How I Cured my Chronic Hives
Acute urticaria (named after its similarity to the sting of a nettle, Urtica) and angioedema usually respond well to Hj receptor antihistamines, although severe cases are relieved more quickly with use of adrenaline (epinephrine) (adrenaline injection 1 mg ml 0.1-0.3 ml, s.c.). A systemic corticosteroid may be needed in severe cases. In some individuals, urticarial weals are provoked by physical stimuli, e.g. friction (dermographism), heat or cold. Exercise may induce weals, particularly on the upper trunk (cholinergic urticaria). Physical urticarias may require combined J I,- and H2-receptor receptor antagonists fully to block the vascular effects of histamine, which causes flushing and hypotension. Cyproheptadine is usually the preferred choice of Hj-antihistamine but causes drowsiness. Chronic urticaria usually responds to an H receptor antihistamine with low sedating properties, Hereditary angioedema, with deficiency of Cj-esterase inhibitor (a complement inhibitor), may not...
From the standpoint of the clinician and the transfusion service, the ideal red cell substitute should deliver oxygen, cause few undesirable effects, require no compatibility testing, remain stable during prolonged storage, persist in the circulation, be easily reconstituted, and be available at a reasonable cost. From the standpoint of the patient, or better of the general public, any alternative to transfusion that would lower the risk of transfusion-transmitted infection would be worth a substantial cost increment. Most candidate red cell substitutes would undergo some pathogen inactivation treatment and nanofiltra-tion process that would address this important issue. Candidate substitutes would also avoid the compatibility issues, the logistic problems with multiple blood types, and many of the problems of storing, transporting, and transfusing refrigerated cells that are at great risk for immune, mechanical and thermal lysis. The other risks of transfusion that might be avoided...
A diet low in molybdenum may increase sensitivity to sulfites. Sulfites are produced by industrial emissions and car exhausts and may also be added to certain foods as preservatives (salad and vegetables, dried fruit, wine). Sulfite sensitivity can produce a range of symptoms including wheezing and shortness of breath, dermatitis, itching and hives, swelling around the eyes, hands, and feet, as well as dizziness, nausea, and vomiting.
Histamine toxicity can result in a wide variety of symptoms such as rash, urticaria, inflammation, nausea, vomiting, diarrhoea, abdominal cramping, hypotension, tingling sensations, flushing, palpitations and headache. In general, toxic symptoms are relatively mild and many patients may not attend a doctor. Thus, the exact prevalence worldwide of histamine toxicity is unclear. The prevalence of cheese-related toxicity is also unclear although several incidences have been reported in the literature. For most individuals, ingestion of even large concentrations of biogenic amines, such as histamine, does not elicit toxicity symptoms since they are rapidly converted to aldehydes by monoamine oxidase (MAO) and diamine oxidase (DAO) and then to carboxylic acids by oxidative deamination. These enzymes, present in the gastrointestinal tract, may prevent reduce the absorption of unmetabolised histamine into the bloodstream. However, if MAO and DAO are impaired due to a genetic defect or the...
Chronic bismuth intoxication is characterized by gastrointestinal disturbances, nausea, vomiting, and jaundice, as well as by an ulcerative gingivostomatitis, generally with pigmentation and accompanied by a metallic taste and burning sensation of the oral mucosa. Ihe tongue may be sore and inflamed. Urticaria, e.xanthematous eruptions of different types, bullous and purpuric lesions, and herpes zoster-like eruptions and pigmentation of the skin and mucous membranes are among the dermatologie lesions attributed to bismuth intoxication. Acute bismuth intoxication, which is less commonly seen, is accompanied by met hemoglobin format ion, cyanosis, and dyspnea.91 Hismuth pigmentation in the oral cavity usually appears
Adverse events from Trastuzumab administration are rare but can result in severe hy-persensitivity, including systemic anaphy-laxis, urticaria, bronchospasm, angioedema, or hypotension. A recent warning of cardiotox-icity has been issued for Trastuzumab, where its use in patients with cardiac dysfunction has resulted in congestive heart failure. This phenomenon is currently under further evaluation and investigation. Adverse events caused by Rituximab infu-m include severe infusion reactions, includ-hypotension, angioedema, hypoxia, bron- shospasm, pulmonary infiltrates, myocardial 'arction, ventricular fibrillation, and cardio-
ACE inhibitors are indicated both in asymptomatic and symptomatic heart failure. These drugs improve survival, diminish symptoms such as shortness of breath, and increase functional capacity.47 In general, ACE inhibitors should be given with care in patients with renal failure and or hyperkalemia. Side-effects include cough, hypotension, and rarely angioedema. In clinical trials an initial side-effect has been reported to occur in up to 10 of all patients. In these cases angiotensin receptor blockers may safely replace ACE inhibitors. Because various ACE inhibitors have been assessed in large-scale clinical trials to date, it appears that they share a class-effect, and that the earliest ACE inhibitors on the market (enalapril, captopril) as well as the newer, once-daily agents, are indicated in heart failure.
