Local Allergic Reactions Research Articles

The Longevity and Clinical Performance of Direct and Indirect Restorations, Including Amalgam, Composite, Ceramic, and Metal Restorations

The longevity of dental restorations depends on patient-related, dentist-related, and material-related factors. Patientrelated factors include restoration size, chewing habits, oral hygiene, and systemic conditions. Strength, wear resistance, water tolerance, dimensional stability, and colour stability are all material-related variables. When deciding on a course of treatment, dentists must take these things into account. Since the 19th century, dental amalgam, which is composed of mercury, silver, tin, copper, and other metals, has been used effectively. Although it has limits in terms of tooth colour matching, it is appropriate for Class I and II restorations. Amalgam offers good load-bearing qualities, wear resistance, and tolerance for various clinical conditions. Safety concerns include the release of mercury vapor and the possibility of localized allergic reactions. Resin-based composites are esthetic and safe materials used for anterior and small to moderate-sized posterior fillings. Postoperative tooth sensitivity and shrinkage-related issues can occur, but improvements have minimized these problems. Adequate field control is essential for successful placement. Indirect restorative materials include all-ceramic and base metal casting alloys. All-ceramic restorations provide excellent aesthetics, high strength, and biocompatibility. However, they rely on resin-based cements and adhesives for retention, and allergies can occur. Base metal alloys offer an economical alternative and are effective for crown-and-bridge restorations. The choice of restorative materials depends on various factors, and dentists must consider the specific needs of each patient to achieve successful outcomes.

Экспериментальное изучение аллергизирующего действия препарата на основе гиалуронидазы, пегилированной по технологии электронно-лучевого синтеза

Introduction. Hyaluronidase is an enzyme preparation widely used in medicine, including ophthalmology. Hyaluronidase, having a protein structure, carries a potential danger in the form of undesirable allergic reactions. To avoid allergenic effects, protein structures are modified by combining with a polymer carrier, for example, by polyethylene glycol (PEG). Aim. To study the possible allergenic potential of hyaluronidase, PEGylated using the technology of electron beam synthesis, with various routes of administration. Materials and methods. The object of the study is PEGylated hyaluronidase (PEG-Hyal). Experimental animals are hybrid mice and guinea pigs. Seven types of experiments were carried out: anaphylactogenic activity; conjunctival challenge test; cutaneous applications; delayed-type hypersensitivity (DTH); active cutaneous anaphylaxis; indirect mast cell degranulation; inflammatory response to concanavalin A (ConA). Results. When studying anaphylactogenic activity, an anaphylactic reaction was not observed in guinea pigs. The conjunctival challenge test also revealed no signs of hypersensitivity to the drug. In the study of sensitization, no development of local allergic reactions was observed. In experiments to the study DTH in mice, there were no significant differences for the DTH index in the experimental and control groups. The assessment of active skin anaphylaxis has been showed that the diameter of the stained spot did not significantly differ in both experimental groups from the control one. In indirect mast cell degranulation experiments, it was found that there was no statistically significant change in the mast cell degranulation index. Evaluation of the allergenic potential of PEG-Hyal in the inflammatory response to ConA showed that there is no statistically significant difference between the experimental and control groups. Conclusion. Based on the results of the experiments, it can be concluded that PEG-Hyal does not have an allergenic potential in various routes of administration, which significantly expands the possibilities of its clinical use.

Anaphylaxis Due to Aedes Mosquito Bites: Case Report And Literature Review

Allergic reactions to mosquito bites are underdiagnosed and undertreated but can cause life-threatening anaphylaxis particularly in patients with underlying allergic rhinitis and asthma. We report a patient who developed two episodes of local allergic reactions due to mosquito bites, then subsequently developed anaphylaxis after the third mosquito bites

Auricular acupressure for adverse events following immunization after COVID-19 vaccine injection: A multicentre, blinded, randomized controlled trial

