Rare Allergic Reactions Research Articles

Erythropoiesis-stimulating agents in the treatment of anaemia in cancer patients: ESMO Clinical Practice Guidelines for use

Erythropoiesis-stimulating agents in the treatment of anaemia in cancer patients: ESMO Clinical Practice Guidelines for use

Erythropoiesis-stimulating agents in cancer patients: ESMO Recommendations for use

Erythropoiesis-stimulating agents in cancer patients: ESMO Recommendations for use

Typ-I-Allergie auf Seminalplasma

Human seminal plasma allergy (HSPA) is a rare allergic reaction to specific protein fractions of seminal plasma, whereof PSA seems to be a relevant allergen. Predominantly Type I-immunoreactions can occur. The main symptoms are localized and generalized urticaria and sometimes anaphylactic symptoms. The diagnosis is based on history, skin tests and on the determination of specific IgE-levels for (un)fractionated seminal plasma. Here we report a patient with recurrent episodes of generalized urticaria after unprotected sexual intercourse and positive prick-test-reaction on seminal plasma.

Induction of late graft-versus-host disease in a patient post-allogeneic stem cell transplantation by progesterone in conjunction with donor lymphocyte infusion

Patients after stem cell transplantation (SCT), often develop graft-versus-host disease (GVHD) which, although potentially dangerous, is associated with the beneficial graft-versus-leukemia (GVL) effect. Where there is high risk of disease recurrence, donor lymphocyte infusions (DLI) are given to provide long-term disease control. We present a patient treated with DLI 4 years post-SCT, who developed acute GVHD after administration of progesterone to induce menstruation. This rare allergic reaction warrants further investigation.

Advances in the Use of Milk Thistle (Silybum marianum)

Milk thistle (Silybum marianum) is an herbal supplement used to treat liver and biliary disorders. Silymarin, a mixture of flavanoid complexes, is the active component that protects liver and kidney cells from toxic effects of drugs, including chemotherapy. Although milk thistle has not significantly altered the course of chronic liver disease, it has reduced liver enzyme levels and demonstrated anti-inflammatory and T cell-modulating effects. There is strong preclinical evidence for silymarin's hepatoprotective and anticarcinogenic effects, including inhibition of cancer cell growth in human prostate, skin, breast, and cervical cells. Milk thistle is considered safe and well-tolerated, with gastrointestinal upset, a mild laxative effect, and rare allergic reaction being the only adverse events reported when taken within the recommended dose range. More clinical trials of rigorous methodology, using standardized and well-defined products and dosages, are needed to evaluate the potential of silymarin against liver toxicity, chronic liver disease, and human cancers.

Pharmacology Review

Extravasation or inadvertent infiltration of fluids into subcutaneous tissue from peripheral intravenous (IV) devices is a common adverse event in newborns. (1)(2) Although fluids occasionally extravasate from central venous lines, the complication is much more common from peripheral catheters, which are used widely in sick neonates. (3) This article focuses on extravasations from peripheral IV devices. Injury to the skin, even in a very immature neonate, results in an inflammatory response and heals by scar formation. (4) Although the scars from many of these injuries appear to improve with time, (5) tissue necrosis from extravasation injury could result in partial or complete skin loss, infection, and nerve and tendon damage, with the potential risk of permanent cosmetic and functional impairment. (6)(7)(8) The incidence of extravasations from Teflon® catheters has been reported to vary from 23% to 63%. (1) A recent survey of regional neonatal intensive care units in the United Kingdom recorded the prevalence of extravasation injury resulting in skin necrosis as 38 per 1,000 neonates, with 70% of these injuries occurring in infants of 26 weeks’ gestation or less. (2) The incidence of extravasation is related closely to the type of device used, insertion site, duration of therapy, infusate administered, patient activity, and gestational age. (1)(3)(9)(10) The fragility of the skin, particularly in the first 2 weeks after birth, and the lack of subcutaneous tissue in preterm neonates makes them uniquely susceptible to injury and skin loss. Extravasation may occur from the tip of the cannula or needle piercing the vessel wall. Alternatively, distal obstruction of the vein due to thrombosis or venoconstriction from irritation of the vessel wall may lead to increased back pressure and leakage from the entry point of the needle or …

Hylaform: A New Hyaluronic Acid Filler

Hylaform is a new facial filler composed of hyaluronic acid. Hylaform is derived from an avian source, and is a clear gel substance. Skin testing is not necessary, although rare allergic reactions can occur form the avian protein content. Hylaform is injected into the dermis to add volume and provide a rapid correction of facial contour defects. It works particularly well in wrinkles, grooves, and thin lips deflated from aging changes.

The management of coumarin-induced over-anticoagulation Annotation.

The management of coumarin-induced over-anticoagulation Annotation.

