Natural Chronic Hives Treatment Systems
Urticaria is a common, transient eruption of erythematous and oedematous papules and plaques, usually associated with pruritis. When dermal and subcutaneous tissues are involved, this reaction is known as angio-oedema. Urticaria and angio-oedema are associated in 50 of cases. They can be complicated by a life-threatening anaphylactic reaction. Urticaria, angio-oedema and anaphylaxis are generally a type I hypersensitivity reaction mediated by IgE antibodies. But other ''anaphylac-toid'' mechanisms, leading to direct and non-specific liberation of histamine or other mediators of inflammation, are also common for drug reactions. Clinically, itchy erythematous, oedematous papules and plaques develop in variable numbers and size (Figure 34.2, between pp. 426 and 427). They are localized anywhere on the body, including the palm, soles and scalp. They frequently last a few hours and disappear within 24 hours, leaving the skin with a normal appearance. Angio-oedema is often associated with...
The Coombs-Gell classification (30) and (b) immunological contact urticaria or J described as ''contact urticaria syndrome''(31). This syndrome is characterized by local or generalized urticaria, urticaria with extracutaneous reactions such as asthma, rhinoconjunctivitis, and gastrointestinal involvement and, ultimately, anaphylaxis (type I reactions after Coombs-Gell (30,32).
Angioedema is a rare (0.1 -0.2 ) but potentially fatal side effect. A. Angiotensin II receptor blockers (ARBs) decrease BP by inhibiting the coupling of AII to the angiotensin receptor. ARBs are as effective as other major classes of antihypertensives at reducing BP. In contrast to ACE inhibitors, ARBs have not been shown to slow the progression to renal failure in patients with diabetes. ARBs do not cause cough or angioedema, but they may cause hyperkalemia. B. These agents are appropriate alternatives for patients who are candidates for an ACE inhibitor but cannot tolerate these agents due to cough or angioedema.
Edema is the collection of fluid in the tissues of the dermis. This is usually localized at least to a particular area of the body. When individual lesions take the form of a small area of swelling with associated pruritis, the eruption is called urticaria. The edema may be extensive, involving either the face or part of an extremity. When the edema involves the face, the eyes may be forced shut by the swollen tissues. Edema is seen in numerous systemic disorders, but there are usually enough other symptoms of the underlying disease to prevent confusion with a skin reaction to an allergen.
ACE Inhibitors are often initiated immediately after a heart attack or when a patient still has mild symptoms of heart failure. The starting dose is low and titrated (gradually increased) up to the maximum tolerated dose (based on heart rate and blood pressure). The most bothersome side effect is a dry cough which develops in some patients. Other side effects include angioedema (facial swelling) and elevated potassium levels.
The classic Gell and Coombs classification has been adapted by Janeway and colleagues ( 52). Subsequently, Kay further expanded the adaptation (53). Type II reactions have been divided into two different subtypes. Type IIa are characterized by cytolytic reactions, such as are produced by antibodies causing immune mediated hemolytic anemia, whereas type IIb reactions are characterized by cell-stimulating reactions such as are produced by thyroid-stimulating antibody in patients with Graves disease or antibodies to the high-affinity mast cell receptor in chronic idiopathic urticaria. The latter antibodies cause mast cell activation.
In warm-blooded hosts, anisakid larvae will attempt to develop to maturity in their normal hosts they will succeed, but in abnormal ones - man being one - they may fail. In man, clinical symptoms of anisakidosis include nausea, vomiting, abdominal and gastric pains, diarrhoea, and sometimes urticaria. Some ingested larvae pass through the digestive tract and are voided via anus, but the majority attempt to attach to, and bore into, the mucosa of the digestive tract, challenging the host's defences, resulting in oedema, eosinophilia, and often eliciting acute gastric pains. In Japan, suspected cases of gastric anisakidosis are now routinely diagnosed by gastric endoscopy, and forceps attached to the instrument can easily remove any visible larvae. Intestinal anisakidosis is difficult to diagnose by endoscopy in such cases X-rays, ultrasound, immunodiagnosis, and serodiagnosis (see Ishikura and Kikuchi 1990) are options. Anisakis simplex larvae may even migrate into other organs, such...
