Late recall urticaria.

In the cases reported of recall urticaria, the clinical manifestations usually develop within an hour. We present the clinical case of an 11-year-old boy who, after 9 weeks of immunotherapy with pollen extracts (Phleum pratense and Festuca elatior), presented an urticarial lesion 48 to 72 h after of the injection on the opposite arm to where it had been applied and in the same place where the previous injections had been administered. This reaction continued for every injection given during the time that the immunotherapy was applied twice a week, and for the 6 weeks that it was applied once a week. Subsequently, the urticarial lesions appeared every two or three injections.

Latex allergy among operating room personnel in Turkey.

This study was performed to evaluate the prevalence of latex allergy among health care workers in Turkey, as well as to compare the medical histories with the skin test results and investigate the risk factors. Using a 1/100 weight/volume commercial skin prick test (SPT), we investigated latex sensitization in 206 health care workers who regularly use latex products. One hundred atopic and 100 nonatopic patients without occupational latex exposure were also examined as control groups. Latex SPTs were positive in 10 health care workers (9.22%), whereas none of the control patients was found to have positive SPT to latex. Health care workers were divided into two groups based on the latex SPT results. There was no significant difference between the latex SPT-positive and -negative health care worker groups according to age, sex and total exposure time to latex. In the latex SPT positive group, daily exposure time and daily glove use were significantly higher (p <0.05). The symptoms related to latex products were limited to hands and itching was present in all, however, erythema was found in 68.4%, and contact urticaria in 52.6% in the latex SPT positive group. These symptoms in the latex SPT negative health care group were 21.4%, 14.4%, and 1.6%, respectively (p <0.0001). History of allergic rhinitis, bronchial asthma and conjunctivitis were also higher in the SPT-positive group (p <0.05). Additionally, we found sensitivity to house dust mites and/or grass pollens in seven cases of latex allergy. Patch tests with rubber additives were positive in five out of 42 medical care workers. Two surgeons were found to have both type-I hypersensitivity to latex and type-IV hypersensitivity to rubber additives. Our results suggest that the frequency of latex allergy is higher in the atopic health care workers with a high exposure to latex, and that SPT is a sensitive, safe, cheap and easy method of testing the diagnosis of latex hypersensitivity.

Systemic reactions due to allergen immunotherapy.

The purpose of this study was to evaluate the incidence, type and potential risk factors of systemic reactions due to conventional allergen immunotherapy with aqueous extracts. The study was carried out retrospectively and included 1,506 patients to whom allergy injections had been given during the last 12 years. Symptoms in each reaction were classified with respect to time of onset, involvement of respiratory tract or skin, and presence of hypotension. The results showed 125 systemic reactions in 109 patients (1 per 1,831 injections), of which 52.8% were of the skin, 12% were respiratory symptoms, 30.4% respiratory symptoms and skin, 0.8% hypertension only, and 4% hypotension with respiratory symptoms and skin reactions. Most of the systemic reactions (84.8%) occurred within the 30 min after injection. Forty-one per cent of the systemic reactions were observed in the build-up period (1/52 patients, 1/1, 158 injections) and 58.4% in the maintenance injection period (1/73 patients, 1/2,311 injections). Seventy-six systemic reactions were related to pollen season (60.8%), 11 were related to injection from a new vial (8.8%) and eight to both pollen season and a new vial (6.4%). Thirty-five per cent of the patients who experienced systemic reactions had bronchial asthma, but there was no correlation between frequency of the two. There was also no correlation between systemic reactions and age or sex. It was concluded that immunotherapy has a low rate of systemic reactions and that maintenance immunotherapy appears to be associated with fewer such reactions than the build-up period. The 30 min waiting period is adequate for conventional immunotherapy. However, a longer waiting period may be necessary for high-risk subjects.

The allergen spectrum in Turkey and the relationships between allergens and age, sex, birth month, birthplace, blood groups and family history of atopy.

This study was performed retrospectively on 2,342 patients who were treated in the allergy department from 1985 to 1996. All patients had been skin prick tested with 40 common aeroallergens in Turkey. Allergen immunotherapy was given to 1,455 of them. Mean age of the patients was 25.9 (range 5 to 69). Fifty-five percent were males and 45.1% females. Forty percent had bronchial asthma and 60.2% had allergic rhinitis. Fifty-five percent of them had a family history of atopy. Sensitization to pollens was 59.7%, to house dust 20.5%, to molds 2%, to pollens and molds 2.9%, to pollens and house dust 11.5%, to molds and house dust 1.4%, and to pollens, molds and house dust 2%. The grass pollen sensitivity was threefold more common than that for trees, and fourfold more common than that for weed pollens. The diagnosis of bronchial asthma in the 5 to 9 age group was higher than in the other age groups (p < 0.005). The mold sensitization increased in parallel with age and it was the highest in 60 to 69 age group (p < 0.0001). There was no relationship between the allergens and sex, history of family atopy or blood group (p > 0.05) (except for house dust allergen). However, there was a relationship between month of birth (p < 0.005, p < 0.05, respectively) and birthplace (p < 0.001) with pollen and house dust allergen. House dust and molds were more common causes of bronchial asthma than pollens (p < 0.001, p < 0.01, respectively). In conclusion, the most common allergen was pollen in Turkey. In addition, atopic diseases are multifactorial, including such factors as genes and environment. Month and place of birth may influence early exposure and subsequent risk for allergy.

