IgE-mediated hypersensitivity reactions to cannabis in laboratory personnel.

BACKGROUND: There have been sporadic reports of hypersensitivity reactions to plants of the Cannabinaceae family (hemp and hops), but it has remained unclear whether these reactions are immunologic or nonimmunologic in nature. OBJECTIVE: We examined the IgE-binding and histamine-releasing properties of hashish and marijuana extracts by CAP-FEIA and a basophil histamine release test. METHODS: Two workers at a forensic laboratory suffered from nasal congestion, rhinitis, sneezing and asthmatic symptoms upon occupational contact with hashish or marijuana, which they had handled frequently for 25 and 16 years, respectively. Neither patient had a history of atopic disease. Serum was analyzed for specific IgE antibodies to hashish or marijuana extract by research prototype ImmunoCAP, and histamine release from basophils upon exposure to hashish or marijuana extracts was assessed. Results were matched to those of 4 nonatopic and 10 atopic control subjects with no known history of recreational or occupational exposure to marijuana or hashish. RESULTS: Patient 1 had specific IgE to both hashish and marijuana (CAP class 2), and patient 2 to marijuana only (CAP class 2). Controls proved negative for specific IgE except for 2 atopic individuals with CAP class 1 to marijuana and 1 other atopic individual with CAP class 1 to hashish. Stimulation of basophils with hashish or marijuana extracts elicited histamine release from basophils of both patients and 4 atopic control subjects. CONCLUSIONS: Our results suggest an IgE-related pathomechanism for hypersensitivity reactions to marijuana or hashish.

Possible circadian variation of serum mast cell tryptase concentration.

BACKGROUND: A temporarily elevated level of serum mast cell tryptase (ST) indicates mast cell activation and occurs in systemic anaphylactic reactions (SAR). We measured ST following a sting challenge in vespid venom-allergic patients treated with venom immunotherapy (VIT) and in healthy controls, respectively. AIM OF THE STUDY: To assess changes of ST over time in vespid venom-allergic patients at the occasion of a re-sting and in healthy controls. METHODS: A sting challenge was performed in 20 patients on vespid VIT to monitor efficacy of VIT. ST was measured between 9.00 and 10.00 a.m. (baseline). Sting challenge was performed at 2.00 p.m., and ST was determined again 20 min, 90 min and 18 h later. Measurements at corresponding times of the day were done in nine healthy controls. RESULTS: One patient developed a mild SAR to the sting challenge which was associated with a temporary increase of ST. In the other 19 patients who tolerated the sting challenge without SAR ST decreased significantly by 18.0% (median, range 8.3-36.7%). Twenty minutes after the sting when compared with baseline levels (P < 0.001), a significant decrease of ST was still present after 90 min (median 13.7%) (P < 0.001), but not after 18 h (P = 0.57). A comparably significant temporary decline was found in controls. CONCLUSIONS: The temporary decline of ST in patients and in controls suggests a circadian variation of ST concentration. A normal diurnal pattern of ST concentration after sting challenge is associated with successful treatment.

Frequency of natural rubber latex allergy in adults is increased after multiple operative procedures.

BACKGROUND: It has been shown that immediate-type allergy to natural rubber latex (NRL) affects predominantly health-care workers and infants with malformations requiring repeated medical procedures. Adult patients with multiple invasive procedures are not thought to be at an increased risk of NRL allergy. METHODS: A total of 325 consecutive adult inpatients (54.4+/-15.6 years; 219 men, 106 women) awaiting surgical or urologic procedures were assessed by questionnaire-based history (atopic diseases, number of previous standard operative or endoscopic procedures, intolerance to rubber products, and adverse reactions during medical care), by skin prick tests with different NRL test solutions, by measurement of NRL-specific IgE in the serum, and, if sensitization to NRL was found, by cutaneous challenge tests with NRL-containing material. Subjects were classified as sensitized to NRL if skin prick test reactions to NRL were positive or if NRL-specific IgE antibodies were found. NRL allergy was defined as NRL sensitization and immediate-type symptoms to NRL. RESULTS: Thirty-one of 325 (9.5%) subjects were found to be sensitized to NRL, 14/285 (4.9%) by skin prick testing and 23/323 (7.1%) by NRL-specific IgE antibodies in the serum. Four individuals (1.2%) were diagnosed as having clinically manifest NRL allergy, and another 27 (8.3%) were sensitized to NRL without symptoms to date. The frequency of previous invasive procedures was zero in eight patients, up to 10 in 245, 11-20 in 52, 21-30 in seven, and over 30 (up to 83) in 13 patients. No association was found between the number of invasive procedures and NRL sensitization without clinical symptoms. However, 3/4 patients with NRL allergy had undergone more than 30 interventions, and 1/4 had had 11 operations. Frequent invasive procedures (more than 10) were significantly associated with NRL allergy (P<0.001). Allergy or sensitization to NRL was associated with atopy (21/31 vs 87/294) (P<0.001). CONCLUSIONS: A remarkable percentage of unselected adult patients undergoing surgical procedures have allergy or sensitization to NRL. Repeated invasive treatment appears to be a risk factor for NRL allergy.

[Occult cutaneous mastocytosis]. / Okkulte kutane Mastozytose.

Mastocytosis is diagnosed without difficulty if it presents with easily recognizable lesions of urticaria pigmentosa. Recently, we have identified hardly visible skin lesions of mastocytosis in Hymenoptera venom allergic patients ("occult mastocytosis"). In addition, in approximately 15% of the patients with typical cutaneous lesions, urticaria pigmentosa was at first mistaken for other conditions and thus not linked to simultaneous symptoms of systemic mastocytosis. In most patients with unrecognized mastocytosis, the diagnosis was supported by raised basal serum tryptase levels. Cutaneous mastocytosis is often overlooked and more frequent than assumed. Measurement of basal serum tryptase concentrations can make an important contribution to the diagnosis of mastocytosis, but it does not replace a meticulous skin examination.

