Allergic Reactions Ebook

How To Win Your War Against Allergies

How To Win Your War Against Allergies

Not Able To Lead A Happy Life Because Of Excessive Allergies? Want To Badly Get Rid Of Your Allergy Problems, But Are Super Confused And Not Sure Where To Even Start? Don't Worry, Help Is Just Around The Corner Revealed The All-In-One Power Packed Manual Containing Ample Strategies And Little-Known Tips To Get Rid Of Any Allergy Problems That Are Ruining Your Life Learn How You Can Eliminate Allergies Completely Reclaim Your Life Once Again

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Allergy Relief

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Dampening Inflammation and Allergy to Fungi A Job for Treg Cells

The inflammatory response to fungi may serve to limit infection but may also contribute to pathogenicity, as documented by the occurrence of severe fungal infections in patients with immunoreconstitution disease (Cheng et al., 2000). These patients may experience intractable fungal infections despite recovery from neutropenia and the occurrence of adaptive immune responses. The above considerations imply that immunoregulation may be essential in fine-tuning inflammation and adaptive Th reactivity to fungi and fungal diseases. This imposes a new job upon the immune system. In addition to efficient control of pathogens, tight regulatory mechanisms are required in order to balance protective immunity and immunopathology. To limit the pathologic consequences of an excessive inflammatory cell-mediated reaction, the immune system resorts to a number of protective mechanisms. CD4+ T cells making immunoregulatory cytokines such as IL-10, transforming growth factor (TGF)-P and IL-4 have long...

Predicting and preventing the risks of allergic reaction to transgenic foods

Gastronomy is not a world only of pleasurable aromas and tastes. More than one-quarter of the population in seven countries of the European Union claims to suffer from food allergies or intolerances. Although clinical tests indicate that the actual incidence of such allergies is much lower than commonly believed (about 3.5 of the population), these reactions pose a major public health problem, all the more because the seriousness of the attacks reported is on the rise. In the last ten years the number of cases of ana-phylactic shock caused by a food allergy has quintupled, and many of these attacks are fatal, notably ones triggered by the ingestion of products derived from peanuts. Jean-Michel Wal and his colleagues at the Institut National de la Recherche Agronomique-Commissariat de l' nergie Atomique (inra-cea) Laboratoire d'Immuno-Allergie Alimentaire in Saclay have shown how a protein found in cow's milk triggers allergies despite its resemblance to a human protein that is readily...

Standardization Of Allergenic Extracts

The need to standardize allergenic extracts has been recognized for many years. Variability in antigen composition and concentration is a major problem in both allergy testing and allergen immunotherapy regimens. Without standardization of extracts, there is no accurate system of quality control. The clinician often is forced to alter immunotherapy schedules with each new vial of extract because of lot-to-lot variability. Each allergen extract supplier uses its own assays and rarely compares specific antigen concentrations with competitors. The result of this disparity is that the clinician must bring more art than science to the field of allergen immunotherapy. Fortunately, this is changing, with the requirement for standardization of ragweed pollen, house dust mite, cat dander, and grass pollen extracts. The development of purified and even cloned allergens that can be expressed in bacteria or yeast hosts have allowed the production of vast quantities of allergen extract with little...

The Allergic Reaction

An allergic reaction is simply the overresponse of the immune system to a specific stimulus, usually environmental. This stimulus is called an antigen. There are 4 basic types of allergic reactions. We are all very familiar with the type 1 response. This reaction is seen as a result of hay fever, bee stings, cats, dogs, or even medications. It is the cause of the itchy, watery eyes, and runny nose many of us experience each spring when we cut the grass or stroll through the park. A brief look at the cause of this response will help us better understand the treatment of these conditions. The best solution to the allergy problem is to stop the cycle. The most successful way to do this is to simply eliminate the cause, or antigen. Most of the time, however, it is very hard to identify the antigen, and even if we can, we cannot avoid it. Tear supplements, such as artificial tears, are useful in allergic conjunctivitis because they help to flush the antigen away from the ocular surface....

Allergenicity Prediction

Allergens are proteins that induce allergic responses. More specifically, they elicit IgE antibodies and cause the symptoms of allergy, which has been a major health problem in developed countries 49 . With many transgenic proteins introduced into the food chain, the need to predict their potential allergenicity has become a crucial issue. Bioinformatics, more specifically, sequence analysis methods have an important role in the identification of allergenicity 25, 29 . One approach to allergenicity prediction is to determine, automatically, motifs from sequences in an allergenic database and then search for the identified motifs in the query sequences. Li et al. 40 described an approach where protein sequence motifs were identified using wavelet analysis 35 . The particular example consists of 817 sequences in an allergen database. A 10-fold cross-validation test is conducted where 90 of the sequences are used for motif identification with the remaining 10 being used as query sequence...

Allergies

An allergy is a physical response to an antigen. The antigen can be a common substance that produces little or no response in the general population. Antigens that can trigger allergic reactions include pollen, animal dander (flakes of skin), dust mites, food, and fungal spores. Allergic symptoms are generally mild, including a runny nose, sneezing, watery eyes, or itchy swellings of the skin. However, some people have extreme and life-threatening reactions to allergies. Many of the symptoms of allergy result from the release of histamine by cells that are exposed to the antigen. Drugs called antihistamines help counteract the effects of histamine and can relieve some symptoms of allergies.

Allergic reactions

Anaphylactic and anaphylactoid reactions, ranging in severity from mild dyspnea to bronchospasm, from periorbital swelling to angio-edema, and rarely shock, may sometimes be seen with streptokinase. Urticaria, itching, flushing, nausea, headache, and musculoskeletal pain have also been observed, as have delayed reactions such as vasculitis and interstitial nephritis. Most reactions can be managed with antihistamines and or corticosteroids, but severe reactions mandate immediate cessation of therapy and treatment with adrenergic agents, antihistamine, and or corticosteroid. Minor allergic reactions may occur to a lesser extent with the other fibrinolytic agents.

Allergy

An allergy is the body's reaction to a substance that may be harmless in itself but the immune system misidentifies and treats it as a pathogen. Antibodies, called immunoglobulin E or IgE, react by attacking the substance and in the process histamine is released by the surrounding cells which causes an allergic reaction. The allergic reaction may include itchy nose and throat, nausea, vomiting, diarrhea, skin irritations, hay fever, hives, asthma, high blood pressure, abnormal fatigue, constipation, or hyperactivity. A severe reaction called anaphylactic .shock will swell the larynx, obstruct the airway, and may be fatal. This is an emergency situation and remedied by an injection of adrenalin. Susceptibility to allergy can be genetic or precipitated by emotional stress. A wide range of chemicals in the environment can act as irritants. Common food allergens are peanuts, cow's milk, soy, egg whites, wheat, and shellfish. Excessive protein in the diet can exacerbate symptoms by causing...

Medical Organizations

The American Academy of Allergy, Asthma and Immunology (AAAI) < http allergy.mcg.edu> The American College of Allergy, Asthma and Immunology (ACAAI) The American Academy of Dermatology released its Position Paper on Latex Allergy in July 1998. Among its recommendations are 1) Encourage all food preparation services to use only non-latex gloves. 2) Routinely use latex-safe operating rooms for all trauma surgery. 3) Encourage all medical facilities to exclusively use powder-free gloves with low latex allergen levels. 4) Encourage all medical facilities to provide non-latex gloves for general physical examinations. This document also provides a detailed description of a latex-safe environment. The House of Delegates of the AMA has passed resolutions in 1996 (503, A-96) and 1997 (504, I-97), which supports the appropriate labeling of latex containing medical devices with warnings about possible allergic reactions. The AMA strongly encourages health care facilities to provide non-latex...

