Local Allergic Reactions Research Articles

An experience in the clinical use of specific immunoglobulin from horse blood serum for prophylaxis of Ebola haemorrhagic fever

The aim of this work was to estimate the efficacy and safety of single intramuscular introduction of specific heterologous immunoglobulin as prophylactic drug against Ebola hemorrhagic fever. Materials and methods. The specific heterologous immunoglobulin was introduced as a special prophylactic drug to 28 patients in epidemic situations, after skin hurt with infectious materials or contact with infectious blood. Clinico-laboratory observation was performed in 24 subjects after single intramuscular introduction of heterologous immunoglobulin Ebola. The samples of blood serum were investigated for immunoglobulin Ebola and antibodies to horse gamma-globulin on the 30th and 60th days after prophylaxis. Results. None of the subjects of the study contracted Ebola fever. There were no anaphylactic reactions after special prophylaxis with specific heterologous immunoglobulin. Among the subjects with normal allergic state 31% responded with local reactions; 13%, with a general reaction (mild case of the serum disease). Almost no reaction was observed in patients with unfavorable allergic state subjected to desensitizing therapy; in the absence of desensitizing therapy, 50% of patients with unfavorable allergic state exhibited local reactions; 17%, mild cases of the serum disease; 33%, moderate cases of the serum disease. In summary, if the tactics of immunoglobulin application was right, the quantity of local allergic reactions was 28%; of wide spread reactions, 6%. Weak serum disease was observed in 11% of the subjects. The prognostic period of resistance to Ebola fever was less than 30 days. Conclusion. The prophylactic use of specific immunoglobulin from horse blood serum against hemorrhagic Ebola fever is effective and relatively safe in patients subjected to desensitizing therapy.

Allergen immunotherapy: an updated review of safety.

Allergen immunotherapy is the only modality that can modify the immune response upon exposure to aeroallergens and venom allergens. This review will update the allergist on recent studies evaluating safety of sublingual and subcutaneous allergen immunotherapy. Multiple clinical trials and retrospective studies have been published evaluating overall safety of these therapies. The risk of systemic reactions with subcutaneous immunotherapy remains quite low, but near-fatal and fatal anaphylaxis does occur, requiring physicians to be aware of potential risks for such events. Sublingual immunotherapy has a high incidence of local site application reactions, but severe anaphylactic events are very uncommon. Subcutaneous immunotherapy and sublingual immunotherapy are beneficial in treating allergic rhinitis and venom hypersensitivity but should be administered only by physicians familiar with potential risk factors and able to manage treatment-related local and systemic allergic reactions.

Safety of essential bee venom pharmacopuncture as assessed in a randomized controlled double-blind trial

Ethnopharmacological relevanceWhile bee venom (BV) pharmacopuncture use is common in Asia, frequent occurrence of allergic reactions during the treatment process is burdensome for both practitioner and patient. Aim of the studyThis study compared efficacy and safety in isolated and purified essential BV (eBV) pharmacopuncture filtered for phospholipase A2 (PLA2) and histamine sections, and original BV to the aim of promoting safe BV pharmacopuncture use. Materials and methodsIn in vitro, we examined the effect of BV and eBV on nitric oxide (NO) production induced by lipopolysaccharide (LPS) in RAW 264.7 macrophages, and clinically, 20 healthy adults aged 20–40 years were randomly allocated and administered eBV 0.2mL and BV pharmacopuncture 0.2mL on left and right forearm, respectively, and physician, participant, and outcome assessor were blinded to treatment allocation. Local pain, swelling, itching, redness, wheals, and adverse reactions were recorded by timepoint. ResultseBV and BV exhibited similar inhibitory effects on NO production. Also, in comparison between eBV and BV pharmacopuncture administration areas on each forearm, eBV displayed significantly lower local pain at 24h post-administration (P=0.0062), and less swelling at 30min (P=0.0198), 2 (P=0.0028), 24 (P=0.0068), and 48h post-administration (P=0.0253). eBV also showed significantly less itching at 24 (P=0.0119), 48 (P=0.0082), and 96h (P=0.0141), while redness was significantly less at 30min (P=0.0090), 6 (P=0.0005), and 24h (P<0.0001). Time-by-treatment interactions were statistically significant for itching and redness (P<0.001, and P<0.001, respectively), and all original BV pharmacopuncture administered regions showed a tendency toward more severe itching and redness in later measurements. ConclusionseBV and BV displayed comparable anti-inflammatory effects, and eBV pharmacopuncture presented less local allergic reactions.