Histamine, generated by decarboxylation of histidine, was the first mast cell mediator to be identified, and it is the sole preformed mediator in this functional class. It is bound to the proteoglycans of mast cell and basophil granules (5 and 1 mg 106 cells, respectively) (2.4,2.5). Histamine circulates at concentrations of about 300 pg mL with a circadian maximum in the early morning hours (26). Histamine excretion exceeds 10 mg 24 hours a small fraction is excreted as the native molecule, and the remainder as imidazole acetic acid or methyl histamine. Histamine interacts with specific H,, H2, and H3 receptors (2.7,28). H receptors predominate in the skin and smooth muscle H2 receptors are most prevalent in the skin, lungs, and stomach and on a variety of leukocytes and H 3 receptors predominate in the brain. The biologic response to histamine reflects the ratio of these receptors in a given tissue. H 1 histamine effects include contraction of bronchial and gut musculature, vascular...
The most potent and selective eosinophil-directed agent is PAF, ( 33) which induces skin or bronchial eosinophilia. Other, less active eosinophil-directed mast cell products include the tetrapeptides Val or ala-gly-ser-glu (eosinophil chemotactic factor of anaphylaxis ECF-A ) ( 49) and others having a molecular weight of 1,000 to 3,000. The latter ones have been found in the blood of humans after induction of physical urticaria or allergic asthma. ECF-A is capable of inducing PAF production by eosinophils (50).
'Skin bends', manifested as pruritus and urticaria affecting the hands, wrists, and trunk, are caused by subcutaneous microbubbles probably combined with a localized inflammatory reaction. Sometimes skin bends are accompanied by marbling or mottling of the affected skin area (cutis marmorata). Localized soft tissue swelling is believed to be due to obstruction of lymphatic vessels by microbubbles.
In few cases, a local urticaria, may develop near the penetration site. Usually about 10 to 15 hours after penetration, discrete papules, 3 to 5 millimeters in diameter, replace the maculae. The development of the papules is accompanied by an intense itching. They are distinct, indurate and surrounded by a zone of erythema, the size of which depends usually on the amount of rubbing or scratching induced by the pruritus. The area surrounding them may be edematous especially after rubbing or scratching. Not infrequently in heavy exposures, the papules become confluent, and the whole area is swollen and edematous. On the second or third day vesicules form on them and these are often ruptured by rubbing or scratching. The papules, usually disappear in about a week after infection, leaving small pigmented spots on the skin. The itching, except in very severe cases, is sporadic and intermittent and usually disappears after several days. The lesions may become pustular from secondary...
Mast cells contain large amounts of the vasoactive amines, such as histamine, which cause vasodilatation and increase vascular permeability, leading to urticaria. They also release other mediators of inflammation, particularly those derived from arachidonic acid. They bind IgE very tightly to their surface, and cross-linking of this leads to mast cell degranulation. Mast cells are potent cellular mediators of inflammation, whose physiological role is probably in defense against parasite infection.
Comparing the rates of IMMP (intensified) spontaneous reporting of specific events with the rates from using PEM questionnaires. An-gioedema urticaria, extrapyramidal effects and blood dyscrasias were as likely to be reported spontaneously as with PEM. Conversely, cardiac dysrythmias, dry mouth, dyspepsia, constipation, death and events suggesting immunological disorders were, by comparison, very unlikely to be reported spontaneously. Other events ranged between these two extremes. It needs to be emphasised that this refers to IMMP intensified spontaneous reporting which has a higher rate of reporting than the standard spontaneous reporting programme in NZ. It follows therefore that studies on specific drugs are not comparable unless the reporting rates are similar. Similarly, rates of reporting may provide a guide as to what types of reactions may have been missed.
Tricyclic antidepressants, originally synthesized for their antihistaminic properties in the 1950s, were never fully developed as antihistamines once it was recognized that they have impressive antidepressant effects (63). Because doxepin has a very high H-, receptor affinity, it has become an acceptable alternative agent for the treatment of chronic idiopathic urticaria (64). Interestingly, the observation that the butyrophenone antipsychotic, haloperidol, also has antihistaminic properties eventually led to the development of the derivative, terfenadine ( 40).
