eosinophils, and the male reproductive tract.5051 Quigley et al. at the Scripps Clinic recently reported that in nine cases of classic HCL and one of HCLv, all patients expressed CD52 on 92-100 of the HCL cells.52 Fietz et al. reported recently that a patient with HCL and shortlived or poor responses to cladribine, interferon, splenectomy, and rituximab had hematologic benefit with alemtuzumab.53 The patient tolerated rituximab more poorly than alemtuzumab because of an allergic reaction to the former. With both mAbs, the patient had an improvement in thrombocytopenia, but failed to reverse blood transfusion dependence.

Immune Stimulation And Myeloma Chronic infections and eczema

Many medical conditions associated with chronic stimulation of the immune system, such as repeated infections, allergic conditions, or autoimmune disease, have been reported to increase the risk of MM. In a case-control study, past history was abstracted from medical records for leukemia, n 299 non-Hodgkin's lymphoma (NHL), n 100 and MM, n 175 patients, and matched with 787 controls. Prior histories of eczema and musculoskeletal conditions were associated with higher risk for MM with no role identified for chronic antigenic stimulation in the etiology of leukemia or NHL.32 Another case-control study of 100 MM cases in whites showed no associations between MM and history of medical conditions that cause prolonged stimulation of the immune system, like chronic infections, autoimmune disorders, allergy-related disorders, or lymphoid tissue surgery.33

Uses Ofthrombolytic Drugs

Streptokinase and anistreplase are antigenic and anaphylactic reactions with rash, urticaria and hypotension may occur for most people have circulating antibodies to streptococci. Antibodies persist after exposure to these drugs and their reuse should be avoided between 5 days and 12 months as the recommended dose may not overcome immune resistance to plasminogen activation.

Modernity and symptoms

These community concerns have been reflected in illnesses with new labels such as 'multiple chemical sensitivity', 'immune system dysfunction', 'electric allergy', 'total allergy syndrome', and 'twentieth-century disease'. All of these illnesses have in common the attribution that illness was caused by an external factor brought on by the stresses or features of modern life. Due to the increase in attention given to threats to health, people's subjective feelings of health have declined over this century. Environmental concerns and worries can interact with psychological distress to make the development of CFS and allergies more common. Studies have demonstrated that individuals who have a history of anxiety or depression are more likely to develop medically unexplained allergy to common environmental agents (Simon, Katon and Sparks 1990) and also CFS after common viral illnesses (Wessely et al. 1995). These provide an example of how both physical and psychological factors, given the...

Mucolytics And Expectorants

Carbocisteine and mecysteine have free sulphydryl groups that open disulphide bonds in mucus and reduce its viscosity. They are given by orally or by inhalation (or instillation) and may be useful chiefly where particularly viscous secretion is a problem (cystic fibrosis, care of tracheostomies). Mucolytics may cause gastrointestinal irritation and allergic reaction.

Initial Evaluation

RC is a 43-yr-old man who presented without complaints for routine care. His past medical history is notable for seasonal allergic rhinitis and erectile dysfunction but is otherwise unremarkable. He has never smoked and eats a typical Western diet. He has a sedentary job but recently started exercising several days a week. He is concerned that his father died suddenly from an MI at the age of 60 his mother survived a stroke at the age of 68. His medications include fexofenadine as needed for allergies, and sildenafil as needed. He wants to know if he should start taking an aspirin every day.

Glomerular function Glomerular filtration

The contrast agents iohexol (Krutzen et al. 1984) and isothalamate (Gaspari et al. 1992 Isaka et al. 1992) are eliminated from plasma mainly by glomerular filtration and have an excellent correlation with the plasma clearance of 51Cr-EDTA and inulin (Gaspari et al. 1995). Iohexol is more commonly used as it reportedly has lower allergenic potential. The most accurate estimate of GFR is obtained by sampling up to 600 min after injection, particularly in individuals with GFR < 40 ml min 1.73 m2. However, the disappearance curve is linear after 120 min, so that in individuals with GFR > 40 ml min 1.73 m2, sampling may be limited to only at 120, 150, 180, 210 and 240 min after injection.

Literary Analysis

PHS medical professionals watched the men unnecessarily suffer unbelievable mental and physical pain. For this reason, as the study progressed into the 14th year, lying to her boys became a burden for Evers, especially when their suspicions caused them to demand new doctorin'. In the end, Ben, the oldest, acquiesced to the study's protocol and died, proud that he had earned a government certificate and a proper burial. The superstitious Hodman went mad, drank a magic potion, and died from the poison. Caleb, the most literate, learned about penicillin and was treated in time. Evers took dancing Willie, the youngest, out of a treatment line, convinced by Douglas that penicillin in Willie's late-stage syphilis might set off an allergic reaction or kill off spirochetes, causing his heart to explode. He suffered the crippling effects of the disease. Today, with a known cure available, it would be considered a heinous bioethical injustice not to give study participants the choice to...

