[Wasp and bee venom allergy]. / Wespen- en bijengifallergie.

To diagnose insect venom allergy a good patient history is important. Allergological tests (skin test, specific IgE titre) confirm the diagnosis. Patients are advised on preventive measures (e.g. with respect to clothing and use of perfume). They are also instructed on medical treatment (antihistaminics, epinephrine) in case they are stung again. In patients having had a serious systemic reaction immunotherapy should be considered. Immunotherapy leads to complete protection in more than 98% of patients with wasp (yellow jacket) venom allergy and in 75-80% of patients with bee venom allergy. Serious adverse reactions to immunotherapy are rare. Immunotherapy lasts at least 3 to 5 years. After cessation of immunotherapy the frequency of systemic reactions to the sting of a wasp or bee is in the range of 5-15%. There are insufficient data on the long-term effect of immunotherapy.

[Immunology in medical practice. V. Constitutional eczema]. / Immunologie in de medische praktijk. V. Constitutioneel eczeem.

Constitutional eczema (late atopic dermatitis) is a frequent condition: some 30% of the skin diseases seen by the GP involve constitutional eczema. A number of links with (external) factors have meanwhile been established. Patients with constitutional eczema often suffer from food allergy (over 60% of the children with the eczema) and many are allergic to airborne allergens (especially housedust mite allergen). The skin of patients with constitutional eczema has a diminished barrier function against irritants (soaps, acids, bases, water, detergents, biological juices (fruit, meat, fish, vegetables). In 90% of the patients with constitutional eczema the skin contains colonies of Staphylococcus aureus (in 5% of people without eczema). S. aureus can influence the eczema through exoantigens (so-called superantigens) and through conventional antigens that may evoke an IgE-mediated immune response. Emotional stress may influence the eczema. The close anatomical relationship between mast cells and nerve endings and between Langerhans cells and nerve endings suggest that the autonomous nervous system can modulate the immune system of the skin and consequently, the eczema. These factors should be taken into account in the treatment: reduction of exposure to food and airborne allergens and to irritants, treatment and prevention of S. aureus infections and psychological support. New therapies include cyclosporine, autologous IgG antigen complexes and phototherapy.

Vineyard snail allergy possibly induced by sensitization to house-dust mite (Dermatophagoides pteronyssinus).

A female patient experienced a severe allergic reaction after consumption of vineyard snails. The patient proved to be sensitized to house-dust mite (HDM) and demonstrated a positive skin test and specific IgE to snail (Eobania vermiculata, Lofarma). The snail RAST was > 80% inhibited by HDM, whereas the mite RAST was < 10% inhibited by snail extract. This is possibly another example of food allergy related to primary sensitization by an aeroallergen.

[Allergy for human insulin]. / Allergie voor humane insuline.

In two patients, a man aged 55 years (patient A) and a man aged 67 years (patient B), severe immediate (type I) and severe delayed (type IV) local reactions to injections of human insulin, respectively, were diagnosed. There had been no previous treatment with insulin of animal origin. The diagnosis of type I allergy was based on the typical early local reaction with biphasic course, the positive immediate skin test and the raised specific IgE level against insulin. The diagnosis of type IV allergy was based on the characteristic late local reaction after 12 hrs, the delayed positive skin test and the negative specific IgE. The first attempt to desensitise patient A in 10 days was not successful, but he was desensitised successfully in 25 days. Patient B recovered spontaneously.

[Peroperative anaphylactic reactions due to latex allergy]. / Peroperatieve anafylactische reacties op basis van latexallergie.

A 10-year-old girl with spina bifida underwent surgery to increase the capacity of her neurogenic bladder using an isolated loop of intestine. During the operation serious circulatory and respiratory problems occurred after the peritoneum was opened, when the ileum was manipulated using gloves containing latex. Latex allergy can lead to potentially fatal anaphylactic reactions. A survey is presented of the risk groups, together with measures recently advocated in the literature to detect latex allergy and to avoid major reactions.

[Etiology of hypersensitivity reactions following Chinese or Indonesian meals]. / De etiologie met betrekking tot overgevoeligheidsreacties na Chinese of Indonesische maaltijden.

Various authors have criticised or confirmed the relation between adverse reactions to Chinese food ('The Chinese Restaurant Syndrome') and the use of monosodium glutamate (Vetsin). In our experience the occurrence of urticaria, angioedema or anaphylaxis after meals in Chinese or Indonesian restaurants is more often due to IgE-mediated Type I food allergy, caused by consumption of shrimp, peanut or spices, in particular those of the parsley family (e.g. coriander). A detailed description of four such cases is presented.

Clinical evaluation of a double-blind dust-mite avoidance trial with mite-allergic rhinitic patients.

Inheritance and allergen exposure are key factors in the development and the course of atopic allergy, expressed as conjunctivitis, rhinitis, asthma or dermatitis. This study concerns the clinical significance of mite and mite-allergen avoidance measures based on intensive cleaning with acaricide (solidified benzylbenzoate) added (10 dwellings), and without biocidal activity (10 other homes) as a control in a double-blind trial with matched pairs. Twenty subjects with persisting rhinitic complaints were selected. They lived in 20 different dwellings and were all sensitized to pyroglyphid mites; 12 of them were also sensitized to stored product mites (Acari). Daily symptoms and medication score, guanine and dust exposure, total and mite-specific IgE in serum, eosinophilia in the blood and in the nasal smear, intracutaneous tests with house dust mite and storage mite extracts were compared in both pairs and groups. Acarological data, physiochemical aspects and exposure assessment are discussed in detail elsewhere. Symptom scores dropped significantly, as did the total IgE and exposure to dust and mite products in the acaricidal cleaner treatment group. After 1 year, the daily symptoms median was 47% (P = 0.025), total IgE was 38% (P = 0.0049), and exposure to dust and mite products (guanine exposure) was 53% (P = 0.0449) better or lower than in the controls. Intensive cleaning, without acaricidal treatment performed twice a year, resulted in clinical improvement in four out of 10 subjects, of whom none became free of complaints. In the Acarosan treatment group (cleaning + benzylbenzoate) eight out of 10 subjects improved, in three cases subjective symptoms disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergy to egg yolk possibly induced by sensitization to bird serum antigens.

Hypersensitivity to ingested hen's egg yolk is described in a 65-year-old female patient. The patient's symptoms started in adult life and coincided with the acquisition of a parrot as a household pet. The bird's presence caused complaints of allergic rhinitis, while the ingestion of eggs caused urticaria and angioedema. Analysis of sequential blood serum samples revealed high levels of IgE antibodies to egg yolk and to various bird sera, but no precipitins. RAST-inhibition experiments indicated that the primary sensitization may have been to antigens from the parrot.