Banana anaphylaxis in Thailand: case series

BACKGROUND: Banana fruit has been recognized as an important food allergen source. Nowadays banana hypersensitivity had been reported more frequently with various presentations from oral allergy syndrome to anaphylaxis.OBJECTIVE: This study aims to describe the pattern of banana hypersensitivity and the sensitivity of diagnostic test.METHODS: Six patients who experienced banana hypersensitivity were recruited from adult allergy clinic, Ramathibodi Hospital, Mahidol University between 2015–2018. Demographic data, pattern of banana allergy consisted of the onset of reaction, symptoms, severity, cross-reactivity to kiwi, avocado, latex including type and amount of banana were collected. Skin test, serum specific IgE to banana and open-label food challenge test had been applied.RESULTS: All patients experienced multiple episodes of banana anaphylaxis. Regarding the diagnostic investigation, prick-to-prick skin test had higher sensitivity (sensitivity, 100%; 95% confidence interval [CI], 54.07%–100%) than the commercial banana extract (sensitivity, 83.33%; 95% CI, 35.88%–99.58%) and serum specific IgE to banana (sensitivity, 50%; 95% CI, 11.81%–88.19%). The discordance between skin prick test using commercial banana extract and skin test was reported. The cross-reactivity between the species of banana, kiwi, the avocado was documented in all patients. Latex skin prick test and application test were applied with negative results. From the oral food challenge test, a case of banana anaphylaxis patient can tolerate heated banana.CONCLUSION: The various phenotypes of banana hypersensitivity were identified. The prick-to-prick test showed the highest sensitivity for diagnosis of banana allergy. However, component resolved diagnostics might be needed for conclusive diagnosis.

Anaphylaxis following intralesional triamcinolone acetonide (Kenacort) injection

Intralesional triamcinolone acetonide injection is indicated for multiple skin conditions such as keloid scars, alopecia areata, and hypertrophic lichen planus. Immediate hypersensitivity reaction remains uncommon. We report on a 24-year-old woman who had received multiple intralesional injections with triamcinolone acetonide (Kenacort) plus lidocaine for keloid scar treatment without any reaction for the previous 10 years. The immediate reaction occurred 15 minutes after injection, with numbness on her face and 5 minutes later with urticaria on her chest wall and upper extremities, together with hypotension (blood pressure of 90/60 mmHg). Allergology workup revealed positive skin prick test for triamcinolone acetonide (Kenacort). Skin tests for other corticosteroids (hydrocortisone, methylprednisolone, and dexamethasone), excipients (carboxymethylcellulose, benzyl alcohol, and polysorbate 80) and lidocaine were negative, including subcutaneous challenge for lidocaine and oral challenge for carboxymethylcellulose. IgE-mediated hypersensitivity reaction must be considered in cases of multiple applications of triamcinolone acetonide injection.

The pilot study of type Ⅰ allergic reaction in Meniere′s disease patients / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the correlation between type Ⅰ allergic reaction and pathogenesis of Meniere′s disease.@*Methods@#A total of 35 (10 male vs. 25 female) patients aged between 21-66 years diagnosed with Meniere′s disease were recruited to this study, mean age of them was (47.3±13.6) years. The control group consisted of 15 inpatients (5 male vs. 10 female) with pharyngolaryngeal diseases but without otologic and rhinologic abnormity, mean age was 45.4±12.8 years. Allergic prevalence, serous total immunoglobulin E( tIgE ) levels, serous specific immunoglobulin E( sIgE ) levels and subtypes of T lymphocytes were measured and compared in patients with Meniere′s disease and the control group. Severity of vertigo, tinnitus and sensation of fullness were compared between Meniere′s disease patients with or without allergy.@*Results@#Allergic prevalence were significantly different (Pearson chi-square 5.832, P<0.05) between patients with Meniere′s disease and the control group(57.1% vs. 20.0%). Patients with Meniere′s disease report higher level of serous tIgE compared with controls, the difference is statistically significant (Z=168.000, P<0.05). However, positive rates of sIgE of food allergens and inhalant allergens were not significantly different between patients with Meniere′s disease and the control group. Scores of vertiginous severity, dizziness handicap inventory (DHI) and tinnitus handicap inventory (THI) were significantly different between Meniere′s disease patients with or without allergy (P<0.05). Treg and Treg/Th17 levels (Z=26.000) were much higher in Meniere′s disease patients with allergy than in the controls(P<0.05).@*Conclusions@#Patients with Meniere′s disease report higher rate of allergy than the control group. Type Ⅰ allergic reaction is thought to be one of the possible reasons that may induce endolymphatic hydrops and lead to Meniere′s disease.