BackgroundSome adverse events following immunization (AEFI) were observed in potential corelation with COVID-19 vaccination but without prevention or ongoing trial for it. We aimed to investigate efficacy of auricular acupressure (AuriAc) therapy in preventing AEFI after first dosage of the vaccine. MethodsWe performed a multicentre randomized controlled trial with three arms, including AuriAc, SAuriAc (sham auricular acupressure), and TrAsU (treatment as usual) group, carried out in four medical institutions in Chengdu, China, from March 17th to April 23rd, 2021. We enrolled participants based on eligibility criteria and randomized them into three groups: AuriAc (AEFI-specific auricular points applied, n = 52), SAuriAc (n = 51) or TrAsU (n = 44) group. Primary outcomes were percentages of any AEFI and local pain, and secondary outcomes were percentages who reported other AEFI. They were followed at 1, 3, 5, 7, and 14 days, by phone or online, with severity evaluated. Results147 participants (73.47% females) were included with median age as 31 years (25–45, IQR). One day after the injection, participants in AuriAc group reported significant reduction on percentages of any AEFI [intention-to-treat, difference of percentage (DP) = −20.13, 95%CI: − 0.39, − 0.02, p = 0.01; per-protocol, DP = −22.21, 95%CI: − 0.40, − 0.03, P = 0.02] and local pain (per-protocol, DP = −18.40, 95%CI: −0.36, −0.01, P = 0.04), compared with TrAsU group. The effects were slight at other follow-up days and for other outcomes, and with a low percentage of mild local allergic reactions. ConclusionsWe firstly explored potential of AuriAc for preventing AEFI related to COVID-19 vaccine injection, which is beneficial for the vaccine recipients, but evidence is limited. Trial registrationchictr.org.cn no. ChiCTR2100043210 (http://www.chictr.org.cn/showproj.aspx?proj=121519)

35320 Pilot evaluation of safety and efficacy in diverse skin types of a novel topical hyaluronidase-polysaccharide formulation for contour irregularities following filler injection

Injectable hyaluronidase is used off-label for skin contour irregularities, nodules or ischemia following hyaluronic acid (HA) fillers, and sometimes for non-HA filler nodules. However, hyaluronidase injections are associated with local allergic reactions (incidence 0.05-0.69% rising to 31.3% with 200,000 IU) and rare urticaria and angioedema (incidence < 0.1%). Availability and use of injectable hyaluronidase are limited by country-specific regulations, Some patients decline injections to address filler complications. After ethical board approval, 17 females aged 23 to 54 (six having skin phototypes IV-VI) with chronic post-filler contour irregularities received 1 to 3 topical treatments with a new formulation of hyaluronidase enzymatically complexed with botanical polysaccharides. Treated areas were infraorbital (10), lips (5), and malar festoons (2). Post-application massage was performed in office and at home. Two to 4 weeks after final treatment, physician-assessed contour improvement was 8-10/10 for 7 patients, 5-7/10 for 6, 1-4/10 for 3, and 0/10 for 1 patient. Fifteen patients evaluated their skin as more uniform (5/10 to 10/10). Satisfaction scores were 7-10/10 for 13 patients, 6/10 for 2, and 0-1/10 for 2. All evaluated treatment as Comfortable to Extremely Comfortable. The topical hyaluronidase-polysaccharide formulation has regulatory classification as a cosmetic. Based on this pilot evaluation, it may be of value in countries that prohibit injectable hyaluronidase, and for patients who decline injections. Larger, controlled studies will raise the evidence level for safety, efficacy and tolerability. It may be appropriate to evaluate nonaesthetic applications including granulomatous foreign body reactions and adjunctive acceleration of subcutaneous drug absorption and dispersion.

Efficacy of intra-lesional injections of meglumine antimoniate once a week vs. twice a week in the treatment of cutaneous leishmaniasis caused by L. tropica in Iran: A randomized controlled clinical trial.

