Anaphylaxis in an 8-year-old boy following the consumption of poppy seed

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Snake (Vipera berus) bite: The cause of severe anaphylactic shock and hepatocellular injury.

Vipera berus bites lead to a variety of clinical manifestations. Local swelling, coagulopathy, nephrotoxicity, cardiac effects and myotoxicity are known to be associated with envenoming by a viper bite. Although a variety of clinical manifestations have been reported in viper bite cases, anaphylactic reactions and liver injury events have not been described. We report a unique case of an anaphylaxis and transitional liver cell injury due to a Vipera berus bite in the case of a 58-year-old man with no past history suggestive of allergy and liver disease. These observations need to be further explored with laboratory studies to identify the venom components which could have pre-disposed the patient to the development of these complications.

Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting.

Hymenoptera venom anaphylaxis after bee or wasp sting is a common problem that affects about 1.2 percent to 3.5 percent of the general population. Venom-specific immunotherapy (VIT) is an established mode of treatment for immunoglobulin (Ig) E-mediated Hymenoptera venom allergy. However, VIT may often be associated with immediate anaphylaxis which can lead to treatment withdrawal. Several cases published in recent years suggest that omalizumab, used as add-on therapy may be able to prevent anaphylaxis during VIT. We report the case of a 30-year-old woman, suffering from mild persistent asthma, who had a history of severe anaphylactic reactions after yellow jacket sting, and after eating peanuts, contact with guinea pig hair, and i.v. administration of dexamethasone natrium phosphate. Initial specific immunotherapy had to be stopped due to severe anaphylaxis (hypotension, dyspnea, and angioedema). The immunotherapy was reintroduced accompanied by the anti-immunoglobulin (Ig) E monoclonal antibody omalizumab. Subcutaneous omalizumab 150 mg was initiated 4 weeks after the anaphylaxis incident and 1 day before the resumption of VIT. Rush treatment was uneventful, and the usual cumulative dose of 111.1 microg was successfully reached. The combination of omalizumab and VIT is a valid option of therapy for these patients and could reduce asthma and food allergy symptoms.

Role of bile acids, prostaglandins and COX inhibitors in chronic esophagitis in a mouse model.

AIM: To develop a new experimental model of esophagitis that serves a complementary tool to clinical investigation in an insight into the mechanism of the damage to the esophagus mucosa by aggressive factors, and role of COX inhibitors in this process. METHODS: The study was conducted in 56 male mice. Animals were divided into seven groups: (1) perfused with HCl, (2) perfused with HCl and physiologic concentration of pepsin (HCl/P), (3) perfused with similar HCl/P solution enriched with conjugated bile acids (glycho- and tauro-sodium salts) designated esophageal infusion catheter under the general anesthesia, (4) perfused as in group 2 treated with indometacin, (5) perfused as in group 2 treated with NS-398, (6) perfused as in group 3 treated with indometacin, and (7) perfused as in group 3 treated with NS-398. The esophagus was divided into 3 parts: upper, middle and lower. The PGE2 concentration was measured in all parts of esophagus using RIA method. Esophagus of sacrificed animals was macroscopically evaluated using a low power dissecting microscope (20x). Specimens, representing the most frequently seen changes were fixed, stained with H&E and assessed microscopically using the damage score, and inflammatory score. RESULTS: The macroscopic changes were significantly severer in HCl/P than those in HCl animals (77%) and in HCl/P/BA group (43%). In HCl/P NS-398 group we noticed significantly less changes than those in not treated group (42%) and in analogical group treated with indometacin (45%). In HCl/P/BA INDO group we observed significantly severer changes than that in not treated group (52%). We noticed less changes in HCl/P NS-398 than that in group with indometacin (46%). In HCl/P/BA NS-398 group we had less changes than that in indometacin group (34%). The microscopic changes observed in HCl/P/BA INDO group were severer than that in not treated group (48%). Esophagitis index in HCl group was significantly lower than in HCl/P and also HCl/P/BA group (32% and 33%). In HCl/P/BA/INDO group the esophagitis surface was larger than that in not treated group (33%). In HCL/P group the surface of esophagus with ulceration was significantly larger (10-fold) than that in HCl/P/BA group. The PGE2 concentration was significantly higher in HCl/P group than in HCl/P/BA group. The PGE2 concentration in lower part of esophagus was also significantly higher in middle than those in HCl and HCl/P/BA groups. In upper part of esophagus the PGE2 concentration was significantly higher in HCl/P/BA group than that in group treated with indometacin (46%). We also observed higher PGE2 concentration in middle part of esophagus in HCl/P/BA group than those in group treated with indometacin and in group treated with indometacin and NS-398 (by 52% and 43% respectively). CONCLUSION: Pepsin is the pivotal factor in the development of chronic esophageal injury. Bile acids diminish chronic esophageal injury induced by HCl/P, indicating its potential negative impact on pepsin proteolytic potential, pivotal for mucosal injury in low pH. The role of selective COX inhibitors is still unclear, and needs more investigations. This novel chronic experimental esophagitis is an excellent model for further study on the role of cytokines in genetically modified animals.