Although CT is superior for defining calcified and fatty structures, MRI provides better tissue contrast resolution, does not require dye, directly measures multiplanar images, and has no biological side effects. Major drawbacks include availability, cost, and the relatively long time needed for imaging. MRI is most commonly used as a problem-solving technique when ultrasonography and CT provide equivocal results. The renal venous circulation is particularly well defined, and MRI is the technique of choice for detection of renal vein thrombus or tumor invasion (Table 7). Gadolinium is approved for use as a paramagnetic contrast agent. Minor side effects occur in 2.4 of patients (nausea, vomiting, urticaria). Only 5 of the usual iodi-nated dosage is delivered. Estimated incidence for anaphylaxis is 0.001 . No renal, hepatic, or cardiovascular toxicity has been reported.
Up to 4 of the population may have a systemic reaction to a hymenoptera sting. Those who have had a systemic reaction have a 50 or greater risk of having a systemic reaction to future slings. These systemic reactions can vary from milder symptoms of nausea, generalized urticaria, or angioedema to severe and life-threatening hypotension, shock, and airway edema. Severe immediate-hypersensitivity reactions usually occur within minutes of the sting.
Adverse effects include hyperuricaemia and arthralgia, which is relatively frequent with daily but less so with intermittent dosing and, unlike gout, affects both large and small joints. Pyrazinoic acid, the principal metabolite of pyrazinamide, inhibits renal tubular secretion of urate. Symptomatic treatment with an NSAID is usually sufficient and it is rarely necessary to discontinue pyrazinamide because of arthralgia. Hepatitis, which was particularly associated with high doses, is not a problem with modern short-course schedules. Sideroblastic anaemia and urticaria also occur.
Pharmacogenomics might enable clinicians to individualize cardiovascular drug therapy based on a person's genotype, as shown in Fig. 1. This approach to cardiovascular disease management has the potential to streamline the management of diseases such as heart failure. Rather than starting all heart failure patients on the same therapy, drug regimens might be tailored according to each individual's genetic predisposition for obtaining benefit or experiencing harm from a particular drug. For instance, patients with heart failure would be genotyped for drug response at the time of heart failure diagnosis. Then, the drug or drugs expected to produce the greatest clinical response for a particular patient with regard to reductions in morbidity and mortality would be started and titrated to maximally tolerated doses. This approach would be particularly beneficial for patients with inadequate blood pressure to safely take recommended doses of both ACE inhibitors and P-blockers. Patients with...
The availability of rofecoxib as an oral suspension facilitated pediatric administration. Doses of 0.5-1.0 mg kg up to a total dose of 50 mg were well tolerated. Children appeared to have pharmacokinetics similar to adults (132). Rofecoxib was voluntarily removed from the market because of an increased incidence of cardiac and central nervous system findings in adults. No comparable untoward findings have been reported in children (133). Angioedema and urticaria have occurred in isolated cases in children taking COX-2 inhibitors for rheumatological disease (134).
The drugs are well tolerated but headache, dizziness, reversible confusion, constipation and diarrhoea may occur. In addition, urticaria, sweating and somnolence are reported with nizatidine. The drugs do not inhibit hepatic microsomal enzymes and do not block androgen receptors.
The thionamide drugs are all liable to cause minor and major adverse effects. Minor are rash, urticaria, arthralgia, fever, anorexia, nausea, abnormalities of taste and smell. Major are agranulocytosis, thrombocytopenia, acute hepatic necrosis, cholestatic hepatitis, lupus-like syndrome, vasculitis.
56.3 An 18-year-old Gl PO at 14 weeks' gestation is noted to have a positive RPR with a positive confirmatory MHA-TP test. The patient states that she is allergic to penicillin, with hives and swelling of the tongue and throat occurring in the past. Which of the following is the most appropriate next step
Early harvesting of honey and beeswax involved the killing the bees living in the hives. In 1851, American apiarist Lorenzo Lorraine Langstroth (1810-1895) discovered how bees build their hives what he called the principle of bee space. Langstroth found that bees built hives with about 0.23 inches (0.6 centimeters) of space between wax combs. With this knowledge, beekeepers made artificial hives so that each comb could remain separated from neighboring combs. Consequently, individual combs could be removed from a hive in order to harvest honey and wax without killing the bees.
