1
|
Conner JE, Steinberg JA. Approach to Idiopathic Anaphylaxis in Adolescents. Med Clin North Am 2024; 108:123-155. [PMID: 37951646 DOI: 10.1016/j.mcna.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Anaphylaxis is a potentially-life threatening condition. Adolescents are particularly vulnerable due to increased risk-taking behaviors, poor disease management, and minimized perception of risk. Although most anaphylaxis can be attributed to food, drug, or venom allergy via a detailed history and confirmatory studies, in nearly 1 in 5 cases, the cause may not be obvious. Clinical differentials including rare allergens, cofactors, mast-cell disorders, and mimic disorders can increase the likelihood of discovering of the cause of anaphylaxis.
Collapse
Affiliation(s)
- Jeanne E Conner
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA
| | - Joshua A Steinberg
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA; Section of Allergy, Department of Medicine, Clement J. Zablocki Veterans' Affairs Medical Center, 5000 West National Avenue, 1AN, Milwaukee, WI 53295, USA.
| |
Collapse
|
2
|
Jungewelter S, Suomela S, Airaksinen L. Occupational IgE-mediated psyllium allergy in contemporary gluten-free and vegan baking: A case of allergic rhinitis. Am J Ind Med 2021; 64:431-434. [PMID: 33651455 DOI: 10.1002/ajim.23238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/11/2021] [Accepted: 02/13/2021] [Indexed: 01/10/2023]
Abstract
Psyllium (from Plantago ovata; ispaghula) is used as a dietary supplement and is supplied in the form of husk, granules, capsules, or powder. Consumers using psyllium-containing laxatives, healthcare workers handling these, and pharmaceutical workers in laxative-manufacturing plants are known to be at risk of sensitization and subsequent rhinitis, asthma, contact urticaria, and even anaphylaxis. To our knowledge, the case we present here is the first of baker's immunoglobulin E (IgE)-mediated occupational allergy due to psyllium exposure. Our patient, a 24-year-old female baker with no previous allergies, was referred to our clinic with suspected occupational rhinitis. After 1 year of baking with cereal flour or gluten-free flour-mix, she began to suffer from rhino-conjunctival symptoms during workdays. Skin prick tests with agents from the patient's workplace revealed allergies not only to wheat and rye flours but also to psyllium, with a remarkable 10 mm wheal. Subsequently, nasal provocation tests confirmed occupational allergic rhinitis to psyllium. We also found work-related sensitization to buckwheat, which she used in gluten-free baking. Due to the increased prevalence of celiac disease and the popularity of gluten-free and vegan food, psyllium has recently become a common ingredient in baking, used as a substitute for gluten or eggs. Bakers handle allergens such as these in high concentrations and this may lie behind the emergence of respiratory and dermal symptoms. It is essential to consider new or recenlty introduced materials as possible allergens if it is suspected that a baker has work-related respiratory or allergic symptoms.
Collapse
Affiliation(s)
| | - Sari Suomela
- Finnish Institute of Occupational Health (FIOH) Helsinki Finland
| | - Liisa Airaksinen
- Finnish Institute of Occupational Health (FIOH) Helsinki Finland
| |
Collapse
|
3
|
Rivers CR, Kantor MA. Psyllium husk intake and risk of type 2 diabetes: an evidence-based scientific and regulatory review of a qualified health claim conducted by the US Food and Drug Administration. Nutr Rev 2021; 78:787-797. [PMID: 31968119 DOI: 10.1093/nutrit/nuz103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The US Food and Drug Administration (FDA) received a petition from a company requesting that FDA issue an authorized health claim for the relationship between psyllium husk and a reduced risk of type 2 diabetes. After an initial assessment of the available scientific evidence, FDA determined that significant scientific agreement was lacking for this substance-disease relationship, whereupon the company agreed to have its petition reviewed as a qualified health claim. This article describes the process FDA used in conducting an evidence-based review of the science underpinning the proposed claim and addresses certain safety issues associated with psyllium husk that FDA considered in its review of the petition. Of the 6 studies from which scientific conclusions could be drawn, as identified through FDA's review, psyllium husk significantly improved plasma glucose levels and insulin sensitivity in only 1 study. Therefore, FDA's enforcement discretion letter for this qualified health claim stated: "Psyllium husk may reduce the risk of type 2 diabetes, although the FDA has concluded that there is very little scientific evidence for this claim."