Pathomorphological changes of the Schneiderian membrane in the mixed form of iatrogenic maxillary sinusitis of stomatogenic origin

Objective: To study the morphological changes of the Schneiderian membrane in the mixed form of iatrogenic maxillary sinusitis of stomatogenic origin. Material and methods . Reactive changes of the mucous membrane of the maxillary sinus were studied in 24 (100 %) patients with the presence of a foreign body in the lumen of the sinus. To differentiate the observed changes in the mucosa Manasse’s pathomorphologic classification was used. Immunohistochemical reaction with monoclonal antibodies CD 8, CD 56, CD 68, CD 138, CD 43 was carried out. Photo documentation was constituted by the computer system, binocular microscope Axiolab, digital camera Axiocam and «AxioVision 4.8» software. Statistical processing of the results was carried out according to the tables of R. B. Strelkov. The significance of differences of the results was estimated using the Student-Fisher method for the confidence level of not less than 95 %, which is common for biological and medical research (p<0.05). Results of the study. Fibrous-form infiltration was noted in 66.7±9.6 % of cases, granulosa – 25.0±8.8 % and cystic in 8.3±5.6 %. Cellular composition of lamina propria mucosae was represented by fibroblasts, fibrocytes, macrophages, lymphocytes, plasma cells. The presence of eosinophils in a large amount indicates the presence of local allergic reaction, the presence of segmented neutrophils infiltrate indicates the presence of the secondary infection. The biopsies revealed CD 8+-lymphocyte cells, numerous CD 68+ macrophages, single CD 43+ and CD 138+ cells. CD 56+ cytotoxic lymphocytes have not been identified. Among the reactive changes in the epithelium absence of the ciliary cover prevails in 83.3±7.6 % of observations, necrosis – 66.7±9.6 %, squamous metaplasia of the epithelium – in 50.0±10.2 % of cases, hyperplasia – in 25.0±8.8 %. Conclusions . Mixed form of iatrogenic sinusitis corresponds to fibrous infiltration, granulosa and cystic patomorphologic forms according to Manasse, cellular composition of lamina propria mucosae was represented by fibroblasts, fibrocytes, macrophages, lymphocytes, plasma cells. The presence of eosinophils in a large amount indicates the presence of local allergic reaction, the presence of segmented neutrophils infiltrate indicates the presence of the secondary infection; among the reactive changes in the epithelium absence of the ciliary cover, necrosis, squamous metaplasia of epithelium and hyperplasia prevail.

Standardized quality house dust mite sublingual tablets (Acarizax®): a guide to their use as sublingual allergy immunotherapy in Europe

Standardized quality (SQ) house dust mite (HDM) allergen extract tablets (Acarizax®) are a valuable option for sublingual allergy immunotherapy (SLIT) in adults with confirmed HDM-induced allergic rhinitis or allergic asthma. In placebo-controlled natural-field and environmental exposure challenge chamber trials, Acarizax® reduced the symptoms of allergic rhinitis in adults with HDM-induced allergic rhinitis (± asthma) and reduced the risk of asthma exacerbations in adults with HDM-induced allergic asthma. A systemic antibody response to HDM allergens has been observed within 4 weeks of initiating SLIT with Acarizax®. Precautions should be followed to minimize the risk of systemic and local allergic reactions inherent to SLIT.

Immunologic changes after diode laser inferior turbinoplasty in allergic rhinitis

Objectives It was suggested previously that turbinoplasty by laser improves the symptomatology of allergic rhinitis (AR) not only by a mechanical effect but also by inhibiting the local allergic reaction at the level of the inferior turbinates. The aim of this study was to determine whether the short-term immunologic effects of diode laser, when used to perform inferior turbinoplasty in AR, can also be detected at the systemic level. Patients and methods Twenty patients, seeking a treatment by laser for AR manifestations refractory to local and systemic medical therapy, were included in a prospective study. Blood picture, total immunoglobulin E, interleukin (IL)-4, IL-5, and interferon-γ levels were assessed immediately before and 1 month after diode laser inferior turbinoplasty (DLIT). Results One month after DLIT, the total leukocytic count increased with relative eosinopenia. Total immunoglobulin E and IL-5 decreased, together with insignificant changes in IL-4 and interferon-γ. Conclusion It is not impossible that DLIT modifies the clinical course of AR not only by a mechanical effect but also by its local or even by a systemic immunologic effect. The laser modulation of T-cell functions in the engorged turbinate submucosa is a plausible biomolecular interpretation of the observed effect.

