Allergic and immunologic profile of symptomatic Persian Gulf War veterans.

BACKGROUND: Persian Gulf War veterans have been enrolled in the Veterans Administration Persian Gulf Health Registry for evaluation of unexplained symptoms and illnesses. The allergy and immunology division at the West Los Angeles Veterans Administration Medical Center evaluated 20 consecutive symptomatic Persian Gulf War veterans. OBJECTIVE: The purpose of this study was to examine the immunologic profiles of symptomatic Persian Gulf War Veterans. METHODS: A detailed history was obtained that included duties/responsibilities, length of time in the Persian Gulf, location, and exposures during the Gulf War. A complete physical examination was performed, with extensive laboratory testing and immediate and delayed hypersensitivity skin testing. Data from these Persian Gulf War Veterans were compared with a control population consisting of 44 non-Persian Gulf War veterans enrolled in our allergy and immunology clinic. Presenting allergic symptoms, presence of atopy, and total serum IgE levels were compared. RESULTS: Persian Gulf study patients and registry patients had a broad spectrum of nonspecific symptoms as compared with allergy clinic control patients who had dermatologic and respiratory symptoms. Persian Gulf study patients with allergy symptoms had a higher mean IgE level (88.7 IU/mL) than Persian Gulf study patients without allergy symptoms (47.5 IU/mL). Persian Gulf study patients with positive skin tests had a higher mean IgE level (161.5 IU/mL) than Persian Gulf study patients with negative skin tests (22.3 IU/mL). Laboratory data showed no significant immune abnormalities. CONCLUSION: Our study showed that 20 Persian Gulf veterans with a multitude of nonspecific symptoms had no immune abnormality. Mean IgE levels and eosinophil counts correlated with atopic state and reported allergy symptoms.

Severe hypersensitivity reaction during hemodialysis.

BACKGROUND: Hemodialysis-associated hypersensitivity reactions are well documented in the literature. Ethylene oxide sensitization and activation of complement are important factors involved during such reactions. The majority of severe hypersensitivity reactions in dialysis patients, however, is due to sensitization to ethylene oxide. METHODS: We report a patient admitted to the hospital with worsening of his renal function. He subsequently required three hemodialysis treatments, all of which resulted in severe hypersensitivity reactions requiring endotracheal intubation. The initial hypersensitivity episode was thought to be due to complement activation to the cupramonium-rayon membrane dialyzer. Despite changing to a polyacrylonitrile membrane, which does not activate complement, a second hypersensitivity reaction developed. Suspecting ethylene oxide hypersensitivity, the third hemodialysis session incorporated a biocompatible dialyzer that was sterilized with gamma irradiation, not ethylene oxide. Yet again, an anaphylactoid reaction resulted. It was postulated that residual ethylene oxide in the tubing might have triggered this last attack. RESULTS: Despite a negative RAST (radioallergosorbent test) to ethylene oxide, the strong history surrounding each of the hypersensitivity episodes and high index of suspicion pointed to ethylene oxide hypersensitivity as the etiologic factor. To this end, the patient fared much better when peritoneal dialysis was initiated. The patient subsequently died from other complications of his illness. CONCLUSIONS: This case report demonstrates both the complex nature involving a hypersensitivity reaction to hemodialysis and the life-threatening severity of such a reaction. Replacing ethylene oxide with steam or gamma radiation to sterilize dialyzers and thoroughly rinsing new dialyzers and tubing with normal saline may help circumvent this problem.

Performance of dust respirators with facial seal leaks: I. Experimental.

The ability of representative half-mask and single-use respirators with facial seal leaks to provide protection against aerosols was evaluated by experimental measurement. Respirators were mounted on a manikin in a test chamber and operated at seven steady flow rates over the range of 2 to 150 L/min. Samples of polydisperse and monodisperse aerosols were taken from inside and outside the respirator and analyzed by a calibrated optical particle counter over the particle-size range 0.1 to 11.3 microns. Measurements were made separately for filter performance as a function of particle size and flow rate, and simulated leak performance (penetration) as a function of particle size, pressure drop, and leak size. Flow rate vs. pressure drop measurements were made for all filters and leaks tested. For a given leak condition the percentage of the total flow traversing the leak varied several fold over the usual range of airflow rates through a respirator. Aerosol penetration was found to depend strongly on particle size and flow rate for filters, and to depend strongly on particle size and less strongly on pressure drop for leaks. One can conclude from these measurements that the aerosol-size distribution inside a respirator will nearly always be significantly different from that outside the respirator.

Acute symptoms secondary to formaldehyde exposure in a pathology resident.

Formaldehyde is ubiquitous and found at work and at home. The National Institute of Occupational Safety and Health (NIOSH) lists fifty-two occupations with substantial formaldehyde exposure. Pathology is one such occupation. This report describes the incapacitating symptomatology that developed from formaldehyde exposure in a pathology resident. Diagnosis and management of formaldehyde hypersensitivity are discussed and the literature reviewed.