You ask about vermilion wax positively it was not in the state of comb, but in solid bits and cakes, which were thrown with other rubbish not far from my hives. You can make any use of the fact you like. Combs could be concentrically and variously coloured and dates recorded by giving for a few days wax darkly coloured with vermilion and indigo, and I daresay other substances. You ask about my crossed fowls, and this leads me to make a proposition to you, which I hope cannot be offensive to you. I trust you know me too well to think that I would propose anything objectionable to the best of my judgment. The case is this for my object of treating poultry I must give a sketch of several breeds, with remarks on various points. I do not feel strong on the subject. Now, when my MS. is fairly copied in an excellent handwriting, would you read it over, which would take you at most an hour or two, and make comments in pencil on it and accept, like a barrister, a fee, we will say, of a couple...
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.
This syndrome is principally reported in children and typically includes fever, arthralgias and rash (morbilliform, urticaria) and lymphadenopathy (Roujeau and Stern, 1994 Knowles et al., 2000). It occurs 1 to 3 weeks after drug exposure. Unlike true serum sickness reaction, hypocomplemen-temia, immune complexes, vasculitis and renal lesions are absent. This reaction occurs in about 1 in 2000 children given cefaclor, which, with minocycline, penicillins, and propranolol are the main drugs responsible for this eruption.
Platinum and the platinum group metals (Ru, Os, Rh, Ir, and Pd) have a strong binding capacity for the electron donor groups in amino acids and have the ability to form chelates. This behavior determines their inactivating effect on enzymes and cell division and, in turn, makes them potential antibacterial and chemothera-peutic agents, as well as immunosuppressants (1-3). Platinum and its complexes stand out especially among platinum group metals for their activity in biological systems. From the perspective of occupational medicine, platinum salts represent a serious hazard, causing asthma, rhinitis, urticaria, and dermatitis. Platinum coordination complexes, a relatively new class of drugs with significant antitumor activity, appear to selectively interact with cellular DNA. Specifically, such activity is found in the neutral platinum complexes, and in the cis, e.g., cisplatin, or ds-Pt(NH3)2Cl2, rather than trans isomers. Cisplatin binds to DNA by forming intrastrand crosslinks in...
Losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro) are Angiotensin II blockers that block angiotension II at the receptor site. ACE inhibitors and angiotensin II receptor antagonists are less effective for treating hypertension in African-American persons. They both may cause angioedema. Angioedema is very similar to urticaria, with which it often coexists and overlaps. The swellings occurs especially in the lips and other parts of the mouth and throat, the eyelids, the genitals, and the hands and feet. Angioedema is life-threatening if swelling in the mouth or throat makes it difficult to breathe. Less often the sheer amount of swelling means that so much fluid has moved out of the blood circulation that blood pressure drops dangerously.
Immunotherapies hasten immune recognition of HPV by the body. Imiquimod 5 cream is an immune response modifier approved in the United States for the treatment of genital warts. When applied to the skin, Imiquimod induces production of interferon-a, TNF-a, IL-1, IL-6, and IL-8. Many small case series or single case reports have anecdotally reported a variety of successful regimens of Imiquimod application for common warts in children. The most effective regimen reported has been a twice-daily application. Usage under a diaper is inadvisable, as severe ulceration may result 70-76 . Other topical immunotherapies used in children include diphencyclopropenone (DCP) and squaric acid (SADBE) 77-79 . SADBE has been described for office or home usage, while DCP is generally used in-office 80-82 . Clearance rates in published studies have varied from 58-90 with eczematous side effects being common and rare urticaria 79 . Oral cimetidine in standard pediatric dosage can enhance wart clearance,...