Rituximab is a chimeric anti-CD20 mAb (Figure 33.1), containing the mouse variable domains of the mAb 2B8 grafted to the human IgG1 constant domains. Rituximab kills CD20+ cells by several mechanisms, including (1) complement-dependent cellular cytotox-icity, (2) antibody-dependent cellular cytotoxicity, and (3) induction of apoptosis.32 Both early phase II testing and phase II pivotal testing of rituximab at 375 mg m2 per week X 4 in relapsed low-grade NHL demonstrated overall response rates of up to 48 (6 CR). The majority of toxic events were infusion related (hypotension, bronchospasm, rhinitis, pruritis, rash, urticaria, and tumor pain) and decreased with repeated dosing. Human antimouse antibodies (HAMA) were not observed. This led to Food and Drug Administration's approval of rituximab for indolent NHL. Its effect against indolent NHL was greatly enhanced by combining the drug with chemotherapy, with 95 overall response rates and 55 CR in patients receiving CHOP...
Angioedema Swelling of the lips, periorbital region, face, hands, or feet. Anaphylactoid reactions Similar clinical picture to anaphylaxis but not The clinical presentation of anaphylactic reactions varies greatly, but the following guidelines are a good rule of thumb. Symptoms usually develop within 5-60 minutes following exposure, although a delayed reaction is possible. Symptoms and signs are variable and are listed in Table 48-1. The key fact to remember is that a true anaphylactic reaction is life-threatening. Angioedema may occur with or without urticaria but is not anaphylaxis unless the reaction is associated with other life-threatening processes, such as hypotension or laryngeal edema.
Menorrhagia, whether primary or induced by an intrauterine contraceptive device. Tranexamic acid may also reduce bleeding after ocular trauma and in haemophiliacs after dental extraction where it is normally used in combination with desmopressin. The drug benefits some patients with hereditary angioedema presumably by preventing the plasmin-induced uncontrolled activation of the complement system which characterises that condition. Tranexamic acid may be of value in thrombocytopenia (idiopathic or following cytotoxic chemotherapy) to reduce the risk of haemorrhage by inhibiting natural fibrinolytic d stabilisation of small platelet plugs the requirement for platelet transfusion is thereby reduced. It may also be used for overdose with thrombolytic agents.
Diethylcarbamazine kills both microfilariae and adult worms. Fever, headache, anorexia, malaise, urticaria, vomiting and asthmatic attacks following the first dose are due to products of destruction of the parasite, and reactions are minimised by slow increase in dosage over the first 3 days.
Urticarial rashes and angioedema (types I, III). 3. Anaphylactic shock (type I) occurs with penicillin, anaesthetics (i.v.), iodine-containing radiocontrast media and a huge variety of other drugs. A severe fall in blood pressure occurs, with broncho-constriction, angioedema (including larynx) and sometimes death due to loss of fluid from the intravascular compartment. Anaphylactic shock usually occurs suddenly, in less than an hour after the drug, but within minutes if it has been given i.v. 5. The serum-sickness syndrome (type III). This occurs about 1-3 weeks after administration. Treatment is by an adrenal steroid, and as above if there is urticaria.
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....
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.
Alopecia, rash, contact dermatitis, urticaria, nausea, vomiting, mucositis, diarrhea, abdominal pain, fever, chills, and (occasionally) anaphylaxis are observable. When given along with cyclophosphamide, its cardiotoxicity is enhanced and enhanced toxicity is seen when given concurrently with methotrexate.
Sixteen patients (6 men and 10 women) with mastocytosis underwent bone density measurements of the PA spine, hip, and total body with DXA (Lunar DPX) and of the distal right radius and ulna with SPA (Osteometer DT 100, Roedovre, Denmark) (66). BMD results from the patients with mastocytosis were compared to a reference population of 317 men and 1123 women from the local population. Both low bone density and increased bone density were found in the patients with mastocytosis. Bone density in the proximal femur was increased in both men and women with mastocytosis if there was increased methylimidazoleacetic acid excretion. In patients with moderately increased mast cell mass, low bone density in the proximal femur, and vertebral fractures were seen. Fractures are thought to occur in approximately 16 of patients with mastocytosis (67). In patients with only urticaria pigmentosa, no change in bone density is apparent. In patients with systemic disease however, the changes in bone density...
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.
C1 esterase inhibitor (C1 INH) deficiency is an inherited autosomal and recessive complement disorder associated with the disease hereditary angioedema (HAE). HAE may result from the synthesis of a mutated C1 INH protein or insufficient production of a normal protein. Clinical manifestations are recurrent episodes of facial tongue and laryngeal edema that may cause obstruction of the upper airways. C1 INH deficiency may lead to edema of the gastrointestinal tract which presents as colic or diarrhea. These clinical manifestations occur following
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.
The drug causes formation of tissue-sensitising IgE antibodies that are fixed to mast cells or leucocytes on subsequent administration the allergen (conjugate of drug or metabolite with tissue protein) reacts with these antibodies, activating but not damaging the cell to which they are fixed and causing release of pharmacologically active substances, e.g. histamine, leukotrienes, prostaglandins, platelet activating factor, and causing effects such as urticaria, anaphylactic shock and asthma. Allergy develops within minutes and lasts 1-2 hours.
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