An unusual hazard of menopause in the workplace: a case report.

Untreated vasomotor symptoms of the menopause can have a major impact on women at work. Recent recommendations advocate modification of the working environment, including adequate air-conditioning, to help relieve these symptoms. However, this may cause discomfort for work colleagues. We report the case of a 40-year-old woman with cold urticaria. Cold urticaria is a serious, potentially life-threatening condition. Our patient's symptoms were exacerbated when her postmenopausal work colleagues turned the air-conditioner temperature down to relieve their vasomotor symptoms.

Leptospirosis in Western Australia, 1983-1984.

The diagnosis of leptospirosis is often difficult to make because of vague and mild symptoms. Patients who present with a "flu-like" illness and who have had either direct or indirect contact with infected animals should be investigated by serological examination. In Western Australia during 1983 and 1984, the sera of 937 patients were tested for the presence of leptospiral antibodies. Of these, 131 gave positive results; in 45, these were consistent with recently acquired infection. Apart from one veterinary worker, all the cases that were diagnosed serologically occurred in farmers and meatworkers. Farmers were most often infected with serovar hardjo. Meatworkers demonstrated a high degree of cross-reactivity among serovars pomona, hardjo, and to a lesser extent, icterohaemorrhagiae. However, in cases in which the infecting serovar was identifiable serologically, serovar pomona predominated.

Extreme cutaneous histamine sensitivity with hay fever and increased IgE concentrations in an unselected population.

Cutaneous sensitivity to histamine, responses to prick tests with allergens, and serum IgE concentrations were measured and hay fever assessed by questionnaire in an unselected population to determine whether increased sensitivity to histamine is an independent phenomenon contributing to allergic disorders or may be caused by allergic reactions. Increased cutaneous sensitivity to histamine was strongly associated with an increased number of positive responses to prick tests, high serum concentrations of IgE, and hay fever. This new test is simple, cheap, applicable to schoolchildren, and provides useful information.

Prevalence of delayed hypersensitivity to the European standard series in a self-selected population.

There are limited reports of the prevalence of positive reactions in healthy adults to patch tests with standard allergens; there are no recent comprehensive studies from Australia. Healthy adult volunteers (n = 219) from the Western Australian community were patch tested using the European standard series of allergens. Seventy-seven (35%) reacted to at least one allergen, positive patch tests being most prevalent to nickel sulfate (20%), potassium dichromate (9%), cobalt chloride (6%) and fragrance mix (4%). Prevalence of positive patch tests to nickel and chromate was higher than that reported for another healthy population, which may stem from self-selection of volunteers or geographical differences, including extent of exposure to allergens.

Positive allergy prick tests associated with bronchial histamine responsiveness in an unselected population.

Bronchial responsiveness to histamine and skin prick test reactions to airborne allergens were measured in a random population sample of 891 adults and 1293 schoolchildren. Total serum IgE concentrations were measured in a subset of 389 adults. The prevalence of bronchial histamine responsiveness (BHR) in the adults increased from 5.8% in those who did not respond to allergen prick tests to 22.2% in those who responded to all five allergen groups (p less than 0.00001). Similarly, the prevalence of BHR in the children increased progressively from 3.5% to 35.3% as the number of positive allergen responses increased from zero through five (p less than 0.0001). In adults for whom IgE data were also available, those with BHR had a significantly higher total serum IgE concentration (p less than 0.002).

Vega testing in the diagnosis of allergic conditions. The Australian College of Allergy.

Vega testing (the Vega test method) is an unorthodox method of diagnosing allergic and other diseases. It has no established scientific basis and there are no controlled trials to support its usefulness. Vega testing may lead to inappropriate treatment and expense to the patient and community.

HLA typing and ACTH stimulation in the detection of carriers for 21-hydroxylase deficiency.

Two methods of carrier detection were applied to the siblings of two children with congenital adrenal hyperplasia due to 21-hydroxylase (21-OH) deficiency. HLA geno-typing showed that the affected children were HLA identical. One of the siblings possessed only one of the relevant haplotypes, and was shown to be heterozygous for 21-OH deficiency by the 17 alpha hydroxyprogesterone response to ACTH stimulation. The other sibling had a maternal recombination between the DR and glyoxylase-1 (GLO) loci. The ACTH stimulation test was normal and therefore confirms recent reports suggesting that the 21-OH gene is between the HLA-A and the GLO loci. Although HLA typing of family members will identify heterozygous 21-OH deficiency in most instances, biochemical definition is still required for some cases with recombinations in the short arm of chromosome 6.

Histamine sensitivity influences reactivity to allergens.

The ability to mount an IgE response to allergens is a prerequisite for the development of positive allergen skin tests, and this is reflected to some extent by the observation that allergen-responsive subjects tend to have higher total serum IgE concentrations. To determine whether histamine sensitivity also contributes to allergen responsiveness, 893 subjects in a rural community were prick tested with 14 allergens and tenfold dilutions of histamine phosphate beginning at 1 mg/ml-1. IgE was measured in a subset of 400 subjects. Three-way contingency table analysis confirmed previous reports of an association between allergen responsiveness and IgE (p less than 0.001) and also demonstrated that allergen responsiveness is associated with sensitivity to histamine (p less than 0.001). This association is independent of IgE so that the additive effect of IgE and histamine sensitivity allows more nearly accurate prediction of allergen responsiveness than either measurement alone.

Heterogeneity of steroid 21-hydroxylase genes in classical congenital adrenal hyperplasia.

Careful genotyping of three families, each having a member with classical salt-losing steroid 21-hydroxylase deficiency, has allowed identification of carrier haplotypes. Digestion with TaqI or EcoRI and probing with a cDNA probe for the 21-hydroxylase genes (pC21/3c) revealed that all six affected haplotypes are abnormal with at least EcoRI. The data suggest that there is extreme polymorphism of the 21-hydroxylase genes and that dysfunction may result from several different abnormalities.

An association between cutaneous sensitivity to histamine and HLA phenotype.

Four hundred and twenty randomly chosen subjects from a normal population were HLA typed and tested for cutaneous sensitivity to histamine by prick testing with 5 concentrations of histamine (10(-3), 10(-2), 10(-1), 1, 10 mg X ml-1). Positive responses to 10(-1) mg X ml-1 histamine occurred in 41% of the subjects, and particularly those with HLA-B7 (55%) (p less than 0.005). It is concluded that genes within the major histocompatibility complex influence cutaneous responses to histamine.