The optics of weight: expert perspectives from the panopticon and synopticon

Objective: That we all weigh something is a fact of life, yet the material reality of weight is refracted through multiple layers of surveillance revealing contradictions in experience and understanding, depending on one's vantage point. We explored the complexities of weight with the specific aim of furthering understanding of this multifaceted surveillance.

Methods and Measures: We used hermeneutics, the philosophy and practice of interpretation, as the method of inquiry. Ten experts by experience and seven professional experts participated in interviews, which were audio- recorded, transcribed, and analyzed. Interpretations were developed through group discussions among the eight authors and reiterative writing.

Results: Using the metaphor of optics, we demonstrate how the interplay of the panopticon (the few watching the many) and synopticon (the many watching the few) help us gain a deeper understanding of weight through "fitting in," being "captured by numbers," "dieting: the tyrannic tower," and "the male gaze."

Conclusion: Monitoring and judging body weight have become so normative in Western society that "weight watching" practices are synonymous with good citizenship and moral character. This study offers insight about how weight is conceptualized in personal and professional contexts, with implications for body image, dieting, eating disorders, public health, and weight bias.

The enigma of weight: Figures, flux, and fitting in

Purpose

In Western society, the measurement of weight is prioritized over a person’s bodily experience. Hermeneutic philosopher Gadamer warned against the emphasis on measurement, rather than experience, in the medical sciences. An examination of the complexity of the experience of weight provides the opportunity to shift focus from quantifying the connection between health and weight to the experience of the person being weighed.

Methods

This qualitative hermeneutic study aims to understand people’s experiences of weight from the interviews of professionals (n = 7) and lay experts (n = 10). Interviews were analyzed using an interpretive hermeneutic method.

Results

The interviews revealed that weight was experienced as a number imbued with meaning and bias, as a number that could be manipulated, and as a constant and anticipated bodily change. Weight change was expected and often unwelcomed, despite weight being a quality of the body that is always in flux. External measures of weight meant to monitor wellness and health inadvertently became an unhealthy fixation that prevented some participants from fully participating in life events and appreciating the stages their bodies were in.

Conclusion

Weight change is a necessary condition of being human, and bodies are and will be constantly changing. To achieve health and harmony, one must fit together the acceptance of change and their bodily experience of weight. It is often the preoccupation with weight, not weight itself, that gets in the way of living.

Weight Bias in Educational Settings: a Systematic Review

PURPOSE

To conduct a systematic literature review of empirical peer-reviewed published studies on the prevalence of weight bias among students, pre-service, and in-service teachers and its impact on the educational experiences and health of students from kindergarten to postsecondary settings.

METHODS

Keywords were searched on three main concepts, (i) weight bias/stigma, (ii) obesity/overweight, and (iii) education, within eight databases. Our search yielded 8323 individual records, of which 45 studies satisfied our inclusion criteria.

RESULTS

Most studies were conducted in K-12 school settings (n = 41), were quantitative in design (n = 37), and used student samples (n = 18). Weight bias is prevalent in educational settings, among peers at school as well as pre-service and in-service teachers, and negatively impacts students' health and educational experiences.

CONCLUSION

These results highlighted the impact of weight bias in creating inequity for students with obesity as well as several underexamined areas, such as weight bias in postsecondary settings and attitudes among teachers and pre-service teachers. Innovative strategies to address weight bias in educational settings are needed.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

Due to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

In situ analysis of Bacillus licheniformis biofilms: amyloid-like polymers and eDNA are involved in the adherence and aggregation of the extracellular matrix

AIMS

This study attempts to determine which of the exopolymeric substances are involved in the adherence and aggregation of a Bacillus licheniformis biofilm.

