Allergy and Asthma Articles

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http://www.foodallergy.org/page/myths

Magician’s asthma.
A 35-year-old male engineer with a 6-month history of rhinoconjunctivitis and asthma, the latter requiring daily medication for control. Further history revealed that he also worked as a professional magician and that he had obtained a rabbit to pull out of a hat 2 months before the onset of symptoms. Skin test results were negative except for rabbit extract. The rabbit was removed from the act, and the patient became free of symptoms off medication.

This journal article has been summarized. The article information is as follows:

Magician’s asthma. Miller JD. J Allergy Clin Immunol. 2009 Aug; 124(2):386; author reply 386-7. Epub 2009 May 27. [J Allergy Clin Immunol. 2009

Anaphylaxis after a cat bite.
A 42-year-old woman with systemic rash and dyspnea following the index finger of her right hand being bitten by her cat. Dyspnea, systemic rash and headache occurred after 30 minutes. Five years after first obtaining the cat, she noticed nasal symptoms and experienced wheal with itching at the bitten part of her skin. She experienced cough and dyspnea once a month. Specific IgE testing was positive for cat dander, dog dander and other common allergens. Prick test of the cat saliva was markedly positive. The major cat allergen Fel d1 is mainly originated from a sebaceous gland of skin and also present in saliva.

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Anaphylaxis after a cat bite.
Maeda Y, Akiyama K.
Allergol Int 2012 Jul 25

Allergy to Car Seats
This is a case report of a female patient showing a delayed allergic reaction to epoxy resin. The allergic contact dermatitis occurred after sitting in her new car equipped with artificial leather seats.

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Hautarzt. Wurpts G, Merk HF. Allergy to car seat. 2010 Nov;61(11):933-4.
Klinik für Dermatologie und Allergologie, Universitätsklinikum Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen. gwurpts@ukaachen.de

Allergen Levels in Your Vehicles
In a 2002 study, dust mite allergen (Der 1) densities in some automobiles were sufficiently high to be risk factors for sensitization and allergic reactions. Most automobile seats had levels of dog and cat allergen that were well above the threshold levels considered to be risk factors for both sensitization and symptoms, regardless of the presence of a pet in the home.

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Relationship among house-dust mites, Der 1, Fel d 1, and Can f 1 on clothing and automobile seats with respect to densities in houses. Ann Allergy Asthma Immunol. 2002 Apr;88(4):410-5.

Co-factor-enhanced food allergy
Alcohol, exercise or non-steroidal anti-inflamatory drugs (NSAID) are frequently mentioned as amplifiers of food allergic reactions but only individual cases or small series have been previously published. A descriptive study including 74 cases of suspected co-factor enhanced food allergy, assessed by skin-prick tests, specific IgE and oral challenges, reports that anaphylaxis accounted for 85.1% of reactions. In 99% of cases culprit food allergens were plant-derived, mainly vegetables and cereals. NSAID were involved in 58%, exercise in 52.7% and alcohol in 12.2%. Lipid transfer protein was the most frequently involved allergen. The study concludes that co-factor enhanced food allergy should be considered when assessing food, alcohol, exercise and NSAID allergic reactions.
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Co-factor-enhanced food allergy.
Cardona V, Luengo O, Garriga T, Labrador-Horrillo M, Sala-Cunill A, Izquierdo A, Soto L, Guilarte M.
Allergy 2012 Jul 30

Unusual Reactions and Cow’s Milk Allergy in Neonates.
A 4-week-old girl presented with acute swelling of hands and feet preceded by a red facial rash. In the days before formula feeding was gradually introduced. This proved to be a rare but severe generalized allergic reaction to cow milk.

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A neonate with acute swelling of hands and feet. [Dutch]
de Boer FA, Rake JP.
Ned Tijdschr Geneeskd 2012;156(11):A2782

Atopic Dermatitis and Urticaria with Allergy to Horses Early in Infancy
This article is in reference to a 4-month-old infant with chronic eczema and recurrent urticaria initially diagnosed as “allergy to cow’s milk resistant to Néocate”. History revealed the presence of horses in the infant’s environment. The allergy workup confirmed early onset IgE-dependant allergy to horse dander (prick-test strongly positive and the presence of specific serum IgE), which led to consider the mechanism of sensitization: via air-borne or garment-bearing particles, or probably by both means.

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Dermatite atopique et urticaire avec allergie précoce au cheval chez un nourrisson : ne pas oublier d’interroger les parents ! / Atopic dermatitis and urticaria with allergic to horses early in an infant: do not forget to question the parents!
M. Pétrus, G. Dutau, F. Tranchard
Revue Française d’Allergologie 2011;51(7):636-639

Wheat Allergy in Children: Outgrowing the Allergy?
The objective of this study was to evaluate the manifestations of wheat allergy and to follow the patients to evaluate whether outgrowing allergy occurs, and when. Eight previously diagnosed wheat allergic patients were re-evaluated together with 13 other new cases. Severe anaphylaxis was seen after wheat ingestion in more than 90% of the patients. Oral tolerance to wheat developed in three patients (37.5%) out of 8 known previous cases who had been followed for eight years, the mean age of oral tolerance to wheat was 68+/-6.36 (range; 36 months to 108 months). Clinical reactions in our wheat-allergic patients were more severe than those reported before. These patients were at risk for developing chronic allergic symptoms such as asthma. Oral tolerance to wheat was occurring in a minority of these patients.