Nursing experience of vacuum sealing drainage applied for plastic surgery post skin flap necrosis

Objective To summarize nursing methods of vacuum sealing drainage (VSD) for plastic surgery patients with skin flap necrosis. Methods VSD was applied to 4 plastic surgery patients with skin flap necrosis in Middle Second Ward of Plastic Surgery Hospital, Chinese Academy of Medical Sciences. The effectiveness of VSD was retrospectively summarized and analyzed. Results Two patients with intercostalartery perforator flap had been treated with VSD for two cycles. There were massive fresh granulation tissue characterized with fine granules, abundant capillaries and no edema. The area of wound had decreased to 2 cm×2 cm. Moreover, the wound recovered well after skin-graft repairing. One patient with ectatic sensate paraumbilical flap had been treated with VSD for one cycle. The area of wound had decreased to 1 cm×1 cm and recovered after four times dressing change. The last case of patient with scapular flap had been treated with VSD for 3 cycles and the area wound had decreased to 2 cm×3 cm. The wound recovered favorably after skin-graft repairing. There were no systemic or local toxicity, allergic reaction and complications in all four cases. Conclusions Application of VSD, which is worth of clinical expansion, is a simple-handling and effective treatment for plastic surgery patients with skin flap necrosis after debridement. Key words: Plastic surgery; Skin flap necrosis; Vacuum sealing drainage

House dust mite sublingual tablets (Actair®): a guide to their use as allergy immunotherapy for house dust mite-induced allergic rhinitis

House dust mite (HDM) allergen extract sublingual tablets (Actair®) are a valuable option to reduce allergy symptoms in patients with HDM-induced allergic rhinitis. Allergy immunotherapy (AIT) with 300 index of reactivity (IR) Actair® reduced the symptoms of allergic rhinitis in placebo-controlled natural-field and environmental exposure challenge chamber trials. Significant beneficial effects with 300 IR Actair® relative to placebo were shown as early as 2 months after the initiation of treatment, with efficacy being continuously maintained during the rest of the 1-year AIT period, as well as during a subsequent AIT-free year. Precautions should be followed to minimize the risk of systemic and local allergic reactions inherent to AIT.

Rapid recruitment of CD14+ monocytes in experimentally induced allergic rhinitis in human subjects

Activated TH2 cells and eosinophils are hallmarks of the allergic inflammation seen in patients with allergic rhinitis (AR). However, which cells activate and attract Tcells and eosinophils to the inflammatory lesion has not been determined. We wanted to assess the role of mucosal mononuclear phagocytes, consisting of monocytes, macrophages, and dendritic cells, in the local allergic inflammatory reaction. Patients with AR and nonatopic control subjects were challenged with pollen extract, and nasal symptoms were recorded. Mucosal biopsy specimens obtained at different time points before and after challenge were used for immunostaining in situ and flow cytometric cell sorting. Sorted mononuclear phagocytes were subjected to RNA extraction and gene expression profiling. In an invivo model of AR, we found that CD14(+) monocytes were recruited to the nasal mucosa within hours after local allergen challenge, whereas conventional dendritic cells accumulated after several days of continued provocation. Transcriptomic profiling of mucosal mononuclear phagocytes sorted after 1week of continued allergen challenge showed an activated phenotype at least partially driven by IL-4 signaling, IL-13 signaling, or both. Importantly, gene expression of several TH2-related chemokines was significantly upregulated by the mononuclear phagocyte population concomitant with an increased recruitment of CD4(+) Tcells and eosinophils. Our findings suggest that the mononuclear phagocyte population is directly involved in the production of proinflammatory chemokines that attract other immune cells. Rapid recruitment of CD14(+) monocytes to the challenged site indicates that these proinflammatory mononuclear phagocytes have a central role in orchestrating local allergic inflammation.