METHODS AND RESULTS

The involvement of extracellular proteins and eDNA were particularly investigated using DNase and proteinase K treatment. The permeability of the biofilms increased fivefold after DNase I treatment. The quantification of the matrix components showed that, irrespective to the enzyme tested, eDNA and amyloid-like polymers were removed simultaneously. Size-exclusion chromatography analyses supported these observations and revealed the presence of associated nucleic acid and protein complexes in the biofilm lysates. These data suggest that some extracellular DNA and amyloid-like proteins were closely interlaced within the matrix. Finally, confocal laser scanning microscopy imaging gave supplementary clues about the 3D organization of the biofilms, confirming that eDNA and exoproteins were essentially layered under and around the bacterial cells, whereas the amyloid-like fractions were homogeneously distributed within the matrix.

CONCLUSION

These results confirm that some DNA-amyloid complexes play a key role in the modulation of the mechanical resistance of B. licheniformis biofilms.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study highlights the need to consider the whole structure of biofilms and to target the interactions between matrix components. A better understanding of B. licheniformis biofilm physiology and the structural organization of the matrix will strengthen strategies of biofilm control.

Clinical features and management of equine post operative ileus (POI): Survey of Diplomates of the American Colleges of Veterinary Internal Medicine (ACVIM), Veterinary Surgeons (ACVS) and Veterinary Emergency and Critical Care (ACVECC)

REASONS FOR PERFORMING STUDY

A recent survey of European Colleges (European College of Equine Internal Medicine [ECEIM] and European College of Veterinary Surgeons [ECVS]) revealed the different strategies implemented by, and some of the challenges facing, European clinicians presented with cases of post operative ileus (POI). It was concluded that further comparative analysis of opinions, canvassed from additional colleges of equine veterinary specialism worldwide, would provide valuable additional insight into current POI knowledge on a more global scale.

OBJECTIVES

To report and compare the current strategies favoured by American veterinary specialists when managing POI in horses that underwent emergency colic surgery.

STUDY DESIGN

Cross-sectional survey.

METHODS

Electronic invitations were sent to 814 Large Animal specialists, including 3 colleges: the American College of Veterinary Internal Medicine (ACVIM), American College of Veterinary Surgeons (ACVS) and the American College of Veterinary Emergency and Critical Care (ACVECC).

RESULTS

The response rate was 14% (115/814). The majority of respondents (68%) reported an estimated prevalence range of POI of 0-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. A lesion involving the small intestine was considered the main risk factor for POI. Anti-inflammatory drugs, intravenous (i.v.) fluids and antimicrobial drugs were the primary strategies used when managing POI. Flunixin meglumine and i.v. lidocaine were the drugs most commonly used in the treatment of horses with POI. Supplementary management strategies targeted mainly the prevention of post operative adhesions, infection and inflammation.

CONCLUSIONS

There is a lack of consensus on the clinical definition of POI. Prospective and objective clinical assessment of the effectiveness of the different strategies contained within this and the European survey is necessary in order to identify a standardised approach to the management of equine POI.

Clinical features and management of equine post operative ileus: Survey of diplomates of the European Colleges of Equine Internal Medicine (ECEIM) and Veterinary Surgeons (ECVS)

REASONS FOR PERFORMING STUDY

There is a need for an improved understanding of equine post operative ileus (POI), in terms of both clinical definition and optimal management. Although the pharmacological strategies that are used to treat POI continue to evolve, little is known about the supplementary strategies used to prevent and manage this condition.

OBJECTIVES

To report the current strategies used to diagnose, prevent and manage POI following emergency abdominal surgeries.

STUDY DESIGN

Cross-sectional survey.

METHODS

An electronic survey invitation was sent by email to 306 European college diplomates (European Colleges of Equine Internal Medicine, ECEIM n = 120, and Veterinary Surgeons, ECVS n = 186).

RESULTS

The response rate was 33% (100 of 306). The median reported estimated incidence of POI was 10-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. Lesions involving the small intestine were thought to be the leading risk factors for developing POI. Anti-inflammatory drugs, antimicrobial drugs and i.v. fluids were the primary preventative strategies when managing cases at high risk for POI. Flunixin meglumine and lidocaine were the drugs most commonly used to treat horses with POI. Supplementary preventative and treatment strategies for POI included control of endotoxaemia, fluid therapy, early ambulation and judicious timing of post operative feeding.

