[Cinnamon rolls triggered anaphylactic reaction. The genesis could be wheat-dependent exercise-induced anaphylaxis]. / Kanelbullar utlöste anafylaktisk reaktion - Genesen kan vara veteberoende ansträngningsutlöst anafylaxi.

Cinnamon rolls triggered anaphylactic reaction. The genesis could be wheat-dependent exercise-induced anaphylaxis Two case reports from our Department of Allergology illustrate the wheat-dependent exercise-induced anaphylaxis (WDEIA), which is a relatively rare, yet potentially fatal form of food allergy. Wheat (Triticum aestivum) is the most commonly grown crop world-wide, and some individuals cannot tolerate it due to wheat hypersensitivity. The most dangerous reaction is the anaphylaxis due to harmful immune responses to various parts of the wheat proteins. ω-5-gliadin is the major causative allergen in wheat hypersensitivity. WDEIA is a poorly recognized disorder. Therefore, any patient presenting anaphylactic reaction at the emergency department, typically after ingestion of wheat products followed by physical exercise within one to four hours, should be referred to an allergy clinic for the allergological evaluation. Further research should be carried out to better understand the mechanisms behind, and to increase the awareness on WDEIA.

Varenicline as compared to bupropion in smoking-cessation therapy--cost-utility results for Sweden 2003.

STUDY OBJECTIVES: To calculate incremental cost-utility ratios (cost per QALY gained) for varenicline (Champix; Pfizer), as compared to bupropion, in smoking-cessation programmes for a lifetime follow-up period. DESIGN: The Benefits of Smoking Cessation on Outcomes (BENESCO) simulation model was used for a male and female cohort, respectively, as a point of departure but further extended in order to include the indirect effects of smoking-cessation on production and consumption in the economy. All calculations were performed in 2003 Swedish prices. SETTING: Sweden in 2003. PATIENTS OR PARTICIPANTS: Model cohort consisting of 25% of all smokers among men and women (168,844 males and 208,737 females), distributed by age, 18 and older, as in the Swedish population of 2003. INTERVENTIONS: Varenicline as compared to bupropion, in smoking-cessation programmes for 20-year, 50-year, and lifetime follow-up periods. MEASUREMENTS AND RESULTS: When the indirect effects on production and consumption were included, the incremental costs per QALY gained were euro2056 (euro14,743) for men and euro1193 (euro14,214) for women, in comparison to bupropion and computed for a time horizon of 20 and 50 years (1euro approximately euroSEK9.12). Excluding the indirect effects on production and consumption, varenicline was cost-saving in comparison to bupropion. Sensitivity analysis indicated that the results are robust. Variation of treatment efficiency and intervention costs, respectively, had a larger effect on cost per QALY gained than other variables. CONCLUSIONS: Estimated costs per QALY gained rated smoking-cessation intervention using varenicline among the most cost-effective life-saving medical treatments.

The cost utility of bupropion in smoking cessation health programs: simulation model results for Sweden.

STUDY OBJECTIVES: To calculate incremental cost-utility ratios (cost per quality-adjusted life-year [QALY] gained) for bupropion (Zyban; GlaxoSmithKline; Gothenburg, Sweden), as compared to nicotine replacement therapy (NRT) in smoking cessation programs for a follow-up period of 20 years. DESIGN: The Global Health Outcomes simulation model was used for a male cohort and for a female cohort as a point of departure but was further extended in order to include the following: (1) the indirect effects of smoking cessation on production and consumption in the economy, and (2) morbidity-specific QALYs gained. SETTING: Sweden in 2001. PATIENTS OR PARTICIPANTS: Model cohort consisting of 612,851 male and 780,970 female smokers, distributed by age, > or = 35 years old, as in the Swedish population of 2001. INTERVENTIONS: Bupropion, as compared to NRT (nicotine patches and nicotine gums), in smoking cessation programs for a follow-up period of 20 years. MEASUREMENTS AND RESULTS: When the indirect effects on production and consumption were taken into account, bupropion was cost saving in comparison to both NRTs. When only the direct costs were included, bupropion was still cost saving in comparison to nicotine gum. The incremental costs per QALY gained were relatively low for bupropion in comparison to nicotine patches, 6,600 Swedish kronas (SEK) (approximately 725 euro) per QALY gained for men and 4,900 SEK (approximately 535 euro) for women, all calculations in 2001 Swedish prices. The comprehensive sensitivity analysis showed robust results; results were, however, more sensitive to quit rates and intervention costs than to other variables. CONCLUSIONS: Bupropion is a cost-effective therapy in smoking cessation programs. Furthermore, recent studies report even higher effectiveness in terms of quit rates than was assumed here, indicating that our estimated cost-utility ratio should be even more favorable to bupropion.

Environmental tobacco smoke (ETS) exposure in children with asthma-relation between lead and cadmium, and cotinine concentrations in urine.

Exposure to heavy metals from environmental tobacco smoke (ETS) was investigated in 23 children with asthma (8.4+/-3.7 yr). ETS exposure was assessed by an inquiry data-based exposure index, the urinary concentration of cotinine (U-cotinine; a major nicotine metabolite) and the house dust (fine and coarse fractions) concentrations of nicotine at home. The corresponding concentrations of the heavy metals cadmium and lead in dust and urine (U-Cd; U-Pb) were determined in the same samples. There were strong associations between the ETS exposure index and U-cotinine (r(s)=0.62; P<0.002) and nicotine in house dust (r(s)=0.77; P<0.001). There was a strong positive correlation between lead and cadmium concentrations in both fine (r(s)=0.86; P<0.001) and coarse dust (r(s)=0.57; P=0.02). Although, there was a tendency for a relation between nicotine and lead concentrations in fine dust (r(s)=0.52; P=0.06), no other significant associations were found between house dust metals and nicotine concentrations. U-Cd correlated well with U-cotinine (r(s)=0.50; P=0.02). Further, U-Pb were associated with U-cotinine, however not statistically significant (r(s)=0.41; P=0.06). A probable explanation is a direct inhalation of side-stream smoke containing heavy metals and/ or an increased pulmonary uptake, due to a small airways disease in children with asthma.