Latexfree Products Can Be Ordered Through These

Ownby D, Tomlanovich M, Sammons N, et al. Anaphylaxis associated with latex allergy during barium enema examinations. Am J Roentgenol. 1991 1566 903-908. 9. Vervloet D, Magnan A, Birnbaum J, et al. Allergic emergencies seen in surgical suites. Clin Rev Allergy Immunol. 1999 17 459-467. 12. Yassin MS, Lierl MB, Fischer TJ, et al. Latex allergy in hospital employees. Ann Allergy. 1994 72 245-249. 13. Kelly KJ, Pearson ML, Kurup VP, et al. A cluster of anaphylactic reactions in children with spina bifida during general anesthesia Epidemiologic features, risk factors, and latex hypersensitivity. J Allergy Clin Immunol. 1994 94 53-61. 14. Brown R, Schauble J, Hamilton R. Prevalence of latex allergy among anesthesiologists Identification of sensitized but asymptomatic individuals. Anesthesiology. 1998 89(2) 287-289. 16. Pailhories G. Reducing proteins in latex gloves. The industrial approach. Clin Rev Allergy. 1993 11 391-402. 17. Yunginger JW, Jones R, Fransway A. Extractable latex...

Background

Allergy to natural rubber latex (NRL, or latex), which contains a complex blend of water-soluble plant proteins, has become a major source of concern in clinical practice. The Food and Drug Administration (FDA) has received incident reports of thousands of allergic reactions involving latex-containing medical products, including anaphylaxis, cardiac arrests and deaths. Latex is the inciting factor in at least 10 percent of the anaphylactic reactions reported under anesthesia. Anesthesiologists, nurse anesthetists, operating room and critical care nurses and surgeons are at high risk of developing hypersensitivity to latex as a result of occupational exposure. 1. Patients with a history of multiple surgical procedures, including those with myelomeningocoele (spina bifida) and congenital genitourinary tract anomalies. Patients with spina bifida have a 30-70 percent incidence of latex allergy. 2. Health care personnel with occupational exposure. Latex allergy is a major occupational...

Litigation

Worker's Compensation Disability related claims by employees who have developed latex allergy are growing exponentially. Americans with Disabilities Act (ADA) Under the provisions of the ADA, employers are required to provide reasonable accommodations to employees with medical-related disabilities such as latex allergy. Exactly what this involves will vary

Federal Agencies

NIOSH issued an alert, Preventing Allergic Reactions to Natural Rubber Latex in the Workplace, in June 1997. (DHHS Publication No. 97-135).61 In this, they listed a series of recommendations for employers and workers to minimize exposure to latex. Prominent among these are 1) Use of non-latex products whenever possible and 2) When latex gloves are used, they should be powder-free. The CDC is updating its guidelines for infection control in health care personnel. They describe several strategies for health care workers with Latex Hypersensitivity, including 1) Develop an institutional protocol for managing personnel with latex allergy 2) Provide workers with a non-latex or low-allergen powderless latex gloves and 3) Consider targeted substitution of non-latex gloves and or powder-free latex gloves.

Acute Management

Display prominent signs such as latex allergy or latex alert on the inside of the 5. The details of any allergic reaction should be clearly recorded, including a description of the anesthetic agents and techniques, surgical products used, resuscita-tive measures required, laboratory evaluation as well as the perioperative course. It is important to immediately initiate a laboratory workup because many of the pathog-nomonic findings of anaphylaxis, such as serum mast cell tryptase levels, complement C3 and C4, and histamine will be transiently altered but return to baseline within four hours. With a severe reaction, elevated tryptase levels may persist for longer, even several days. The patient should be referred to an allergist, and the patient's chart should be flagged in order to alert subsequent caregivers. Management of the Health Care Worker With Latex Allergy Health care workers who are regularly exposed to latex are at risk for sensitization. Personnel sensitized to latex...

In Memoriam Jacob J Pruzansky PhD June 20 1921April 5 2001

Jack Pruzansky served as an author in five editions of Allergic Diseases. He spent many hours mentoring fellows in the Allergy-Immunology Division during his 35-year tenure at Northwestern University. After his retirement, he still functioned as a consultant and provided scientific expertise to the division. Jack was an expert on in vitro basophil histamine release and discovered how dilute hydrochloric acid would allow for removal of IgE from basophils. This discovery allowed him to study passive transfer experimentally and led to studies of histamine releasing factors. His intellect and advice helped fellows and faculty stay out ofdark alleys as he would say.

In Memoriam Martha A Shaughnessy BS December 3 1943September 9 1997

Martha Shaughnessy was a chapter author in the last two editions of Allergic Diseases. She had a terrific sense of humor and quick wit. Her contributions to the division included performing immunologic research, writing research papers and grants, teaching fellows, and administration of the Allergy-Immunology Division. She coauthored 71 peer-reviewed papers, 66 of which were in collaboration with other members of the Allergy-Immunology Division. She also coauthored ten book chapters, primarily in areas of allergen immunotherapy and occupational immunologic lung disease, her two major research interests. She was admired and respected

Adverse Reactions To Intravascular Radiographic Iodinated Contrast Media

Adverse reactions can be broadly classified as idiosyncratic (meaning the mechanism for the initiation of the reaction is not understood) and nonidiosyncratic (2). Idiosyncratic reactions have manifestations indistinguishable from those seen with true allergic reactions. Nonidiosyncratic reactions have manifestations that generally do not resemble allergic reactions but instead are believed to reflect physiologic effects of contrast media or direct toxicity of contrast media on a variety of organ systems.

Administering Medication To Pediatric Patients

Before administering medication to a pediatric patient consult with the parents to assess if the patient has allergies to food, medications, and the environment, a family history of allergies, an experience with medications and illnesses, or is taking any other medication or herbal remedies.

Assessing The Elderly

Determine if the patient has any barriers to taking medication safely such as allergies, physical handicaps, memory loss, cultural beliefs, and financial constraints. Also, learn if the patient has support from family, friends, and neighbors. Most importantly, be aware of the cost of medication prescribed to the

Preface to the First Edition

Part II, Mucosal Diseases, addresses the secretory immune system with special reference to mucosal diseases. Section E consists of chapters on the stomach, intestine, and liver, and includes diseases of GALT and intestinal tract, a chain and related lymphoproliferative disorders, gastritis and peptic ulcer, malabsorption syndrome, food allergy, intestinal infections, and diseases of the liver and biliary tract (Chapters 35-42). Section F covers selected areas of lung and lower airway and includes chapters on BALT and pulmonary diseases, mucosal immunity in asthma, respiratory infections, and inhalant allergy (Chapters 43-46). Section G presents information on the oral cavity, upper airway, and mucosal regions in the head and neck (Chapters 47-50), as well as ocular immunity, tonsils and adenoids, and middle ear. Sections H and I are devoted to mammary glands and genitourinary tract, respectively. These sections consist of chapters on milk, immunological effects of breast feeding...

The Central Role of the Tryptophan Metabolic Pathway in Tolerance and Immunity to Fungi

The implication for IDO in immunoregulation in candidiasis may help to accommodate several, as yet unexplained findings. As C. albicans is a commensal of the human gastrointestinal and genitourinary tracts and IFN-y is an important mediator of protective immunity to the fungus, the IFN-y IDO axis may accommodate fungal persistence in a host environment rich in IFN-y. In its ability to downregulate anti-fungal Th1 response in the gastrointestinal tract, IDO behaves in a fashion similar to that described in mice with colitis where IDO expression correlates with the occurrence of local tolerogenic responses. Alternatively, the high levels of IL-10 production, such as those seen in patients with CMC, may be a consequence of IDO activation by the fungus, impairing antifungal Th1 immunity and thus favoring persistent infection (Romani & Puccetti, 2006b). In aspergillosis, the level of inflammation and IFN-y in the early stage set the subsequent adaptive stage by conditioning the...