Perspectivas no tratamento da alergia ocular: revisão das principais estratégias terapêuticas / Ocular allergy therapy perspectives: Review on the main therapeutic targets

As alergias oculares englobam uma série de doenças inflamatórias da superfície ocular, causadas por diferentes mecanismos de hipersensibilidade. Acometem aproximadamente 20% da população e podem ser classificadas em formas mediadas por hipersensibilidade tipo I (CAS, CAP), tipo I e IV (CCV, CCA) e tipo IV (BCC, CPG). As formas mais prevalentes são CAS e CAP. As formas crônicas (CCV, CCA) estão mais frequentemente relacionadas a complicações e comprometimento da função visual decorrentes do processo inflamatório e consequente remodelação da superfície ocular. Comorbidades como olho seco e ceratocone podem estar presentes. O tratamento envolve diagnóstico e afastamento dos fatores etiológicos envolvidos, uso de drogas anti-inflamatórias que atuem na ação de linfócitos Th2, eosinófilos, mastócitos e células dendríticas Avanços no conhecimento da ativação e tráfego de células do sistema imune têm sido promissores na perspectiva de novas abordagens terapêuticas.

Ocular allergies encompass a number of inflammatory diseases in the ocular surface which have different hypersensitivity mechanisms and occur in 20% of population. They can be classified as being type I hypersensitivity mediated (PAC, SAC), type I and IV (VKC, AKC) and type IV (BKC, GPC). The most prevalent forms are PAC and SAC. The chronic presentations are mostly related to visual impairment due to remodeling in the ocular surface caused by chronic inflammation. Dry eye disease and keratoconus are comorbidities observed in severe cases. The management is based on accurate diagnosis, avoidance of etiological factors and the rational use of drugs that control the inflammatory events caused by Th2 driven. The advances in knowledge on activation and traffic of immune cells are providing new drugs and many perspectives on different approaches.

Immunoglobulin E to allergen components of house dust mite in Korean children with allergic disease

BACKGROUND: House dust mites (HDMs) are important sources of indoor allergens. Seventeen components have been identified from Dermatophagoides pteronyssinus (Der p). OBJECTIVE: Our aim was to define the prevalence of specific IgE to components of Der p in Korea and investigate the clinical features of them in children with allergic disease. METHODS: We performed a prospective evaluation of 80 HDM sensitized patients with history of allergic rhinitis (AR), atopic dermatitis (AD), asthma and urticaria (UC). Patients underwent ImmunoCAP for total IgE, Der p, Der f, Der p 1, Der p 2, and Der p 10. RESULTS: Seventy-nine patients had detectable serum IgE to Der p, 80 patients were sensitized to Der f, 66 patients were sensitized to Der p 1, 63 patients to Der p 2, and 7 patients were sensitized to Der p 10. Der p 1 specific IgE was significantly lower in the UC group compared with the AD and AR group. Total IgE was significantly higher in the Der p 10 sensitized group. Der p 10 serum IgE level was highly correlated with crab and shrimp specific IgE. There was a significant positive correlation between total IgE and specific IgE to Der p and its components and Der f. CONCLUSION: Sensitization to HDM and its components in Korea is similar to previous studies from temperate climate. The determination of Der p 1, Der p 2, and Der p 10 specific IgE helps in obtaining additional information in regards to allergic disease.