Adrenocorticotrophic hormone ACTH corticotropin

Synthetic corticotropins have the advantage that they are shorter amino acid chains (devoid of amino acids 25-39) and so are less likely to cause serious allergy, though this can happen. In addition they are not contaminated by animal proteins which are potent allergens.

Adverse Effects Of Insulin

Other adverse reactions to insulin are lipodystrophy (atrophy or hypertrophy) at the injection sites (rare with purified pork and human insulin), after they have been used repeatedly. These are unsightly, but otherwise harmless. The site should not be used further, for absorption can be erratic, but the patient may be tempted to continue if local anaesthesia has developed, as it sometimes does. Lipoatrophy is probably allergic and lipohypertrophy is due to a local metabolic action of insulin. Local allergy also is manifested as itching or painful red lumps. Generalised allergic reactions are very rare, but may occur to any insulin (including human) and to any constituent of the formulation. Change of brand of insulin, especially to highly purified preparations (or to one with a different mode of manufacture) may rectify allergic problems. But zinc occurs in all insulins (though very little in soluble insulin) and can be the allergen.

Valvular Heart Disease

The prophylactic antibiotic regimens depend on the location of the index procedure.65 For example, in dental procedures amoxicillin 2.0 g is recommended orally one hour before the scheduled dental treatment. In gastrointestinal or urinary procedures, the recommendation is ampi-cillin or amoxicillin 2.0 g intravenously or amoxicillin together with a bodyweight-adjusted dose of gentamicin (at 1.5mg kg intravenously). Alternative regimens are available if there is a history of allergic reactions to penicillin derivatives.

Adverse reactions

Blood disorders (< 3 10 000 patient years) are most common in the first 2 months of treatment. Routine leucocyte counts have been advocated in order to detect blood dyscrasia before symptoms develop but agranulocytosis may be so acute that the counts give no warning. Patients must be advised to stop the drug and have a leucocyte count performed if symptoms of a sore throat, fever, bruising or mouth ulcers develop. Any suggestion of anaemia should be investigated. Cross allergy between the drugs occurs sometimes, but must not be assumed for agranulocytosis. Treatment of agranulocytosis consists of drug withdrawal, admission to hospital, and administration of broad-spectrum antibimi-crobials plus granulocyte colony stimulating factor (where available).

Phenylalanine Dihydrobiopterin O2 Tyrosine Tetrahydrobiopterin H2O

Histidine - Decarboxylation of histidine yields histamine (see here). In the stomach, histamine promotes secretion of hydrochloric acid and pepsin as digestion aids. Histamine is a potent vasodilator, released at sites of trauma, inflammation, or allergic reaction. Reddening of inflamed tissues is a result of local enlargement of blood capillaries. Antihistamines block binding of histamine to its receptors. Figure 21.23 shows that histidine is catabolized to glutamate.

Hh Uman biochemistry

The action of epinephrine and related agents forms the basis of therapeutic control of smooth muscle contraction. Breathing disorders, including asthma and various allergies, can result from excessive contraction of bronchial smooth muscle tissue. Treatment with epinephrine, whether by tablets or aerosol inhalation, inhibits MLCK and relaxes bronchial muscle tissue. More specific bronchodilators, such as albuterol (see figure), act more selec-

Short Term In Vivo Testing

Practice for testing guinea pigs for contact allergens guinea pig maximization test. A two-stage induction procedure employing Freund's complete adjuvant and sodium lauryl sulfate, followed two weeks later by a challenge with the extract material. Ten animals per test material.

Bilateral Visual Field Obliteration

A 15-year-old member of the high school marching band comes to your office for evaluation of hearing loss. He had multiple ear infections as an infant and toddler, and had to have myringotomy tubes inserted in his ears. Additionally, he suffers from many allergies. His hearing is diminished in the right ear. When you place a vibrating tuning fork on the top of his head, the sound lateralizes to the right ear. The name of this test is

Comprehension Questions

17.2 A 48-year-old male presents for follow-up of an elevated calcium level of 12.3 mg dL found on routine screening labs at his last well-male visit. He takes no medications other than an occasional antihistamine for allergies. He recently started smoking a half-pack of cigarettes per day. He was prompted to attend to his well-male visit by his wife who claims that he has become forgetful, has a decreased appetite, and has had a 10-pound weight loss over the past 2 months. As part of his follow-up labs, you obtain a serum PTH. which comes back within the normal range. What is the next step in diagnosis

Approach To Bites And Stings Insect Stings Local Reactions

Large local reactions are immunoglobulin (Ig) E-mediated allergic reactions to the hymenoptera venom. These reactions are often confused with cellulitis. as large areas (> 1() cm in diameter) of redness and warmth develop over 24-48 hours. These reactions are not infectious and will not respond to antibiotics. These reactions are best treated with oral steroids initiated early after the sting. Tetanus prophylaxis should be reviewed and updated, if needed. A person with a history of a large local reaction to a bee sting is likely to have similar reactions to subsequent stings. However, the history of this type of reaction does not result in an increased risk of anaphylaxis to subsequent stings.