Longterm Followup and Prevention

Six hours after the initial reaction described in the opening problem statement, the 10-year-old patient develops an episode of tachycardia with shortness of breath. Is this a continuation of the same problem or more likely another allergic reaction

Inhibition of Mediator Actions

The first mediator to be implicated in the pathogenesis of asthma was histamine. Bronchoconstriction induced by histamine is inhibited by histamine H1-receptor antagonists, or so-called classical antihistamines. Drugs of this group include clemastine, chlorpheniramine, asternizole, and terfenadine. In general, antihistamines are administered orally for the treatment of a variety of allergic disease. However, aerosolized clemastine has been shown to cause bronchodilation in asthmatic subjects 71 and to inhibit antigen-induced bronchoconstriction 72 . Interestingly, the aerosol route of administration of the antihistamines appears to be more effective in eliciting bronchodilation than the oral route 73 , an observation related, in part, to the limitation on oral dosage caused by the sedative actions of these drugs. The newer, nonsedating antihistamines (e.g., astemizole, cetirizine, loratadine), while effective in treating some allergic conditions, have proven to...

At The Patients Bedside

Ask the patient if he or she has any allergies to food or medication. The patient may be aware of food allergies such as shellfish, but unaware of allergies to medication. However, patients who are allergic to shellfish are also allergic to some medications. 6. Examine the patient's identification band to see if the patient has allergies. Allergies may be noted on the identification band.

Ocular Phamacodynamics

In conducting human ocular studies, measuring ocular pharmacokinetics in intraocular fluids and tissues is difficult if not impossible. These samples can only be removed at death of the patient or in the case of removal of a diseased eye. As a result, pharmacological response measurements usually replace concentration assays in describing the effect of a drug in the human eye. Unfortunately, responses can vary widely between individuals, presumably because of differences in dose-response relationships and ocular pharmacokinetics (8). Eye pigmentation, wearing of contact lenses, allergies to drug or formulation components, and physiological factors all play a role in causing high variability in response data (8). Nevertheless, pharmacodynamic measurements continue to be applied, and where possible pharmacokinetic data are coupled with pharmacodynamic data.

Signs And Symptoms Of Skin Disease

The most common, most annoying, and least specific symptom encountered in dermatologic conditions is pruritis. Among the causes of itching may be included infectious agents, allergic conditions, neuroses, parasitic infestations, dryness of the skin, anoxia of the skin, and chronic irritation of the skin. The actual pathological change responsible for this symptom takes place in minute nerve endings in the skin. The exact change is not known, but these endings become h. Fever. Fever is usually seen in infectious diseases, but it may also be present in cases of allergy. This is not a common concern to the dermatologist, because disease limited to the skin will not cause fever.

Preface to the Third Edition

Mucosal immunology has grown in the last decade from a discipline of perhaps peripheral interest to the mainstream immunologist into a major subspecialty with implications for the physiology of the entire immune system. An enormous and highly variable load of foreign substances, which includes indigenous mucosal microbiota as well as environmental and food antigens encountered mainly at the vast surface areas of mucosal membranes, has resulted during evolution in a strategic distribution of specialized cells involved in the uptake, processing, and presentation of antigens, the production of antibodies, and cell-mediated immunity at the front line of host defense. Furthermore, the great majority of infectious diseases and potential agents of bioter-rorism directly afflicts or is acquired through the mucosal surfaces of the respiratory, gastrointestinal, and genitourinary tracts. In addition to the induction of protective responses to infectious agents, the unique immunoregulatory...

Histamine The Role of Mast Cells

Numerous natural compounds inhibit the release of histamine from mast cells. This release is referred to as mast cell granulation, since histamine is stored in in-tracellular pouches called granules. Natural compounds that inhibit mast cell granulation are listed in Table 8.3. Note that many of these compounds occur in traditional herbal formulas used to treat asthma and allergies, which are diseases mediated by histamine release. Some compounds listed in the table are PTK inhibitors, which have been reported to inhibit histamine release from mast cells in some circumstances.124,125 PKC inhibitors may also inhibit histamine release.126 Apigenin, luteolin, and EGCG are PTK and PKC inhibitors, and genistein inhibits PTK.

Side Effects And Dosimetric Considerations

Other side effects may arise from allergic reactions to the contrast medium or local anesthetics, thrombosis as a result of immobilization, or flush symptoms or hyperglycemia in diabetic patients owing to systemic resorption of the intra-articularly applied steroids. In diabetic patients, the dose of intra-articular steroids may be reduced, and the patients should be instructed to regularly check their blood glucose levels for the next two days. In patients with a history of thrombosis or other disorders with an increased risk of blood clotting, antithrombotic measures are recommended and the patients should be carefully instructed to watch for any signs of thrombosis after treatment and immobilization of joints of the lower limbs.

Is this an acute or chronic problem

Defined as diarrhea that lasts longer than 4 weeks. Common causes include chronic, nonspecific diarrhea (toddler's diarrhea), lactose intolerance, milk-protein allergy, encopresis, irritable bowel syndrome, various infections, drugs, and IBD. It can present with an acute exacerbation.

Nergies and Anaphyaxis Immediate Hypersensitivity

Allergies and anaphylaxis represent antigen-specific immunologic reactions involving IgE antibodies bound (by their Fc domain) to the membranes of mast cells and basophils (95). When antigen is bound, resulting in cross-linking of the IgE molecules, the mast cells are stimulated to degranulate and release histamine, serotonin, platelet-activating factors, and other mediators of immediate hypersensitivity. The result is the rapid onset of an inflammatory response. Immediate hypersensitivity may develop against a wide array of environmental substances and may be localized (e.g., itching, tearing) or systemic (e.g., involving the circulatory system). The latter may be life-threatening if severe. Treatment involves the prompt administration of pharmaceutical agents (e.g., epinephrine, antihistamines).

Local Complications After Radiation Synovectomy

Radiation exposure and future malignancy Other risks associated with the procedure are allergic reactions to contrast medium and local anesthetics, hyperglycemia in diabetic patients and flush symptoms from steroids, thyreotoxicosis as a result of iodine-containing contrast medium, and thrombosis due to immobilization Patients should be advised to report any worsening or other uncommon changes in the treated joint, and the patient should be given a contact he can reach at any time

Regulatory T Lymphocytes in Pemphigus

There is evidence that Tr1 cells may indeed act in an Ag-specific manner. In nickel (Ni) allergy, nonallergic subjects carry Ni-specific T cells that fulfill the criteria of Tr1 cells based on their cytokine profile (higher IL-10, IL-5, IFN-y, and low IL-4 levels) and their ability to suppress the proliferative response of Ni-activated Th1 cells (Cavani et al., 2000) and may thus be critically involved in the downreg-ulation of Ni-specific Th cell responses in vivo. IL-10+ Tr cells also were detected in patients allergic to bee venom upon specific immunotherapy with phospholi-pase A, which suppressed the proliferative response of allergen-specific Th cells (Akdis et al., 1998). Moreover, the expression of IL-10 increased during specific

General Comments

Cobalt is an essential trace element. It occurs in vitamin B12, which is required by all mammals for hemoglobin synthesis. In humans and all other monogastric species, B12is the only bioavailable form of cobalt, since these organisms are unable to synthesize the vitamin from dietary cobalt. Uptake of cobalt from the diet, therefore, must be in the form of vitamin B12 (1), which is also suspected to exacerbate, if not induce, cobalt allergy (2). Cobalt compounds can pose significant dermal and respiratory toxicity problems, primarily in industry, due to their allergenic potential (3,4) and as causative factors for hard metal disease, a particular form of pneumoconiosis (5). Occurrence of the latter, ranging in form from intense alveolitis to end-stage pulmonary fibrosis, appears to require concomitant exposure to other agents, including tungsten metal dust (6,7). It is prevalent among workers exposed to metal-containing, respirable dust generated in the production and use of hard metal...

Other Specific Therapies

Because of the high cross-reactivity between milk and soy protein, switching to a soy formula is usually ineffective. Most patients respond to an elemental formula (ie, protein hydrolysate formula) and should be maintained on this for 1 year before performing a challenge. Prognosis is excellent, with most infants tolerating milk-containing products by 1-2 years of age.

Receptors and Signal Transduction

Agonists of the H1 receptor are substances like 2,3 (trifluoromethyl)-phenyl-histamine, 2-methylhistamine and 2-(pyridyl)-ethylamine. In addition, different specific antagonists have been found which interact with the H1 receptors. Some of these antagonists have been used in the treatment of allergies, but since they cross the blood-brain barrier they exhibit side-effects within the central nervous system, predominantly tranquilizing effects, by inhibition of cerebral H1 receptors. Therefore, considerable efforts have been made to develop H1 receptor antagonists which do not cross the blood-brain barrier and so are without a sedative effect.