CONCLUSIONS

Appreciation of the potential risk factors associated with the development of POI appeared to have an impact on the choice of management strategies that are implemented. The majority of ECEIM and ECVS Diplomates in the survey used flunixin meglumine and lidocaine, often in combination, to treat horses with POI, which is likely to reflect the contributory role of inflammation in its pathophysiology. Various supplementary strategies were used to prevent and manage POI risk factors intraoperatively and post operatively.

An assessment tool to help producers improve cow comfort on their farms

Effective management and an appropriate environment are essential for dairy cattle health and welfare. Codes of practice provide dairy producers with best practice guidance for the care and handling of their cattle. New Canadian recommendations have been established for the dairy industry. The objectives of this study were to develop an on-farm assessment tool that helps producers assess how well they are meeting their code of practice and that identifies management and environment modifications that could improve dairy cow comfort on their farms. The assessment tool addressed critical areas of dairy cow comfort, including accommodation and housing (stall design, space allowance, stall management, pen management, milking parlor, and transfer alleys), feed and water (body condition scoring, nutrition), and health and welfare (lameness, claw health, and hoof-trimming). Targets of good practices were identified from the requirements and recommendations of the code of practice. Each farm received a score for each target, ranging from 0 (target not reached) to 100 (target reached). One hundred tiestall and 110 freestall farms were surveyed in 3 provinces of Canada (Quebec, Ontario, and Alberta). The duration of the assessment, in 2 visits lasting, on average, 8 and 9h (range between freestall and tiestall farms) and 4 and 4.1h, was beyond the targeted 3 to 4h due mainly to the animal-based measures; strategies to reduce the duration of the assessment were discussed. Standard operating procedures were developed to ensure consistency in measuring and recording data. Periodical checks were conducted by trainers to ensure all 15 assessors remained above target agreement of weighted kappa ≥0.6. Average scores for all critical areas ranged from 25 to 89% for freestall farms and from 48 to 95% for tiestall farms. These scores need to be considered with caution when comparing farms because scores could not always be calculated the same way between housing systems. An evaluation report was provided and discussed with each producer, identifying strengths and areas for improvement that could benefit dairy cow comfort on their farms. The producers were convinced of the effectiveness of our tool for assessing cow comfort (freestall: 86%; tiestall: 95%) and in assisting them to make decisions for improvements (freestall: 83%; tiestall: 93%). Our cow comfort assessment tool served as background material for the Dairy Farmers of Canada animal care assessment program.

Short dry period management improves peripartum ruminal adaptation in dairy cows

The present study aimed to determine whether the improvement in postpartum energy balance frequently reported in cows under short dry period management could be due to an improvement in ruminal function related to the reduction in the number of diet changes before calving. Six multiparous and 6 primiparous Holstein cows equipped with ruminal cannula were assigned to 6 blocks of 2 cows each according to parity, projected milk production at 305 d, and expected calving date. Within each block, cows were randomly assigned to either a conventional (CDP; 63.2 ± 2.0 d) or a short dry period (SDP; 35.2 ± 2.0 d) management in a randomized complete block design. The CDP cows were fed a far-off diet until 28 d before calving, followed by a prepartum diet, whereas SDP cows received only the prepartum diet. After calving, both groups were fed the same lactation diet. Milk yield and dry matter intake (DMI) were recorded daily and milk composition, weekly. Blood samples were taken twice a week during the first 4 wk postcalving and weekly otherwise. Omasal and ruminal samples were collected approximately 3 wk prior and 3 wk after calving. From 28 d before calving until calving, when the 2 groups of cows were fed the same prepartum diet, there was no effect of the dry period length management on DMI, plasma concentrations of β-hydroxybutyrate, nonesterified fatty acids, and glucose and nutrient digestibility in the rumen. However, CDP cows tended to have lower ruminal pH and higher ruminal concentrations of total volatile fatty acids than SDP cows. From calving to 60 d in milk, daily DMI was higher for SDP than for CDP cows (22.3 ± 0.44 vs. 20.7 ± 0.30 kg), but milk production and milk concentrations and yields of fat, protein, and total solids were not affected by the dry period length management. After calving, body weight loss was reduced and body condition score tended to increase more rapidly for SDP than for CDP cows. Nutrient digestibility in the rumen, expressed in kilograms per day, was greater or tended to be greater for SDP cows, but differences were no longer significant when expressed per unit of nutrient ingested. The decrease in plasma nonesterified fatty acids and β-hydroxybutyrate in SDP cows without effect on milk yield suggests an improved energy balance likely due to greater DMI. Results from the present study seem to indicate that reducing the number of diet changes before calving could facilitate ruminal adaptation to the lactation diet and improve energy balance postpartum.