Two Cases of Allergy to Insulin in Gestational Diabetes

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

Synergistic suppression of pre-perfusion of donor livers with recipient serum and cobra venom factor treatment on hyperacute rejection following liver xenotransplantation / Supressão sinérgica da rejeição hiperaguda no xenotransplante hepático com uso da pre-perfusão dos fígados doadores tratados com soro do receptor e com fator veneno de cobra

PURPOSE: To investigate synergistic suppression of donor liver pre-perfusion with recipient serum (RS) and cobra venom factor (CVF) treatment on hyperacute rejection (HAR) following liver xenotransplantation. METHODS: Guinea-pigs (GP, n=24) and Sprague-Dawley rats (SD, n=24) were recruited. Before transplantation, serum was collected from SD rats and used for preparation of inactivated complements. GP and SD rats were randomly assigned into four groups (n=6), respectively: RS group, CVF group, RS+CVF group and control group. Orthotopic liver xenotransplantation was performed with modified two-cuff technique. The survival time and liver function of recipients, morphological and pathological changes in rat livers were investigated. RESULTS: There was no piebald like change in the recipient livers in all experiment groups. The survival time of recipients in all experiment groups was longer than that in control group (p<0.05). Moreover, the survival time in the RS+CVF group was markedly longer than that in the RS group (p<0.01) and CVF group (p<0.05). The serum ALT level in all experiment groups were lower than that in the control group (p<0.05). Furthermore, the ALT level in the RS+CVF group was significantly lower than that in the CVF group (p<0.05) and RS group (p<0.01). The histological damages were significantly improved when compared with the control group, and the histological damages in the RS+CVF group were milder than those in the remaining groups (p<0.05) CONCLUSION: Pre-perfusion of donor liver with recipient serum and cobra venom factor treatment can exert synergistic suppressive effects on the hyperacute rejection following liver xenotransplantation.

OBJETIVO: Investigar a supressão sinérgica da pré-perfusão do doador de fígado com soro do receptor (SR) e tratamento com fator veneno de cobra (FVC) na rejeição hiperaguda (RHA) após o xenotransplante de fígado. MÉTODOS: Foram utilizados Cobaias (GP, n=24) e ratos Sprague-Dawley (SD, n=24). Antes do transplante foram coletadas amostras de soro dos ratos SD e usados para a preparação dos complementos inativados. Cobaias GP e ratos SD foram randomicamente distribuídos em quatro grupos (n=6), respectivamente: grupo RS, grupo FVC, grupo SR+FVC e grupo controle. Xenotransplante ortotópico do fígado foi realizado com a técnica de dois cuffs modificados. Foram investigados o de tempo de sobrevida, a função hepática dos receptores e alterações morfopatológicas em fígados de ratos. RESULTADOS: Não houve alteração na coloração do parênquima dos fígados nos receptores. O tempo de sobrevida dos receptores em todos os grupos experimentais foi mais longo do que o grupo controle (p<0,05). Além disso, o tempo de sobrevida do grupo SR+ FVC foi marcadamente maior do que o grupo SR (p<0,01) e o grupo FVC (p<0,05). O nível sérico ALT foi menor em todos os grupos experimentais do que o grupo controle (p<0,05). O nível de ALT no grupo SR+ FVC foi significantemente menor do que no grupo FVC (p<0,05) e o grupo SR (p<0,01). As alterações histológicas foram significantemente melhoradas quando comparado com o grupo controle, e os danos histológicos no grupo SR+ FVC foram mais moderados do que nos grupos restantes (p<0,05). CONCLUSÃO: Pré-perfusão do fígado doador com soro do receptor e fator veneno de cobra pode exercer efeito supressor sinérgico da rejeição hiperaguda após xenotransplante de fígado.

