Generalized cutaneous reactions to the anthrax vaccine: preliminary results of anthrax vaccine-specific cell mediated immunity and cytokine profiles.

Over two years, the Vaccine Adverse Event Reporting System reported that 0.042% of all anthrax vaccine (Biothrax, Bioport Corporation) doses administered were associated with cutaneous reactions, half of which were eczematous. This case series attempts to immunologically detail this eczematous reaction in four patients by measuring anthrax vaccine-specific cell mediated immunity (ASCMI), profiling TH1 and TH2 cytokine response to the anthrax vaccine in vitro, and analyzing of skin biopsy specimens. Results demonstrated that (1) ASCMI was variable and likely unrelated to this reaction; (2) a lack of TH1 cytokine response to anthrax vaccine may be associated with an increased risk of this eczematous reaction; and (3) skin biopsy findings were nonspecific but supportive of a clinical diagnosis of eczema. Future studies with more patients may yield data to further characterize the ASCMI response and cytokine profiles among patients with this type of reaction.

Natural history of large local and generalized cutaneous reactions to imported fire ant stings in children.

BACKGROUND: There are no published data on the natural history of large local and generalized cutaneous reactions to imported fire ant (IFA) stings in children. OBJECTIVE: To determine the natural history of large local and generalized cutaneous reactions to IFA stings in children not treated with immunotherapy by reviewing medical records from a venom clinic during the past 20 years. METHODS: Patients were selected for the study if they were 16 years or younger at the time of the reaction, had only cutaneous symptoms (generalized cutaneous or large local), and did not initiate immunotherapy. Each patient's parents were asked to recall whether the patient had experienced any further stings since the last evaluation at the venom clinic. RESULTS: We contacted 31 of 57 patients evaluated between July 10, 1984, and February 5, 2004. Twenty patients (65%) reported that they had not developed more severe reactions with subsequent stings. Reactions remained cutaneous only. Eleven patients (35%) had not been stung again since the original evaluation. Five of these patients had moved out of the IFA-endemic region. None of the previously evaluated patients reported subsequent life-threatening anaphylaxis from IFA stings. CONCLUSIONS: These limited data on IFA stings suggest a benign outcome in children 16 years and younger with large local or generalized cutaneous reactions. Larger and more extensive studies need to be conducted to further define the natural history of cutaneous reactions to IFA stings in children.

Cross-reactivity between coconut and hazelnut proteins in a patient with coconut anaphylaxis.

BACKGROUND: The medical literature reports few cases of severe allergic reactions to coconut. We encountered a patient with anaphylaxis to coconut and oral symptoms to tree nuts. OBJECTIVE: To identify cross-reactive antibodies between coconut and other tree nuts. METHODS: We performed commercial radioallergosorbent tests to coconut and various tree nuts using the patient's serum. Skin prick testing was performed to fresh coconut and commercial extracts of coconut, almond, Brazil nut, cashew, pecan, walnut, and hazelnut. Proteins from fresh coconut, commercial coconut extract, and tree nuts were extracted. Immunoblot and inhibition assays were performed to evaluate for cross-reacting IgE antibodies between similar-sized allergens in coconut and hazelnut. RESULTS: Positive skin test results occurred to the coconut and multiple tree nut extracts. In vitro serum specific IgE was present for coconut, hazelnut, Brazil nut, and cashew. Immunoblots demonstrated IgE binding to 35- and 50-kDa protein bands in the coconut and hazelnut extracts. Inhibition assays using coconut demonstrated complete inhibition of hazelnut specific IgE, but inhibition assays using hazelnut showed only partial inhibition of coconut specific IgE. CONCLUSIONS: Our study demonstrates the presence of cross-reactive allergens between hazelnut (a tree nut) and coconut (a distantly related palm family member). Because there are many potentially cross-reactive allergens among the tree nuts, we recommend patients with coconut hypersensitivity be investigated for further tree nut allergies.