Preprandial food-dependent exercise-induced anaphylaxis to banana.

Food-dependent exercise-induced anaphylaxis is a disorder in which a reaction develops only in association with physical exertion that generally takes place postprandially. The reaction that occurs following food intake after exercise is uncommon. Banana is an infrequent cause of anaphylaxis, which has been previously reported in combination with postprandial exercise in only 1 patient. A probable case of preprandial food-dependent exercise-induced anaphylaxis to banana is described herein together with a brief review of recent related literature.

Anaphylaxis in laboratory workers because of rodent handling: two case reports.

INTRODUCTION: Occupational allergy to rodents among laboratory animal workers is common. Most patients generally experience allergic symptoms after the first few years of work. Associated symptoms are usually mild, such as rhinoconjunctivits, urticaria, and asthma. Anaphylaxis, although rare, could be severe and life threatening. METHODS: We have described in this study two cases of laboratory workers that developed skin and respiratory reactions following laboratory rat and mouse bites, consistent with anaphylaxis. RESULTS: Skin testing was found positive for rat epithelium in the patient with anaphylaxis due to rat bite. Elevated levels of specific IgE antibodies against rat and mouse epitheliums were also detected in both the patients. CONCLUSION: These cases illustrate a severe hypersensitivity reaction that could potentially occur in occupational workers that are in close contact with rodents. Reduction of allergen exposure, regular screening, and job modification could be beneficial for affected individuals. Health care workers should be made aware that anaphylaxis could be a serious consequence of laboratory animal bites, particularly in those already sensitized.

Heterogeneity in presentation and treatment of catamenial anaphylaxis.

BACKGROUND: Few reports have documented the uncommon association of the female menstrual cycle with anaphylaxis, an entity known as cyclic or catamenial anaphylaxis. OBJECTIVE: To examine cases of perimenstrual anaphylaxis, focusing on differences in presentation and response to treatment, in the hopes of enriching the description of this rare entity. METHODS: A cohort of 8 women with catamenial anaphylaxis were identified and retrospectively compared with regard to age at onset, organ involvement, diagnostic studies, and response to therapy. RESULTS: The median age at onset was 34 years (range, 14-40 years), and the median number of perimenstrual anaphylactic episodes at presentation was 10 per patient (range, 4-24 per patient). Most had cutaneous and gastrointestinal symptoms. The results of extensive investigations for anaphylactic triggers were negative, and masquerading conditions, such as carcinoid syndrome, pheochromocytoma, and systemic mastocytosis, were ruled out in all patients. Skin test results for progesterone were negative in all but 1 of 4 patients tested. None had elevated total serum IgE levels. Response to suppressive treatments regimens varied considerably, but none treated with high-dose systemic steroids had improvement. Similarly, ketotifen, celecoxib, rofecoxib, and oral contraceptives failed to control the anaphylactic reactions. Although antihistamines failed in 7 patients, 1 had improvement. Others responded to leuprolide, medroxyprogesterone, or salpingo-oophorectomy. CONCLUSION: Whether the mechanism causing cyclical anaphylaxis may involve hypersensitivity to progesterone or prostaglandins, the variable response to suppressive medications in these cases suggests that catamenial anaphylaxis is a heterogeneous disorder in which a number of mechanisms and mediators may play a role. It is an emergent and probably underrecognized entity in the medical literature.

The diagnostic value of basophil activation test in patients with an immediate hypersensitivity reaction to radiocontrast media.