Constitutively raised serum concentrations of mast-cell tryptase and severe anaphylactic reactions to Hymenoptera stings.

Anaphylactic IgE-mediated reactions to Hymenoptera stings vary in their severity for reasons that are not clear. We investigated patients with a history of systemic anaphylatic reactions to honeybee or wasp stings. Nine (75%) of 12 patients with raised tryptase concentrations but only 28 (28%) of 102 patients with lower tryptase concentrations, had a history of severe sting reactions (p=0.004). Raised baseline serum concentrations of mast-cell tryptase and mastocytosis are potential risk factors for severe allergic reactions to Hymenoptera venom.

[Exertion-induced anaphylaxis after eating pork and beef]. / Anstrengungsinduzierte Anaphylaxie auf Schweine- und Rindfleisch.

HISTORY AND CLINICAL FINDINGS: A 72-year-old woman developed generalized urticaria. Quincke oedema, shortness of breath and hypotension two hours after eating a meal containing pork and after mild physical activity (ironing) in-between. She was treated by an emergency physician and then admitted to hospital for one day of monitoring her condition. During the past several years such episodes of generalized urticaria had recurred twice to four times a year. INVESTIGATIONS: Pin-prick tests gave an immediate-type reaction to beef but not to pork. Specific serum IgE antibodies were demonstrated to pork and beef, cat's epithelia, milk albumin and casein. Oral provocation tests were negative for pork and beef. But when pork and beef were eaten mild physical activity (bicycle ergometry at 20 W), generalized urticaria occurred after eating pork and beef, but not after drinking milk. TREATMENT AND COURSE: Exercise-induced anaphylaxis to pork and beef was diagnosed. No allergic reaction has occurred in more than 12 months of avoiding eating these meats. CONCLUSION: The picture of exercise-induced anaphylaxis caused by food allergy can be precipitated by even mild activity. This must be taken into account in the diagnosis of systemic rapid-reaction response and in the performance of provocation tests.

Electronic measurements of relative tongue-palate contact time. Development and testing for orthodontic functional analysis.

The importance of the tongue to the form of the jaws and dental arches has long been accepted. Clear-cut differences in arch width and arch height are observed between mouth and nasal breathing. Course measurements, e.g. duration of tongue contact with the gum, are not feasible with traditional measuring methods. The palatal measuring appliance presented here together with the purpose-developed storage and evaluation equipment permits for the first time continuous 24-hour measurement of tongue contact with the palate. The clinical observation is confirmed by the presented results. Nasal obstruction is associated with lower tongue-palate contact times. In our probands, these times fell by an average of 72% after forced mouth breathing. Since complex movements within the mouth cavity cannot be directly observed, functional analysis relating to the tongue position was previously impossible, at least over a longer period. The measuring device presented here is suitable for analyzing in more detail the diagnostically difficult complex of tongue movements and breathing habits. It might therefore conceivably be used to assess myofunctional disturbances and therapeutic methods.

Electrothermal debonding of ceramic brackets. An in vitro study.

Two different kinds of devices for electrothermal debonding of ceramic brackets are evaluated. Thirty human premolars were bonded with two types of ceramic brackets. Both devices were tested for electrothermal removal of the two bracket types. The pulpal wall temperature increase during electrothermal debonding was recorded in vitro under various circumstances. After debonding, the fracture site was located. The data were compared to the temperature rise after simulated exposure of the teeth to warm beverages. Irreversible pulp damage due to electrothermal debonding of ceramic brackets with both instruments is not to be expected because the obtained results stayed below established primate threshold temperatures and significantly below that of the stimulated control groups. A significant difference was noted when air cooling was initiated during electrothermal debonding. Fracture site location was significantly different in the two ceramic bracket types after electrothermal debonding.

[Anterior tooth injury/anterior tooth loss--the epidemiological and orthodontic aspects]. / Frontzahntrauma/Frontzahnverlust--epidemiologische und kieferorthopädische Aspekte.

Trauma to incisors, especially loss of permanent anterior teeth, often effects aesthetics, function, psychology and phonetics. The following article describes the frequency, cause and effect of incisors lost as a result of the trauma. The treatment possibilities are discussed with respect to the specific orthodontic considerations. In addition, the indications for space closure by orthodontic or prosthetic procedures are discussed.

[Technology and progress in orthodontics]. / Technologie und Fortschritt in der Kieferorthopädie.

As in other areas of dentistry, too, technological progress has resulted in new developments for diagnostic and therapeutic applications in orthodontics. The use of new technologies is focussed on two main areas: the use of new materials and methods in the treatment with fixed appliances, and the use of electronic data processing in diagnosis, particularly in cephalometry.

[Forensic problems in extractions by the genral dentist on orders by the orthodontist]. / Forensische Probleme bei Extraktionen durch den hauszahnarzt auf Anweisung des Kiefeorthopäden.

The dentist in a general practice usually carries out extractions ordered by the patient's orthodontist. While the specialist establishes the indications, the extraction is performed by a collegue who is not subject to instructions. The dentist doing the extraction therefore assumes responsibility for the procedure. If the orthodontist's order is incorrect or misleading, not only the orthodontist but also the dentist extracting the tooth or teeth may be held responsible for any errors. A number of safety measures built into the communication between the two therapists would help to avoid unnecessary or incorrect extraction teeth.