Accuracy of milk ketone bodies from flow-injection analysis for the diagnosis of hyperketonemia in dairy cows

The objectives of this study were (1) to determine the correlations between blood β-hydroxybutyrate (BHBA) and milk components [BHBA, acetone, fat, protein, and fat:protein (F:P) ratio], and (2) to establish optimal thresholds for milk components to predict hyperketonemia in dairy cows. Data on 163 cows from 37 herds were used in this cross-sectional study. Herds were visited once during the study period, and cows between 2 and 90 d in milk were blood sampled within 4h of milk sampling for the Dairy Herd Improvement test. Blood BHBA concentrations were measured using a cow-side electronic meter, Precision Xtra, which was considered the gold standard test in this study. Milk BHBA and acetone concentrations were measured in Dairy Herd Improvement milk samples by flow-injection analysis; whereas, milk fat and protein were tested using Fourier transform infrared spectroscopy. Hyperketonemia was defined by a blood BHBA concentration ≥ 1.4 mmol/L. The prevalence of hyperketonemia (based on blood BHBA values) in this study population was 21.0%. Pearson correlation coefficients between blood BHBA and milk BHBA, acetone, fat, protein, and F:P ratio were 0.89, 0.73, 0.21, 0.04, and 0.17, respectively. Receiver operating characteristic curves were generated and thresholds for each individual milk component were determined based on the maximal sum of sensitivity and specificity. Optimal threshold values for hyperketonemia were milk BHBA ≥ 0.20 mmol/L, acetone ≥ 0.08 mmol/L, fat ≥ 4.2%, and F:P ratio ≥ 1.3. Based on these thresholds, milk BHBA and acetone had greater sensitivity (84 and 87%, respectively) and greater specificity (96 and 95%, respectively) than the other milk components (fat, protein, and F:P). Series and parallel testing slightly improved the accuracy of milk BHBA and acetone values to predict hyperketonemia. A multivariable model that accounted for milk BHBA and milk acetone values simultaneously had the highest accuracy of all tested models for predicting hyperketonemia. These results support that milk BHBA and milk acetone values from flow-injection analysis are accurate diagnostic tools for hyperketonemia in dairy cows and could potentially be used for herd-level hyperketonemia surveillance programs.

Fate of organic matter during moderate heat treatment of sludge: kinetics of biopolymer and hydrolytic activity release and impact on sludge reduction by anaerobic digestion

Temperature-phased anaerobic digestion with a 50-70 °C pre-treatment is widely proposed for sludge. Here, such a sludge pre-treatment (65 °C) was studied against the physical, enzymatic and biodegradation processes. The soluble and particulate fractions were analysed in terms of biochemical composition and hydrolytic enzymatic activities. Two kinetics of organic matter solubilisation were observed: a rapid transfer of the weak-linked biopolymers to the water phase, including sugars, proteins or humic acid-like substances, to the water phase, followed by a slow and long-term solubilisation of proteins and humic acid-like substances. In addition, during the heat treatment a significant pool of thermostable hydrolytic enzymes including proteases, lipases and glucosidases remains active. Consequently, a global impact on organic matter was the transfer of the biodegradable chemical oxygen demand (COD) from the particulate to the soluble fraction as evaluated by the biological methane potential test. However, the total biodegradable COD content of the treated sludge remained constant. The heat process improves the bio-accessibility of the biodegradable molecules but doesn't increase the inherent sludge biodegradability, suggesting that the chemistry of the refractory proteins and humic acids seems to be the real limit to sludge digestion.