The current views of the treatment of diffuse external otitis

The objective of the present study was to evaluate the clinical effectiveness and safety of the local application of triderm for the treatment of diffuse external otitis. The study included 68 patients presenting with bacterial and fungal diffuse external otitis. The treatment in the form of local empiric therapy was continued till the results of microbiological treatment became apparent. The beneficial outcome achieved in 91.2% of the patients was clinically manifest as the regression of the inflammatory process in the external auditory meatus. No complications, such as ototoxic events, either local or systemic allergic reactions, were documented. The authors substantiate the possibility of the application of the medication under consideration for the treatment of diffuse external otitis based on the knowledge of the mechanism of the actin of its constituent components, viz. betamethasone, dipropionate, gentamicin sulfate, and clotrimazole, taking into account the occurrence of the most common causative agents of diffuse external otitis. It is concluded that triderm is a safe medication for the local application and, probably, for the initial empiric therapy of diffuse external otitis to be continued till the results of the microbiological treatment become apparent.

EFFICACY AND SAFETY OF A NEW COMBINED MEDICATION WITH RECOMBINANT INTERFERON AND BETAMETHASONE IN THE TREATMENT OF HAY FEVER DURING PERIODS OF EXACERBATION

Objective: to assess the efficacy, safety and tolerability of the new combined medication Allergoferon® beta in patients with moderate-to-severe hay fever (seasonal allergic rhinitis and conjunctivitis) during periods of exacerbation. patients and methods: the object of our study was medication Allergoferon® beta (recombinant human interferon alpha-2b, not less than 5000 IU/ml + betamethasone sodium phosphate, 1.0 mg/ml) in the form of eye and nasal drops. Total of 120 patients aged 18-65 years with hay fever for at least two years were enrolled in the clinical trial, including 76 women and 44 men. All patients had a clinical picture of moderate-to-severe hay fever during periods of exacerbation. Patients were divided into two equal groups. The main group received Allergoferon® beta, the control group was treated with Oftan® Dexamethasone and Nasobek medications. This trial used a randomized, open-label, multicenter, parallel, comparative, controlled study design. results: we found that new combined medication Allergoferon® beta had a significant therapeutic effect in relieving main clinical manifestations of acute hay fever and showed a higher efficacy, than the comparison remedies. By comparing similar symptoms in both groups, we observed that in patients treated with Allergoferon® beta clinical symptoms of acute hay fever were relieved earlier (on the 5th day of treatment), than in the control group (on the 10th day of treatment) and the disease itself proceeded milder. Therapeutic efficacy of Allergoferon® beta was 85,96% (in the control group — 74,73%, p&lt;0.05). During clinical trial we have not observed any adverse effects; general or local toxic and allergic reactions were also not discovered. The medication tolerability was rated as “good” for patients. Conclusion: according to the clinical study results, the medication Allergoferon® beta (eye and nasal drops) is recommended for the state registration and can be used by medical professionals in the treatment of moderate-to-severe hay fever (seasonal allergic rhinitis and conjunctivitis), including periods of exacerbation.

Evidences for Local Allergic Rhinitis

Local allergic rhinitis is defined as a localized allergic reaction of the nasal mucosa in the absence of systemic atopy. Its main pathophysiological mechanism can be summarized as: 1) increased specific immunoglobulin E in the nasal fluid, and 2) Th2 allergic mechanism localized in the nasal mucosa...

Clinical Significance of Component Allergens in Fagales Pollen-Sensitized Peanut Allergy in Korea.

PurposeClinical features of peanut allergy can range from localized to systemic reactions. Because peanut and birch pollen have cross-reactivity, peanut can lead to localized allergic reaction in Fagales pollen-sensitized oral allergy syndrome (OAS) patients without peanut sensitization per se. The purpose of this study was to discriminate true peanut food allergy from cross-reactive hypersensitivity in birch-sensitized peanut allergy.MethodsBirch-sensitized (n=81) and peanut anaphylaxis patients (n=12) were enrolled. Peanut-related allergic reactions and sensitization profiles were examined. Specific IgE to Fagales tree pollens (birch, oak), peanut, and their component allergens (Bet v 1, Bet v 2, Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9) were evaluated. Based on these specific IgEs and clinical features, the patients were classified into 4 groups: group 1 (Fagales pollen allergy without OAS), group 2 (Fagales pollen allergy with OAS), group 3 (OAS with peanut anaphylaxis), and group 4 (peanut anaphylaxis).ResultsAfter peanut consumption, one-third of OAS patients experienced oral symptoms not associated with peanut sensitization. Ara h 1 or Ara h 2 was positive in peanut anaphylaxis patients, whereas Ara h 8 was positive in OAS patients. There were 4 patients with both peanut anaphylaxis and OAS (group 3). Both Ara h 2 and Ara h 8 were positive in these patients. Foods associated with OAS in Korea showed unique patterns compared to Westernized countries.ConclusionsAra h 2 and Ara h 8 may be important component allergens for discriminating peanut allergy.