Antituberculosis Drugs

Alternative or reserve drugs are used where there are problems of drug intolerance and bacterial resistance. They are in this class because of either greater toxicity or of lesser efficacy and include ethionamide (gastrointestinal irritation, allergic reactions), capreomycin (nephrotoxic), and cycloserine (effective but neurotoxic). Quinolone antibiotics such as ciprofloxacin and the more recently introduced macrolides such as clarithromycin and azithromycin also have useful activity against mycobacteria.

Class I The Lanthionine Containing Lantibiotic Bacteriocins

Anti-inflammatory and anti-allergy drug been ascribed to any particular gene product in the comprehensive array of putative ORFs identified in the cinnamycin locus. Intriguingly, the CinA prepeptide has a much longer leader peptide than that of other lantibiotics, and it has been proposed that cinnamycin may be secreted by a more general export mechanism such as the general secretory (Sec) pathway, once again illustrating the broad diversity of the lantibiotic class (Widdick et al. 2003). Cinnamycin has been shown to be a potent inhibitor of phospholipase A2 (an enzyme involved in the synthesis of prostaglandins and leukotrienes in the human immune system) through the sequestration of its substrate phos-phatidylethanolamine. Due to this activity, cinnamycin may prove to have a useful application as an anti-inflammatory and anti-allergy drug (Marki et al. 1991).

Epoxides and Aldehydes

Formaldehyde is a gas that readily undergoes oxidation to formic acid and polymerization to paraformaldehyde. It usually is used as formalin, an aqueous solution containing not less than 37 formaldehyde and 10-15 methanol to prevent polymerization. Formaldehyde exerts a slow but potent germicidal action thought to involve direct nonspecific alkylation of nucleophilic groups on proteins to form carbinol derivatives (Equation 13.4). It is used to disinfect surgical instruments. Formaldehyde is highly allergenic and a cancer suspect agent.

Randa ElZein Melissa Bondy and Margaret Wrensch

A wide variety of risk factors, including diet, smoking, alcohol, occupation exposures, radiation, infections, allergies, head trauma, and family history are being intensively investigated for their role in brain tumors. In recent years, a greater focus is being directed at inherited polymorphisms in genes related to carcinogen metabolism, and DNA repair, as well as, gene environment interactions. The relative rarity of brain tumors makes the assembly of large cohort studies difficult and, therefore, most commonly these analytic studies use the case-control approach.

Cell Signaling Cascades Soluble And Insoluble Triggers

Bacterial or viral pathogens or abnormal mechanical stress) that have both short- and long-term effects. Furthermore, some signals may initiate a long-term detrimental effect, such as in disease states, cancer pathogenesis, viral or bacterial infection, or genetic disorders that increase the extent of cell death or adherent cell behavior. Other signals may be short term, including synaptic transmission in nerves, transient nitric oxide bursts from endothelial cells, and contractile activation by smooth muscle cells. Such signals may also produce host physiological responses, e.g., eating of a hot pepper causing perspiration due to activation of the vanilloid-1 receptor in peripheral neurons inflammatory responses ranging from activation of eisonophils due to anaphalaxis allergic reaction to antigens such as pollens, pet dander, or other sensitizing chemicals or signals that control cell cycles coinciding with aging and or cell turnover.

Production Of Biologically Active Substances By Serumfree Cultures

The vaccine industry has seen the emergence of new processes for production utilizing serum-free culture systems. In many cases the traditional method of production has led to many problems including adverse allergic reactions (e.g., from chick eggs used to propagate the virus) to the transfer of biological contaminants from animal components used in the process. Furthermore, many of the more traditional processes were inefficient and time-consuming. The use of animal cells for the production of vaccines alleviated some of these problems by allowing large-scale production with minimal supervision and monitoring. However, the use of serum in the culture medium was still required, which posed the threat of transferring contaminants to the end product. The recent advancements in serum-free formulations have reduced the dependence on serum in industrial-scale processes. This has allowed the minimization of potential contamination by adventitious agents.

