Controlled trial of H1 antagonists in the treatment of chronic idiopathic urticaria.

The efficacy of astemizole, diphenhydramine, and hydroxyzine hydrochloride in the treatment of chronic idiopathic urticaria was evaluated in this 3-month double-blind, randomized, parallel group study. Thirty-six adult patients were randomly assigned, 13 to the astemizole group (10 mg daily), 12 to the diphenhydramine group (25 mg t.i.d.), and 11 to the hydroxyzine hydrochloride group (25 mg t.i.d.). Demographic data were statistically similar for all variables assessed in the three treatment groups. Seven (58%) of the diphenhydramine patients withdrew before the end of the study, six because of lack of efficacy and one because of drowsiness. Two (18%) of the hydroxyzine hydrochloride patients withdrew, one because of lack of efficacy and one because of drowsiness. Two patients (15%) in the astemizole group withdrew, one because of adverse reaction, and the other because of lack of efficacy. Mean total symptom scores and mean individual symptom scores were lower in the astemizole group than in the other two groups. Wheal area measurements (0.1 mg/mL histamine challenge) decreased more in the astemizole and hydroxyzine hydrochloride groups than in the diphenhydramie group (P = .02). With regard to symptoms, 12/13 patients in the astemizole group improved clinically during their treatment period, versus 8/11 in the hydroxyzine hydrochloride group and 5/12 in the diphenhydramine group. The mean time to first observed therapeutic effect (maintained for three consecutive days) was 5.5 days in the astemizole group, 10.9 days in the hydroxyzine hydrochloride group, and 7.2 days in the diphenhydramine group. In this study, astemizole was as effective as hydroxyzine in patients treated for chronic idiopathic urticaria.

Psyllium allergy in hospital personnel: a report on twelve patients.

We have followed 12 patients with acute symptoms on exposure to psyllium over a three-year period. All were hospital personnel with evidence of atopy. Exposure was by inhalation on dispensing psyllium powder. Symptoms which occurred within minutes of exposure included rhinitis (12/12), conjunctivitis (10/12), shortness of breath and wheezing (9/12). All patients had psyllium-specific IgE antibodies demonstrated by either positive prick-skin tests (1:100) or serum antibodies (rast). Controls had no reactivity to psyllium. Sensitivity persisted over the entire three-year period. We conclude that sensitivity to psyllium is an IgE-mediated occupational allergy in hospital personnel; that it produces significant symptoms and it is often unrecognized; and that persistance of sensitivity necessitates strict avoidance of psyllium by all routes of exposure.

Anaphylactic reaction to thiopentone: a case report.

A 32-year-old female was admitted for a minor elective surgical procedure. Her past history included at least six uneventful general anaesthetics. Anaphylaxis developed shortly following induction of anaesthesia with thiopentone, Innovar and gallamine. Resuscitation was successful but was complicated by ventricular fibrillation. Full recovery followed. Subsequent allergy skin tests revealed hypersensitivity to thiopentone. Recommendations for investigation of suspected hypersensitivity to anaesthetic agents are included, as are guidelines for the recognition and treatment of anaphylaxis.

IgD multiple myeloma. Review of 133 cases.

One hundred thirty-three patients had IgD myeloma. The IgD comprises 0.8% of M-components in general and 2.1% of myelomas in particular. Males predominate and 65% of the patients are younger than 60 years at the diagnosis. More than half of the patients have lymphadenopathy, hepatomegaly, or splenomegaly. Extraosseous spread and amyloidosis are frequent. Severe anemia and azotemia are common. Total serum protein and IgD M-component levels are usually not high. LAMBDA-type light chains are found in 90% of IgD M-components. Bence Jones proteinimia is frequent and Bence Jones proteinuria appears in almost all patients. Mean survival is 13.7 months from diagnosis. The IgD is different from IgG and IgA myeloma, indicating that the clinical picture and course of multiple cyeloma may be related to the class and type of M-component.