One week of treatment with esomeprazole-based triple therapy eradicates Helicobacter pylori and heals patients with duodenal ulcer disease.

BACKGROUND: Proton pump inhibitor (PPI) monotherapy is commonly continued for 3 weeks after Helicobacter pylori eradication with PPI-based triple therapy regimens to ensure duodenal ulcer (DU) healing. This randomized, double-blind, multicentre study evaluated whether only 1 week of triple therapy with the new PPI esomeprazole was sufficient to ensure high rates of ulcer healing and H. pylori eradication. METHODS: A total of 446 H. pylori-positive patients with active DU received twice daily treatment with esomeprazole 20 mg (n = 222) or omeprazole 20 mg (n = 224) in combination with amoxicillin 1 g and clarithromycin 500 mg for 1 week (EAC and OAC, respectively). Patients in the OAC group then received 3 weeks' monotherapy with omeprazole 20 mg once daily; those treated with EAC received placebo. Ulcer healing was assessed by endoscopy on completion of therapy and H. pylori status was assessed by (13)C-urea breath testing and histology 4-6 weeks later. RESULTS: Ulcer healing rates (95% CI) for intention-to-treat and per-protocol populations were: EAC + placebo 91% (87-95%) and 94% (90-97%); OAC + omeprazole 92% (88-95%) and 96% (92-98%). Corresponding H. pylori eradication rates were: EAC + placebo 86% (81-90%) and 89% (84-93%); OAC + omeprazole 88% (83-92%) and 90% (85-93%). Both eradication regimens were well tolerated, and patient compliance was high. CONCLUSIONS: A 1-week regimen of esomeprazole-based triple therapy is sufficient for DU healing and H. pylori eradication in patients with DU disease.

Correlation between Helicobacter pylori infection and food allergy in chronic gastritis.

The purpose of this study was to evaluate the intensity of gastric inflammatory changes in atopic patients infected with H. pylori, and to find out whether a long-term exposure to a sensitizing allergen intensified the acuteness of inflammatory changes. The examinations were performed on patients with atopic diathesis who suffered from dyspepsia and gastralgia. The examined group included 72 women between 16 and 57 years of age (mean age: 36.5 years) and 38 men from 16 to 60 years of age (mean age: 34.4 years). The control group included 40 patients with no traits of atopy (13 men and 27 women between 18 and 56 years old, mean age: 34.8 years) with chronic gastritis confirmed by endoscopic and histopathological tests. All patients were subjected to endoscopy of the upper alimentary tract. Biopsy specimens were taken for histopathological analyses. They were stained with eosin and hematoxylin (the H&E method), and with a modified Giemsa method. The evaluation included the presence of chronic inflammation of gastric mucosa, its activity and intensity. The presence of H. pylori colonization was determined with the use of histopathological method of staining. Significant differences were found concerning inflammation intensity in atopic patients additionally infected with H. pylori, in comparison with the group of patients with food allergy without bacterial colonization. The differences were found during the evaluation of mucosa of both the prepyloric area and body of the stomach (p < 0.001). Moreover, statistically significant differences were found in the inflammation intensity between the examined group and the control group with no symptoms of allergy. In atopic patients infected with Helicobacter pylori, a long-term exposure to food allergens increases the intensity of gastric mucosa inflammation.

Evaluating the profile of selected cytokines in patients with food allergy and chronic gastritis.

