[Osteoporotic vertebral fractures or Scheuermann's disease?]. / Osteoporotische wervelfracturen of ziekte van Scheuermann?

A 56-year-old man was treated with bisphosphonates following incidental findings of vertebral deformities on a chest radiograph taken for cough. After re-evaluation with DEXA and spinal radiographs he was diagnosed with Scheuermann's disease, not osteoporosis. His gastrointestinal symptoms resolved after bisphosphonates were stopped. A 42-year-old man with limb-girdle muscular dystrophy and complaining of back pain underwent investigations. Radiographs showed loss of height in multiple thoracic vertebrae, yet DEXA bone mineral density was high-normal and an MRI scan suggested Scheuermann's disease. Recent osteoporotic vertebral fractures are an indication for anti-osteoporotic treatment, because they are highly predictive of future fracture risk. There are a number of differential diagnoses that should be considered in individuals with vertebral deformities, including Scheuermann's disease, especially if the clinical picture is not typically osteoporotic. This is important in order to avoid unnecessary medical treatment, which should be reserved for patients with osteoporosis. Refining vertebral fracture definitions may help to improve diagnostic accuracy.

[Allergy to latex: an underestimated problem]. / Allergie voor latex: een miskend probleem.

Three patients who showed an allergic reaction to latex products are described. By means of history, skin tests, measurement of IgE antibodies against latex and challenge tests the diagnosis could be established. To prevent the spread of infectious diseases the use of latex gloves and condoms is increasing. Therefore, the incidence of allergic reactions to latex may also rise. Latex allergy should be considered when evaluating 'idiopathic' anaphylaxis during an operation. Moreover, latex allergy may be the cause of occupational rhinitis and asthma.

PIP: Allergy to latex is an underestimated problem. A 28-year old woman developed eye, throat, and tongue irritation with dyspnea and tachycardia. Exanthem ensued on the arms and the patient felt sick. About half an hour later complete recovery occurred. Previously she had regularly had nasal congestion whenever her husband used a condom. The patient had had rhinitis complaints since she was 19 on account of allergy to house dust, cats and dogs. Skin prick tests were conducted to investigate the influence of the condom. A phosphate buffer was laid on the underarm, upon which a piece of a condom of 1 cu. cm was placed. This was pierced with a needle and the surface was raised this way. This test was carried out with washed and unwashed condoms and judged 15 minutes later. At the same time, control tests were also conducted with phosphate buffer and with histamine (mg/ml). An distinct positive reaction developed both to the unwashed and washed condoms. The same tests performed with 3 control persons gave negative reactions. The outcome of the slice test with rubber auxiliary materials of the European standard series was negative. The total immunoglobulin E (IgE) content in the serum amounted to 125 kU/ml. The specific IgE against latex was positive (class 1). The patient later related that she had teary, itchy eyes and runny nose when she blew up an air balloon. By means of history, skin tests, measurement of IgE antibodies against latex (radio-allergo-sorbent test) and challenge tests, the diagnosis could be established. To prevent the spread of infectious diseases the use of latex gloves and condoms is increasing. Therefore, the incidence of allergic reactions to latex may also rise. Latex allergy should be considered when evaluating idiopathic anaphylaxis during an operation. Moreover, latex allergy may be the cause of occupational rhinitis and asthma.

Anaphylaxis due to latex allergy.

An anaphylactic reaction to latex is reported in two patients. One occurred intraoperatively with exposure to the surgeon's latex gloves and the other during vaginal contact with a latex condom. Radioallergosorbent test (RAST) and scratch test with latex material identified the allergen. With the increasing use of latex gloves and condoms, one should be aware of the possibility of a severe immediate hypersensitivity reaction to latex products. Latex allergy should be considered when evaluating intraoperative and idiopathic anaphylaxis.

[Enuresis and encopresis as a reaction to food]. / Enuresis en encopresis als reactie op voedingsmiddelen.

A meanwhile 10-year old girl, suffering from diurnal and nocturnal enuresis and encopresis since she was a baby, had been repeatedly examined and treated by various medical specialists and a homeopathic doctor without any significant improvement. The incontinence persisted. Finally her problem was solved after an allergological examination. The skin tests and specific IgE antibodies were positive for various foods, some of them confirmed later by food ingestion challenge. She was put on a complete elimination diet, combined with oral disodium cromoglycate, and has been free of all complaints since 1 1/2 years.

Double-blind comparison of loratadine (SCH 29851), astemizole, and placebo in hay fever with special regard to onset of action.

In this double-blind study, 65 patients with hay fever were treated for 14 days with either loratadine 10 mg once daily, astemizole 10 mg once daily, or placebo. On the third day of treatment loratadine was statistically superior to placebo, but astemizole and placebo showed no significant differences according to the ratings for symptomatology, efficacy, and individual symptoms. Adverse effects were minimal and did not differ between the three groups. Loratadine had a significantly earlier onset of action than astemizole with comparable efficacy and safety.

Cross-reactivity among birch pollen, vegetables and fruits as detected by IgE antibodies is due to at least three distinct cross-reactive structures.

Sera of patients suffering from birch pollinosis were studied in the radio-allergo-sorbent test (RAST) for the presence of IgE antibodies to various allergens of vegetable origin. The sera selected were positive in the RAST for both birch pollen and fruits. IgE antibodies directed against at least three different cross-reacting determinants in birch pollen were detected. In addition to periodate-susceptible cross-reacting determinants, which are found on a number of glycoproteins, two non-related periodate-resistant determinants were found in birch pollen, with molecular weights of 20 and 18 kD, respectively. The 20-kD component appears to be responsible for the co-occurrence of the binding of IgE to allergens of fresh fruits, whereas the 18-kD component appears to cause the cross-reactivity among grass pollen, potato and fruits.

Birch pollen asthma in The Netherlands.

The occurrence of birch pollen asthma is related to high birch pollen concentrations in the air, and therefore this type of asthma is rather common in Scandinavia. High birch pollen concentrations are rare in The Netherlands, but in the spring of 1984 extremely high levels were reached, whereas the concentrations of alder and hazel pollen were very low. During this period nine pollinosis patients known to the allergist developed asthmatic complaints. The appearance and disappearance of the asthmatic symptoms in these patients showed strong correlation with the course of the birch pollen concentration in the air, which strongly suggests that birch pollen asthma can occur in The Netherlands. The significance of this finding may be that this type of asthma can be observed regularly when the birch pollen concentrations are very high. This may also hold for other western European countries.