Infectious Conjunctivitis

Infectious conjunctivitis is one of the most common causes of red eye. Infectious conjunctivitis is commonly caused by bacterial or viral infection. The clinical term red eye is applied to a variety of infectious or inflammatory diseases of the eye. Conjunctivitis is most frequently caused by a bacterial or viral infection. Sexually transmitted diseases such as chlamydial infection and gonorrhea are less common causes of conjunctivitis. Ocular allergy is a major cause of chronic conjunctivitis.

Indications For An Immunologic Workup

Although many immune-deficient patients present with a clear history of distinct episodes of infection, the allergist is frequently called on to see patients with less severe, nonspecific symptoms such as nasal stuffiness, chronic and recurrent rhinorrhea, or cough, which may be due to infection, allergy, or other factors. The first step in sorting out such complaints is to try to distinguish whether the symptoms are, in fact, due to infection. Inciting factors, such as seasonality, and clearly identifiable trigger factors may suggest allergic etiologies, but changes in the weather and changes in seasons are frequently accompanied by changes in exposure to infectious diseases. Although many patients with primary immune deficiencies present with recurrent and chronic respiratory infections ( 2,5,6), gastrointestinal disorders are also common in these patients. The combination of recurrent respiratory infections with recurrent gastrointestinal symptoms may prompt immunologic screening...

Diet in the pathogenesis of ibd

The etiology of Crohn's disease and ulcerative colitis has been elusive, and questions regarding the pathogenesis of the disease have led to many proposals, including some related to diet. Over the years there have been theories that a cow's milk allergy was an underlying factor in these diseases. Other related proposals have implicated lack of breast feeding. High sugar consumption and lack of dietary fiber have been suggested to be associated with the occurrence of IBD 19 .

Examination of the eye

Herpes labialis or a dermatomal vesicular eruption (suggestive of shingles) is indicative of a herpetic conjunctivitis. B. Purulent discharge suggests a bacterial infection. Stringy mucoid discharge suggests allergy. Clear watery discharge suggests viral infection.

General Laboratory Screening Tests

The Clinical and Laboratory Immunology Committee of the American Academy of Allergy, Asthma and Immunology has assembled a set of practice parameters for the diagnosis and management of immunodeficiency (37). These may help provide guidelines for the allergist-immunologist and the referring physician to those screening tests that might first be ordered and interpreted by the primary physician, as compared with situations in which referral to the specialist becomes appropriate. Often, the specialist is called by the primary care physician to determine whether a patient should be referred.

Endothelial AMs Involved in Leukocyte Trafficking

VCAM-1 is found at very low levels, if at all, on nonacti-vated ECs, but is upregulated substantially after long-term exposure to cytokines. It is expressed on the surface of IL-1 and TNF activated EC, and similar to the ICAMs, binds to integrins. However, it binds to a different class of integrins with Pj and P7 subunits. The most common ligand for the binding of VCAM-1 is very late antigen-4 (VLA-4, CD49d CD29), found on eosinophils, basophils, mast cells, lymphocytes, and monocytes, but not neutrophils. VLA-4-VCAM-1 binding has been shown to mediate leukocyte rolling and adhesion. In particular, VCAM-1 ligation is essential for eosinophil and monocyte migration, and exposure of ECs to the Th2 dependent cytokines IL-4 and IL-13 (and TNF and IL-1 synergistically) selectively increases VCAM-1 expression, indicating the potential importance of VCAM-1 in Th2-mediated diseases such as allergy and asthma.

Protamines and Other Biologically Important Proteins

Protamines are small basic proteins which provide compact DNA binding in vertebrate sperm. Mammals possess two classes of protamines, P1 and P2. P1 rich in arginine and cysteine, but not histidine, is expressed in all mammals, while P2, which also contains histidines, has been detected in just a few mammalian species, including mice and humans 157,158 . Its presence at the levels of 50-70 of total protamine is, however, required for male fertility in humans 159 . HP2 contains the N-terminal tripeptide albumin-like sequence Arg-Thr-His. Analogous N-terminal sequences, containing histidine in the third position (Xx-Yy-His), are known for their specificity for Cu(II) and Ni(II) binding 18 . They are also present in several human peptide hormones and proteins, human serum albumin (HSA) being the most prominent 160 . The Asp-Ala-His sequence of HSA is the physiological carrier of Cu(II) 161 , and it is also involved in nickel toxicity, providing the antigen for nickel allergy when...

In Memoriam W James Metzger Jr MD October 30 1945November 17 2000

Jim was a fellow at Northwestern University from 1974 to 1976 and spent his career in academic medicine at the University of Iowa and East Carolina Medical School where he was Division Chief of Allergy Asthma and Immunology and Vice-Chair of the Department of Medicine. He moved to Denver to the National Jewish Hospital in Jim had many accomplishments in Allergy-Immunology including the early discovery that allergen vaccine therapy inhibited some of the late airway response to

Was the substance truly blood Was it the patients blood

Causes in children are multifactorial and not completely understood. Can occur in a stressed preterm or a healthy term infant. May be related to maternal medications (eg, tolazoline, a-adrenergic agonists, or NSAIDs). Maternal cocaine use also can be a risk factor. Ingesting certain medications, including aspirin, NSAIDs, and steroids, is a risk factor. Hemodynamically significant GI bleeding can result from standard dosing of NSAIDs. Parents may not consider these as medications, so ask specifically about their use. Stresses, including surgery, burns, increased intracranial pressure, or sepsis, can cause gastritis or ulceration. Other causes include mucosal irritation from milk-protein allergy, a lodged foreign body, gastrostomy tubes, or infection (Haemophilus pylor).

Cautions And Warnings Associated With Local Anesthetics

Some patients are hypersensitive (allergic) to some local anesthetics. Although such allergies are very rare, a careful patient history should be taken in an attempt to identify the presence of an allergy. There are two basic types of local anesthetics (the amide type and the ester type). A patient who is allergic to one type may or may not be allergic to the other type.

Assessment of Protein Quality

The quality of a protein is defined by its ability to support growth in animals. Higher-quality protein produces a faster growth rate. Such growth rate measurements evaluate the actual factors important in a protein (a) pattern and abundance of essential amino acids, (b) relative amounts of nonessential and essential amino acids in the mixture, (c) digestibility when eaten, and (d) presence of toxic materials such as trypsin inhibitors or allergenic stimuli. Methods of determining the quality of a formula or protein source have generally fallen into two categories empiric biologic assays and scoring systems.

Antimicrobialsstuff Microorganisms Die

Medication used to stop the growth of microbials or kill them outright have side effects, some of which can adversely affect the patient. Some cause an allergic reaction while others lead to an exaggerated immune response. Here are a few common ones that you probably recognize

Potential Complications

As with any procedure utilizing iodinated contrast, the patient should be informed that a contrast reaction could occur. To minimize this possibility, only nonionic contrast should be used. Patients with a history of allergy should first receive a course of oral steroid prophylaxis. Bleeding risk is minimal nevertheless, to avoid epidural hematoma, these procedures should not be performed on anticoagulated patients, and patients on chronic aspirin therapy should stop the medication a week prior to the spinal injection.

Umanganese For Pimples

In adults, stress, hormonal fluctuations, and possibly food allergies may be the cause of acne. Oral contraceptives can cause breakouts. Excess dietary iodine irritates the pores and can induce flareups. Iodine is found in iodized salt, shellfish, seaweed, and fast foods in which an average meal can contain 30 times the RDA, and in milk, which can be contaminated from milking equipment and cow medication.10 Acne may be caused by a deficiency in zinc.

