Raynaud's phenomenon as initial manifestation of cutaneous polyarteritis nodosa

The case of a 45 year old man with cutaneous polyarteritis nodosa and Raynaud's phenomenon as initial manifestation of the disease is reported. Although peripheral vascular disease is a well characterised extracutaneous manifestation of cutaneous polyarteritis nodosa, to our knowledge this is the first reported case in which Raynaud's phenomenon was the initial and sole manifestation of the disease for a long time.

Bakers' asthma: prevalence and evaluation of immunotherapy with a wheat flour extract

One hundred thirty-nine bakers and pastry cooks were included in a prevalence study of IgE-mediated hypersensitivity to wheat flour demonstrated by skin tests, specific IgE to wheat flour (RAST), and inhalation challenge. From the sensitized workers, we selected 30 asthmatic patients. Twenty patients were treated with a standardized wheat flour extract, and ten with a placebo in a double-blind clinical trial. Before and after immunotherapy we performed tests in vivo (skin tests with wheat flour and methacholine tests), and in vitro (total IgE and specific IgE to wheat flour). We found substantial prevalence of wheat flour allergy (25.17% of workers), and a significant decrease (P less than .001) in hyperresponsiveness to methacholine, skin sensitivity (P = .002), and specific IgE (P less than .005) to wheat flour after 20 months of immunotherapy. There was also significant subjective improvement (P less than .001). The placebo group showed no changes in these variables.

Exercise-induced anaphylactic reaction to grain flours

On rare occasions, reproducible exercise-induced anaphylactic reactions (EIA) occur in some patients only after certain foods have been eaten before exercise, yet eating these foods alone or exercising alone causes no symptoms. This special response has been evident sometimes with shellfish, nuts, and wheat. We describe a patient in whom grain flour was a triggering factor for EIA. Skin tests and RAST were positive for grain flours. Normally, the patient tolerated grain flours without symptoms and IgE mechanisms had not been suspected. Testing for food hypersensitivity may be important in patients with EIA.

Rush immunotherapy with a standardized Bermuda grass pollen extract

We carried out a double-blind clinical trial in 30 patients who were sensitized to Bermuda grass pollen. Before and after immunotherapy we performed in vivo tests (skin tests and standardized tests of specific and nonspecific bronchial hyperreactivity), in vitro tests (histamine release), and specific IgE and IgG antibodies to BGP. We found a significant decrease (P less than .001) in specific bronchial hyperreactivity and skin sensitivity to BGP in the group of patients treated with immunotherapy, a decrease in the delayed responses (P less than .05) in histamine release (P less than .01), and an increase (P less than .001) in specific IgE and IgG antibodies to BGP. The placebo group showed no changes in these parameters.

Septic arthritis by Salmonella enteritidis after heart transplantation

A 13-year-old boy underwent orthotopic heart transplantation for end-stage idiopathic dilated cardiomyopathy. Immunosuppressive therapy consisted of cyclosporine, azathioprine, prednisone, and antithymocyte globulin. Endomyocardial biopsies revealed persistent moderate rejection, which was treated aggressively. In the sixth week, septic arthritis by Salmonella enteritidis developed. We discuss our management of this exceptional complication and the poor results obtained because of superimposed cytomegalovirus infection.