Effects of allergen immunotherapy on the nasal mucosa in patients with allergic rhinitis.

Despite the varied immunological changes occurring after allergen immunotherapy, the precise mechanism, or the mechanisms responsible for clinical effectiveness of allergen immunotherapy have not been clearly determined. Postulated immunomodulatory mechanisms include a decrease in cellular responsiveness, a production of blocking antibodies, a reduction in the number of mast cells, and activation of T-cell suppressor mechanisms. Nineteen allergic rhinitis patients (study group) with house dust mite sensitivity and 10 nonallergic control subjects were studied. In the study group, the nasal mucosal biopsies were obtained prior to immunotherapy and were repeated after 1 year, and specimens were evaluated by light and electron microscopy. After the third month of immunotherapy, nasal symptom scores were reduced significantly and disappeared in the sixth month (p <0.01). No significant changes were observed in the levels of immunoglobulins, IgG subclasses and complement levels (p <0.05), except IgG4/IgG1 ratio (p <0.05). A comparison of histopathological findings of nasal mucosa in each case revealed an improvement in epithelial loss, inflammation, thickening of basal membrane and fibrosis (p <0.05). A significant correlation was observed between epithelial loss and mast cell accumulation with symptom score (p <0.001). These results suggest that the improvement of nasal epithelial cells and reduction of mast cell accumulation in nasal mucosa may be one of the mechanisms that could explain the improvement of nasal allergy symptoms following immunotherapy.

Comparison of skin tests to aeroallergens in Ankara and Seoul.

BACKGROUND: The environment contains many allergenic proteins, and skin test reactivity to aeroallergens may be different among people living in different regions. OBJECTIVE: To compare skin test results of Turkish and Korean patients with respiratory allergies. METHODS: The charts of 304 (160 male, 144 female) patients from Ankara, Turkey, and 208 (111 male, 97 female) patients' charts from Seoul, Korea, who had undergone skin prick tests were reviewed. Skin tests were classified as positive when the allergen-induced wheal size was the same size or larger than that caused by histamine. RESULTS: Grass pollens were found to be major allergens more often in Ankara than in Seoul (74.34% vs. 15.87%, p < 0.001). Skin test reactivities in Ankara were significantly lower (p < 0.001) than in Seoul to weed (6.91% vs. 37.50%) and tree pollens (4.61% vs. 39.42%). Allergic reactions to indoor allergens were significantly higher (p < 0.001) in Seoul than in Ankara: house dust mites (HDM) (83.17% vs. 32.90%), cockroaches (45.67% vs. 1.97%), and cats (17.79% vs. 1.65%). CONCLUSION: Due to the different aeroallergen environment, the positive skin test results were different in both cities: grass pollens were the most common allergens in Ankara, while patients from Seoul reacted more commonly to indoor allergens, especially to HDMs and cockroaches.

Impact of Helicobacter pylori and Giardia lamblia infections on chronic urticaria.

The etiology of chronic urticaria is largely unknown. The role of Helicobacter pylori infection, which is the most important cause of gastritis and peptic ulcer, is not clear in the pathophysiology of chronic urticaria. In this study, we aimed to define the impact of H. pylori on chronic urticaria. Thirty-eight patients who had chronic urticaria of unknown origin and dyspepsia were included in the study. In all patients, standard laboratory tests for detection of urticaria etiology were performed. Mean urticaria symptom scores of patients were carried out. All patients underwent upper gastrointestinal endoscopy. The presence of H. pylori was investigated using urease testing and histopathology. Duodenal fluid aspirated during upper endoscopy was examined for the presence of Giardia lamblia. H. pylori infection was detected in 29 patients. After successful eradication of H. pylori infection, the mean symptom score of patients did not change significantly (2.6 +/- 0.6 vs., 2.4 +/- 0.8). Only one patient had a total disappearance of urticaria symptoms. Out of 38 patients, only one had G. lamblia infection. The results of our study suggest that there is no association between H. pylori infection and chronic urticaria.