Preparing to Administer Antimicrobial Medication

Antimicrobial medication requires the nurse to follow the same general administration procedures that are required for any type of medication. The most critical step is to determine if the patient has allergies to drugs, food, environmental stimuli, and a family history of allergies to antibiotics. There is also a high incidence of cross sensitivity between some antibiotics such as penicillin and cephalasporins. Always display allergies in red and clearly write them on the patient's record. Even if the patient's record indicates that the patient doesn't have allergies, always ask the patient each time you administer the antimicrobial medication. Risk of fluid volume deficit related to adverse GI reaction such as anorexia, nausea vomiting diarrhea, and complications of allergic reaction.

Carbonic Anhydrase Inhibitors

Systemic acetazolamide may cause severe systemic side effects including metabolic acidosis, renal problems, and hepatic necrosis. Owing to its chemical structure, acetazolamide should not be given in cases with a sulfonamide allergy. Under controlled circumstances, acetazolamide is sometimes used for short periods, preferably in older children. Topical carbonic anhydrase inhibitors, such as dorzolamide and brinzo-lamide, are less likely to cause side effects than oral acetazolamide, but seem to be less effective in pressure reduction 45 . Little is known about the disturbance of endothelial function in buphthalmic eyes with extensive Haab striae on treatment with topical carbonic anhydrase inhibitors.

Transdermal Oxybutynin

When we initiate oxybutynin therapy, we will offer patients either 10 mg of Ditropan XL or a 3.9-mg patch. Depending on the response, tolerability, and other factors, some patients may increase the dosage to 15 mg of Ditropan XL or 1.5 to 2 patches weekly. Alternatively, patients may supplement the oxybutynin dosage by adding 2.5 to 5mg of immediate-release oxybutynin as necessary for a social event or travel. As with any anticholinergic agent, it is contraindicated in patients with narrow-angle glaucoma, severe constipation, or an allergy to the medication.

Spontaneous Methods Used At The Case Series Characterization Step

Within the reported case series, different clinical outcomes may be associated with different age groups, gender, dosage, or concomitant medications (Inman et al., 1970 Bateman et al., 1986 Amery, 1994). Halothane-hepatitis is a classic example of the sometimes substantial impact such numerator-only (internal correlative) characterizations can have (Inman and Mushin, 1974). In this instance, a product-AE case series demonstrated a decreasing time-to-onset with increasing numbers of exposures, thereby supporting an associative argument and providing a potential explanatory mechanism (allergy) by which the event could occur. Numerator only'' characterizations are also the basis for many spontaneous registries (e.g. disease or pregnancy outcomes) where the primary interest lies in patterns of relevant features among the cases.

Treatment of Subjects with Type 2 Diabetes Using Pulmonary Inhalation of Insulin

The lungs with their large surface area and the thin alveolar epithelium allow rapid absorption of inhaled insulin 52 . The bioavailability has a range of 15-25 52 . The exubera insulin is a fine powder insulin in doses of 1 or 3 mg, corresponding to approximately 3 and 9 units of human insulin. The clinical trials have shown that the insulin antibody levels increase with the use of inhaled insulin, but this has not been linked to any changes in glycemic control and episodes of hypoglycaemia or allergic reactions 53 . The pharmacokinetic profile of exubera is quite similar to that of rapid-acting insulin analogues, but with a duration of action between that of rapid-acting analogues and fast-acting human insulin 54 .

Chronic Fatigue Syndrome

Chronic fatigue syndrome is characterized by profound fatigue that is not alleviated by sleep, and a myriad of other symptoms including impairment of memory and concentration, muscle pain, and swollen lymph nodes. There is no single cause of the illness and a physician should be consulted to explore all possibilities. Causes may be a viral infection, adrenal gland dysfunction, chemical sensitivity, autonomic nervous system disorder, or food allergy.

Other Adverse Effects

Cholestatic jaundice is observed infrequently, usually during the first few weeks of treatment. This is thought to be a hypersensitivity reaction and is usually mild and self-limited. Cutaneous allergic reactions are occasionally reported. Both types of problems normally disappear upon changing to an antipsychotic from a different chemical class. Photosensitivity usually manifests as an acute hypersensitivity reaction to sun with sunburn or rash, but the condition is generally mild and does not require dosage adjustment.

Human Fungal Diseases

Mold spores can cause mild to serious allergies in some people. Mold spores can become airborne and may then be inhaled, triggering an allergic reaction. Sniffling, sneezing, and respiratory distress are symptoms of an allergic reaction. Some fungi can also infect and poison humans. Table 26-2 lists some human fungal diseases.

Immunologic Disorders

Pasteur is widely quoted as saying, Chance favors the prepared mind. This was certainly the case with Charles Richet in his discovery of hypersensitivities, commonly called allergies, near the end of the nineteenth century. Richet was a well-known physiologist who had discovered, among other things, that the acid in the stomach is hydrochloric acid. Richet also performed early experiments with antisera. He and his colleague, Paul Portier, while cruising in the South Seas on Prince Albert of Monaco's yacht, decided that the Portuguese man-of-war jellyfish must have a toxin responsible for its ugly stings. They made an extract of the tentacles of one such jellyfish and showed that it was very toxic to rabbits and ducks. Hypersensitivity reactions to usually harmless substances are often called allergies or allergic reactions. Antigens that cause allergic reactions are allergens. Hypersensitivities are categorized according to which parts of the immune response are involved and how...

Types Of General Anesthetic Agents

Inhalation anesthetic agents are gases or volatile liquids. These substances are often mixed with oxygen and the patient is allowed to breathe the mixture. After a period, a sufficient level of the anesthetic agent is obtained in the blood and anesthesia is produced. In general, anesthesia can be well controlled with these agents because the concentration of the agent in the blood can be increased or decreased easily by either increasing or decreasing the concentration of the agent in the air the patient is breathing. It is relatively uncommon for a patient to have an allergic reaction to one of the inhalation general anesthetic agents. However, the side effects of some of these agents can be quite serious. There is rapid recovery for the patient when this type of agent is used. That is, when the patient is no longer allowed to breathe the agent, the depression of the central nervous system quickly disappears.

And a few more visitors

Whilst the children pester me for a pet and I dogmatically say no, I cannot escape the fact that our colourful household seems to attract far more than other children We did at one point have seven birds, one for each ofthe children, but as these died they were never replaced and I have to say that as much as they were part of the family and I was sorry to see them go, I was not sorry that I didn't need to clean up feathers and bird poo along with the mess and chaos created by the children. My sister has violent allergies to most animals, Sarah is violently allergic to cats and rabbits, and those are the allergies that we know about .and I am allergic to cleaning up after anything other than my hyper, destructive little two and my lazy, hormonal five teenagers For these reasons we have no pets at the moment.

Resistance to Beta Lactam Antibiotics

The b-lactam family includes the penicillins and cephalosporins and is the best-known and most widely used group of antibiotics. All contain the b-lactam structure, a four-membered ring containing an amide group, which reacts with the active site of enzymes involved in building the bacterial cell wall. Cross-linking of the peptidoglycan is prevented, so causing disintegration of the cell wall and death of the bacteria. Since peptidoglycan is unique to bacteria, penicillins and cephalosporins have almost no side effects in humans, apart from occasional allergies.

Structurerelated Toxicity

Proxicromil and FPL 52757 5 were oral anti-allergy agents that utilized the strongly acidic chromone skeleton as a starting point (Figure 8.3). This skeleton contained the pharmacophore. To achieve oral absorption substantial lipophilicity was added and these changes resulted in surface active (detergent) molecules. The hepatobiliary route of excretion and resultant high concentrations of the compounds at the biliary cannaliculus resulted in hepatotoxicity 5 .

Supplemental Reading

Therapeutic options in allergic disease Antihistamines as systemic antiallergic agents. J Allergy Clin Immunol 2000 106 S303-S309. Nicolas JM. The metabolic profile of second-generation antihistamines. Allergy 2000 55 46-52. Taglialatela M and Annunziato L. Evaluation of the cardiac safety of second-generation antihistamines. Allergy 2000 55 Suppl 60 22-30. Walsh GM et al. New insights into the second-generation antihistamines. Drugs 2001 61 207-236.