Skin Physiology and Textiles Consideration of Basic Interactions

The skin exerts a number of essential protective functions ensuring homeostasis of the whole body. In the present review barrier function of the skin, thermoregulation, antimicrobial defence and the skin-associated immune system are discussed. Barrier function is provided by the dynamic stratum corneum structure composed of lipids and corneocytes. The stratum corneum is a conditio sine qua non for terrestrial life. Impairment of barrier function can be due to injury and inflammatory skin diseases. Textiles, in particular clothing, interact with skin functions in a dynamic pattern. Mechanical properties like roughness of fabric surface are responsible for non-specific skin reactions like wool intolerance or keratosis follicu-laris. Thermoregulation, which is mediated by local blood flow and evaporation of sweat, is an important subject for textile-skin interactions. There are age-, gender- and activity-related differences in thermoregulation of skin that should be considered for the...

Conclusion Chlamydia pneumoniae Chronic Nonspecific Lung Disease Cnsld And The Dutch Hypothesis

Bronchitis, asthma, emphysema and irreversible or persistent obstructive lung disease. In 1961 Orie(23) proposed the Dutch Hypothesis which stated that CNSLD represented different expressions of a single disease entity characterized by an hereditary predisposition to develop allergy and bronchial hyper reactivity in response to environmental factors. Prior to the discovery of the Cpn-asthma association, the pros and cons of the Dutch Hypothesis were fully debated without the hypothesis being proven or disproven.(9,10) It should be obvious to the reader of this review that the discovery of Cpn as a potential factor in asthma and COPD casts new light on the importance of examining the concept of CNSLD as a pathophysiologic entity.


History should also be obtained with particular attention to medical history, prior pregnancies, delivery outcomes, pregnancy complications, neonatal complications, and birth weights. Gynecologic history should focus on the menstrual history, contraceptive use. and history of sexually transmitted diseases (STDs). Allergies, current medications both prescription and OTC and substance use should also be investigated. Social history should consider whether the pregnancy was planned, unplanned, or unintentional. A discussion of social supports for the patient during the prenatal and postpartum period is also warranted. Genetic history should be obtained for the patient and partner's family, if known. Women who will be in their third trimester during flu season should be offered the influenza vaccine. Influenza vaccine is safe in any stage of pregnancy provided there is no allergy to any of its components. Tetanus toxoid vaccination can also be given safely during pregnancy. Varicella and...


With many drugs there are differences in pharmacodynamics and pharmacokinetics according to whether their use is in a single dose or over a brief period (acute pharmacology) or long term (chronic pharmacology). The proportion of the population taking drugs continuously for large portions of their lives increases as tolerable suppressive and prophylactic remedies for chronic or recurrent conditions are developed e.g. for arterial hypertension, diabetes mellitus, mental diseases, epilepsies, gout, collagen diseases, thrombosis, allergies and various infections. In some cases long-term treatment introduces significant hazard into patients' lives and the cure can be worse than the disease if it is not skilfully managed. In general the dangers of a drug are not markedly increased if therapy lasts years rather than months exceptions include renal damage due to analgesic mixtures, and carcinogenicity.


Some patients, e.g. those with a history of allergy or previous reactions to drugs, are up to four times more likely to have another adverse reaction, so that the incidence does not fall evenly. It is also useful to discover the causes of adverse reactions, for such knowledge can be used to render avoidable what are at present unavoidable reactions.

Drug Interactions

Allergic reactions to drugs are the resultant of the interaction of drug or metabolite (or a nondrug element in the formulation) with patient and disease, and subsequent re-exposure. Lack of previous exposure is not the same as lack of history of previous exposure, and 'first dose reactions' are among the most dramatic. Exposure is not necessarily medical, e.g. penicillins may occur in dairy products following treatment of mastitis in cows (despite laws to prevent this), and penicillin antibodies are commonly present in those who deny ever having received the drug. Immune responses to drugs may be harmful (allergy) or harmless the fact that antibodies are produced does not mean a patient will necessarily respond to re-exposure with clinical manifestations most of the UK population has antibodies to penicillins but, fortunately, comparatively few react clinically to penicillin administration. The chief target organs of drug allergy are the Allergic reactions in general may be...


The mechanism underlying desensitisation may involve the production by the patient of blocking antibodies that compete successfully for the allergen but whose combination with it is innocuous or the threshold of cells to the triggering antibodies may be raised. Sometimes allergy is to an ingredient of the preparation other than the essential drug and merely changing the preparation is sufficient. Impurities are sometimes responsible and purified penicillins and insulins reduce the incidence of reactions.