Typical idiosyncratic reactions to contrast media are urticaria (hives), diffuse cutaneous and subcutaneous edema (angioedema), upper airway (laryngeal) edema, bronchospasm, and hypotension with tachycardia. However, there is some overlap with nonidiosyncratic reactions. Subclinical bronchospasm and vasodilatation (which in pronounced cases may produce hypotension) may be detectable in many patients if carefully looked for these manifestations are probably related to the direct physiologic effects of contrast media rather than an allergic-like response.
Goldsobel AB, Rohr AS, Siegel SC, et al. Efficacy of doxepin in the treatment of chronic idiopathic urticaria. J Allergy Clin Immunol 1986 78 867. 86. Wanderer AA, St. Pierre JP, Ellis EF. Primary acquired cold urticaria double blind study of treatment with cryproheptadine, chlorpheniramine and placebo. Arch Dermatol 1977 113 1375. 87. Bernstein IL, Bernstein DI. Efficacy and safety of astemizole, a long-acting and nonsedating H1 antagonist for the treatment of chronic idiopathic urticaria. J Allergy Clin Immunol 1986 77 37. 88. Fox RW, Lockey RF, Burkantz SC, et al. The treatment of mild to severe chronic idiopathic urticaria with astemizole double-blind and open trials. J Allergy Clin Immunol 1986 78 1159.
Allergic contact dermatitis and even burns from prolonged skin contact with the cloves have been reported. Systemic allergy with bronchospasm or hives from ingestion occurs rarely. There is some concern that chronic high doses may lead to decreased hemoglobin production.
The larvae penetrate skin that is in contact with contaminated water and then migrate through the lymphatics and blood vessels to the liver. After maturing, schistosomes migrate into the mesenteric or vesicular vein, where the adults mate and release eggs. The eggs secrete enzymes that enable them to pass through the wall of the intestine (Schistosoma mansoni and Schistosoma japonicum) or bladder (Schistosoma haematobium). In addition, some eggs may be carried to the liver or the lung by the circulation. Penetration of the skin is associated with petechial hemorrhage, some edema, and pruritus that disappears after about 4 days. Approximately 3 weeks after trematode penetration, patients complain of malaise, fever, and vague intestinal symptoms. With the laying of eggs, acute symptoms of general malaise, fever, urticaria, abdominal pain, and liver tenderness are reported. Diarrhea or dysentery is associated with infestations by S. mansoni and S. japonicum, whereas...
Tomazic VJ, Shampaine EL, Lamanna A, et al. Cornstarch powder on latex products is an allergen carrier. J Allergy Clin Immunol. 1994 93 751-758. Swanson MC, Bubak ME, Hunt LW, et al. Quantification of occupational latex aeroallergens in a medical center. J Allergy Clin Immunol. 1994 94 445-451. Karathanasis P, Cooper A, Zhou K, et al. Indirect latex contact causes urticaria anaphylaxis. Ann Allergy. 1993 71 526-528. Grattan C, Kennedy C. Angioedema during dental treatment. Contact Dermatitis. 1985 13 333. Cohen D, Scheman A, Stewart A, et al. American College of Dermatology's position paper on latex allergy. J Am Acad Dermatol. 1998 39 98-106. Turjanmaa K, Reunala T, Rasanen L. Comparison of diagnostic methods in latex surgical glove contact urticaria. Contact Dermatitis. 1988 19 241-247. Konrad C, Fieber T, Schupfer G, et al. Comparing the Enzyme Allergosorbens and Coated Allergen Particle tests for latex allergy Which in vitro test should be chosen by an anesthesiologist Anesth...
Hair itself is not an important allergen because it is not buoyant or water soluble. Water-soluble proteins of epidermal or salivary origin that are attached to the hair are important allergens, however. Dander is a term used to describe desquamated epithelium. Desquamation is a continuous process for all animals, and the dander materials contain many water-soluble proteins that are highly antigenic and allergenic. Saliva also is rich in proteins such as secretory IgA and enzymes. People commonly develop local urticaria at the sites where they have been licked by a cat or dog or where they have been scratched by claws or teeth. Rodents excrete significant amounts of allergenic protein in their urine. All of these substances become part of the amorphous particulate matter of the air and are responsible for allergic morbidity.
