Current Epidemiology and Management of Radiocontrast-Associated Acute- and Delayed-Onset Hypersensitivity: A Review of the Literature.

Radiocontrast-associated acute-onset hypersensitivity reactions now occur less frequently than before 1990, when high-osmolar, ionic, radiocontrast agents were widely used. Premedication with corticosteroids and antihistamines does not reliably prevent recurrent low-osmolar radiocontrast-associated acute hypersensitivity reactions. Corticosteroid prophylaxis for acute hypersensitivity currently causes more morbidity than benefit. The specific radiocontrast agent that is associated with a patient's adverse reaction must be displayed in the drug intolerance or drug "allergy" field of their electronic health record to enable effective management and prevention of future reactions. The term iodine allergy should never be used in the context of radiocontrast-associated adverse reactions because it leads to poorer clinical outcomes. The time to onset of the reaction and the nature of the reaction must be noted in enough detail in the drug intolerance comment fields in the electronic health record to determine the potential mechanism for the reaction and to enable selection of the appropriate radiocontrast material for future exposures. Most individuals with a history of radiocontrast agent hypersensitivity can be effectively managed by selecting an alternative radiocontrast agent, without any premedication. Radiology Departments, catheterization laboratories, and all physicians who use parenteral radiocontrast media must have management plans in place to treat severe acute reactions when they occur. Patients should be informed that delayed-onset reactions, mostly benign rashes within one week of exposure, are as common or more common than acute reactions. Future radiocontrast-associated acute and delayed-onset reactions can be minimized, but never completely avoided, by using an appropriate alternative agent.

Assessment of possible immunotoxicity of the antipsychotic drug clozapine.

OBJECTIVES: The immunomodulatory effects of clozapine (CLZ), antipsychotic drug, were investigated in vivo using female Balb/c mice. The main aim of this study was to evaluate the immunomodulatory effects of CLZ, antipsychotic drug, following daily intraperitoneal injection to female Balb/c mice over a period of 21 days. METHODS: Mice were divided into five groups, eight animals per group. Group I, served as a control group, received only the vehicle. Groups II-V received a daily intraperitoneal dose of CLZ (1, 5, 10 and 20 mg/kg, respectively) over a period of 21 days. KEY FINDINGS: CLZ has shown a significant decrease in the animal body weight, and it showed a significant decrease in the percentage of circulating neutrophils and lymphocytes while circulating monocytes were increased. The immunotoxicity has been also assessed by evaluating spleen cellularity, humoral immune response to a foreign antigen using sheep red blood cells and delayed-type hypersensitivity reaction. The results showed a marked suppression in these responses in CLZ-treated mice compared with the control group. Detectable changes have also been noticed in the histology of the footpad tissue and spleen. CONCLUSIONS: Results showed significant immunomodulatory effects of CLZ when used in Balb/c mice.

[Medical and biological safety assessment of genetically modified maize event MIR604].

There are presented the results of genotoxicologic, immunologic and allergologic examinations which were conducted within the framework of integrated medical and biological assessment of genetically modified rootworm Diabrotica spp.-protected maize event MIR604. Analysis of damages of DNA and structural chromosome aberrations, assessment of the allergenic potential and immunoreactive properties has not confirmed any genotoxic, allergenic and immunotoxic effect of maize event MIR604.

Citrus pulp for cattle.

Citrus pulp is classified as an energy concentrate by-product feed. Citrus by-products fed to beef cattle include citrus molasses, citrus meal, wet citrus pulp, dried citrus pulp, and pelleted citrus pulp; however, in current production systems, pulp (wet, dry, and pelleted) is the only by-product commonly used. Citrus pulp production in the United States is limited to specific subtropical regions, of which south central Florida remains the largest with additional production in California and Texas.

Assessment of injection site reactions to an acellular pertussis-based combination vaccine, including novel use of skin tests with vaccine antigens.

Recent reports indicate that children receiving a fifth consecutive dose of DTPa vaccine have a moderate likelihood of developing a large injection site reaction, the etiology of which remains unknown. We assessed the frequency, severity and outcome of local reactions in 205 children who had participated in earlier studies of DTPa-based vaccines and were due for a fifth dose at 4-6 years. DTPa.IPV vaccine was given intramuscularly in the deltoid. To explore the role of cell-mediated immunity in local reactions we applied epicutaneous (patch) tests at the same visit, using code-labeled solutions of DTPa.IPV, DT, Pa, IPV, alum solution and saline, leaving them in place for 48 h. Subjects were assessed by research staff on the following day. Injection site redness or swelling >/=50 mm diameter was present in 24.4 and 20.5%, respectively, but none of the subjects had fever or persistent limitation of arm movement. Large local reactions were more common in bigger children (P<0.01) but not in those with allergy/atopy. Large reactions resolved within 14 days. Positive skin tests (erythema) occurred at 85 test sites in 51 of 187 evaluable children, principally with DTPa.IPV, IPV and alum solutions. However, only DT and Pa solutions caused positive tests significantly more often in children with injection site redness > or =50 mm than in non-reactors (P < 0.05, odds ratios 5.2 and 6.1, respectively). Presence of alum in most test solutions might have confounded the results as it caused non-specific inflammation when applied alone. We conclude that local reactions to a fifth dose of DTPa-type vaccine are frequent and sometimes extensive but not incapacitating and that concurrent skin testing has potential to identify the vaccine antigens and immune mechanism contributing to local reactions with more refinement of the method.

Natural rubber latex allergy.

Rubber is an important industrial and consumer product encountered in many household items and medical devices. Whereas the chemical additives used in its manufacture are well recognized as a cause of delayed-type hypersensitivity (allergic contact dermatitis), it is only during the past decade that immediate-type allergy to natural rubber latex (NRL) proteins (latex allergy) has emerged as a serious health issue. Frequent, prolonged wearing of NRL gloves, especially amongst health care workers, is a major risk factor for such sensitization. Latex allergy is now an important medical, occupational, medico-legal and financial problem, and it is essential that policies are developed to reduce it. Undiagnosed latex allergy is potentially very serious for patients. This article briefly overviews latex allergy with emphasis on the practical issues of diagnosis and management.

[Studies on the safety assessment of pesticides by means of immunological criteria].

The immunological response induced by pesticides HCH, Sevin and Malathion were studied. The results showed that the pesticides can produce the immunological changes even on low dose. These responses appeared more sensitive to toxicants than other biological responses indicated by biochemical parameters. The sensitiveness we found is especially meaningful in setting-up a early sensitive criterion for detecting the toxicity of those chemicals whose low toxicity were known but could not be determined due to lack of specific criterion. In addition, our studies also showed the dose-response relationship, and that this relationship gave the same as the specific criterion. Thus, the authors suggest that immunological criteria be considered as one of the toxicological assessment criteria on food safety.

[Assessment of postoperative infective risk by delayed hypersensitivity tests. The influence of deficient nutrition and its correction (author's transl)]. / Appréciation du risque infectieux post-opératoire par les tests d'hypersensibilité retardée. Influence de la dénutrition et de sa correction.

Cellular immunity was assessed in 120 patients by simple skin tests (tuberculin, candidine, varidase, C.C.B., trichophyton). There is a close relationship between total anergism and the risk of severe infection in digestive surgery, and between anergism and deficient nutrition as determined by laboratory and anthropometric criteria. Preoperative correction of nutritional deficiency, which is often underestimated, has an inconstant effect upon skin test responses, but seems to decrease severe postoperative infective complications.