BACKGROUND: No available test diagnoses allergic reactions to radiocontrast media (RCM). The basophil activation test (BAT) has been introduced for the diagnosis of both immunoglobulin (Ig) E and non-IgE-dependent mast cell degranulation, but its value to diagnose immediate RCM reactions is still unknown. OBJECTIVE: This study aims to evaluate the diagnostic value of BAT in immediate RCM hypersensitivity. METHODS: The BATs were performed in 26 patients with immediate RCM reactions and in 43 specimens from healthy volunteers. The sample's whole blood was incubated with the responsible RCM and % activated (CD63+/CCR3+) basophils were analyzed by flow cytometry. Receiver operating characteristics (ROC) curve analysis was performed to calculate the optimal cutoff value of activated basophils to diagnose patients with RCM hypersensitivity. RESULTS: The incubation of blood with RCM yielded significantly higher activated basophil percentages in patients with a history of immediate RCM reactions than in normal controls with both 1:100 and 1:10 dilutions (13.11% vs. 2.71%, P value = .01; and 19.23% vs. 3.73%, P = .001, respectively). Both % activated basophils and stimulation index (SI) had acceptable discrimination powers to diagnose RCM hypersensitivity. The area under the curve was 0.79 (95% CI 0.67-0.91, P = .000) by using SI as the diagnostic criteria with 1:100 dilution of RCM. The specificity of the test ranged from 88.4% to 100%. CONCLUSION: Our study demonstrated the potential of BAT as a diagnostic tool for an immediate RCM hypersensitivity, particularly as a confirmation test. Further studies are required to confirm the test accuracy and identify a patient's predisposing factors.

Polymyalgia rheumatica as the first presentation of metastatic lymphoma.

A 48-year-old HIV-positive woman presented with progressive pain and stiffness of both shoulders and hips. She was given the diagnosis of polymyalgia rheumatica (PMR) due to high erythrocyte sedimentation rate. However, a 1-week course of prednisolone failed to improve her symptoms. She later discovered a breast lump of which histopathological tissue was consistent with a diffuse large B-cell lymphoma. Whole body bone scan revealed multiple bony metastases. The presence of atypical features of PMR and lack of dramatic response to steroids should prompt physicians to raise the probability of differential diagnoses other than PMR, and in particular, malignancy.

Recurrent severe angioedema associated with imidapril and diclofenac.

BACKGROUND: Angioedema due to angiotensin-converting enzyme inhibitors (ACEIs) therapy occurs not infrequently and is sometimes associated with life-threatening conditions. CASE SUMMARY: A 59-year-old woman presented with recurrent angioedema of the tongue complicated by upper airway obstruction which required endotracheal intubation. Laboratory tests including complement levels were normal. ACEI-associated angioedema precipitated by NSAIDs was suspected. Her condition improved after discontinuation of imidapril and diclofenac without other specific treatment. DISCUSSION: ACEIs, and in particular concomitant use with NSAIDs, should be avoided in patients with a history of angioedema because continuing administration tends to lead to more severe attacks.

Fatal Kikuchi-Fujimoto disease associated with SLE and hemophagocytic syndrome: a case report.

Kikuchi-Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare, benign, autoimmune condition characterized by lymphadenopathy, fever, and neutropenia. KFD can frequently mimic various diseases including infection, malignancy, and autoimmune disease. KFD has also been infrequently reported in association with SLE, which can be diagnosed previously, simultaneously, or after the diagnosis of SLE. The author presents here the first case of fatal KFD simultaneously occurred with SLE complicated with hemophagocytic syndrome and severe infection. The recognition of this association is of significance for management of affected patients with early intensive immunosuppressive therapy for favorable outcome.

The efficacy of combination treatment with narrowband UVB (TL-01) and acitretin vs narrowband UVB alone in plaque-type psoriasis: a retrospective study.

BACKGROUND: NarrowBand Ultra Violet B phototherapy (NB-UVB) is a highly effective therapeutic modality for plaque-type psoriasis, however several hospital visits are often required. Oral acitretin is moderately effective as monotherapy, but when combined with phototherapy, its use has reduced the number of treatments required for clearing. There is only sparse data on the combination of acitretin with NB-UVB. MATERIAL AND METHOD: Twenty nine patients with plaque-type psoriasis who were treated with NB- UVB alone or in combination with acitretin were retrospectively analyzed for treatment outcome in terms of total numbers and cumulative doses of narrowband UVB treatments. Of these, nine had the combination while 20 received NB-UVB alone. RESULTS: The combination of low dose acitretin (25 mg/day) and NB-UVB resulted in marked improvement of patients. The numbers of irradiation, final doses and cumulative doses of NB-UVB were lower albeit not statistically significant in the combination group. The combination was well tolerated and associated with typical retinoid and NB-UVB side effects. CONCLUSION: The combination treatment with acitretin and NB-UVB in plaque-type psoriasis has more therapeutic advantages than phototherapy alone.