Sensitivity in typeⅠ hypersensitivity compared between BN rats and Wistar rats / 中国药理学与毒理学杂志

OBJECTIVE To compare sensitivity in typeⅠ hypersensitivity between BN and Wistar rats, and to establish a sensitive and reliable determination system for typeⅠ hypersensitivity. METHODS BN and Wistar rats were sc given ovalbumin (OVA) 10, 20 and 40 μg·kg~(-1) every other day for 5 times and normal control group with sc normal saline. The total immunoglobulin E (IgE) levels in serum were determined with ELISA and the specific IgE levels in serum were determined by passive cutaneous anaphylaxis on the 21st day from the 1st injection. The blood pressure, serum histamine and tryptase levels were determined after challenge on the 22nd day. RESULTSTotal IgE, specific IgE, histamine and tryptase levels in serum significantly increased and blood pressure decreased in OVA 10, 20 and 40 μg·kg~(-1) BN rat groups compared with normal control group, while in Wistar rats these symptoms only appeared in OVA 40 μg·kg~(-1) group. CONCLUSION BN rats are more sensitive than Wistar rats in typeⅠ hypersensitivity. The blood pressure, serum total IgE, specific IgE, histamine and tryptase levels can be used as the important indicators in typeⅠ hypersensitivity.

O papel do aleitamento materno no desenvolvimento de alergias respiratórias: [revisão] / The role of breastfeeding on the development of respiratory allergies: [review]

Objetivos: revisar a literatura que trata da relação entre aleitamento materno e asma na infância.Fonte de dados: publicações científicas recentes, selecionadas através das bases de dados Scielo, Lilacs e Pubmed. Foram escolhidas publicações nos idiomas Português, Inglês e Espanhol. Procurou-se identificar o processo das reações alérgicas e das alergias respiratórias e qual o papel do leite materno na proteção de alergias respiratórias como asma a atopia.Síntese dos dados: a síndrome alérgica respiratória é constituída por asma e rinite alérgica, com características de reação de hipersensibilidade tipo I, que resultam da interação de alérgenos ambientais com anticorpos IgE específicos. A maioria das revisões sobre fatores de risco para asma recomenda aleitamento materno exclusivo para reduzir a probabilidade do desenvolvimento de atopia e asma na infância. Embora tal visão seja amplamente aceita e difundida, os resultados da literatura são conflitantes.Conclusões: apesar das muitas pesquisas sobre o tema, não se pode concluir se o aleitamento materno ajudará a prevenir a sensibilização a alérgenos em crianças com enfermidades como asma. No entanto, por todas as suas conhecidas vantagens, o aleitamento materno exclusivo deve ser encorajado nos primeiros meses de vida.

Aims: To review the publications that investigated the association between breastfeeding and asthma in childhood.Source of data: Recent scientific publications from the databases Scielo, Lilacs and Pubmed. Publications in English, Portuguese and Spanish have been included. We have tried to review the mechanisms of allergic reactions and respiratory allergies, as well as publications related to breast milk and the protection of respiratory allergies such as asthma.Summary of findings: The allergic respiratory illnesses are constituted by asthma and allergic rhinitis, with characteristics of type I hypersensitivity, which results from the interaction of environmental allergens with specific IgE antibodies. Most of the reviews on asthma risk factors recommended exclusive breastfeeding to reduce the probability of the development of atopy and asthma in childhood. Although such opinion has been widely accepted, the results from the literature are conflicting.Conclusions: Despite the elevated number of studies published on the subject, it is not possible to conclude that breastfeeding will help to prevent sensitization to allergens in children with asthma. Nevertheless, exclusive breastfeeding must be encouraged during the first months of life because of its large well known benefits.