Acute toxicity

The major acute toxicity of 2-CdA is myelosuppression. In their long-term follow-up study, investigators at Scripps Clinic noted a 16 incidence of Grade 3 and a 71 incidence of Grade 4 neutropenia in the first 135 consecutive treated patients.5 Ten percent had Grade 3 and 10 had Grade 4 thrombocytopenia. Grade 3 anemia occurred in 20 and Grade 4 in 2 . Forty-two percent developed neutropenic fever, though in only 13 , was an infection documented. Of these, the most common infecting organism was Staphylococcus, usually associated with the indwelling intravenous catheter. Although there were several oral herpetic infections and acute dermatomal herpes reactivations, no fungal infections were found. This high rate of neutropenia with culture negative neutropenic fever was also noted at similar rates in other single-institution series with 2-CdA. Despite the frequency of myelosuppression, additional acute toxicities were uncommon. There were no significant rates of nausea, vomiting,...


Adverse effects include gastrointestinal upset and allergic reactions (rash, pruritus, arthralgia, photosensitivity and anaphylaxis). CNS effects may develop with dizziness, headache and confusion, and are sufficient to require cautioning the patient against driving a motor vehicle. Convulsions have occurred during treatment (avoid or use with


The relapse rate following IS therapy may be substantial. For ATG CsA, it may be as high as 35 in 7 years.1281 In general, relapse has a good prognosis and survival of relapsed patients is not significantly shortened.81 Patients with falling blood counts can receive a trial of CsA. If unsuccessful in rescuing the counts, a repeated course of ATG should be given. The response rates are likely comparable to those seen in the initial course of ATG. In some instances, rabbit ATG can be used instead of horse ATG, but it is unclear whether this measure helps to avoid more dramatic allergic reactions. High-dose cyclophosphamide (see above) has been suggested to prevent subsequent relapses.


There is no report as of now regarding the expression of CD137 on basophils. CD137 expression on eosinophils could be observed in patients suffering from IgE-mediated allergic responses, but not in normal subjects or those patients suffering from non-IgE-mediated eosinophilic disorders (Heinisch et al., 2001). In both neutrophils and eosinophils, CD137 stimulation promoted apopto-sis in these cells, even in the presence of GM-CSF and or IL-5 survival factors (Heinisch et al., 2000). In this regard, CD137 stimulation may play an important role in regulating granulocyte survival during the initiation and resolution of an inflammatory response. Combined with a report showing CD137 transcript that was frequently found in mast cells, a key type of cells storing and releasing inflammatory mediators for allergy, CD137 may also participate in the control of asthma induced by extrinsic allergens.

C1inh Et Cannabis

The complaints of difficulty swallowing and breathing sound like the complaints of a hyperallergic individual and or asthmatic. This occurs when there is p-agonist activation of smooth muscles and airway spasm. Further questioning and lung function tests are used to determine if this is an allergic reaction. Lung function is determined by measuring conventional parameters. It turns out that Peter does not have asthma or a known allergy to environmental allergens. Indeed, while these might help explain these latest symptoms, they would not address the issue of the intermittent lip swelling.

First Visit

Abnormal bleeding tendencies such as nosebleeds, prolonged bleeding from minor cuts, spontaneous ec-chvmoses, tendency toward excessive bruising, and excessive menstrual bleeding should be cited. 7. History of allergy should be taken, including hay fever, asthma, sensitivity to foods, or sensitivity to drugs such as aspirin, codeine, barbiturates, sulfonamides, antibiotics, procaine, and laxatives, to dental materials such as eugenol or acrylic resins. < S. Information is needed regarding the onset of puberty and, for females, menopause, menstrual disorders, hysterectomy, pregnancies, and miscarriages. 9. Family medical history should be taken, including bleeding disorders and diabetes.


In the skin also contributes and may be responsible for much of the itch of urticarial allergic reactions. Histamine release by bile salts may explain some, but not all, of the itch of obstructive jaundice. It is likely that other chemical mediators, e.g. serotonin and prostaglandins, are involved. Antihistamines (Hj receptor), especially chlor-phenamine and hydroxyzine orally, are used for their sedative or anxiolytic effect (except in urticaria) they should not be applied topically over a prolonged period for risk of allergy.


Identifying and avoiding triggering factors are important. These include stress (exertion, excitement, anxiety, fatigue, anger), food containing vasoactive amines (chocolate, cheese), food allergy, bright lights and loud noise, and also hormonal changes (menstruation and oral contraceptives) and hypoglycemia. These pr cipitants may initiate release of vasoactive substances stored in nerve endings and blood platelets. Many attacks, however, have no obvious trigger.