Gebruik van antivirale middelen in de diergeneeskunde

De interesse voor het gebruik van antivirale geneesmiddelen in de diergeneeskunde neemt duidelijk toe. Tot op heden blijft de behandeling van virale infectieziekten in de diergeneeskunde beperkt tot het gebruik van enkele humane geneesmiddelen bij gezelschapsdieren, maar de ontwikkeling van specifieke diergeneeskundige middelen is aan de gang. Ook in de sector van de nutsdieren, waar virale infectieziekten kunnen leiden tot grote economische verliezen, is er toenemende interesse voor het gebruik van antivirale geneesmiddelen. De toediening van geneesmiddelen aan voedselproducerende dieren stelt echter specifieke eisen met betrekking tot farmacokinetiek, de uitwerking van maximale residulimieten (MRLs) en wachttijden, alsook (eco)toxiciteit. Ervaringen uit de humane geneeskunde leren dat de therapeutische doeltreffendheid van antivirale middelen soms negatief beïnvloed wordt door het ontstaan van minder gevoelige (resistente) virusvarianten. Bij de ontwikkeling van nieuwe antivirale producten is het dus van uitermate belang rekening te houden met de kans op antivirale resistentieontwikkeling. Dit is zeker het geval wanneer er wordt gedacht aan de grootschalige toepassing in de diergeneeskunde. In dit artikel wordt een korte inleiding gegeven over antivirale resistentieontwikkeling. Daarnaast wordt voor de meest voorkomende virale ziekten bij huisdieren een literatuuroverzicht gegeven van de mogelijke behandeling met chemische antivirale moleculen waarbij specifiek aandacht wordt besteed aan de beschikbare gegevens over antivirale resistentieontwikkeling. Het aantal studies over de effectiviteit van (humane) antivirale middelen tegenover diervirussen is beperkt en klinisch onderzoek limiteert zich meestal tot de werkzaamheid en toxiciteit. Er is een gebrek aan wetenschappelijke gegevens omtrent de dosering en de kans op resistentieontwikkeling van antivirale producten voor gebruik bij dieren. De bestrijding van virale dierziekten door middel van een antivirale therapie lijkt omwille van verschillende redenen aanlokkelijk, maar er is nog veel onderzoek vereist om tot een verantwoorde praktische toepassing te komen.

Growth modeling of dairy heifers in Québec based on random regression

Cue, R. I., Pietersma, D., Lefebvre, D., Lacroix, R., Wade, K., Pellerin, D., de Passillé, A-M. and Rushen, J. 2012. Growth modeling of dairy heifers in Québec based on random regression. Can. J. Anim. Sci. 92: 33–47. A total of 144 006 weight (calculated from tape girth measurements) and height data records from Québec dairy heifers were analyzed using random regression to estimate growth curve parameters of Ayrshires, Brown Swiss and Holstein animals to permit prediction of individual heifer growth from 0 to 32 mo. There were, on average, 5.15 records per heifer (minimum 3 records, maximum 25 records). The body weight data were analyzed using linear and quadratic fixed and random regressions, with a power-of-the-mean (POM) function to model the residual variance. The POM was 1.2 for Holstein and Ayrshire and slightly less than 1 for Brown Swiss. Estimated body weight at 24 mo was 507, 564, 624 kg, for Ayrshires, Brown Swiss and Holstein, respectively. The height data were analyzed with a Brody, monomolecular non-linear growth curve model. Mature height was estimated to be 148 cm in both Holstein and Ayrshires, and 150 cm in Brown Swiss. Random regression models were shown to be able to predict individual growth, and can be incorporated in decision-support tools to help producers reducing the average age at first calving.

[Scientific research in family medicine: practitioners' experience, barriers and needs]

Scientific data from family medicine are relevant for the majority of the population. They are therefore essential from an ethical and public health perspective. We need to promote quality research in family medicine despite methodological, financial and logistic barriers. To highlight the strengths and weaknesses of research in family medicine in the French-speaking part of Switzerland we asked practitioners from this region to share their experience, critics and needs in relation to research. This article summarizes their contribution in light of the international literature.