Identification of a Neuronal Receptor Controlling Anaphylaxis.

Allergic reactions can in severe cases induce a state of circulatory shock referred to as anaphylaxis. Histamine, the primary mediator of this condition, is released from immune cells, and, therefore, anaphylaxis has so far been considered an immune system disorder. However, we here show that the glutamatergic receptor mGluR7, expressed on a subpopulation of both peripheral and spinal cord neurons, controls histamine-induced communication through calcium-dependent autoinhibition with implications for anaphylaxis. Genetic ablation of mGluR7, and thus altered regulation of histamine-sensing neurons, caused an anaphylaxis-like state in mGluR7(-/-) mice, which could be reversed by antagonizing signaling between neurons and mast cells but not by antagonizing a central itch pathway. Our findings demonstrate the vital role of nervous system control by mGluR7 in anaphylaxis and open up possibilities for preventive strategies for this life-threatening condition.

Treatment for superficial infusion thrombophlebitis of the upper extremity.

Although superficial thrombophlebitis of the upper extremity represents a frequent complication of intravenous catheters inserted into the peripheral veins of the forearm or hand, no consensus exists on the optimal management of this condition in clinical practice. To summarise the evidence from randomised clinical trials (RCTs) concerning the efficacy and safety of (topical, oral or parenteral) medical therapy of superficial thrombophlebitis of the upper extremity. The Cochrane Vascular Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (2015, Issue 3). Clinical trials registries were searched up to April 2015. RCTs comparing any (topical, oral or parenteral) medical treatment to no intervention or placebo, or comparing two different medical interventions (e.g. a different variant scheme or regimen of the same intervention or a different pharmacological type of treatment). We extracted data on methodological quality, patient characteristics, interventions and outcomes, including improvement of signs and symptoms as the primary effectiveness outcome, and number of participants experiencing side effects of the study treatments as the primary safety outcome. We identified 13 studies (917 participants). The evaluated treatment modalities consisted of a topical treatment (11 studies), an oral treatment (2 studies) and a parenteral treatment (2 studies). Seven studies used a placebo or no intervention control group, whereas all others also or solely compared active treatment groups. No study evaluated the effects of ice or the application of cold or hot bandages. Overall, the risk of bias in individual trials was moderate to high, although poor reporting hampered a full appreciation of the risk in most studies. The overall quality of the evidence for each of the outcomes varied from low to moderate mainly due to risk of bias and imprecision, with only single trials contributing to most comparisons. Data on primary outcomes improvement of signs and symptoms and side effects attributed to the study treatment could not be statistically pooled because of the between-study differences in comparisons, outcomes and type of instruments to measure outcomes.An array of topical treatments, such as heparinoid or diclofenac gels, improved pain compared to placebo or no intervention. Compared to placebo, oral non-steroidal anti-inflammatory drugs reduced signs and symptoms intensity. Safety issues were reported sparsely and were not available for some interventions, such as notoginseny creams, parenteral low-molecular-weight heparin or defibrotide. Although several trials reported on adverse events with topical heparinoid creams, Essaven gel or phlebolan versus control, the trials were underpowered to adequately measure any differences between treatment modalities. Where reported, adverse events with topical treatments consisted mainly of local allergic reactions. Only one study of 15 participants assessed thrombus extension and symptomatic venous thromboembolism with either oral non-steroidal anti-inflammatory drugs or low-molecular-weight heparin, and it reported no cases of either. No study reported on the development of suppurative phlebitis, catheter-related bloodstream infections or quality of life. The evidence about the treatment of acute infusion superficial thrombophlebitis is limited and of low quality. Data appear too preliminary to assess the effectiveness and safety of topical treatments, systemic anticoagulation or oral non-steroidal anti-inflammatory drugs.