Prevalência de aspergilose broncopulmonar alérgica em pacientes com fibrose cística na Bahia, Brasil / Prevalence of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis in the state of Bahia, Brazil

OBJETIVO: Determinar a prevalência de aspergilose broncopulmonar alérgica (ABPA) em pacientes com fibrose cística acompanhados em um centro de referência da Bahia. MÉTODOS: Estudo transversal, com coleta prospectiva de dados, realizado no Centro de Referência de Fibrose Cística da Bahia do Hospital Especializado Octavio Mangabeira. Foram incluídos no estudo 74 pacientes que tinham diagnóstico de fibrose cística, com idade acima de 6 anos e tratados entre 9 de dezembro de 2003 e 7 de março de 2005. Foram analisadas as seguintes variáveis: gênero, idade, capacidade vital forçada, volume expiratório forçado no primeiro segundo, resposta a prova farmacodinâmica, achados em radiografia torácica e de seios de face, presença de sibilância, culturas para Aspergillus spp., imunoglobulina E (IgE) total, IgE específica para Aspergillus fumigatus e teste cutâneo de leitura imediata para aspergilina. RESULTADOS: Dos 74 pacientes, 2 foram diagnosticados com ABPA. Níveis de IgE total > 1.000 UI/mL foram observados em 17 pacientes (23%), teste cutâneo de leitura imediata para A. fumigatus positivos em 19 (25,7%) e sibilância em 60 (81,1%). CONCLUSÕES: A taxa de prevalência de ABPA foi de 2,7%. As altas taxas de IgE total, de teste cutâneo imediato para A. fumigatus positivos e de sibilância sugerem que estes pacientes devam ser acompanhados cuidadosamente por haver a possibilidade do desenvolvimento de ABPA.

OBJECTIVE: To determine the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis treated at a referral center in the state of Bahia, Brazil. METHODS: A cross-sectional study, with prospective data collection, carried out at the Cystic Fibrosis Referral Center of Bahia of the Octavio Mangabeira Specialized Hospital. We evaluated 74 patients diagnosed with cystic fibrosis, older than six years of age, treated between December 9, 2003 and March 7, 2005. We analyzed the following variables: gender, age, forced vital capacity, forced expiratory volume in one second, pharmacodynamic response, chest X-ray findings, facial sinus X-ray findings, wheezing, cultures for Aspergillus spp., total immunoglobulin E (IgE), specific IgE for Aspergillus fumigatus and immediate skin test reactivity to A.fumigatus antigen. RESULTS: Of the 74 patients, 2 were diagnosed with ABPA. We found total IgE levels > 1,000 IU/mL in 17 (23%), positive immediate skin reactivity to A. fumigatus antigen in 19 (25.7%) and wheezing in 60 (81.1%). CONCLUSIONS: The prevalence of ABPA was 2.7%. The high levels of total IgE, high incidence of wheezing and high rate of immediate skin test reactivity to A. fumigatus antigen suggest that these patients should be carefully monitored due to their propensity to develop ABPA.

Alergia ao látex em profissionais de saúde de São Paulo, Brasil / Latex allergy in healthcare professionals in the State of Sao Paulo, Brazil

FUNDAMENTOS: Alergia ao látex é comum em trabalhadores da saúde, resultando em absenteísmo e afastamento das atividades profissionais. Há no Brasil poucos estudos publicados sobre o assunto. Enquanto na população geral a prevalência de alergia ao látex é menor que 2 por cento, nos profissionais de saúde pode chegar a 30 por cento. OBJETIVO: Estudar a prevalência de alergia ao látex em profissionais de saúde do Hospital do Servidor Público Estadual de São Paulo. MÉTODOS: Foi aplicado questionário aberto a profissionais que têm contato com luvas de borracha em todos os serviços do hospital. Foi colhido sangue daqueles que referiram sintomas e dosado anticorpo IgE específico por meio do ImmunoCAP. Para análise estatística utilizaram-se porcentagens, tabelas e teste qui-quadrado. RESULTADOS: Foram distribuídos 2.349 questionários, e respondidos 1.045, dos quais 129 referiram correlação entre uso de látex e sintomas sugestivos de alergia, e 54 permitiram a coleta de sangue para determinação de IgE específica. Neste grupo houve dois casos em que foi demonstrado anticorpo específico, estabelecendo-se prevalência de 3,7 por cento de alergia ao látex. Fatores como gênero, profissão, freqüência de contato com luvas, setor de trabalho e antecedentes de atopia foram relacionados com maior prevalência de alergia ao látex. CONCLUSÃO: A prevalência de alergia ao látex encontrada foi de 3,7 por cento.