An advisory tool to improve management practices affecting calf and heifer welfare on dairy farms

We developed an advisory tool addressing 10 critical areas of calf and heifer management, including calving management, care to newborn calves and painful procedures, colostrum management, cow-calf separation, calf feeding, weaning, calf housing, heifer feeding, heifer housing, and general monitoring. Targets and indicators for each critical area were validated by a panel of experts and maximum scores were assigned based on experts' opinions and reviews of scientific literature. The tool was tested on 28 Quebec dairy farms for feasibility and repeatability between 2 observers. Farmers were asked to test colostrum quality, measure blood IgG concentrations, and record health events. The on-farm evaluation included an interview on management practices and an evaluation of conditions in the barn. Scorings and recommendations were discussed with producers. The usefulness of our on-farm welfare tool was evaluated by the producers themselves during a final debriefing. We reached the main goals of a successful advisory tool of calf and heifer management to improve welfare on dairy farms. We respected the targeted time limit of a 3-h visit covering all aspects of our tool including data collection on management and environment, scoring, practical demonstration with producers, and debriefing. We had no problems collecting management- and environment-based data and had high repeatability of qualitative environment-based measures (kappa value>0.6). Our tool helped to detect problems and to discuss these problems with the producers; producers scored below 50% for some targets in calving management, care to newborn calves and painful procedures, colostrum management, and calf feeding. The targets were realistic so producers were not discouraged. All producers were convinced of the usefulness of our tool for identifying areas of calf and heifer management in need of improvement. They were also convinced of the usefulness of our tool as an advisory tool for technical advisors and veterinarians. Six months after the on-farm visit, recommended practices were implemented in many of these areas. Voluntary improvements in animal welfare can be facilitated by using appropriate tools to educate producers and help them change their attitudes toward calf management and animal welfare.

A survey of dairy calf management practices in Canada that affect animal welfare

There is growing interest among the public in farm animal welfare and a need for methods to assess animal welfare on farm. A survey on calf rearing practices that might affect dairy calf welfare was performed via a 1-h interview on 115 dairy farms (mean +/- SD: herd size=52.5+/-20.9 cows; milk production=8,697+/-1,153L) distributed throughout the province of Quebec. Despite frequent recommendations, many dairy producers continue to use management practices that increase the health risks of milk-fed calves. Major risk factors for poor calf welfare identified were 1) no use of calving pen in 51.3% of herds and low level of surveillance of calvings, especially at nighttime (once every 12h), 2) no disinfection of newborn's navel in 36.8% of herds, and delayed identification and, hence, calf monitoring (3 d), 3) 15.6% of farms relied on the dam to provide colostrum and none checked colostrum quality or passive transfer of immunity, 4) dehorning and removal of extra teats proceeded at late ages (6.4 wk and 6.7 mo, respectively) and without adequate pain control, 5) use of traditional restrictive milk feeding and waste milk distributed to unweaned calves without precaution in 48.2% of herds, 6) abrupt weaning performed in 16.5% of herds, and 7) calves housed individually in 87.9% of herds, and most inappropriate housing systems (crate=27.0%, tie-stall=13.9%, attached against a wall=5.7%) remained. This risk factor assessment was the first step in an intervention strategy to improve calf welfare on dairy farms.

An anaphylactic reaction to transdermal delivered fentanyl

Immediate allergic hypersensitivity reactions with fentanyl are rarely reported. We diagnosed a presumably IgE-mediated allergic hypersensitivity reaction comprising generalized erythema and bronchospasm 4 h after the first-time application of transdermal fentanyl. Prick test remained negative with fentanyl whereas an intradermal test (IDT) with fentanyl was positive (dilution 10(-2)). Cross-reactivity was found with sufentanil but not with remifentanil. The diagnosis was supported by the clinical history and a positive IDT with fentanyl. This case report confirms the need for a systematic allergological investigation in case of immediate hypersensitivity reactions for all drugs and all modes of administration.