INTRODUCTION: Evaluating the profile of selected cytokines in patients with food allergy and chronic gastritis. Cytokines are produced by many cells and they play a role of mediators in the development of local and systemic inflammatory reaction. The aim of the study was to determine serum concentrations of IL-4, IL-5, IL-8, TNF alpha in patients with chronic gastritis and food allergy, who had been infected with H. pylori. MATERIAL AND METHODS: The study was conducted on patients with atopic diathesis, who were allergic to certain foods. The study group consisted of 71 patients, including 42 females aged 16-54 years (mean age 35.5 years) and 29 males aged 18-60 years (mean age 36.2 years). One control group was formed of 40 non-atopic patients aged 18-56 years (mean age 34.8 years), suffering from chronic gastritis. The other control group consisted of 30 subjects with the diagnosis of functional dyspepsia. Serum levels of selected cytokines were determined with the kits manufactured by ENDOGEN (Cambridge MA, USA) using enzyme immunoassay ELISA. The concentrations of parameters were determined in two tests and they were given as mean value. RESULTS: Mean serum Il-4 level in atopic patients was 27.85 pg/ml, while it was 13.26 pg/ml in non-atopic subjects with chronic gastritis and 4.3 pg/ml in patients with functional dyspepsia. The concentration of IL-5 ranged between 0 and 111.3 pg/ml (mean value: 7.43 pg/ml) in subjects with food allergy. Comparative analysis of IL-4 and IL-5 concentrations in atopic patients and in control subjects showed the presence of statistically significant differences (p < 0.001). The remaining cytokines, i.e. IL-8 and TNF alpha showed a significant increase in serum levels in patients chronic gastritis when compared to the subjects with functional dyspepsia, without inflammatory changes. CONCLUSIONS: Chronic exposure of the patients with food allergy to a given food allergen makes the levels of IL-4 and IL-5 rise. In atopic subjects with chronic gastritis and H. pylori infection, the increase in IL-4, IL-5, IL-8 and TNF alpha levels suggests that both infectious and allergic factors play an important role in the pathogenesis of inflammation.

Macroscopic picture of gastric mucosa in endoscopic examination of patients with chronic gastritis and food allergy.

INTRODUCTION: The aim of the study was to evaluate the difference in macroscopic picture of the stomach in patients with food allergy and in non-atopic patients with H. pylori infection. MATERIAL AND METHODS: In the study, patients with atopic diathesis, suffering from dyspepsia or abdominal pain were analysed. The study group included 72 women aged 16-57 years (mean age 36.5 years) and 38 men aged 16 and 60 years (mean age 34.4 years). Control group was formed of 40 patients without atopy (13 men and 27 women, aged 18-56 years--mean age 34.8 years), with endoscopically and histologically confirmed gastritis. All the patients underwent endoscopy of upper gastrointestinal tract with the use of fiberoscope GIF-E OLYMPUS and video endoscopy monitor OEV 203 OLYMPUS (Japan). The following features of gastritis were considered in endoscopic assessment: oedema, reddening and fragility of mucous membrane, spotted and macular exudate, flat and raised erosions, proliferation and atrophy of mucosal folds, vascular network, intramural extravasation, mucosal structure. The results obtained were verified statistically with chi-squared independence tests for 2 x 2 tables. CONCLUSIONS: Statistical analysis of the incidence of these signs of inflammation in patients with food allergy did not show significant differences in relation to subjects with non-atopic gastritis.

[Eosinophilic activation based on measurements of eosinophil cationic protein in patients with acute myocardial infarction and patients with angina pectoris]. / Aktywnosc eozynofilów oceniana na podstawie oznaczania wartosci eozynofilowego bialka kationowego (ECP) u chorych ze swiezym zawalem miesnia sercowego i pacjentów z dusznica bolesna.

Increased activation of polymorphonuclear neutrophils in the wideness of irreversible myocardial injury was described by many authors. Released proteolytic enzymes may cause deliquescence of necrotic muscle tissue and attenuate collagenic structure of myocardium, lead to endothelium damage and generate free oxygen radicals. Eosinophilic leucocytes reveal also enhanced proinflammatory activation. They take participation in inflammatory and immunologic reactions, among others, by producing and releasing many biologic mediators. One of the most important and powerful mediators is eosinophil cationic protein (ECP), the specific marker of eosinophil activation in vivo. We studied 17 patients (pts) with acute myocardial infarction (MI) and 21 pts with angina pectoris (AP). The plasma concentrations of ECP and the number of eosinophils in peripheral blood were measured 3 times-near before beginning of the treatment, and on the 4-th and 8-th day of MI. During the first 4 days measurements of CK-MB every 6 hours were made. We observed the significant increase of eosinophils and ECP correspondingly on the 8-th and 4-th day, when compared to the first day of MI (p < 0.05) and the patients with AP (p < 0.01). Despite tendency, the significant correlation of eosinophils and ECP values was not obtained (r = 0.36). In the group of patients with AP the eosinophil and ECP values were significantly higher at the pts with unstable angina, when compared to pts with stable angina (p < 0.001).