Differential diagnostics

A correct diagnosis of swimmers' itch is not always very easy. Similar external symptoms may occur after insect bites and in some communicable diseases, such as chickenpox, measles, and some venereal diseases. Similar symptoms may also sometimes be induced by plants in sensitive persons. The localization of the affected skin areas is important to consider for the differential diagnosis. A history of bathing or immersion of affected skin areas in water is of course most important for a presumptive diagnosis. However, allergic reactions after exposure to blue-green algae (cyanobacteria) have also been recorded (Solomon and Stoughton 1978).

Chapter References

The diverse potential effector and immunoregulatory roles of mast cells in allergic disease. J Allergy Clin Immunol 2000 105 847-859. 2. Bingham CO, Austen KF. Mast-cell responses in the development of asthma. J Allergy Clin Immunol 2000 105 S527-S534. 3. Bernstein JA, Lawrence ID. The mast cell a comprehensive, updated review. Allergy Proc 1990 11 209. 6. Benyon RC, Church MK, Clegg LS, et al. Dispersion and characterization of mast cells from human skin. Int Arch Allergy Applied Immunol 1986 79 332. 15. McGlashan D, Lichtenstein LM, McKenzie-White J, et al. Upregulation of FceRI on human basophils by IgE antibody is mediated by interaction of IgE with FceRI. J Allergy Clin Immunol 1999 104 492-498. 18. Lie WJ, Mue FPJ, Roos D, et al. Degranulation of human basophils by picomolar concentrations of IL-3, IL-5, or GM-CSF. J Allergy Clin Immunol 1998 101 683-690. 20. Siriganian RP. Mechanism of IgE-mediated hypersensitivity. In Middleton E, Reed CE, Ellis EF, et...

Bioaerosols and Disease Donald E Gardner PhD

Bioaerosol monitoring is a rapidly emerging area of industrial hygiene. Airborne sampling for bioaerosols is complex, expensive, and may include measuring bacteria, viruses, fungal spores, endotoxins, allergenic and toxic substances of plant and animal origin, and protein aerosols (3). The airborne concentration may be expressed in different ways, depending on the type of particle. Bacteria and fungal spores, for example, may be expressed in terms of the number of bacteria entities of a given type per unit volume of air (i.e., number per m of air). On the other hand, viable particles may be expressed in terms of their ability to reproduce that is, the number of colony-forming units per unit of volume of air (i.e., cfu per m of air). For endotoxin and allergenic materials, it is appropriate to express concentration in terms of the mass of the active component per unit volume of air (i.e., mg per m of air) Such diversity presents many difficulties in sampling and measurement methodology...

Regarding Contamination Risk

As a simple rule of thumb, the more operations carried out in a given facility or in a given piece of equipment, the more complicated the cleaning situation becomes, and the potential for contamination increases geometrically. Thus, if we want to minimize risk and the occurrence of cross-contamination it would behoove us to manufacture pharmaceutical products in a dedicated facility. This principle is already required by regulations that dictate that very allergenic substances such as penicillin and cephalosporins be manufactured in dedicated facilities 2 . Certain cytotoxic and biotechnology products are also prime candidates for dedicated manufacturing facilities.

Acari mites and ticks

Non-insect arthropods of great medical importance in the northern Holarctic region include several groups of ectoparasitic mites, for example, the minute chigger mite larvae (Leptotrombidium, Neotrombicula) as well as endoparasitic mites (e.g. Sarcoptes scabiei) and the larger ticks (Ixodidae, Argasidae). Mites and ticks (Acari) belong to the class of arthropods denoted as Arachnida. The scorpions, harvest-men, and true spiders also belong to the arachnids. About 30000 species of mites and 800 species of ticks have been described, but about half a million species of mites are believed to exist (Varma 1993). Most Acari, except the nymphs and adults of most ticks, are very minute animals and should preferably be studied with a compound or scanning electron microscope. Nearly all mite species lay eggs. The egg develops to a six-legged larva, which then becomes an eight-legged nymph. Depending on the species there may be one or several nymphal stages. The life-cycle in some species can be...

Centrally acting muscle relaxants

This is a peripherally acting muscle relaxant. Peripherally acting muscle relaxants depress neuron activity at the skeletal muscles and have a minimal effect on the central nervous system. These are most effective for spasticity or muscle contractions caused by chronic neurologic disorders. This is also used to treat malignant hypertension which is an allergic reaction to anesthesia.

Prevention and Treatment

Use of pacifiers beyond the age of two years is associated with a substantial increase in otitis media. Viral infections and other conditions that cause inflammation of the nasal mucosa play a role in some cases. Nasal allergies and exposure to air pollution and cigarette smoke are examples of nasal irritants. Administration of influenza vaccine to infants in day care facilities substantially decreases the incidence of otitis media during the flu season. Ampicillin or sulfasoxazole given continuously over the winter and spring are useful preventives in people who have three or more bouts of otitis media within a six-month period. Surgical removal of enlarged adenoids improves drainage from the eustachian tubes and can be helpful in preventing recurrences in certain patients. In those with chronically malfunctioning eustachian tubes, plastic ventilation tubes are sometimes installed in the eardrums so that pressure can equalize on both sides of the drum (see figure 23.7). In the United...

Immediate Questions

What is the time course of the irritability Acute, unexplained crying is defined as an episode lasting longer than any previous crying episode or more than 2 hours. Although infectious disease appears to be the most common cause, initially consider a broad differential diagnosis. Long-standing or chronic, persistent crying suggests colic, gastroesophageal reflux, milk-protein allergy, increased intracranial pressure, abuse, or an underlying metabolic problem.

The mechanism of anaphylaxis antibodies

IgE is responsible for the majority of true anaphylaxis. Very small concentrations exist in serum, and the majority of the immunoglobulin is bound to mast cells. The physiological role of IgE is not known. Bridging of IgE molecules by antigen leads to anaphylactic mediator release. Elevated levels of IgE are usually found in patients with a history of allergy, atopy, or asthma.

Nonsteroidal antiinflammatory drugs

The clinical properties of NSAIDs include mild to moderate analgesia with a ceiling effect with increasing dose, an anti-inflammatory action, an antipyretic action, reduction in renal blood flow and the glomerular filtration rate, gastric irritation, reduction in platelet adhesiveness, and rare idiosyncratic allergic reactions.

Epidemiology and Demographics

1995,Baggish and Miklos5 performed a meta-analysis of 15 studies with 450 patients in an attempt to more accurately characterize women with vulvar vestibulitis. The typical vulvar vestibulitis patient is white, nulliparous, well-educated, and young. The women have frequently seen multiple clinicians, and have sought treatment for 2 to 3 years before the diagnosis is made. Many are diagnosed with recurrent urinary tract infections, candidal infections, human papillomavirus (HPV), and allergies. An increased rate of prior sexual abuse in these patients has been reported, but is controversial.6,7

Immunogenetics In Infectious Diseases Drug Hypersensitivity

Many hypersensitivity reactions appear to be the result of direct activation of the immune system. There is strong evidence for a role of drugs or drug metabolites as antigens or haptens in major histocompatibility complex (MHC)-restricted T-cell activation. Drugs may be conjugated to intracellular proteins and presented by MHC class I or class II molecules to CD8+ or CD4+ T-cells (164). They may also directly alter the MHC-associated peptide complex with subsequent recognition and activation of peptide-specific CD8+ T-cells (165). MHC alleles have been associated with idiosyncratic reactions to nonsteroidal anti-inflammatory agents, pyrazolone derivatives, trimethoprim-sulfamethoxazole, and contact allergens (166-169). Two recent studies used immunogenetics to approach the problem of early, and some times deadly, hypersensitivity reactions to the reverse transcriptase inhibitor abacavir used in the treatment of HIV infection (170,171). The genetic susceptibility to abacavir...

Adverse Effects Contraindications and Drug Interactions

Zanamivir is generally well tolerated. Bronchospasm and impaired lung function have been reported in some patients taking this medication, but many of these individuals had serious underlying pulmonary disease. Zanamivir should be discontinued if an individual develops bronchospasm or breathing difficulties treatment and hospitalization may be required. Allergic reactions, including angioedema, have been rarely reported. The efficacy of zanamivir depends upon the proper use of the inhaler device.