Treatment of Cutaneous leishmaniasis (CL) is based on using antimoniate derivatives; patients’ compliance for systemic injections is low due to the pain and systemic complications. In this randomized open trial, the efficacy of intra-lesional (IL) injections of meglumine antimoniate (MA) once a week vs. twice a week in the treatment of Anthrpoponothic CL caused by L. tropica was studied. Eligible volunteer patients were selected according to inclusion/exclusion criteria. The included patients were randomly allocated to receive IL-MA injections once a week or twice a week. The primary outcome was set as complete healing of the lesion(s), and defined as complete re-epithelialization and absence of induration in the lesions. A total of 180 parasitologicaly proven CL patients caused by L. tropica were recruited, 90 patients were treated with weekly IL-MA and 90 patients received IL-MA twice a week. The complete cure was 87.9% vs. 89.2% in the group received weekly and twice a week IL-MA injections, respectively (P = 0.808). Patients’ compliance was acceptable and side effects were limited to a few local allergic reactions to MA. Median time to healing was significantly shorter in patients who received IL-MA twice a week (median ± SE) 37±3.8, (CI: 29.6–44.4) days compared to whom received IL-MA once a week 60±2.3, (CI: 55.6–64.5) days (P< 0.001), however the number of injections was higher in group who received IL-MA twice a week (12 vs. 9 injections). In conclusion, the rate of cure in the group of CL patients with IL-MA twice a week was not significantly different from the group who received IL-MA once a week shorten, but the duration of healing was shorter in the group who received IL-MA twice a week while the group received more injections so is recommended to use IL-MA once a week due to the fact the compliance is acceptable with limited side effects.Clinical Trial Registration: IRCT20081130001475N13; https://en.irct.ir/.

Venom allergen immunotherapy.

Venom immunotherapy (VIT) with Hymenoptera venom extracts is highly effective in preventing large local, systemic allergic, and anaphylactic reactions to insect stings. VIT is not required for patients with cutaneous systemic or large local allergic reactions to stings because it is uncommon for reactions to become more severe. The clinical history, with confirmatory skin or serum tests for venom IgE, can clarify the risk for future anaphylaxis and the need for VIT. For initial treatment, rush regimens are recommended because they have the same or less risk of systemic reactions than slower traditional regimens. VIT is relatively safe with a low incidence of systemic reactions. Injection-site reactions can be bothersome but do not predict systemic reactions to venom injections. Patients who need VIT should be screened for baseline serum tryptase and possible underlying mast cell disorders. VIT can be discontinued after five years in most patients, but those with known high-risk factors should continue VIT indefinitely.

Delivery options for sublingual immunotherapy for allergic rhinoconjunctivitis: clinical considerations for North America

Background: Sublingual immunotherapy (SLIT) can be delivered via tablets (SLIT-T) or aqueous drops (SLIT-D). SLIT-D dosing recommendations using North American extracts were published in 2015. We review the 2015 recommendations in the context of recent research, and compare and contrast dosing, efficacy, safety, adherence, and cost of SLIT-T and SLIT-D for allergic rhinoconjunctivitis (ARC) in North America. Methods: Randomized controlled trials (RCT) of SLIT-D and SLIT-T trials were identified by a systematic PubMed search through March 1, 2022. Results: Dose-finding studies have been conducted for all approved SLIT-T; efficacy in North American populations was demonstrated in 11 RCTs. Approved SLIT-T are uniform internationally. Few dose-finding studies for SLIT-D have been conducted using North American extracts; efficacy was demonstrated in 2 RCTs. Extrapolation of dosing from SLIT-D studies conducted with extracts from other geographic regions is unreliable. Since the 2015 SLIT-D dosing recommendations, no new RCTs of SLIT-D have been conducted with North American extracts, whereas 6 SLIT-T RCTs have since been conducted in North America. Local allergic reactions are the most common adverse events with SLIT-T and SLIT-D, but both can induce systemic allergic reactions. Adherence to SLIT-D and SLIT-T remains a challenge. Patients must pay for SLIT-D directly, whereas SLIT-T is usually covered by insurance. Conclusion: As part of shared decision-making, patients should be informed about the scientific evidence supporting the use of SLIT-T and SLIT-D for ARC.