Collapse
Affiliation(s)
- Crystal R Rivers
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, Maryland, USA
| | - Mark A Kantor
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, Maryland, USA
| |
Collapse
|
4
|
Attard A, Iles A, Attard S, Atkinson N, Patel A. Clozapine: why wait to start a laxative? BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
SUMMARYClozapine, the antipsychotic of choice for treatment-resistant schizophrenia, has a number of side-effects, some of which are potentially life-threatening. Historically viewed as a relatively minor side-effect, there is increasing awareness of the potentially severe sequalae of constipation secondary to clozapine-induced gastrointestinal hypomotility (CIGH). These include ileus, intestinal obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death. CIGH is significantly more common than clozapine-induced blood dyscrasias and has a higher mortality rate. Although strict criteria must be followed to assertively monitor, detect and treat blood dyscrasias in patients taking clozapine, no such framework exists for CIGH. We recommend that prescribing guidelines, regulatory agencies and information from manufacturers should more clearly highlight the risks identified in the literature. Furthermore, we recommend that, in people taking clozapine, constipation should be prevented by prophylactic treatment with laxatives rather than treated only when clinically identified.LEARNING OBJECTIVES:After reading this article you will be able to:
•understand the mechanism of gastrointestinal hypomotility in those taking clozapine•improve the monitoring of clozapine-induced constipation•understand prophylactic laxative treatment and the use of less commonly prescribed laxatives in patients who experience clozapine-induced constipation.
Collapse
|
5
|
Baker MG, Saf S, Tsuang A, Nowak-Wegrzyn A. Hidden allergens in food allergy. Ann Allergy Asthma Immunol 2019; 121:285-292. [PMID: 30219174 DOI: 10.1016/j.anai.2018.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/14/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Mary Grace Baker
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Saf
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Hôpital d'Enfants Armand Trousseau, Paris, France
| | - Angela Tsuang
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anna Nowak-Wegrzyn
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
6
|
Skypala IJ. Food-Induced Anaphylaxis: Role of Hidden Allergens and Cofactors. Front Immunol 2019; 10:673. [PMID: 31001275 PMCID: PMC6457317 DOI: 10.3389/fimmu.2019.00673] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Food anaphylaxis is on the increase, with those who have an allergy to peanuts, tree nuts, milk, and seafood at the highest risk of developing such a reaction. However, the diet in many societies is increasingly varied, much of the food consumed is prepared outside the home, and meals are often composed of many different ingredients. Anaphylaxis may occur to a composite food, and it may be unclear whether the reaction is due to contamination or to a culprit allergen present in an added ingredient. Composite foods can contain many allergic proteins present in small amounts, which do not always have to be labeled, unless they feature in European or US labeling regulations. These “hidden” allergens include mustard, celery, spices, lupine, pea, natural food colourings, and preservatives, but can occasionally include allergenic material from contaminants such as cereal mites. Hidden allergens can provoke severe reactions to seemingly unconnected foods which might then lead to a diagnosis of idiopathic anaphylaxis. The same problem can arise with two well-known types of food allergy; wheat-dependant exercise induced anaphylaxis and allergy to non-specific Lipid Transfer Protein allergens, both of which might only manifest when linked to a cofactor such as exercise. Many of these risk factors for food anaphylaxis have a common link; the public's engagement with popular concepts of health and fitness. This includes the development of a food and exercise culture involving the promotion and marketing of foods for their health-giving properties i.e., meat substitutes, wheat substitutes, supplements and alternative, or “natural” remedies for common ailments. Some of these foods have been reported as the cause of severe allergic reactions, but because they are often viewed as benign unlikely causes of severe allergic reactions, could be considered to be hidden allergens. The best resource to elicit the likelihood of a hidden allergen provoking an allergic reaction is to take a detailed history of the allergic reaction, presence of co-factors, foods suspected, type of food and where it was consumed. A good knowledge of commonly used ingredients, and list of potential hidden allergen suspects are essential tools for the food allergy detective.
Collapse
Affiliation(s)
- Isabel J Skypala
- Department of Allergy and Clinical Immunology, Imperial College, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
7
|
Baker MG, Sampson HA. Phenotypes and endotypes of food allergy: A path to better understanding the pathogenesis and prognosis of food allergy. Ann Allergy Asthma Immunol 2018; 120:245-253. [PMID: 29378246 DOI: 10.1016/j.anai.2018.01.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/19/2018] [Accepted: 01/19/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Mary Grace Baker
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hugh A Sampson
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
8
|
Anaphylaxis in the Workplace. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Serrano-Falcón B, Rey E. The safety of available treatments for chronic constipation. Expert Opin Drug Saf 2017; 16:1243-1253. [DOI: 10.1080/14740338.2017.1361402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Blanca Serrano-Falcón
- Department of Digestive Diseases, Hospital Clinico San Carlos, Complutense University, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Enrique Rey
- Department of Digestive Diseases, Hospital Clinico San Carlos, Complutense University, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
10
|
Abstract
Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs.