RASpolymorphisms associated with adverse reactions to ACE inhibitors In general, ACE inhibitors are well tolerated in young and older adults and improve a variety of cardiovascular functions. However, the RAS polymorphisms have been associated with adverse reactions, such as the ACE inhibitor-related cough and other effects (e.g., angioedema). The II genotype has been associated with increased susceptibility to the development of cough during the treatment period (161). After 4 weeks of therapy, the threshold of cough was significantly reduced for individuals bearing the II genotype but not in individuals bearing the DD genotype. The reported incidence of dry cough is variable, and the reason why ACE inhibitors cause coughing in only certain individuals is still unclear. However, the appearance of this cough in association with ACE inhibitors is thought to be related to the activity of the bradykinin B2 (BDKRB2) receptor gene (162), because treatment with these agents increases the...
Acquired Angioedema histamine mediated inflammation (Urticaria) secondary to a variety of substances 2. Congenital (Hereditary) Angioedema deficiency in C1 esterase Common Causes of Acquired Angioedema medications (ACE inhibitors, ASA, antibiotics, NSAIDs), food allergies (eggs, peanuts), insect bites, transfusions, infections (Hepatitis B, viral infections), emotional, other allergens 3. consider prophylactic Danazol for Hereditary Angioedema (increases C1 esterase inhibitor)
The onset of action by the intravenous route is slower than that of the b-agonists because of the need to deliver it over 20 to 30 min. Side-effects include nausea and vomiting, central nervous system irritability and seizures, flushing, hypotension, and a variety of tachyarrhythmias including cardiac arrest. Seizures due to theophylline toxicity are often difficult to treat. The ethlyenediamine component of aminophylline can cause urticaria, erythema, and exfoliative dermatitis. Cautions include liver disease, epilepsy, cardiac disease, and pregnancy.
Kallikrein activation, producing kinins, has been implicated as a cause of reaction to plasma products. The role of the bradykinin system is important patients using angiotensin-converting enzyme inhibitors for the first time can develop angioedema. Angiotensin-converting enzyme inhibitors block kininase, which promotes the conversion of angiotensin I to angiotensin II but is also responsible for the breakdown of bradykinin. Interactions between angiotensin-converting enzyme inhibitors and plasma products have been described.
Reactions usually begin within minutes of exposure. Symptoms can run the entire spectrum from mild (skin redness, hives, itching), to more severe (cough, hoarse voice, chest tightness, runny nose, itchy or swollen eyes), to life-threatening (bronchospasm and shock). Type I reactions from latex exposure have been reported in patients and health care workers and in a variety of clinical settings, including vaginal deliveries,30 gynecological examinations,31 dental procedures,32 intra-abdominal33 and genitourinary surgery and during the act of donning gloves.34 Current data indicate a prevalence of latex sensitization of 12.5 percent to 15.8 percent among anesthesiologists and nurse anesthetists.14'1 Brown et al. identified predisposing risk factors such as skin symptoms with latex glove use (hives, rash, itching), a history of atopy and a history of allergy to certain fruits (bananas, avocados, kiwis). In contrast to most other studies, duration of exposure to latex gloves, either by...
Injectable iron dextran, containing 50 mg of iron per mL, is supplied in a 2-mL single-dose vial. Adverse reactions include headache, dyspnea, flushing, nausea and vomiting, fever, hypotension, seizures, urticaria, anaphylaxis and chest, abdominal or back pain. A small test dose (0.5 mL) should be given to determine whether an anaphylactic reaction will occur. If the patient tolerates the test dose, the full-dosage may then be given at a rate of 50 mg per minute, up to a total daily dosage of 100 mg.
Allergies to the local anesthetics are rare and are usually specific to ester-type agents. These allergic patients can usually be given amide-type agents because cross-reactivity between local anesthetics is rare. A true history of allergy will include the development of hives, wheezing, cardiac arrest, or shock. Most patients who claim a local allergy often have really had an adverse reaction. Symptoms of palpitations and nervousness may be a response to an additive such as Paraben or epinephrine. Patients may be describing the sequelae of inadvertent intervascular injections (4).