Persistence of treatment with 5-grass pollen tablets in patients with allergic rhinitis: a real-life study

BackgroundIn patients with allergic rhinitis, treatment adherence to allergen immunotherapy varies greatly in randomized and real-life studies. ObjectiveTo evaluate the use of a 5-grass pollen tablet as sublingual immunotherapy, its treatment persistence, and the reasons for discontinuation in a real-life clinical setting. MethodsThis multicenter, prospective, open-label, noncontrolled observational study evaluated the use of sublingual immunotherapy with a 5-grass pollen tablet in a cross-sectional population of patients (≥5 years old) with grass pollen-induced allergic rhinitis with or without asthma. The primary objective was to determine the percentage of patients persisting with treatment across 1 season in a pre–co-seasonal scheme. Secondary objectives included evaluation of reasons for treatment discontinuation, safety and adverse events; effectiveness (based on physician and patient assessments), and treatment compliance. ResultsThe study included 196 patients (49.2% male, mean age 27.5 years, range 5.3–65.7 years), with treatment provided by 47 participating physicians. Sixty-seven percent of patients had polysensitivity and 32% had coexistent asthma. On average, patients were treated for 7 months with the 5-grass pollen tablet. After 1 month, 85% of all patients persisted with treatment, and 70% persisted after 7 months. Treatment discontinuation was due chiefly to known side effects (mild to moderate local allergic reactions). Most patients reported symptom improvement; 80% of all patients intended to continue treatment next season. ConclusionMost patients with allergic rhinitis treated pre–co-seasonally with a 5-grass pollen tablet persisted with treatment after the first pollen season. Patients were willing to continue their treatment in the following season owing to improvement of symptoms.

Insect sting allergy in adults: key messages for clinicians.

During their lifetime, 94.5% of people are stung by wasps, honeybees, hornets, or bumblebees (order Hymenoptera). After a sting, most people show typical local symptoms, 5% to 15% develop local allergic reactions, and 3% to 8.9%--systemic allergic reactions (SARs), which may be potentially life-threatening in about 10% of them. In mild forms of Hymenoptera-venom allergy (HVA), the leading symptoms are urticaria and edema (grades I and II, respectively, according to the Mueller classification). Severe SARs are classified as grade III (respiratory symptoms) and IV (cardiovascular symptoms). Rare manifestations of HVA are Kounis syndrome and takotsubo cardiomyopathy. All patients after an SAR require standard (skin test, IgE, tryptase) or comprehensive (component diagnosis, basophil activation test) allergy testing. All patients with severe systemic symptoms (hypertension, disturbances in consciousness) should be tested for mastocytosis. Additionally, a relationship was found between the severity of HVA symptoms and intake of angiotensin-converting enzyme inhibitors (ACEIs). There is a similar concern, although less well-documented, about the use of β-blockers. Patients with HVA who have experienced a SAR are potential candidates for venom immunotherapy (VIT), which is effective in 80% to 100% of individuals treated for 3 to 5 years. An increased risk of a VIT failure has been reported in patients with systemic mastocytosis and those treated with ACEIs. In certain groups (beekeepers, patients who develop a SAR to stings during a VIT with a standard dose, as well as those with a SAR to maintenance doses of VIT), a twice higher maintenance dose is recommended. Indications, contraindications, treatment protocols, and vaccine doses are regulated by the international guidelines of allergy societies.

Comparison of Microneedles and Adhesive-Tape Stripping in Skin Preparation for Epicutaneous Allergen Delivery

Background: Epicutaneous immunotherapy targets the network of dendritic cells in the epidermis. Allergen exposure of the dermal layers should be limited as these contain mast cells and blood vessels, which increases the risk for local and systemic allergic reactions. Methods: This intraindividually controlled trial included 20 subjects with birch pollen allergy. Three areas of the volar forearms were treated by repeated adhesive-tape stripping, single-prick lancet piercing and microneedle array application. Four 10-fold dilutions of allergen extract were applied to each area and the IgE-mediated immediate-phase reactions and cell-mediated eczema were assessed. Results: Allergen application after tape stripping led to an immediate-phase reaction in 2 subjects (10%) at the highest allergen concentration of 10 HEP/ml. Both prick needle and microneedle pretreatment resulted in immediate-phase reactions in all subjects (100%). The reactivity pattern, however, differed significantly: 95% of the reactions after pricking occurred at concentrations of ≤0.1 HEP/ml, whereas 50% of the reactions after microneedle preparation were noted at ≥1 HEP/ml. In 3 subjects (15%), eczema was observed on the microneedle-treated skin area. No serious adverse events occurred. Conclusions: Microneedles enhance stratum corneum penetration when compared to tape stripping. However, they do not resolve the problem of mast cell-mediated local reactions, possibly due to diffusion into the dermis. The occurrence of eczema after the microneedle treatment suggests induction of dendritic cell-mediated T cell responses. Therefore, skin preparation with microneedles may be a promising method for epicutaneous allergen immunotherapy.