CASE STUDY - ALLERGIC CONTACT DERMATITIS IN RELATION TO TATTOOS

As tattooing becomes more and more popular, growing numbers of skin reactions caused by tattoos are also becoming frequently encountered by medical professionals. We present a generic case of a tattoo-induced allergic reaction and explore its’ immunological mechanism. This paper also highlights components of tattoo inks, their allergenic potential, and possible options for treatment. There can be different types of allergens in tattoo inks. Some are biodegradable, while others are not. Examples of biodegradable components include natural dyes and preservatives. Allergic reactions caused by such agents may resolve with simple therapy since after a short period they will be cleared from the skin. On the other hand, synthetic molecules and other non-degradable dyes will need invasive therapy, such as surgery, dermatome shaving and most commonly used - laser removal therapy. Most notable in this regard is red ink with the highest incidence. There are no current regulations on tattoo inks, which puts tattoo enthusiasts at a higher risk of developing allergic reactions. There are certain preventive measures, such as patch and dot tests. Because the specificity of these tests is mediocre, despite negative results, an allergic reaction may develop weeks or months later. There are no strict treatment guidelines and each case must be assessed individually. Our patient was a young woman, who developed a local allergic reaction due to the red pigment used in her tattoo. Initial treatment, in this case, was anti-inflammatory to reduce inflammation. The only way to get full resolution in such cases is to remove the allergen (red pigment) from the dermis. The patient was prescribed topical treatment with corticosteroids. Once irritation subsided tattoo removal therapy with Q-switched Nd 532 nm laser was initiated. The inflammation returned after the first session, for which local anti-inflammatory medications were started. Due to the ineffectiveness of laser removal and local treatments systemic therapy with corticosteroids was prescribed with gradually decreasing the dosage and controlling the disease. After two months of this treatment, the patient's condition improved. She is still undergoing therapy with systemic corticosteroids.

DIAGNOSTICS, PREVENTION AND THERAPY OF HELMINTH INFECTIONS OF THE RED DEER IN THE KALININGRAD REGION

The research purpose is to identify and study parasite fauna of the red deer in the Kaliningrad Region, to determine intermediate hosts of helminths and their role in the spread of helminth infections of animals, and to study the efficacy of new domestic drugs Monizen-forte, Iversan and Gelmicide produced by NVC Agrovetzashchita, LLC against the main helminth infections of the deer. We ran diagnostics of European red deer (Cervus elaphus) for helminthiasis by helminthoscopic methods on Kaliningrad Region reindeer farms from 2018 to 2021. We identified 45 helminth species in red deer in the Kaliningrad Region. Of these, 6 trematode species, 4 cestode species and 35 nematode species. The dehelminthization used the following domestic antiparasitic drugs produced in NVC AVZ, LLC: Monizen-forte, Iversan and Gelmicide, whose therapeutic efficacy was 100% for nematode infections, and 95% for trematode and cestode infections. The drugs are well tolerated and do not cause any local irritation or allergic reactions on the skin and mucous membranes. We conducted dehelminthization of 3 groups of deer three times a year: in March, July and October 2021. The obtained study results made it possible to develop and take veterinary measures to treat and prevent helminth infections of antler deer in the Kaliningrad Region.

The use of an adhesive balm with magnetic polymers, hexethydine, cytylpyridinium chloride and hyaluronic acid in the treatment of inflammatory periodontal diseases

The article presents the results of a study of an adhesive balm with magnetic polymers, hexethidine, cytylpyridinium chloride and hyaluronic acid in the treatment of inflammatory periodontal diseases. Revealed and scientifically proven its effectiveness in acute and subacute periods of the course of gingivitis and periodontitis. The study involved 40 patients aged 20 to 60 years, in whom the anti-inflammatory and hemostatic effect of the adhesive balm on the inflamed periodontal soft tissues was studied. During the monitoring of index indicators, it was revealed that the PMA index decreased from 50,72 to 16,31 by the end of the study. After 14 days, the hemostatic efficiency was 56,25%. Local allergic reactions and irritation were not observed during the study. It has been proven that an adhesive paste with magnetic polymers, hexethydine, cytylpyridinium chloride and hyaluronic acid has a bactericidal effect on the microflora of the oral cavity.

Contact dermatitis in hemodialysis patients at Al Wakra hospital.