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Follow-up of the wheat allergy in children; consequences and outgrowing the allergy.
Mansouri M, Pourpak Z, Mozafari H, Abdollah GF, Shokouhi SR.
Iran J Allergy Asthma Immunol 2012 Jun;11(2):157-163

Diagnostic Approach to Drug Allergies
The approach to drug hypersensitivity always comprises a clinical and a diagnostic workup. About 15% of drug side effects are due to hypersensitivity reactions. All types of immunological reactions can be induced by drugs, but type I and type IV reactions are seen most often. The initial judgment of the skin symptoms is therefore one of the key factors besides a stringent history of drug intake for a further diagnostic workup. The goal of a diagnostic workup is not only to identify the culprit drug, but also to defer the patient from similar drugs in order to prevent a second episode. In the case of missing alternatives and unidentified drug sensitivity, reexposure to the previous drug must be discussed; however, in severe cutaneous reactions this should generally be avoided.

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Diagnostic approach to drug allergy.
Harr T.
Chem Immunol Allergy 2012;9747-60

Contact allergy to dimethacrylate.
A 55-year-old woman with a 10-year history of persistent pruritus and burning sensation of the gums every time she wore her dentures. Initially she developed swelling and redness of the face soon after the dentures were placed on the gums. These symptoms abated after a barrier liner was applied between her gums and the dentures. However, the burning sensation and pruritus of the gums progressively worsened and she started to develop blisters on the gums. The skin allergen patch test was 3+ positive with erythema, edema, papules, ulceration, and pruritus for the denture component dimethacrylate. The diagnosis was supported by the patient’s medical history, notably positive patch test, and complete amelioration of the symptoms upon cessation of dimethacrylate denture usage.

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Contact allergy to dimethacrylate.
Vaswani R, Kim SJ, Sanchez A, Vaswani S.
Cutis 2012 Jan;89(1):10-12

Fish and shellfish allergy in children: Review of a persistent food allergy.
This review discusses interesting and new findings in the area of fish and shellfish allergy. New allergens and important potential cross-reacting allergens have been identified within the fish family and between shellfish, arachnids, and insects. The diagnostic approach may require prick to-prick tests using crude extracts of both raw and cooked forms of seafood for screening seafood sensitization before a food challenge or where food challenge is not feasible. Allergen-specific immunotherapy can be important; mutated less allergenic seafood proteins have been developed for this purpose. The persistence of allergy because of seafood proteins’ resistance after rigorous treatment like cooking and extreme pH is well documented. Additionally, IgE antibodies from individuals with persistent allergy may be directed against different epitopes than those in patients with transient allergy. For a topic as important as this one, new areas of technological developments will likely have a significant impact, to provide more accurate methods of diagnosing useful information to patients about the likely course of their seafood allergy over the course of their childhood and beyond.

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Fish and shellfish allergy in children: Review of a persistent food allergy.
Tsabouri S, Triga M, Makris M, Kalogeromitros D, Church MK, Priftis KN.
Pediatr Allergy Immunol 2012 May 3

Patch testing is a useful investigation in children with eczema.
The aim of this analysis was to investigate the results of patch testing of selected children with eczema of various types (mostly atopic dermatitis) and to assess potential allergens that might elicit allergic contact dermatitis. A retrospective evaluation of the patch test results in 110 children aged between 2 and 18 years, found 1 or more positive allergic reactions of current or past relevance in 48/110 children (44%; 29 females and 19 males). There were 94 allergy-positive patch test reactions in 110 patients: 81 had a reaction of current or past relevance, 12 had a reaction of unknown relevance, and 1 had reaction that was a cross-reaction. The commonest allergens with present or past relevance were medicaments, plant allergens, house dust mite, nickel, Amerchol(R) L101 (a lanolin derivative), and 2-bromo-2-nitropropane-1,3-diol. However, finding a positive allergen was not associated with a better clinical outcome. Patch testing can identify relevant allergens in 44% of children with eczema. Patch testing can be performed in children as young as 2 years with the proper preparation.

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Patch testing is a useful investigation in children with eczema.
Moustafa M, Holden CR, Athavale P, Cork MJ, Messenger AG, Gawkrodger DJ.
Contact Dermatitis 2011 Oct;65(4):208-212

Allergic Contact Dermatitis From a Mobile Phone
Allergic contact dermatitis was caused by chromium in a mobile phone.

Allergic contact dermatitis caused by chromium in a mobile phone.
Tan S, Nixon R.
Contact Dermatitis 2011 Oct;65(4):246-247