Mps Vi

Thritis, allergies, and reperfusion injury. Se-lectins are a family of glycoproteins that are involved in the adhesion of leukocytes to platelets or vascular endothelium (71). Adhesion is an early step in leukocyte extravasation in which sequelae includes thrombosis, recirculation, and inflammation. Three protein receptors, E-, L-, and P-selectins, are assigned to the selectin family based on their cDNA sequences. Each contains a domain similar to calcium-dependent lectins or C-lectins, an epidermal growth factor-like domain, and several complement binding protein-like domains


Ethosuximide (Zarontin) (t 2 55 h) differs from other antiepilepsy drugs in that it blocks a particular type of calcium channel that is active in absence seizures (petit mal), and it is used specifically for this condition. Adverse effects include gastric upset, CNS effects and allergic reactions including eosinophilia and other blood disorders, and lupus erythematosus.

Protective Factors

Decreased risks of glioma that have been found in association with past history of allergies 32-34 , autoimmune diseases 32 or certain common viral infections 33, 35 may all indicate a role for immunological factors in the etiology of glioma. These results should be treated with caution, however, as they were based on questionnaires in case-control studies without validation from medical records. Moreover, proxy respondents supplied information on a substantial proportion of cases, usually because the subject was too ill to respond or had died. For allergies, the odds ratios in different studies were inversely correlated with the percentage of proxy respondents, indicating possible bias 36 . Two studies, however, that were not susceptible to recall bias also provide support for an immune-related etiology of glioma. A large cohort study in Sweden, involving record linkage between the population-based Twin Registry, Hospital Discharge Registry, and Cancer Registry, found an inverse...


The mite causes intense itching, which is often worse at night and is aggravated by heat and moisture. The irritation spreads outside the original point of infection resulting from an allergic reaction to mite feces. This irritation may persist for approx 2 weeks after treatment but can be alleviated by antihistamines.


Adverse effects include reactions at the site of infusion, rashes, gastrointestinal upset, hepatitis, thrombocytopenia and neutropenia. It appears to have a remarkably low risk of causing p-lactam allergy, and may be used with caution in some penicillin-allergic patients.

Diet Ulcer

Dietary factors play a central role in ulcer frequency and severity.3,4 High intakes of sugar and refined carbohydrate can contribute to ul-cers.5 Milk, traditionally recommended to reduce acidity, actually produces only a transient rise in pH. This is often followed by a large rebound increase in acid secretion, which can worsen ulcers. Heavy alcohol consumption can cause erosions and ulceration of the stomach lining. Both decaffeinated and regular coffee can aggravate heartburn and ulcers. Food sensitivities (such as allergy to cow's milk) may contribute to ulcer formation identifying and avoiding the offending foods often improves healing and may prevent recurrence.6 Raw cabbage juice contains large amounts of S-methylmethionine and glutamine, two amino acids that can accelerate healing of ulcers.


Cephalosporins are well tolerated. The most usual unwanted effects are allergic reactions of the penicillin type. There is cross-allergy between penicillins and cephalosporins involving about 7 of patients if a patient has had a severe or immediate allergic reaction or if serum or skin testing for penicillin allergy is positive (see p. 217), then a cephalosporin should not be used. Pain may be experienced at the sites of i.v. or i.m. injection. If cephalosporins are continued for more than 2 weeks, thrombocytopenia, haemolytic anaemia, neutropenia, interstitial nephritis or abnormal liver function tests may occur especially at high dosage these reverse on stopping the drug. The broad spectrum of activity of the third generation cephalosporins may predispose to opportunist infection with resistant bacteria or Candida albicans and to Clostridium difficile diarrhoea. Ceftriaxone achieves high concentrations in bile and, as the calcium salt, may precipitate to cause...

Types Of Asthma

Asthma associated with specific allergic reactions This extrinsic type is the commonest and occurs in patients who develop allergy to inhaled antigenic substances. They are also frequently atopic showing positive responses to skin prick testing with the same antigens. The hypersensitivity reaction in the lung (and skin) is of the immediate type (type 1) involving IgE-mediated mast cell activation. Allergen Asthma not associated with known allergy

Preparations And

When injections are refused or are impracticable (rare allergy, bleeding disorder), administration as snuff or aerosol has been effective, but these routes are less reliable. Large daily oral doses (1000 micrograms) are probably preferable depleted stores must be replaced by parenteral cobalamin before switching to the oral preparation the patient must be compliant monitoring of the blood must be more frequent and adequate serum vitamin B17 levels must be demonstrated.