Background: Patients undergoing hemodialysis are exposed to various potential allergens from medication, dialysis catheters, topical antiseptics, and different adhesive dressings. Many patients develop a local allergic reaction and get itchy rashes, which may get infected, leading to significant morbidity and preventable health cost. In this study, we aimed to report the incidence of contact dermatitis (CD) and its potential complications in hemodialysis (HD) patients at the Al Wakra Hospital Dialysis unit.Methods: We performed a retrospective chart review of documented local allergic reactions at vascular access sites for the HD patients at the Al Wakra Hospital.Results: Currently, 102 patients are getting maintenance HD through catheters or arteriovenous (AV) fistula. Twelve (14.4%) patients developed CD (7 [58%] had cuffed jugular dialysis catheter, and 5 [42%] had an AV fistula). Most patients (75%) developed CD in the early period of dialysis initiation, and 25% developed it later in the course. Most patients responded to removing adhesive plasters and dressing the vascular access site using gauze only and topical steroids (hydrocortisone 1% cream/mometasone 0.1% cream). Two (16.6%) of the 12 patients developed vascular access site infection, of whom 1 had an AV fistula and developed a severe rash with cellulitis leading to sepsis and 2 admissions, although blood cultures remained negative. The patient responded to IV antibiotics and local mometasone 0.1% cream. Complete removal of all adhesive tapes helped prevent recurrence of the rash. Later, dressing of the AV fistula site was performed only with a cotton gauze. The second patient had a jugular catheter and developed an allergic rash leading to cellulitis and tunnel infection. Swab culture showed Staphylococcus aureus from the exit site sensitive to cloxacillin/cefazolin. The patient improved after local and oral antibiotics and removal of adhesive tapes. The catheter was not removed, and the patient did well.Conclusion: The incidence of CD at our dialysis unit is 14.4%. Previously published reports from other dialysis units showed a lower incidence of 1.25%. Early identification and diagnosis of allergic rash at the vascular access site and avoidance of adhesive plasters and other potential allergens prevent complications like infection and loss of precious vascular accesses in these patients.

Abstract P4-10-05: Safety and efficacy of low dose topical testosterone for sexual function improvement in women with breast cancer under treatment with ovarian suppression and aromatase inhibitor

Abstract Background: Premenopausal, high-risk, hormone receptor-positive breast cancer patients areoften treated with ovarian suppression in combination with aromatase inhibitors (AI). Thiscombination results in important adverse effects, particularly in sexual function, such as vaginaldryness and loss of libido. Vaginal estrogen is effective but may elevate serum estradiol levelsand, theoretically, may increase recurrence risk. Vaginal testosterone is also commonlyprescribed to ameliorate symptoms, though its safety remains uncertain, with limited availabledata. In our study, we aimed to determine the safety and efficacy, particularly regarding sexualfunction, of a low-dose, topical testosterone gel administration.Methods: This is a pilot, single-center study, designed to evaluate the efficacy of topicaltestosterone gel (3 mg/ml/per day) in improving sexual function in 30 premenopausal patientson ovarian suppression in combination with an AI. The primary safety endpoint was todetermine serum estradiol, measured by liquid chromatography mass spectrometry (E2) on amonthly a basis for 3 consecutive months. The primary efficacy endpoint was assessed by meansof the Female Sexual Function Index (FSFI) questionnaire, that include various domains of sexualfunction such as libido, sexual satisfaction and vaginal lubrication. The score can range from 2to 36, being 2 the lowest and 36 the highest sexual satisfaction. Patients had to have a baselineE2 of less than 2.7 pg/ml prior to study entry.Results: Herein, we report the preliminary results on the first 20 patients. The mean age was39.3 years, 85% had early or locally advanced disease and 15% had metastatic disease. Tenpatients completed the 3-month treatment, while five are still on therapy. Four of the 20discontinued treatment, mainly due to logistical difficulties during the follow-up visits. Onepatient had a localized allergic reaction and, also, discontinued treatment. A total of 15 patientsmaintained the value of E2 of less than 2,7 pg/ml during the 3-month treatment in all 3measurements. We observed an improvement in FSFI measures over the visits, with an increasefrom a mean of 10.2 at baseline to 19.4 at the third month (P&amp;lt;0.001), with the greatestimprovement observed between the second and third months.Conclusion: Our preliminary findings suggest that topical testosterone appears safe andeffective in improving sexual function in patients on ovarian suppression and aromataseinhibitor. Further studies are clearly warranted. Citation Format: Patrícia Taranto, Diogo de Brito Sales, Luciano de Melo Pompei, Alessandro Leal, Gustavo Schvartsman, Antonio Carlos Buzaid. Safety and efficacy of low dose topical testosterone for sexual function improvement in women with breast cancer under treatment with ovarian suppression and aromatase inhibitor [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-05.