In sepsis-related distributive hypotension, clinical findings generally include signs of decreased systemic resistance and a hyperdynamic circulatory response (e.g. warm skin, tachycardia, increased pulse pressure, and tachypnea). Both anaphylaxis and anaphylactoid reactions invariably cause flushing and tachycardia, but may also present with symptoms indicating an advanced form of an allergic reaction including urticaria, dyspnea, laryngeal edema, bronchospasm, or abdominal cramps and nausea.
Several studies have confirmed the high incidence of ADRs in elderly patients taking antihypertensives. For example, on a geriatric ward de V Mering noted severe cough induced by captopril, enalapril-induced angioedema and bronchospasm, peripheral vascular symptoms caused by ,3-adre-noceptor blockers and gout precipitated by thia-zides (de V Mering, 1991). In the community, 3.1 of respondents reported an ADR with propranolol, 2.5 with methyldopa and 2.2 with nifedipine (Chrischilles et al., 1992a). For patients admitted to geriatric wards, antihyperten-sive drugs were a frequent cause of ADRs leading to hospital admissions (Hallas et al., 1992). The fl-adrenoceptor blockers were a particularly common cause, and in some patients had been prescribed despite contraindications (Gosney and Tallis, 1984 Lindley et al., 1992).
When I beheld how long a letter you had written. I know that you are indomitable in work, but remember how precious your time is, and do not waste it on your friends, however much pleasure you may give them. Such a letter would have cost me half-a-day's work. How capitally you seem going on I do envy you the sight of all the glorious vegetation. I am much pleased and surprised that you have been able to observe so much in the animal world. No doubt you keep a journal, and an excellent one it will be, I am sure, when published. All these animal facts will tell capitally in it. I can quite comprehend the difficulty you mention about not knowing what is known zoologically in India but facts observed, as you will observe them, are none the worse for reiterating. Did you see Mr. Blyth in Calcutta He would be a capital man to tell you what is known about Indian Zoology, at least in the Vertebrata. He is a very clever, odd, wild fellow, who will never do what he could do, from not sticking...
Hypersensitivity reactions are immunological reactions that cause tissue damage. Type I hypersensitivity reactions mediated by cell-bound IgE antibodies occur immediately after exposure to antigen. The reactions are caused by the release of mediators from mast cell granules. Localized anaphylactic reactions include hives, hay fever, and asthma generalized reactions lead to anaphylactic shock. Immunotherapy is directed toward
Mercury compounds have been administered for medical purposes since the earliest times, applied directly to the skin, or given by mouth, and more recently by intramuscular or intravenous injection. Hypersensitivity (i.e., contact sensitivity) to mercury as a consequence of medicinal administration was first described in 1895 (93). Like other transition group elements and highly electropositive heavy metals, such as lead and cadmium, mercury can act as a coordination center for electronegative groups (SH groups and disulfide bridges, cysteinyl and histidyl residues) present in proteins, purines, and pteridines. Such complexation can cause conformational changes and hence immunogenicity (94). Hypersensitivity reactions to host proteins haptenized by mercury following skin contact or systemic exposure can be (a) of type I or anaphylactic, mediated by immunoglobulin E (IgE) (presenting clinically as urticaria) (b) of type III or Arthus reactions involving antigen-antibody complexes with...
Sinus problems, hay fever, bronchial asthma, hives, eczema, contact dermatitis, food allergies, and reactions to drugs are all allergic reactions associated with the release of histamine and other autocoids, such as serotonin, leukotrienes, and prostaglandins. Histamine release is frequently associated with various inflammatory states and may be increased in urticarial reactions, mas-tocytosis, and basophilia. Histamine also acts as a neu-rotransmitter in the central nervous system (CNS). Upon release from its storage sites, histamine exerts effects ranging from mild irritation and itching to ana-phylactic shock and eventual death.
Pheromones are also used for other purposes. For example, honeybees use pheromones to identify their own hives and to recruit other members of the hive in attacking animals that threaten the hive. Some insects secrete pheromones to attract mates. The female silkworm moth, for example, can attract males from several kilometers away by secreting less than 0.01 pg of a pheromone. Sensory hairs on the large antennae of a male moth make it exquisitely sensitive to the pheromone.