Collapse
|
11
|
How should occupational anaphylaxis be investigated and managed? Curr Opin Allergy Clin Immunol 2016; 16:86-92. [PMID: 26828245 DOI: 10.1097/aci.0000000000000241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Anaphylaxis is a systemic allergic reaction that can be life-threatening or fatal and can result from work-related exposures. This review study focuses on the assessment, main triggers, and management of occupational anaphylaxis. RECENT FINDINGS Exposed workers can be sensitized through inhalation and skin contact, and the risks increase with penetration of the allergen through the skin. The main eliciting agents of occupational anaphylaxis include stinging insects and animal bites, natural rubber latex and other vegetable allergens, food products, and drugs. Workers sensitized to occupational allergens may also develop anaphylaxis outside the work environment from exposure to the same or to cross-reacting allergens. Cofactors at work such as exercise may increase the risk. The relevant medical records and laboratory tests (e.g. tryptase) performed during the episode should be reviewed. SUMMARY It is very important to confirm the diagnosis and to identify the specific trigger of anaphylaxis. Component-resolved diagnosis may help in the identification of primary sensitizers or cross-reactive allergens. Adrenaline must be administered to all patients experiencing anaphylaxis. Removal from exposure is mandatory to prevent further episodes. A written emergency management plan, health and safety education, and training and surveillance should be enforced in occupations at greater risk.
Collapse
|
12
|
Busardò FP, Marinelli E, Zaami S. Is the diagnosis of anaphylaxis reliable in forensics? The role of β-tryptase and its correct interpretation. Leg Med (Tokyo) 2016; 23:86-88. [PMID: 27890110 DOI: 10.1016/j.legalmed.2016.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/14/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy.
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| |
Collapse
|
13
|
Kline A, Fischer G. Acute generalised exanthematous pustulosis and other severe drug eruptions from over the counter medications: A case report and review of the literature. Australas J Dermatol 2016; 57:92-96. [PMID: 25880610 DOI: 10.1111/ajd.12336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/21/2015] [Indexed: 11/27/2022]
Abstract
We present a case of acute generalised exanthematous pustulosis in an 11-year-old girl who used Duro-Tuss, an over-the-counter cough mixture containing pholcodine, and present a comprehensive review of the literature on severe drug reactions resulting from using non-prescription medications. This case reinforces the importance of taking a complete medication history.
Collapse
Affiliation(s)
- Amy Kline
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Botanicals: An alternative remedy to radiotherapy-induced dysuria. Complement Ther Med 2015; 23:90-9. [DOI: 10.1016/j.ctim.2014.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/14/2014] [Accepted: 11/26/2014] [Indexed: 02/06/2023] Open
|
15
|
Siracusa A, Folletti I, Gerth van Wijk R, Jeebhay MF, Moscato G, Quirce S, Raulf M, Ruëff F, Walusiak-Skorupa J, Whitaker P, Tarlo SM. Occupational anaphylaxis--an EAACI task force consensus statement. Allergy 2015; 70:141-52. [PMID: 25369880 DOI: 10.1111/all.12541] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/26/2022]
Abstract
Anaphylaxis is a systemic allergic reaction, potentially life-threatening that can be due to nonoccupational or, less commonly, to occupational triggers. Occupational anaphylaxis (OcAn) could be defined as anaphylaxis arising out of triggers and conditions attributable to a particular work environment. Hymenoptera stings and natural rubber latex are the commonest triggers of OcAn. Other triggers include food, medications, insect/mammal/snake bites, and chemicals. The underlying mechanisms of anaphylactic reactions due to occupational exposure are usually IgE-mediated and less frequently non-IgE-mediated allergy or nonallergic. Some aspects of work-related allergen exposure, such as route and frequency of exposure, type of allergens, and cofactors may explain the variability of symptoms in contrast to the nonoccupational setting. When assessing OcAn, both confirmation of the diagnosis of anaphylactic reaction and identification of the trigger are required. Prevention of further episodes is important and is based on removal from further exposure. Workers with a history of OcAn should immediately be provided with a written emergency management plan and an adrenaline auto-injector and educated to its use. Immunotherapy is recommended only for OcAn due to Hymenoptera stings.