Self-reported reactogenicity of CoronaVac (Sinovac) compared with Comirnaty (Pfizer-BioNTech): A prospective cohort study with intensive monitoring

ObjectiveCoronaVac (Sinovac) Covid-19 vaccine has recently been approved for emergency use by the World Health Organization. However, data on its reactogenicity in real-world settings is scant. This study aimed to compare self-reported post-vaccination adverse reactions between CoronaVac and Comirnaty (Pfizer-BioNTech). MethodsWe adopted a prospective cohort study design using online surveys from the day of first-dose vaccination with intensive follow-up through two weeks after the second dose (11 time points). The primary outcome was adverse reactions (any versus none) and secondary outcomes were the sub-categories of adverse reactions (local, systemic, and severe allergic reactions). Potential effect modification across multimorbidity status, older age, and sex was examined. ResultsIn total, 2,098 participants who were scheduled to complete the 14th-day survey were included, with 46.2% receiving Comirnaty. Retention rate two weeks after the second dose was 81.0% for the CoronaVac group and 83.6% for the Comirnaty group. Throughout the follow-up period, 801 (82.7%) of those receiving Comirnaty and 543 (48.1%) of those receiving CoronaVac reported adverse reactions. Adjusted analysis suggested that compared with Comirnaty, CoronaVac was associated with 83%-reduced odds of any adverse reactions [adjusted odds ratio (AOR) = 0.17, 95% confidence interval (CI) 0.15–0.20], 92%-reduced odds of local adverse reactions (AOR = 0.08, 95% CI 0.06–0.09), and 76%-reduced odds of systemic adverse reactions (AOR = 0.24, 95% CI 0.16–0.28). No significant effect modification was identified. ConclusionThis post-marketing study comparing the reactogenicity of Covid-19 vaccines suggests a lower risk of self-reported adverse reactions following vaccination with CoronaVac compared with Comirnaty.

Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know.

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.

Impetigo

Impetigo is a contagious, superficial bacterial infection of the skin. Over 140 million people are suffering from impetigo, globally at any given time. Impetigo is the most common skin infection in children aged two to five, but it can occur at any age. The incidence decreases with growing older. Infection generally occurs in warm, humid conditions, and risk factors include poor hygiene, poverty, and scabies. There are two clinical forms of impetigo: non-bullous and bullous. Non-bullous impetigo is more common form. It usually occurs on the face, predominantly on the nose or the extremities after trauma. The change begins as an erythematous macula that rapidly evolves into a vesicle or pustule. After the vesicle or pustule ruptures, erosion occurs, covered with a honey-colored crust on an erythematous basis. The causative agents of non-bullous impetigo are Staphylococcus aureus and Streptococcus pyogenes. Bullous impetigo mostly occurs in newborns and children aged 2 to 5 years. It is characterized by the appearance of a flabby bulla, initially filled with serous contents, which burst easily and erosions are formed covered with brownish-yellow crusts. The changes most often occur on the trunk, extremities and wet intertriginous areas. Bullous impetigo is exclusively caused by strains of Staphylococcus aureus. Skin lesions, which occur in patients with impetigo, should be kept clean, washed with soap and warm water, and secretions and crusts removed. The use of systemic antimicrobial agents is indicated when they are affected by an infection of a deeper structure (subcutaneous tissue, muscle fascia). The use of systemic antibiotics is also indicated if fever, lymphadenopathy, pharyngitis, infections near the oral cavity, scalp infections and/or multiple lesions occur. The use of topical antibiotics in the treatment of localized impetigo has shown high efficacy. The advantages of using topical antibiotics are that they minimize the development of antibiotic resistance and avoid gastrointestinal and other systemic side effects. The duration of local treatment varies depending on the product itself, but clinical trials have shown that the duration of therapy of seven days is effective. Potential disadvantages of topical antibiotics include local allergic reactions, skin hypersensitivity, and difficulty applying to parts of the body such as the eyelids, lips and back. There are a number of topical antibiotics used to treat impetigo. The most commonly used today are mupirocin, fusidic acid, neomycin, bacitracyn, retapamulin and gentamicyn sulfate. Patients should be educated about the mode of transmission, clinical course, hygiene and precautions in case of infection. It is especially important to emphasize the need of hygienic measures in order to prevent the spread of infection. These measures include washing hands, cleaning minor injuries with soap and water, bathing regularly and avoiding close contact with infected people.

Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

BackgroundSublingual immunotherapy tablets (SLIT-T) are an effective treatment for allergic rhinitis (AR), but some patients experience local allergic reactions (LAR) in the first few weeks of treatment that can lead to treatment discontinuation. Although oral antihistamines are recommended for the treatment and pretreatment of LAR associated with SLIT-T, there are no clinical trial data to support this recommendation. Rupatadine is an H1 antihistamine that also inhibits platelet activating factor activity. The objective of this case series is to describe real-world clinical situations in which rupatadine was used to treat or mitigate SLIT-T–related LAR.Case presentationsFive cases are presented by the managing allergist and off-label use of rupatadine is their expert opinion only. Patients in all 5 cases were treated with a SLIT-T (e.g. ragweed, tree, grass, or house dust mites) for the management of allergic rhinitis and experienced bothersome LAR with the first SLIT-T administration. In 3 cases, rupatadine 10 mg was administered for the immediate treatment of LAR (either in-office with the first SLIT-T dose or for subsequent LAR experienced at home) and the symptoms resolved. In 3 cases, pretreatment with other second-generation H1 antihistamines was unable to prevent LAR and the patients discontinued the SLIT-T. In these 3 cases, switching to pretreatment with rupatadine allowed the patients to restart and tolerate SLIT-T treatment with minimal or no LAR. In these patients with an established history of LAR, proactive pretreatment with rupatadine in subsequent seasons or with initiation of a different SLIT-T mitigated the previously experienced LARs.ConclusionsIn the cases presented, treatment with rupatadine resolved LAR associated with SLIT-T treatment and rupatadine pretreatment appeared to mitigate subsequent LAR. Rupatadine may be an option to treat or improve the tolerability of the SLIT-T, potentially improving early treatment persistence.

Circadian rhythm disruption exacerbates Th2-like immune response in murine allergic airway inflammation.

BackgroundChronic jet lag (CJL)‐induced circadian rhythm disruption (CRD) is positively correlated with an increased risk of allergic diseases. However, little is known about the mechanism involved in allergic rhinitis (AR).MethodsAberrant light/dark cycles‐induced CRD mice were randomly divided into negative control (NC) group, AR group, CRD+NC group, and CRD+AR group (n = 8/group). After ovalbumin (OVA) challenge, nasal symptom scores were recorded. The expression of Occludin and ZO‐1 in both nasal mucosa and lung tissues was detected by reverse transcription–quantitative polymerase chain reaction (RT‐PCR) and immunohistochemical staining. The level of OVA–specific immunoglobulin E (sIgE) and T‐helper (Th)‐related cytokines in the plasma was measured by enzyme‐linked immunosorbent assay (ELISA), and the proportion of Th1, Th2, Th17, and regulatory T cell (Treg) in splenocytes was evaluated by flow cytometry.ResultsThe nasal symptom score in the CRD+AR group was significantly higher than those in the AR group with respect to eosinophil infiltration, mast cell degranulation, and goblet cell hyperplasia. The expression of ZO‐1 and Occludin in the nasal mucosa and lung tissues in the CRD+AR group were significantly lower than those in the AR group. Furthermore, Th2 and Th17 cell counts from splenocytes and OVA‐sIgE, interleukin 4 (IL‐4), IL‐6, IL‐13, and IL‐17A levels in plasma were significantly increased in the CRD+AR group than in the AR group, whereas Th1 and Treg cell count and interferon γ (IFN‐γ) level were significantly decreased in the CRD+AR group.ConclusionCRD experimentally mimicked CJL in human activities, could exacerbate local and systemic allergic reactions in AR mice, partially through decreasing Occludin and ZO‐1 level in the respiratory mucosa and increasing Th2‐like immune response in splenocytes.