Release of MMA monomer in the general circulation is a potential cause of adverse general reaction after cement injection. MMA monomer was constantly found in blood samples taken from the radial artery and the inferior vena cava during hip replacement (30). However, although a decrease in blood pressure was sometimes associated with the peak value of the monomer, no statistical relationship was found between the monomer concentration and the hypotensive event. Absence of systemic allergic manifestation such as hives, erythema or bronchodilatation makes an allergic reaction unlikely.
Numerous studies have been undertaken to examine the clinical utility of H 2 antagonists in allergic and immunologic diseases. Although several studies report that these agents have promising immunologic changes in vitro, these findings have not been substantiated clinically ( 3,22,113,114,115,116 and 117). Generally, H2 antagonists have limited or no utility in treating allergen-induced and histamine-mediated diseases in humans ( 118,119,120 and 121). One notable exception to this rule may be their use in combination with H antagonists in the treatment of chronic idiopathic urticaria (122). The studies evaluating the clinical efficacy of H 2 antagonists in allergic and immunologic disorders are extensively reviewed elsewhere ( 3,117).
This drug-induced eruption corresponds to a cutaneous necrotizing vasculitis consisting of palpable purpuric papules, which predominate on the lower extremities (Figure 34.4, between pp. 426 and 427). Urticaria-like lesions, ulcers, nodules, hemorrhagic blisters, Raynaud's disease and digital necrosis also occur. The vasculitis may involve other organs, with fever, arthralgias, myalgias, headache, dyspnea, neurological involvement and renal abnormalities, sometimes life-threatening. The histology of small blood vessels exhibits necrotizing and or leukocytoclasic vascu-litis. The direct immunofluorescence is often positive, with IgM and C3 deposits on capillary walls.
Almitrine bismesylate is highly lipid soluble and is absorbed from the gut in 2 to 3 h and highly bound to albumin in the circulation. The plasma half-life is about 2 days. Almitrine is mostly lost through bile and is not excreted in the urine. The physiological effect of a single dose lasts for approximately 6 h. Few adverse reactions have been reported in short-term use they include headache, urticaria, diarrhea, chest pain, nausea, and vomiting. The most significant side-effect is possible sensory neuropathy in long-term use, already noted above.
Drug-induced dermatitis is characterized by skin lesions that can be a rash, urticaria, papules, vesicles or life-threatening skin eruptions such as erythema multiforme (red blisters over a large portion of the body) or Stevens-Johnson syndrome (large blisters in the oral and anogenital mucosa, pharynx, eyes, and viscera). As a result of having a hypersensitive reaction to a drug, the patient may form sensitizing lymphocytes. If the patient received multiple drug therapy, the last drug administered to the patient may have caused hypersensitivity and skin eruptions. Drug-induced dermatitis may take a few minutes, several hours, or a day for urticaria (hives) to appear. Certain drugs such as penicillin are known to cause hypersensitivity.
A 32-year-old man with quadriplegia and neuro-genic bladder was admitted to the hospital from a long-term care facility. The patient had vomiting, fever, and cloudy urine. A year ago, the patient developed urticaria, wheezing, and hypotension within an hour after his first dose of nafcillin. Subsequently his penicillin skin test was positive. During the current admission, the physician examiner noted fever, quadriplegia, and chronic indwelling bladder catheter. Laboratory tests revealed leukocytosis in blood and urine. Urine stain showed gram-negative rods, and urine culture grew P. aeruginosa. Which of the following drugs would be most appropriate for this patient 3. A 26-year-old woman, a kindergarten teacher, had pharyngitis last year treated with ampicillin for 3 days. She stopped the ampicillin when she learned her throat culture was negative. Three days after she stopped the ampicillin, she developed a rash. Her physician noted symmetrical erythematous confluent macular-papular...