Collapse
Affiliation(s)
- A. Siracusa
- Formerly professor of Occupational Medicine; University of Perugia; Perugia Italy
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia Italy
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| | - M. F. Jeebhay
- Centre for Occupational and Environmental Health Research; School of Public Health and Family Medicine; University of Cape Town; Cape Town South Africa
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid Spain
| | - M. Raulf
- Institute of Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum; Bochum Germany
| | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | | | - P. Whitaker
- Department of Respiratory Medicine; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | | |
Collapse
|
16
|
Mayer DE, Krauskopf A, Hemmer W, Moritz K, Jarisch R, Reiter C. Usefulness of post mortem determination of serum tryptase, histamine and diamine oxidase in the diagnosis of fatal anaphylaxis. Forensic Sci Int 2011; 212:96-101. [PMID: 21664082 DOI: 10.1016/j.forsciint.2011.05.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 05/10/2011] [Accepted: 05/14/2011] [Indexed: 11/30/2022]
Abstract
The diagnosis of fatal anaphylaxis can be difficult for clinical features may not always be evident in necropsy. Therefore post mortem determination of tryptase and other blood parameters can be helpful in verifying the diagnosis. We compared post mortem tryptase, histamine and diamine oxidase (DAO) serum levels of two patients who had died after a Hymenoptera sting and one patient who died of bronchospasm during anaesthesia with data obtained from 55 control subjects who had died from other causes than anaphylaxis. In the three anaphylactic cases, serum tryptase level was 880, 68 and 200 μg/l (normal range in living subjects: <11.4 μg/l), histamine was 37.5, 8.5 and 23.2 ng/ml (normal range: <0.3 ng/ml) and DAO was 1, 30 and 4 U/ml (normal range 10-30 U/ml), respectively. Values in the control group were as follows: tryptase 1-340 μg/l (mean 24.2 ± 58.2), histamine 5.0-22.0 ng/ml (mean 14.7 ± 3.9) and DAO 0-114 U/ml (mean 21.1 ± 27.8). 19/55 (34.5%) of the controls had elevated tryptase levels >11.4 μg/l, with four of them showing values >45 μg/ml. Significantly higher histamine levels were seen in blood samples taken more than 24h post mortem (p<0.05), whereas the timing of blood collection had no effect on tryptase and DAO levels. While moderately elevated tryptase levels are common in post mortem sera, values above 45 μg/l may support the diagnosis of fatal anaphylaxis. Strongly elevated histamine levels might give an additional clue on fatal anaphylaxis, whereas DAO does not seem to be helpful.
Collapse
Affiliation(s)
- D E Mayer
- FAZ - Floridsdorf Allergy Center, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
17
|
Ramirez DA, Bahna SL. Food hypersensitivity by inhalation. Clin Mol Allergy 2009; 7:4. [PMID: 19232116 PMCID: PMC2651849 DOI: 10.1186/1476-7961-7-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 02/20/2009] [Indexed: 11/23/2022] Open
Abstract
Though not widely recognized, food hypersensitivity by inhalation can cause major morbidity in affected individuals. The exposure is usually more obvious and often substantial in occupational environments but frequently occurs in non-occupational settings, such as homes, schools, restaurants, grocery stores, and commercial flights. The exposure can be trivial, as in mere smelling or being in the vicinity of the food. The clinical manifestations can vary from a benign respiratory or cutaneous reaction to a systemic one that can be life-threatening. In addition to strict avoidance, such highly-sensitive subjects should carry self-injectable epinephrine and wear MedicAlert® identification. Asthma is a strong predisposing factor and should be well-controlled. It is of great significance that food inhalation can cause de novo sensitization.
Collapse
Affiliation(s)
- Daniel A Ramirez
- Allergy & Immunology Section, Louisiana State University Health Science Center in Shreveport, 1501 Kings Highway, Shreveport, LA, USA
| | - Sami L Bahna
- Allergy & Immunology Section, Louisiana State University Health Science Center in Shreveport, 1501 Kings Highway, Shreveport, LA, USA
| |
Collapse
|
18
|
Abstract
Idiopathic anaphylaxis is a prednisone-responsive condition without external cause, but it can coexist with food-, medication-, or exercise-induced anaphylaxis. Mast cell activation may occur at night or after foods that have been eaten with impunity many times previously. Idiopathic anaphylaxis can be classified into frequent (if there are six or more episodes per year or two episodes in the last 2 months) or infrequent (if episodes occur less often). Idiopathic anaphylaxis-generalized consists of urticaria or angioedema associated with severe respiratory distress, syncope or hypotension, and gastrointestinal symptoms. Idiopathic anaphylaxis-angioedema consists of massive tongue enlargement or severe pharyngeal or laryngeal swelling with urticaria or peripheral angioedema. The differential diagnosis of idiopathic anaphylaxis is reviewed, and treatment approaches are presented.