Levothyroxine versus ketotifen in the treatment of patients with chronic urticaria and thyroid autoimmunity.

BACKGROUND: Thyroid hormone replacement therapy has previously been discussed as a feasible therapeutic approach in patients with chronic urticaria and/or angio-oedema (CUA) and thyroid autoimmunity (TA). OBJECTIVE: The efficacy of levothyroxine was investigated in patients with CUA and TA by comparing it with ketotifen treatment. METHODS: A total of 60 patients with CUA and TA were included in the study. Patients were divided into two groups, which were matched with respect to sex, age and symptom score. Each group consisted of 30 patients. Patients in one group were treated with ketotifen and the other with levothyroxine. After completion of the treatment periods, the pre- and post-treatment symptom scores, onset time of drug effects, duration of symptom-free period, recurrence ratios, recurrence times and side effects were evaluated for each drug. The two drugs were compared with each other according to these parameters. RESULTS: Ketotifen treatment provided significant relief of symptoms. However, these beneficial effects were observed only in ongoing treatment. Symptoms reappeared in all patients during the drug-free follow-up period. On the other hand, 18 of 30 patients were completely improved and three patients partially improved with levothyroxine treatment. Symptoms did not recur in the completely improved patients. CONCLUSION: Levothyroxine is an important and inexpensive treatment alternative in patients with CUA and TA.

Renin angiotensin aldosterone system and drug allergies complicated with hypotension.

It has been discussed in several studies that non-immunologic factors, such as renin angiotensin aldosterone system (RAAS) may play a role in the pathophysiology of anaphylaxis. This study aimed to determine whether RAAS plays a part in the fall in blood pressure during drug reactions or not. Twenty patients who experienced hypotension during drug reaction and 15 healthy volunteers were enrolled in this study. None of the patients in the study or control groups were under treatment with any drug that was capable of influencing to RAAS. Serum levels of angiotensin-I (A-I), angiotensin-II (A-II), angiotensin converting enzyme (ACE) and aldosterone were measured in both study and control groups. The Mann-Whitney U test was used to compare the results of the groups. There were no statistically significant differences between the groups with respect to A-I, A-II, ACE and aldosterone levels. It was concluded that a fall in blood pressure during drug reaction must be the result of mast cell mediator effects on the vascular wall rather than RAAS impairment.

Severe anaphylaxis from rifamycin SV.

BACKGROUND: Anaphylaxis to topical application of rifamycin SV, which is used topically in the fields of surgery and dermatology, is rare. METHODS: We report two cases of systemic reactions occurring after local administration of rifamycin (Rifocine, Gruppo Lepetit, Italy). Both of them needed repeated intermittent topical applications. Skin prick tests with Rifocine constituents were performed on our patients, and also on ten atopic and ten nonatopic subjects. Although an old investigative tool, Prausnitz-Küstner (P-K) test was also performed on one of the patient's spouses to show passive transfer and the IgE-mediated mechanism. RESULTS: Allergy assessment with skin tests on the patients were negative for aeroallergens, latex, and Rifocine constituents (except rifamycin SV). The patients' prick tests with rifamycin SV were positive, and the control subjects were negative. P-K testing was positive. CONCLUSION: Two case reports support the existence of IgE-mediated reactions to rifamycin SV. IgE-mediated anaphylactic reactions from rifamycin SV appear to be extremely rare.

Fever of unknown origin in a 10-year-old boy with allergic rhinitis and asthma.

We believe this case represents a clear example of drug fever, and it appears to be the first report to implicate ketotifen as the responsible agent, confirmed with double rechallenge. The recognition of drug fever is clinically important. Failure to recognize the etiologic relationship between the drug and fever has unnecessary consequences, including extra testing, empiric therapy, and longer hospital stays. We suggest that ketotifen should be considered as a possible cause of fever in allergic patients receiving this drug.

Nonpigmenting solitary fixed drug eruption after skin testing and intra-articular injection of triamcinolone acetonide.

BACKGROUND: Although several medications have been reported to cause fixed drug eruption (FDE) reactions, triamcinolone acetonide has not been previously described as an offending agent. OBJECTIVE: To emphasize both an unprecedented causative agent and the extraordinary development of a FDE, we describe this response in a 42-year-old female patient. METHODS: Because her history included a questionable reaction to corticosteroid preparations, prick and intradermal testing with triamcinolone acetonide was done to determine whether she could safely receive a triamcinolone acetonide injection. RESULTS: Both skin test procedures and the intra-articular administration of triamcinolone acetonide caused FDEs on her right retroauricular area. CONCLUSIONS: Because any drug may induce a FDE by any administration route, physicians should be aware of this delayed skin reaction when skin testing drugs.