BACKGROUND: Latex allergy is common among healthcare workers and leads to absence from work and withdraw from professional activities. There are few studies published in Brazil on this subject. In the general population the prevalence of allergy to latex is less than 2 percent, whereas in healthcare workers it may reach 30 percent. OBJECTIVE: To study the prevalence of latex allergy in healthcare workers at the Hospital do Servidor Público Estadual de São Paulo. METHODS: A self-administered questionnaire was distributed to healthcare professionals from any sector of the hospital who have contact with rubber gloves. Blood was drawn from those who referred symptoms, for analyses of serum antilatex IgE antibody by Immunocap assay. Percentages, tables and the chi-square test were used for statistical analysis. RESULTS: A total of 2349 questionnaires were distributed, and 1045 were answered. In that, 129 reported association between latex and allergy symptoms and 54 out of them agreed to blood collection for specific IgE determination. Specific antibody was demonstrated in tow cases, determining a prevalence of 3.7 percent of latex allergy. Gender, occupation, frequency of use of gloves, work sector and past history of atopy were related to greater prevalence of latex allergy. CONCLUSION: The prevalence of latex allergy found was 3.7 percent.

Korean Ginseng-Induced Occupational Asthma and Determination of IgE Binding Components

A number of case reports on occupational asthma caused by herbal medicines have been issued, for example, on Sanyak, Chunkung, Banha, and Brazilian ginseng. Recently, cases of occupational asthma induced by Sanyak and Korean ginseng have been reported, but the pathogenic mechanisms involved are unknown. This study was carried out to evaluate the immunologic mechanism underlying Korean ginseng-induced occupational asthma. A patient engaged in Korean ginseng wholesale was referred for recurrent dyspnea, wheezing, and nasal symptoms, which were aggravated at work. Allergen bronchial provocation testing to Korean ginseng extract showed a typical immediate response, and skin prick testing to Korean ginseng extract also showed a strong positive response. Moreover, serum-specific IgE levels to Korean ginseng extract were significantly higher than in controls. Enzymelinked immunosorbent assay (ELISA) inhibition tests showed a dose-dependent inhibition by Korean ginseng, but not by Dermatophagoides farinae, wheat flour, or Chinese balloon flower. Sodium dodecylsulfate-poly-acrylamide gel electrophoresis (SDS-PAGE) and immunoblotting revealed four specific Immunoglobulin E (IgE) binding components at 26, 30, 47, and 60 kDa, which were not bound by control sera. These results strongly suggest that occupation asthma induced by Korean ginseng is induced via an IgE-mediated mechanism.

Comparison of basophil histamine releasability between atopic and nonatopic thmatics

To compare the mediator releasability between atopic and nonatopic asthmatics, we measured basophil histamine releasability (BaHR) using a calcium-ionophore A23187 and anti-IgE in 137 subjects who were treated at Seoul National University Hospital. Subjects were categorized into atopic (group AA, n=77) or nonatopic asthmatics (group NA, n=32), or normal controls (group NC, n=28). Serum total IgE levels were determined and correlation with BaHR was assessed. Anti-IgE-induced maximal BaHR in groups AA, NA, and NC was 41.0+/-3.2, 23.1+/-4.5, and 16.8+/-3.8, respectively (mean+/-SE, %). Anti-IgE-induced BaHR in group AA was significantly higher than that in groups NA and NC (p<0.05). Calcium ionophore A23187-induced maximal BaHR was 43.1+/-2.8, 40.8+/-4.4, and 50.5+/-5.2, respectively (mean+/-SE, %), and there was no significant difference among the groups. Serum total IgE level correlated significantly with anti-IgE-induced maximal BaHR (r=0.281, p<0.01) but not with that induced by calcium ionophore A23187. In conclusion, IgE receptor-related BaHR is higher in atopic asthmatics than in nonatopic asthmatics, and this increased BaHR in atopics is significantly associated with increased serum total IgE level.