GMOs and Health

If the gene being shuffled from one organism to another is not known to be toxic or cause an allergic reaction, the FDA considers it to be substantially equivalent to the foods from which they were derived, that is, GRAS. If a modified crop contains a gene derived from a food that has been shown to cause a toxic or allergic reaction in humans, it must undergo testing prior to being marketed. This method of determining potential hazard worked well in the case of a modified soybean that carried a gene from the Brazil nut. This engineering was done in an effort to increase the protein content of soybeans. Since Brazil nuts were known to cause allergic reactions in some people, the modified beans were tested and did indeed cause an allergic reaction in susceptible people. The product was withdrawn and no one was harmed. Proponents of genetic engineering cite this as an example of the efficacy of the FDA rules. Opponents of genetically modifying foods wonder whether it will always be...

Hepatitis B

Adverse effects following HBV vaccination of children have been reported in recent years. Allergic reactions, such as urticaria, ocular inflammation, and asthma, appear to be the most commonly reported HBV-vaccine-induced effects. There have also been reports of delayed neurologic development in children who received the vaccine, although a causal relationship has not been proven. These adverse effects have been attributed to the presence of the preservative, thimerasol, a mercury derivative, in the vaccine preparation (17). Newer HBV vaccines are free of thimerasol or any other mercury derivative.


In patients with stage II III breast cancer with no previous chemotherapy, Glaspy et al.32 showed that the leukapheresis yield was 70 higher for those receiving SCF 10 g kg perday concomitantly with G-CSF than those receiving G-CSF alone. The combination of SCF+G-CSF has also been shown to be effective in patients with breast cancer with previous chemotherapy and those with heavily pretreated lymphoma. Moskowitz et al.33 conducted a phase I II randomized trial of SCF (5, 10, 15, or 20 g kg per day) plus G-CSF 10 g kg per day, or G-CSF 10 g kg per day alone to mobilize PBSC in NHL patients. The combination of SCF+G-CSF was better than G-CSF alone for patients who had received extensive prior therapy. Similar results were reported by Stiff et al.34 in another randomized study using SCF 20 g kg per day plus G-CSF 10 g kg per day versus G-CSF 10 g kg per day in 102 heavily pretreated patients with Hodgkin's disease and NHL. Compared with the G-CSF alone group, the SCF+G-CSF group showed...


Although it is clear that naturally occurring CD4+CD25+ Tr cells arise in the thymus, the cells, signals, and Ags that stimulate their development are poorly characterized. In humans, CD4+ CD25+ Tr cells are present in the thymus, particularly in the perivascular areas of fibrous septa 5 , and these cells share many phenotypic and functional similarities with their peripheral counterparts. Moreover, patients with thymic hypoplasia (DiGeorge syndrome) have low numbers of peripheral CD4+CD25+ Tr cells, supporting the concept that they are thymically derived 94 . Whether or not CD4+CD25+ Tr cells exclusively recognize self-Ags, or posses a repertoire broad enough to include foreign Ags, remains unclear. Analysis of V gene region diversity in human cell populations does not reveal any significant differences between that CD4+CD25+ Tr cells and nonsuppressive controls 51, 96 , suggesting the Tr cells do not recognize a specialized subset of Ags. A definitive answer to this question is...


An uncontrollable superweed that fills the air with high-allergenic pollen is only one of the new organisms that some scientists fear will result from proliferation of genetically modified crops. Genetically modified foods have been widely consumed in the U.S. since the late 1990s, in part because the population is unaware of the genetic manipulation of their food. In contrast, much of the European public is aware of the proliferation of genetically modified foods elsewhere. Because of their concerns, governments in much of Europe have banned the planting, harvesting, or sale of genetically modified agricultural products.

Drug Eruptions

An increase in the incidence of skin and oral manifestations of hypersensitivity to drugs has been noted since the advent of the sulfonamides, barbiturates, and various antibiotics, t he eruptive skin and oral lesions are attributed to the fact that the drug acts as an allergen, either alone or in combination, sensitizing the tissues and then causing the allergic reaction. The development of gitigix'al lesions due to contact allergy to mercurial compounds present in dental amalgam has been c learly documented 1 Because ot financial considerations, biopsy and patch testing max be indicated before the indiscriminate replacement ol dental amalgam restorations. Similarly, desquamative gingivitis has been reported with the use of tartar control toothpaste. Pyrophosphates and flavoring agents have been identified as the main causative agents of this unusual condition.-* Oral reactions to cinnamon compounds (cinnamon oil, cinnamic acid and cinnamic aldehyde) used to mask the taste of...

Case Study3

E. is a 55-year-old machinist who comes to your office complaining of pain in his right eye for the past 24 hours. He describes the pain as severe, aching, and deep he has noticed a decline in his vision. He does not wear corrective lenses. He denies any work-related exposures. He denies any upper respiratory infection or allergies. He has a history of hypertension and sees his physician regularly for checkups he has been told that his blood pressure is controlled on his medication. He has not experienced nausea, vomiting, diaphoresis, or abdominal pain.