The severity of myelosuppression seems to be related to prolonged infusions. Because of poor aqueous solubility, pacli-taxel is formulated in polyoxyethylated castor oil (cremophor EL), which leaches the plasticizer out of polyvinylchloride containers and tubings. Cremophor, known to induce histamine release, is most likely responsible for the well-recognized hypersensitivity reactions seen with paclitaxel. Major anaphylactoid manifestations include bronchospasm, urticaria, and hypotension that usually occurs within 2 to 3 minutes after administration. The taxane structure itself may be contributory. Before the routine use of premedication with antihistamines and corticosteroids, severe acute hyper-sensitivity reactions occurred in 20 to 30 of patients treated with paclitaxel in early Phase I trials. With standard premedication, the incidence of major hypersensitivity reactions nowadays is low (less than 5 ) and similar for the 3- or 24-hour infusion. Particularly pertinent to...
Hypersensitivity to the salivary secretions of biting insects exists. Local immediate and delayed allergy to the bites of mosquitoes, fleas (papular urticaria), sand flies, deer flies, horse flies, and tsetse flies has been reported. Other case reports have described generalized reactions to multiple bites (deer fly) consisting of fever, malaise, and hypotension associated with antibodies to the offending insect. Experimental sensitization in humans with flea bites results first in the induction of delayed, and then in immediate, wheal-and-flare hypersensitivity on skin testing. Cottonseed is the seed of the cotton plant. After extracting the oil, which is not allergenic, the seed is ground into meal, which may be used for animal feeds or fertilizer. Cottonseed meal and flour also are used in the baking industry for certain cakes, cookies, and pan-greasing compounds. Cotton linters are the short cotton fibers that adhere to the seeds after the cotton is ginned. These are separated and...
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. Skin and blood tests may be required to find the source of an allergy. For chronic hives, check with a physician that the thyroid is functioning properly and that there are no antithyroid antibodies present. Thyroid hormone replacement therapy may be necessary. Although they may be necessary in...
It is important to test for drug sensitivity by administering a small (200 mg) dose by slow intravenous injection before giving the full amount of suramin. Since adverse reactions occur with greater frequency and severity among the malnourished, greater caution is necessary for patients with advanced trypanosomiasis. An acute reaction in sensitive individuals results in nausea, vomiting, colic, hypotension, urticaria, and even unconsciousness fortunately, this reaction is rare. Rashes, photophobia, paresthesias, and hyperesthesia may occur later these symptoms may presage peripheral neuropathy. Mild albuminuria is not uncommon, but hema-turia with casts suggests nephrotoxicity and the need to stop treatment.
Diloxanide furoate (Furamide) is an amebicide that is effective against trophozoites in the intestinal tract. In mild or asymptomatic infections, cures of 83 to 95 have been achieved in patients with dysentery, cure rates may be less impressive. The drug is administered only orally and is rapidly absorbed from the gastrointestinal tract following hydrolysis of the ester group. It is remarkably free of side effects, but occasionally flatulence, abdominal distention, anorexia, nausea, vomiting, diarrhea, pruritus, and urticaria occur. Diloxanide is excreted in the urine, largely as the glucuronide. It is not available in the United States.
Hydroxychloroquine is approved for the treatment of both systemic and cutaneous lupus erythematosus. Both chloroquine and quinacrine (Atabrine) are also effective in this skin disease. Low-dose chloroquine is used for the therapy of porphyria cutanea tarda in patients in whom phlebotomy has failed or is contraindi-cated. Other skin diseases in which the drugs are useful (after sunscreens and avoidance of sun exposure) include polymorphous light eruption and solar urticaria.
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.
The adverse reactions associated with the use of antibacterial chemotherapy include allergic reactions, toxic reactions resulting from inappropriately high drug doses, interactions with other drugs, reactions related to alterations in normal body flora, and idiosyncratic reactions. Several types of allergic responses occur, including immediate hypersensitivity reactions (hives, anaphylaxis), delayed sensitivity reactions (interstitial nephritis), and hapten-mediated serum sickness.Allergic cross-reactions to structurally related antibiotics can occur. Although an alternative non-cross-reacting antibiotic is generally preferred, desensitization protocols are available for situations in which there is no good alternative.
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