Leukocytoclastic Vasculitis Associated with Nizatidine Therapy

Nizatidine is a histamine H2-receptor antagonist that has recently been FDA approved for the treatment of duodenal ulcers, benign gastric ulcers, and gastroesophageal reflux disease. Like other prescription and over-the-counter H2-blockers, nizatidine has been extensively used with infrequent side effects. Although rare allergic reactions to the drug have been reported, most nizatidine-associated toxicities have been described as mild and without serious consequences. We describe a patient who developed a serious, rapidly progressing leukocytoclastic vasculitis when treated with nizatidine as prophylaxis against gastric ulceration during interleukin-2 (IL-2) therapy and also when later rechallenged with this same H2-blocker. This is the first recognized case of leukocytoclastic vasculitis associated with nizatidine administration.

Recognition and prevention of barium enema complications

The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia. Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion. The ensuing shock may be rapidly fatal. Prompt fluid replacement and laparotomy are essential. If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula. Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm. The most dramatic complication of barium enema is venous intravasation of barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina. Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia. Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias. Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed. Toxic megacolon is a contraindication to the procedure. In cases of recent deep biopsy, polypectomy, or myocardial infarction, the examination should be delayed. In all cases, a safe tip-balloon design should be used and inserted by a physician after a careful digital rectal examination. A retention balloon should be inflated only under fluoroscopic monitoring. Use of a retention balloon is best avoided in infants, within a colostomy stoma, or in rectal neoplasms or strictures. To limit the intraluminal pressure during the examination, the barium reservoir should be no more than four feet above the table unless an extremely viscous barium suspension is used. Rapid insufflation of air can generate transient high intraluminal pressure or induce spasm and should therefore be avoided. Overdistention can be avoided by fluoroscopic monitoring during filling. Adequate hydration should be encouraged during preparation, especially in the elderly. Ready availability of resuscitation equipment and medications in the radiology department may be life-saving in case of a rare allergic or cardiac reaction.

Systemic and Local Allergic Reactions to the Tine Test Purified Protein Derivative

To the Editor. — The Tine Test Purified Protein Derivative (PPD) (Lederle Laboratories, Pearl River, NY) is an epicutaneous skin test used to assess cell-mediated immunity to tuberculosis. A systemic allergic reaction temporally following the administration of the Tine Test Old Tuberculin (Lederle) has been reported, 1 but the following is the first report of such a reaction after the Tine Test PPD. Rare local allergic reactions to the test are an immediate wheal-flare reaction and/or a reaction of erythema and induration that peaks after 6 hours and subsides within 24 hours. 2 Report of a Case.— A 35-year-old white woman with a history of allergic rhinitis for 8 years and urticaria/angioedema due to shellfish ingestion for 9 years received a Tine Test PPD as part of a hospital employee health evaluation. She had received two intradermal Mantoux PPD tests 8 and 16 years previously without experiencing a reaction. She

Aplastic anemia after meprobamate (2-methyl-2-N-propyl-1,3-propanediol dicarbamate) therapy.

MEPROBAMATE (Miltown), 2-methyl-2-n-propyl-1,3-propanediol dicarbamate, was recently introduced as a sedative and tranquilizing drug. In doses of one or two tablets (400 mg. each) three times a day, no adverse hematologic effects were noted after two months.1 Rare allergic reactions were reported by Selling.2 More recently Carmel and Dannenberg3 described 3 cases of nonthrombocytopenic purpura after ingestion of 400 to 1200 mg.In the following case aplastic anemia developed after daily ingestion of 1200 mg. for eight days.Case ReportF.D., a 28-year-old woman, was admitted to the South Nassau Communities Hospital on May 13, 1956, because of malaise, weakness, headache . . .

Bishydroxycoumarin, ethyl biscoumacetate, and 4-hydroxycoumarin anticoagulant No. 63; comparative effects.

Bishydroxycoumarin (dicumarol®) has been used clinically as an anticoagulant for 10 years. 1 Recently two other coumarin compounds, ethyl biscoumacetate (tromexan®) 2 and 4-hydroxycoumarin anticoagulant No. 63 3 (hereafter in this paper designated as anticoagulant No. 63), have been investigated experimentally and clinically with the hope that they might have advantages over bishydroxycoumarin for clinical use in anticoagulant therapy (Fig. 1). Like bishydroxycoumarin, these two coumarin compounds induce hypoprothrombinemia, which is defined for this paper as that coagulation defect indicated by prolongation of the one-stage prothrombin time. Also, as is the case with bishydroxycoumarin, other effects or untoward reactions not related to the coagulation defect have not been noted, except for rare mild allergic reactions and occasional mild gastrointestinal irritation. It is well known that the response of the one-stage prothrombin time varies greatly among different patients who receive certain fixed doses of bishydroxycoumarin. Body weight, nutritional status, gastrointestinal disease