Foods and Feeding

Freeze-dried foods Freeze-dried zooplankton (krill) are rich in proteins and fats, including HUFAs, but they are dusty and should be sifted before feeding. The dust should be saved as food for newly hatched fry. Freeze-dried bloodworms induce allergic reactions in some people. Freeze-dried tubifex worms are associated with municipal sewage containing fecal bacteria.

Vinca Alkaloids

Toxicity Toxicities of the two agents are similar. The dose-limiting toxicity for both is myelosuppres-sion, which mainly manifests as leukopenia. Thrombocytopenia occurs less often and is usually not as severe.5 Reversible alopecia, mild nausea and vomiting, and stomatitis are common. Allergic reactions including anaphylaxis have been observed. These are more common with tenioposide, which is less-water soluble than etoposide. Hepatotoxicity has been reported in up to 3 of patients receiving etoposide, consisting of hyperbilirubinemia, ascites, and transaminase elevations. Secondary leukemias, including AML and APL, have been reported. Toxicity in general is enhanced in patients with low serum albumin levels because of the decreased binding of the drug and increased free levels.19 Toxicity While toxicity to the bone marrow is minimal, L-asparaginase and related compounds are associated with a variety of adverse effects. Hypersensitivity reactions, including anaphylaxis, can occur...

Present Illness

Medications should be noted, including name, dose, route, and frequency of use. Also list home remedies, nonprescription drugs, vitamins, mineral or herbal supplements, birth control pills, and medicines borrowed from family members or friends. It is a good idea to ask patients to bring in all of their medications so you can see exactly what they take. Allergies, including specific reactions to each medication, such as rash or nausea, must be recorded, as well as allergies to foods, insects, or environmental factors. Note tobacco use, including the type used. Cigarettes are often reported in pack-years (a person who has smoked 1 2 packs a day for 12 years has an 18-pack-year history). If someone has quit, note for how long. Alcohol and drug use should always be queried


Eosinophils are a type of white blood cell (comprising about 1-4 per cent of the peripheral leukocytes) that is recruited from the peripheral circulation into the tissue, and is especially prominent at sites of allergic reactions and parasite infections. These immune cells contain


Conjunctivitis is an infection of the palpebral and or bulbar conjunctiva. It is the most common eye disease seen in community medicine. Most cases are caused by bacterial or viral infection. Other causes include allergy and chemical irritants. The mode of transmission of infectious conjunctivitis is usually direct contact to the opposite eye or to other persons via fingers, towels, or handkerchiefs.


Remarkable in other tissues and cells, as could be exemplified by measuring 5-10 ig mg-1 total protein in kidney tubules and endothelial cells 27-29 . These high cytosolic concentrations enable Cyp18-binding drugs, notably high-affinity cyclosporins, to accumulate in the cell at high intracellular levels where they could translate into potent physiological signals. This is an important determinant of cyclosporin efficacy because cells lacking high levels of cyclophilins, as could be achieved in gene deletion experiments, might become resistant to the drug 30 . Despite the fact that the Cyp18 gene is regarded as a housekeeping gene, the regulated expression of Cyp18 mRNA in rat brain points to stress control 31 . Many larger cyclophilins are subject to stress regulation as well 32-34 . Similarly, pro-teome analyses detected upregulation of Cyp18 in the higher passages of fetal skin cells and downregulation in the fibroblasts of higher aged adults 35,36 . Autoantibodies against...


Moniae, N. menigitidis) and other serious infections where j3-lactam allergy or resistance is a problem. The antibiotic is well distributed in all tissues including the brain, which enables its use in the treatment of meningitis Dosage is typically 50 mg kg day orally administered at 6-h intervals and peak serum levels are achieved 1-3 h after an oral dose.

Safety and Toxicity

Allergic reactions have been anticipated because aprotinin is an animal-derived peptide. IgE-mediated anaphylaxis to aprotinin has been documented. Aprotinin-specific IgG antibodies have also been found in patients suffering severe or fatal anaphylaxis on re-exposure. Large clinical experiences or trials have consistently reported allergic reactions of 0.5 on first exposure to aprotinin. The majority of serious allergic reactions have been reported during the

Andrea Lazzaretto

Symptomatic treatment includes head elevation, suctioning of secretions after spraying the nasal passages with saline antipyretics for fever cool, humidified oxygen for hypoxemia and adequate hydration. If the infant is at high risk for aspiration. IV fluids may be the safest way to deliver nutrients. A therapeutic trial with albuterol, especially in infants with personal or family history of allergies, could identify a few responders. Parents of infants with bronchiolitis should be instructed not to expose the infant to cigarette smoke and educated on frequent handwashing to prevent transmission of the disease.