Equine Hypersensitivity: the Dark Horse of Allergy.

A significant amount of medical literature has been published on the prevalence and treatment modalities of allergies to common household pets like dogs and cats. Although sensitization rates to horses are high in many urban areas, allergies to horses are rarely discussed. In order for allergists to treat effectively horse-allergic patients, they must be aware of various clinical presentations and treatment modalities that exist. A literature search was conducted in PubMED using the terms horse, immunotherapy, inhalant allergies, and food allergy limited to human studies from any period. What follows is a review of the prevalence, clinical presentations, and treatment modalities of horse aeroallergens and food allergies.

Latex content in adult vaccines.

INTRODUCTION: Hypersensitivity reactions to natural rubber latex are well-characterized occupational concerns for health care personnel. Health care providers are at increased risk for exposure and possibly transmission of vaccine preventable diseases. Therefore, many health care facilities require providers to be vaccinated against these diseases to maintain employment. Mandatory vaccination for these health care providers presents potential challenges and safety concerns. MATERIALS AND METHODS: Using a commercial Latex Allergen ELISA Assay kit for Hev b 1, we evaluated the latex content of HAVRIX, ENGERIX-B, TWINRIX, and BOOSTRIX all manufactured by GlaxoSmithKline. RESULTS: These data demonstrate undetectable Hev b 1 content among all of the vaccines tested. This study provides the first known data regarding natural rubber latex content in adult vaccines. CONCLUSIONS: Our study revealed undetectable levels of Hev b 1 natural rubber latex content in the tested adult vaccines. These data provide evidence for prospective studies into the safety of vaccinating latex allergic patients.

Patterning of the third pharyngeal pouch into thymus/parathyroid by Six and Eya1.

Previous studies have suggested a role of the homeodomain Six family proteins in patterning the developing vertebrate head that involves appropriate segmentation of three tissue layers, the endoderm, the paraxial mesoderm and the neural crest cells; however, the developmental programs and mechanisms by which the Six genes act in the pharyngeal endoderm remain largely unknown. Here, we examined their roles in pharyngeal pouch development. Six1-/- mice lack thymus and parathyroid and analysis of Six1-/- third pouch endoderm demonstrated that the patterning of the third pouch into thymus/parathyroid primordia is initiated. However, the endodermal cells of the thymus/parathyroid rudiments fail to maintain the expression of the parathyroid-specific gene Gcm2 and the thymus-specific gene Foxn1 and subsequently undergo abnormal apoptosis, leading to a complete disappearance of organ primordia by E12.5. This thus defines the thymus/parathyroid defects present in the Six1 mutant. Analyses of the thymus/parathyroid development in Six1-/-;Six4-/- double mutant show that both Six1 and Six4 act synergistically to control morphogenetic movements of early thymus/parathyroid tissues, and the threshold of Six1/Six4 appears to be crucial for the regulation of the organ primordia-specific gene expression. Previous studies in flies and mice suggested that Eya and Six genes may function downstream of Pax genes. Our data clearly show that Eya1 and Six1 expression in the pouches does not require Pax1/Pax9 function, suggesting that they may function independently from Pax1/Pax9. In contrast, Pax1 expression in all pharyngeal pouches requires both Eya1 and Six1 function. Moreover, we show that the expression of Tbx1, Fgf8 and Wnt5b in the pouch endoderm was normal in Six1-/- embryos and slightly reduced in Six1-/-;Six4-/- double mutant, but was largely reduced in Eya1-/- embryos. These results indicate that Eya1 appears to be upstream of very early events in the initiation of thymus/parathyroid organogenesis, while Six genes appear to act in an early differentiation step during thymus/parathyroid morphogenesis. Together, these analyses establish an essential role for Eya1 and Six genes in patterning the third pouch into organ-specific primordia.

A systematic review to ascertain whether the standard needle is more effective than a longer or wider needle in reducing the incidence of local reaction in children receiving primary immunization.

CONTEXT: Millions of doses of vaccines are given to children within the United Kingdom (UK) each year, yet there is conflicting national guidance on the length of needle to use. Prefilled syringes come supplied with 25 Gauge 16 millimetres long needles. OBJECTIVES: A systematic review was completed to answer the clinical question of whether the standard needle is more effective than a longer and/or wider needle in reducing local reactions in children receiving primary immunizations. DATA SOURCES: A comprehensive search strategy, including searching of electronic databases, hand searching, reference/citation searching, contacting researchers in the field and searching for unpublished literature. STUDY SELECTION: Selection of studies was guided by the clinical question, the inclusion and exclusion criteria being applied by two people independently. Study quality assessment: An established quality checklist was used. Critical analysis of the quality of the components of the studies is included in the discussion. DATA EXTRACTION: Two people independently applied a data extraction form, designed for the study. RESULTS: (1). Rev Man (a Windows-based software package used by the Cochrane Collaboration) was used to perform a meta-analysis on the binary results of two small studies using Relative Risk as the summary statistic 16 mm vs. 25 mm needle. (2). The pooled Relative Risk for redness was 2.52 [95% confidence interval (CI) fixed 1.70-3.72] P < 0.00001. (3). The pooled Relative Risk for swelling was 2.31 (95% CI fixed 1.55-3.43) P < 0.00003. CONCLUSION: (1). The results are statistically very highly significant and favour the use of the 25 millimetre long needle. (2). No studies were identified to separate the effect of the gauge of the needle used, but the discussion shows that needle length is the most important variable. (3). The results should be incorporated into any future guidelines on vaccine administration in the UK.