Anaphylactic histamine release from human gastric and duodenal mast cells.

Mast cells from human gastric and duodenal walls were isolated using a collagenase dispersion technique. The reactivity of both mast cell populations with anti-human IgE antibodies and specific antigens was tested in an in vitro model of anaphylactic reaction. Mast cell populations were sensitive to the action of anti-IgE, and histamine release was 17.4-27.4% (duodenal) and 19.3-29.3% (gastric mast cells). No significant differences between both mast cell populations of the same individuals were observed. Gastric and duodenal mast cells obtained from patients with peptic ulcer and positive intradermal test with allergens (grass pollen, tomato, cocoa) released histamine after challenge with adequate antigens. The reaction was dose-dependent. Gastric mast cells were more reactive than duodenal cells to challenge with antigen.

[Evaluation of heart function during endoscopic examination of the upper gastrointestinal tract together with a trial of direct provocation of the sensitizing allergen--initial report]. / Ocena czynnosci serca podczas badania endoskopowego górnego odcinka przewodu pokarmowego polaczonego z próba bezposredniej prowokacji alergenem uczulajacym--doniesienie wstepne.

The heart function was evaluated during endoscopy examination connected with the gastric challenge with the sensitizing allergen. The study involved 13 patients with diagnosed pollinosis and without any disorder of the cardiovascular system. The heart function was evaluated by Holter monitoring, performed both in 24 hours of control before endoscopy examination and in 24 hours of exposure during and after gastric challenge with the sensitizing allergen. In all cases, there was no important heart dysfunction, in spite of positive results of provocation confirmed by histopathological and immunological examinations.

[Therapeutic effectiveness of lidocaine in patients with ventricular arrhythmias estimated relative to measurements of drug concentration in serum]. / Skutecznosc terapeutyczna lidokainy u chorych z komorowymi zaburzeniami rytmu serca, oceniana z uwzglednieniem pomiaru stezenia leku we krwi.

Therapeutic effectiveness of lidocaine intravenous infusions preceded by an initial intravenous dose was studied in 29 patients with ventricular arrhythmias in a course of ischemic heart disease admitted to CCU. Clinical effects were evaluated in correlation with obtained lidocaine concentrations and basic pharmacokinetic parameters. Regression of cardiac arrhythmias was stated in 23 patients (79.3%), inclusive of all acute MI cases. Partial therapeutic effect was observed in 4 patients (13.8%) and no effect in 2 (6.9%). In 12 patients (52.2%) with stated regression of ventricular arrhythmias the full therapeutic effect was observed after initial dose administration. Serum drug concentrations were above the lower limit of the therapeutic range in all cases. Side effects were observed in 3 cases with high serum lidocaine levels caused by impaired drug metabolism or elimination due to the patient's clinical state. Correlation between the infusion rate and obtained stationary condition of drug concentration within therapeutic range seemed to be highly effective in management of ventricular premature beats caused by acute myocardial ischemia but less effective in cases of ischemic and postinfarction cardiomyopathy with heart failure.

Allergy to cockroach antigens in patients with peptic ulcers and chronic gastritis.

Cockroach allergy was investigated in 10 patients with the endoscopic diagnosis of peptic ulcers and chronic gastritis, all with positive skin reactions to Blatella germanica extract. In all the cases examined, the total serum IgE level was raised, specific serum IgE detectable and both the increased number of eosinophils and IgE-bearing cells found in biopsy specimens of gastric and/or duodenal tissues. The direct provocation test of the gastric mucosa, done under fiberoscopic control, was positive in all patients, in which the immediate oedematous and haemorrhagic reaction was observed after allergen challenge. Seven patients reacted also a few minutes later with abdominal pains and/or nasal and conjunctival manifestations. The provocation with the same cockroach extracts was negative in 4 control patients with peptic ulcers but without symptoms of allergy. In the authors' opinion, cockroach antigens, like other food and inhalant allergens, may be partly responsible for the chronic inflammatory processes as well as ulcerations of gastroduodenal tissues in predisposed persons.