Dangerous liaison: sexually transmitted allergic reaction to Brazil nuts.

Brazil nuts are the second most frequent cause of nut allergy in the United Kingdom. We report the case of a 20-year-old woman with documented Brazil nut allergy who developed widespread urticaria and mild dyspnea after intercourse with her boyfriend who had earlier consumed Brazil nuts. Skin prick testing with the boyfriend's semen after Brazil nut consumption confirmed significant reactivity whereas a sample before nut consumption was negative. We believe this to be the first case of a sexually transmitted allergic reaction.

Low prevalence of clinical latex allergy in UK health care workers: a cross-sectional study.

The prevalence of natural rubber latex allergy amongst health care workers has been reported to vary between 1 and 40%. This is because different diagnostic criteria have been used on heterogeneous groups of subjects. We have undertaken a cross-sectional study of all 5600 employees in two National Health Service trusts served by one department of occupational health and one department of clinical immunology. The period prevalence (1999-2000) for Type I clinical latex allergy in the clinical health care workers was found to be 17/3500 (0.5%). Difficulties in diagnosis and factors which may have contributed to this low prevalence rate are discussed. No cases were forced to leave health care work as a consequence of their allergy.

Localised Wegener's granulomatosis in otolaryngology: a review of six cases.

Wegener's granulomatosis (WG) is a necrotising granulomatous disease affecting the upper and/or lower respiratory tracts and is associated with focal glomerulonephritis. Formerly believed to be a multisystem disease, a localised form (LWG) is now recognised as a distinct subtype. We describe 6 cases of LWG with no renal or pulmonary involvement detected at the presentation or during follow-up. The total follow-up period ranged from 3 to 7 years in 5 cases. The diagnosis was based on clinical features, antineutrophil cytoplasmic antibody test and histological findings (necrotising granulomatous vasculitis, epithelioid granulomas with varying degrees of chronic inflammatory cells). All patients responded to standard immunosuppressive treatment. Our cases highlight the predilection of LWG for the head and neck region and hence these patients frequently present in the ENT departments. LWG has been discussed as a subtype of WG with a better prognosis and the previous literature has been reviewed on this subject. A high index of suspicion helped by serology and histology enables an early diagnosis, and commencement of proper treatment can prevent the irreversible destructive lesions.

Sub-clinical systemic lupus erythematosus presenting with acute myocarditis.

A 46 year old woman presented with fever and normochromic anaemia followed rapidly by severe myocardial failure, unresponsive to maximum inotropic support and broad spectrum antibiotics. There were no classical clinical stigmata of systemic lupus erythematosus (SLE) but a possible immunological cause was looked for, and on the basis of her immuno-serology a diagnosis of SLE-like disease was made. She responded rapidly to high dose steroids. The importance of considering the possibility of SLE or 'lupus overlap' in an acutely ill 'undiagnosed' patient is emphasized. The relevance of instigating appropriate immuno-serological tests in the course of such an illness is discussed.

Intravenous, intralesional and endolymphatic administration of lymphokines in human cancer.

Starting in 1976 we have given two types of lymphokine preparation to 78 individual patients with cancer with no evidence of long-term toxicity. Lymphokine from the 1788 lymphoblastoid line (1788-LK) was given intravenously and intralesionally to 39 of these patients and buffy coat interleukin (BC-IL) to 40 of the patients. On intravenous injection both preparations produced pyrexia and other acute phase changes but with an earlier time course after BC-IL. Feelings of well-being were volunteered and the patients often remained in a steady clinical state for a long time when previously their condition had been deteriorating. Histological studies after intralesional injection into recurrent breast nodules (1788-LK and BC-IL) and prostate (1788-LK) showed an inflammatory cell infiltrate and tumour cell necrosis. Endolymphatic infusion of BC-IL in 23 patients with malignant melanoma was followed by clinical, radiological and histological evidence of lymph node activation. 10 of these patients had had excision of poor prognosis primary tumour only and during the follow-up period (5-17 months) none had a recurrence. Our experience suggests that administration of lymphokines has a place in the total management of cancer patients.

Renal carcinoma in Lindau's disease.

A case of Lindau's disease is presented where renal carcinoma was detected 2.5 years after surgical removal of a cerebellar haemangioblastoma. This patient had no retinal lesions. The importance of screening for renal carcinoma in patients showing one or more manifestations of the disease and screening relatives is emphasized.