Daniel Brooks and Robert K Bush

Department of Allergy Immunology, University of Wisconsin, Madison, Wisconsin *Department of Medicine, University of Wisconsin, Department of Allergy, William S. Standardization of Allergenic Extracts QuantiMipn of, Allergens ClasMficatipnof Allergenic,, Plants Anatomy A knowledge of the pathophysiologic mechanisms of the allergic response is essential to the understanding and proper treatment of allergic diseases. Too often, however, inadequate attention is directed to the nature of the allergen in an allergic response. The first and foremost treatment recommendation for allergies is avoidance of the trigger. Such advice is impossible to render without an intimate familiarity with the nature of common environmental allergens. This chapter presents a comprehensive yet lucid overview of allergen biology for the clinician. An allergen is an antigen that produces a clinical allergic reaction. In atopic diseases, allergens are antigens that elicit an immunoglobulin E (IgE) antibody...

Sampling Methods for Airborne Allergens

Increasing attention is being focused on the daily levels of airborne allergens detected in a particular locale. Patients commonly seek out daily reports of ragweed or Alternaria levels, frequently reported in newspapers and on television, to correlate and predict their allergy symptoms. The clinician must be acquainted with the various sampling techniques used to accurately assess the validity and accuracy of the readings reported. All of the methods involve averaging pollen exposure, so these pollen predictions are actually reports of yesterday's levels. Aerobiologic sampling attempts to identify and quantify the allergenic particles in the ambient atmosphere, both outdoors and indoors. Commonly, an adhesive substance is applied to a microscope slide or other transparent surface, and the pollens and spores that stick to the surface are microscopically enumerated. Devices of varying complexity have been used to reduce the most common sampling errors relating to particle size, wind...

General Comments And Immunology

A rare and chemically inert metal similar to platinum, palladium occurs at such low concentrations in alloys (e.g., in jewelry or dental fillings) as to pose no notable toxicological hazard. No acute or systemic effects in humans have been reported, other than the observation of allergic sensitization, which can involve the respiratory system, skin, oral mucosa, and eyes, ascribed to contact with the metal itself. Acute contact dermatistis (ACD) and oral mucosal lesions, such as erosive lichen planus, are the principal clinical expression of palladium sensitivity seen in the general population, acquired mainly from the metal in alloys used in dental prostheses which can contain up to 79 of the metal (1,2). Rare cases of immediate type allergy have been reported (3-8). The prevalence of reactions to dental materials has been on the increase since the introduction of palladium-silver alloys in 1973 as a substitute for other materials containing metals suspected of toxicity or...

HLA Peptide B27PD in EAU

The mechanism of oral tolerance (Mowat, 1987) is usually effective for nutritional proteins, preventing adverse reactions that potentially lead to food allergies. When autoantigens are fed, autoimmune reactions can be suppressed as well, indicating a potential for oral tolerance as a therapeutic approach for autoimmune diseases (Weiner, 1997). Tolerance is mediated by suppressor cells specific for the respective antigen however, the exact mechanisms underlying orally induced suppression are not yet fully elucidated. It is assumed that suppressor T cells recognize the respective antigen and secrete suppressive cytokines, such as TGF-P (Miller et al, 1992), IL-10 (Rizzo et al, 1999 Slavin et al., 2001) (Th3, Tr type), or cytokines belonging to the respective antagonistic Th type of the pathogenic immune response (Weiner, 2001).

Quantitation of Allergens

That most allergenic moieties of pollens are proteins, and that the ratio of protein to dry weight of pollen varies from plant to plant. In this method, nitrogen is precipitated by phosphotungstic acid and measured by the micro-Kjeldahl technique. Total nitrogen is another method of standardization, but it offers no advantage and is used infrequently. Both of these methods are used for other inhalant and food allergens, and clinicians generally must communicate in terms of these standards. Unfortunately, neither the weight per volume method nor the protein-nitrogen unit truly measures allergenic activity, because not all measured proteins and extractable components in the solution are allergenic. In addition, many complex allergens are destroyed during the harsh extraction procedure. Such problems have been circumvented through the use of biologic assays of functional allergen reactivity. Currently, ragweed pollen, grass pollen, house dust mite, and cat allergen extracts are...

Characterization of Allergens

Many methods are available to characterize an allergen. Many of these, such as the determination of protein content, molecular weight, and isoelectric point, are not unique to the study of allergenic compounds. These are simply methods of describing any protein. Several categories of tests, however, are restricted to studying molecules responsible for IgE-mediated symptoms. Both immunologic in vitro methods, such as RAST and Western blotting, as well as in vivo biologic assays, such as end-point dilution skin tests, will be considered here.

Magnetic Resonance Imaging Techniques for the Assessment of Pulmonary Emboli

However, disadvantages of CT include the need for large intravenous injections of potentially nephrotoxic contrast medium and exposure to ionizing radiation 10 . Although CT has already gained wide acceptance as the primary cross-sectional technique to evaluate PE, many patients cannot have a CT examination because of an allergy to iodinated contrast media or severe renal insufficiency. These are not, however, contraindications to magnetic resonance imaging (MRI) evaluation.

RAST Inhibition Assay

The most widely used assay for in vitro potency of allergenic extract is the RAST inhibition method. This test is a variation of the direct RAST. Serum from an allergic individual (containing IgE) is first mixed with the soluble unknown allergen. Next, a standard amount of the solid-phase (immobilized) allergen is added. The more potent the fluid phase allergen, the less IgE is free to bind to the solid-phase allergen ( 32). The technique and its statistical analysis have been standardized. RAST inhibition usually is the key technique to assess total allergenic activity of an extract and is used by manufacturers to calibrate new batches by comparison with the in-house reference preparation. Recently, some workers have raised concern regarding the continued use of RAST inhibition as a standard technique ( 33). The arguments concern the fact that the choice of antigen for the solid-phase reaction is variable and may influence results. In addition, the finite supply of allergenic...

Closer Look at Antigens

Penicillin does not have an antigen effect in most people. However, when penicillin attaches to serum proteins an allergic reaction results in some people. These people are said to be allergic to penicillin. An allergic reaction is a typical immune response.

Particle Problem and Its Multiple Mechanisms

Global initiative for asthma (GINA) and its objectives. Clin. Exp. Allergy 30(Suppl 1), 2-5. This is the asthma classification most accepted worldwide, and it clearly recognizes inflammation as an important feature of asthma and as a target of therapy. More information for doctors and patients can be found at http www.ginasthma.com . 3. Nelson, H. S. (2003). Advances in upper airway diseases and allergen immunotherapy. J. Allergy Clin. Immunol. 111(3 Suppl), S793-S798. 6. Greenberger, P. A. (2002). Allergic bronchopulmonary aspergillosis, allergic fungal sinusitis, and hypersensitivity pneumonitis. Clin. Allergy Immunol. 16, 449-468.

D Other Biological Activities

Gies against food or environmental allergens are mainly induced by the reaction classified as type I allergy, in which induction of allergen-specific IgE plays an essential role. Thus, Monascus pigment may be considered an anti-allergenic substance. In addition, it is clear that lipophylic coloring can be a stimulator of the humoral immune system.122

Ragweed Pollen Antigens

Amb a 1 is a protein contained primarily in the intine of the pollen grain ( 13). It accounts for about 6 of the total protein of whole ragweed extract. Quantitative studies of ragweed-sensitive patients with Amb a 1 have shown a positive correlation with skin test reactivity and leukocyte histamine release, but no correlation with protein-nitrogen content in six commercial preparations of ragweed extract (43). Techniques are available, however, such as radial immunodiffusion, that allow direct quantitation of Amb a 1 in allergenic extracts, and, by use of RAST inhibition, the potency of ragweed allergenic extracts can be assessed. The U.S. Food and Drug Administration (FDA) requires that ragweed allergenic extracts be labeled with their Amb a 1 content. Amb a 1 consists of two fragments, named A and B. These fragments are not bound covalently and are dissociated readily, which results in a significant loss of allergenic activity. Recombination of these polypeptide chains does not...