The Aspects of Clinical Manifestation and Diagnostics of Irritable Bowel Syndrome in Infants

The work deals with the present conceptions concerning irritable bowel syndrome (IBS) in infants. IBS is a functional intestinal disorder when abdominal pain or discomfort are associated with defecation, or changes of the intestinal function and peculiarities of defecation. It is the only disease with various variants of the course connected with disorders of a regulating role of the central nervous system and vegetative dysfunctions resulting, first of all, in the development of motor disorders of the large intestine and is manifested by defecation disorders, changes of frequency and quality of stools, and is accompanied by abdominal pain. The main aspects of etiopathogenesis are: compromised heredity, increased sensitivity of the large intestine to extension, enzymatic insufficiency and imbalance of neuroendocrine mechanisms, disorders of the intestinal endocrine system, leading to the intensification of the intestinal motor function, secretion, activation of the kinin system, occurring of pain impulses, regulative disorders of psychic and sensory functions. The main factors playing their role in IBS pathogenesis are: disorders of a regulating role of the CNS and development of vegetative dysfunctions; motor disorders and disorders of intestinal biocoenosis, which can be treated as a target mechanism of IBS and/or as the consequence of the disease. Diagnostic criteria, approaches to interpret the findings of the study and the principles of IBS treatment in infants are estimated. The initial diagnosis of IBS is made on the basis of clinical signs, the final diagnosis – on the basis of a combined estimation of clinical and paraclinical examinations. Proctosigmoidoscopy is a compulsory examination which should be performed to make or exclude the diagnosis of IBS. The results of clinical-paraclinical examinations of infants with clinical signs of IBS, aged 3-4 years, are presented. Much more considerable level of albumin, A1-AT, calprotectin and sIgA were found in their evacuations as compared to the infants of the control group which is indicative of a local inflammation, increased permeability of the intestinal mucus and local allergic reaction, which can be a predictor to develop further atopic dermatitis. The changes mentioned above are accompanied by considerable alterations of intestinal microbiocoenosis, which is manifested by a decreased content of physiological microflora with prevailed colonies of opportunistic microorganisms. The diagnosis of IBS is the diagnosis of exclusion, it can be verified only in case other diseases are excluded (first of all, inflammatory intestinal diseases).The treatment of IBS requires a comprehensive therapy with the use of medicines of a combined regulation action, it should be accurately differentiated considering a clinical variant of its course and individual reaction of the patient, substantiated and well-considered administration of medicines, keeping to the essential period of treatment to prevent relapsed signs.

Local anaesthetic systemic toxicity

Access the CPD MCQs for this issue online here ### Key points Well-placed local anaesthetics (LAs) can yield great clinical benefits. But systemic toxicity related to their use can be devastating. The highly publicized case in 2004 of Mayra Cabrera, a theatre nurse who died shortly after delivery of her baby boy when her epidural infusion of bupivacaine was mistakenly connected to her i.v. line, reminds us to be vigilant and to learn from such rare events. While prevention is clearly the most important element in avoiding morbidity and mortality associated with local anaesthetic systemic toxicity (LAST), such cases still occur despite best practice. Knowing how to manage these uncommon events is vital. In this review, we cover LA toxicity, its incidence, clinical features, risk factors, prevention, and management and examine i.v. lipid emulsion (ILE) therapy in more detail. LAST has been recognized for more than a hundred years, but the precise incidence is currently unknown. In 1928, the American Medical Association reported 40 deaths attributable to LAs.1 Cocaine was responsible for half of these deaths, but procaine was also implicated. These findings prompted the search for less toxic agents. Lidocaine, first synthesized in 1944, was the first amide LA to be used clinically. However, in 1979, the potentially fatal toxicity of amide LAs was highlighted by Albright.2 More recently, studies from 1993 …