Collapse
Affiliation(s)
- Paul A Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Suite 14018, 676 North St. Clair Street, Chicago, IL 60611, USA.
| |
Collapse
|
19
|
Banks DE, Jalloul A. Occupational asthma, work-related asthma and reactive airways dysfunction syndrome. Curr Opin Pulm Med 2007; 13:131-6. [PMID: 17255804 DOI: 10.1097/mcp.0b013e32802c7d0f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Over the past twenty years, work-related asthma has been increasingly recognized to focus on three entities; occupational asthma, work-aggravated asthma, and reactive airways disease syndrome. Of these three entities, work-aggravated asthma has been recently identified to be important in worker health, but little is known about its impact on worker health. RECENT FINDINGS In this review, it is our intent to summarize the different 'types' of work-related asthma and to emphasize what is known about the outcomes of these three types, with emphasis on work-aggravated asthma. Although data is scanty, compared to occupational asthma and reactive airways dysfunction syndrome, it appears that work-aggravated asthma may well have a very important level of impact on worker health that has not been well recognized in the past. SUMMARY All of these entities have the potential to adversely alter the health of workers and, in many instances, require the worker to leave the job. Of these three entities, it appears that most is known about the natural history of occupational asthma. The recognition that workers must leave the workplace when this diagnosis is made is generally agreed upon. The second entity, reactive airways dysfunction syndrome, is not as clearly understood, particularly when one recognizes that there appears to be a considerable difference in the prevalence of this illness when one compares prospective and retrospective reporting of the disease. Finally, work-aggravated asthma remains the least well described and has only been accepted as a part of the triad of work-related asthma in the past several years. The most appropriate clinical response to the diagnosis of this entity in workers has yet to be fully explored.
Collapse
Affiliation(s)
- Daniel E Banks
- Department of Medicine, Louisiana State University School of Medicine, Shreveport, LA 71103, USA.
| | | |
Collapse
|
20
|
|
21
|
Nielsen GD, Olsen O, Larsen ST, Løvik M, Poulsen LK, Glue C, Brandorff NP, Nielsen PJ. IgE-mediated sensitisation, rhinitis and asthma from occupational exposures. Smoking as a model for airborne adjuvants? Toxicology 2005; 216:87-105. [PMID: 16139408 DOI: 10.1016/j.tox.2005.07.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Revised: 07/22/2005] [Accepted: 07/28/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Airborne pollutants with adjuvant effect, called airborne adjuvants, may promote IgE-sensitisation and development of allergic airway diseases. Smoking and occupational allergen exposures were reviewed to establish a general and verified framework for hazard identification and risk assessment of adjuvant effects of airborne pollutions. METHODS The relative risks and the attributable risks of adjuvant effect of smoking were determined for co-exposures with green coffee and castor beans, ispaghula, senna, psyllium, flour and grain dust, latex, laboratory animals, seafood, enzymes, platinum salts, organic anhydrides, or reactive dyes. RESULTS Adjuvant effects of smoking depended on the types of allergen, but not on whether sensitisation or allergy was promoted by atopy-the hereditarily increased ability to increase IgE formation. CONCLUSION Promotion of IgE sensitisation in humans and in animals may serve for hazard identification of adjuvant effects. Risk assessment has been based mainly on epidemiological studies, which are sensitive to confounding factors. This highlights the need to develop appropriate animal models for risk assessment.
Collapse
Affiliation(s)
- Gunnar D Nielsen
- National Institute of Occupational Health Denmark, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW Occupational asthma is often associated with serious work and financial consequences. Correct management of occupational asthma must be based on a good knowledge of the natural history of the disease and of its prognostic factors. RECENT FINDINGS Longitudinal studies have demonstrated that improvement of symptoms and airway hyperresponsiveness may be prolonged after cessation of exposure. Severity of asthma at diagnosis is the best predictor of clinical symptoms and functional impairment at follow-up. The molecular weight of the causal agent does not seem to be a prognostic factor. Airway inflammation is associated with persistence of symptoms and airway hyperresponsiveness after cessation of exposure. Reduction of exposure has proved to be effective in improvement of latex-induced asthma. SUMMARY Further studies are needed to investigate the prognostic value of sputum eosinophils and neutrophils, and to determine whether some specific agents are associated with a better prognosis than others.
Collapse
Affiliation(s)
- Jacques Ameille
- Department of Occupational Health, Raymond Poincaré Hospital, ap-hp, Garches, France.
| | | |
Collapse
|
23
|
Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000162314.10050.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
24
|
Current World Literature. Curr Opin Allergy Clin Immunol 2004. [DOI: 10.1097/01.all.0000136752.28324.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|