Specific Features of the Course of Toxocariasis Chorioretinitis

Toxacariasis is a parasitic disease from the group of nematodoses, the causative agents of which are toxocaras of dogs and cats (Toxocara canis and Toxocara mystax). Most often, the source of human invasion is dog — the main host of the parasite. Invasion occurs when helminth's eggs are ingested by means contaminated food, water, accidental geophagy, and direct contact with a dog. In the human gut, the larva releases from the egg and migrates, causing a general parasitic infestation known as “visceral migrating larvae” (Visceral larval migrans). Toxocara settles in various organs (lungs, spleen, liver, eyes, brain), which causes the local inflammatory and allergic reactions. The incidence of toxocariasis is a serious problem in recent years, especially in large cities. Each year, relatively low rates of toxocariasis and sporadic ocular infestations are recorded. This situation does not indicate stability of the situation, but rather may be due to insufficient alertness of ophthalmologists in relation to the toxacarous etiology of the inflammatory process in the eye, which leads to incomplete examination of patients and diagnostic errors. An ocular form of toxocariasis may manifest as granulomatous choroiditis, chorioretinitis and parsplanitis with the formation of peripheral granulomas and vasculitis. Complications of these inflammatory diseases are traction retinal detachment, and with a long course, chronic endophthalmitis which develops with the outcome in subatrophy and atrophy of the eye-globe, leading to its death. The disease occurs in children and adult patients. The ophthalmologists should be on the alert to the toxacariasis etiology of the inflammatory process in the choroid and retina. The article cites two case reports of toxacarous chorioretinitis (females of 53 and 57 y.o.) with development of posterior vitreous detachment and hemophthalmos. The dynamics of the pathological process, diagnostic approaches and treatment tactics are described.

230 Ultrasound-Guided Serratus Anterior Plane Block Improves Pain Control in Patients With Rib Fractures

The serratus anterior plane block (SAPB) is an ultrasound-guided compartment block; limited data suggest that it can decrease pain in patients with rib fractures or chest wall pain. We sought to determine the effect of SAPB on pain and incentive spirometry maximal vital capacity in adult patients with rib fractures. We enrolled a prospective cohort of adult patients ages 18 or above with at least 2 unilateral rib fractures in the anterior or lateral aspect of ribs 2-9, who were being admitted to the trauma service for pain control. The SAPB was performed by six emergency medicine residents, ultrasound fellows, and attending physicians who completed a one hour didactic and hands-on training in performing SAPB under ultrasound guidance. We used a standard dose of 20mL 0.5% bupivacaine with 10mL of normal saline for the block. We measured the effect of SAPB on chest wall pain at rest and during incentive spirometry using a 11-point Numeric Rating Scale (NRS-11), as well as maximum vital capacity. Measurements were obtained 15 and 60 minutes after SABP. We followed patients for 24 hours to evaluate for complications attributable to SABP including pneumothorax, cardiac arrhythmia, local anesthetic systemic toxicity, allergic reaction, infection or hematoma at SAPB site, or clinically significant bleeding. 20 patients (ages 33 to 95, median age 60) were enrolled (Table 1). The median number of rib fractures was four. SABP consistently decreased pain scores. Compared to pre-block pain scores at rest, mean and median pain scores decreased by 1.8 (SD 2.17, 95% CI:0.79-2.81) and 2.0 points (95% CI:0-3.0), respectively, at 15 minutes, and 2.5 (SD 2.69, 95% CI:1.24-3.76) and 2.0 points (95% CI:1.00-3.00), respectively, at 60 minutes (Figure 1a). Compared to pre-block pain scores during incentive spirometry use, mean and median pain scores decreased by 1.95 (SD 1.99, 95% CI:1.02-2.88) and 2.0 points (95% CI:1.00-3.00), respectively, at 15 minutes, and 2.4 (SD 2.42, 95% CI:1.27-3.53) and 2.0 points (95% CI:1.00-3.00), respectively, at 60 minutes (Figure 1b). Mean and median maximum vital capacity increased by 13mL (SD 672, 95% CI:-311-337) and 0mL (95% CI:0-250), respectively, at 15 minutes and 232mL (SD 406, 95% CI:36-427) and 100mL (95% CI:0-250), respectively, at 60 minutes (Figure 2). Zero complications attributable to SAPB were identified in our study population in the 24 hours following enrollment. In patients with multiple rib fractures, SAPB reduced pain scores at rest and during incentive spirometry, and increased maximal vital capacity. The SABP is a safe and effective modality for pain control in trauma patients with multiple rib fractures.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)