Grass Pollen Antigens

Worldwide, grass pollen sensitivity is the most common cause of allergic disease. This is because of the wide distribution of wind-pollinated grasses. Important grass species involved in allergic reactions are Lolium perenne (ryegrass), Phleum pratense (timothy), Poa pratensis (June grass, Kentucky bluegrass), Festuca pratensis (meadow fescue), Dactylis glomerata (cocksfoot, orchard grass), Agrotis tenuis (redtop), Anthoxanthum odoratum (sweet vernal), Sorghum halepense (Johnson grass), and Cynodon dactylon (Bermuda grass). The last two are subtropical grasses, whereas the others are temperate grasses. Grass pollens differ from ragweed pollen in their allergenic and antigenic properties, and offer additional immunologic perspectives because of their extensive cross-reactivity. In addition, in contrast to ragweed, grasses typically release their pollen grains in the afternoon. Among the grasses, ryegrass and timothy have been most extensively studied (12,67,68). Examination of a number...

Further Market Withdrawals

Within a week of the release of these study findings, phenylpropanolamine products were voluntarily withdrawn by several companies in the United States.828 2 Novartis Consumer Health voluntarily withdrew its phenylpropanolamine-containing cold and allergy products and announced that they had started to reformulate the products using pseudo-ephedrine as the decongestant ingredient. Over-the-counter phenylpropanolamine-containing products

Glaucoma Medication Preservatives

There is a growing body of literature indicating that higher concentrations of BAK are associated with inflammatory changes in the conjunctiva and even trabecular meshwork.1 If a BAK allergy is suspected, one could consider a provocative test in one eye of a BAK preserved artifical tear to determine if the symptoms of redress and discomfort are re-created i.e. a BAK challenge test.

Adverse Reactions Contraindications and Interactions

Echinacea appears to be a very safe herb, producing only minor gastrointestinal (GI) side effects and an occasional allergic reaction, usually in atopic patients already sensitized to other members of the Compositae plant family. Anaphylaxis has occurred rarely. Use in HIV is discouraged because of the concern that long-term therapy may eventually suppress the immune system.

Other Plant And Animal Allergens

Glues and gums are occasional causes of human allergy. Impure gelatin is the adhesive obtained from the bones and hides of terrestrial animals and fish bones. Other natural glues are made from casein, rubber, and gum arabic. Synthetic adhesives recently have minimized the glue allergy problem, although the amine hardeners used in the manufacture of epoxies have caused asthma and rhinitis in factory workers. In addition to gum arabic, other vegetable gums (acacia, chicle, karaya, and tragacanth) have been reported to cause allergy by inhalation or ingestion. These are used in candies, chewing gum, baked goods, salad dressings, laxatives, and dentifrices. They also are used as excipients in medications. Guar gum is a vegetable gum that recently has been shown to induce IgE-mediated asthma. This gum is used in the carpet industry and affects about 2 of workers in carpet-manufacturing plants. The gum is used to fix colors to carpeting. It is also In hair-setting preparations, gums have...

Noninfectious Conjunctivitis

Symblepharon Treatment

Acute conjunctivitis should be distinguished from the group of allergic forms of conjunctivitis, which can be due to seasonal influences and often affect the nasal mucosa. Examples include allergic conjunctivitis (hay fever Fig.4.17) and vernal conjunctivitis. In giant papillary conjunctivitis, the inflammation is triggered by a foreign body (hard or soft contact lenses. There may also be an additional chronic microbial irritation such microbial contamination of contact lenses. Phlyctenular keratoconjunctivitis is a delayed allergic reaction to microbial proteins or toxins (staphylococcal inflammation). This disease occurs frequently in atopic individuals and is promoted by poor hygiene. The cardinal rule in allergic conjunctivitis is to avoid the causative agent. Desensitization should be performed as a prophylactic measure by a dermatologist or allergist. Long-term treatment includes cromoglycic acid eyedrops to prevent mast cell degranulation. Treatment of acute allergic con-...

Malnutrition syndromes of childhood

Failure to thrive (FTT) can be caused by primary malnutrition, malignancy, and toxin exposure, congenital anomalies (i.e., Bloom's syndrome, Russell Silver syndrome, immune deficiency, GI disorders, and psychosocial eating disorders. For most cases of FTT, the causes can be found with a comprehensive history physical, and limited laboratory studies. Some cases of true FTT have an unknown etiology, with simple under-nutrition due to behavioral abnormalities and inadequate parenting the most common cause. Infants require nutrient rich diets to sustain growth and development. Although rare, exclusively breast fed infants can show signs of growth abnormalities. One cause can be a maternal genetic abnormality in zinc transport into milk, resulting in severe zinc deficiency in the infant 98 . It is widely appreciated that many so-called health food diets and beverages that may be harmless for adults are not appropriate for infants due to their need to maintain continued growth and their...

Fattal Valevsk 2001 On Micronutrient

1 Cunningham-Rundles S, McNeeley DF, Moon A (2005) Mechanisms of nutrient modulation of the immune response. J Allergy Clin Immunol 115 1119-1128 quiz 1129 12 Liu T, Howard RM, Mancini AJ, Weston WL, Paller AS, Drolet BA, Esterly NB, Levy ML, Schachner L, Frieden IJ (2001) Kwashiorkor in the United States fad diets, perceived and true milk allergy, and nutritional ignorance. Arch Dermatol 137 630-636 49 Vandenbulcke L, Bachert C, Van Cauwenberge P, Claeys S (2006) The innate immune system and its role in allergic disorders. Int Arch Allergy Immunol 139 159-165 Bjorksten B, Sepp E, Julge K, Voor T, Mikelsaar M (2001) Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol 108 516-520 Kalliomaki M, Kirjavainen P, Eerola E, Kero P, Salminen S, Isolauri E (2001) Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol 107 129-134 Prescott SL, Macaubas C, Holt BJ, Smallacombe TB,...

Healing Powers Of Secretions History Of Breastfeeding

Finally, several studies have identified intestinal and respiratory tract axes in homing of IgA-committed, antibody- forming cells from the intestinal Peyer's patches and bronchus-associated lymphoid tissues to the mammary glands (Montgomery et al., 1974, 1978 Goldblum et al., 1975 Roux et al., 1977 Fishaut et al., 1981 also see subsequent discussion). During the past 20 years it has become clear that many of the observations made by our ancestors have been proved to be accurate. These include the effects of breastfeeding on mucosal infections, childhood allergy, birth spacing, childhood survival, as well as effects on modulation of immune response and its regulation in autoimmune diseases.

Immunologic Reactions

Immediate hypersensitivity is an allergic reaction induced by a specific antigen (allergen), provoked by reex-posure to the same antigen, and is mediated by specific IgE antibodies in genetically susceptible individuals (atopics). In the most extreme systemic form of the reaction, called anaphylaxis, mast cell- and or basophil-derived mediators can restrict airways leading to asphyxiation and producing potential fatal cardiovascular collapse. Allergies may be thought of as Th2-dependent disease because Th2 cells produce IL-4, which is required for IgE production, and IL-5, which stimulates eosinophilic inflammation, a characteristic of many allergic diseases. This reaction differs from delayed-type hypersensitivity, which is mediated by CD4+ Th1 and CD8+ T cells and macrophages with no central role of antibodies. sonal or family history of allergy, with negative skin tests, and with normal serum levels of IgE. These patients are said to have idiosyncratic asthma.

Pathogenomic Tools Microarrays in the Diagnosis of Microbiologic Agents as Bioweapons

The biodefense array will present a comprehensive, singlestep test to simultaneously identify genetic fingerprints for 26 different bacterial species, 10 viral species, hundreds of their subspecies selected from the National Institute of Allergy and Infectious Disease (NIAID) high-priority pathogen list, and 56 different toxic genes from bacteria. As a result, this array could replace dozens of existing tests. It could even detect an attack where multiple pathogens are used, something current methods may not detect.