Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present a case of hypersensitivity to kiwi in a 26 year-old patient with no previous atopic history. The first reaction episode occurred a few minutes after kiwi ingestion, presenting with a localized pruritic reaction. This symptomatology repeated itself a few months later, again immediately after eating kiwi and was accompanied by dysphagia, vomiting and urticaria. In the complementary laboratory analyses a total IgE of 187 IU/ml was appreciated. The skin test to inhalant and food antigens were negative, while the kiwi extract produced a + + + + reaction. The histamine release test was positive (20%). Specific IgE levels (Kallestad) demonstrated results of 0.35 AEU/ml (class I). Specific IgG4 levels were normal and the hemagglutination test was negative. With the above results, we concluded that we were dealing with a case of monosensitivity to kiwi which was probably IgE mediated.
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PMID:A rare case of food allergy: monosensitivity to kiwi (Actinidia chinensis). 281 64

In 10 patients presenting with acute recurrent dysphagia, seen over a 4-year period, idiopathic, eosinophilic esophagitis (IEE) was diagnosed. The diagnosis was confirmed histologically. Dysphagia of other causes or other diseases causing eosinophilic infiltration was ruled out. Endoscopy showed discrete white structures in the esophagus which were partly finely reticular or plaque-like in 9 of the 10 patients. Of these one had a web and another a mucosal ring. Peripheral eosinophilia and elevated IgE-levels were found in 70% of the cases. To date IEE has been thought to be a rare disorder. Emerging evidence suggests its prevalence has been underestimated. It may also be the most frequent form of eosinophilic gastroenteropathy. The flat, only endoscopically visible form may be more common than the proliferative type. With knowledge of the typical history and of the distinct endoscopic pattern, and with adequate diagnostic workup, the disease will be found more often in the future. Prompt diagnosis also avoids further diagnostic procedures and permits rapid remission through treatment with steroids and antihistamines.
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PMID:[Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]. 793 9

We herein report a patient with myasthenia gravis (MG) and atopic dermatitis (AD). Heretofore, there have been no reports of patients with MG and AD. Nine years ago, a 25-year-old man noted muscle weakness of upper and lower extremities on physical labor, and the muscle weakness was gradually exacerbated. Two years ago, he noted acute skin eczema with itching on his hands and feet. Neurological examination revealed mild left ptosis, facial muscle weakness and proximal muscle weakness of upper and lower extremities, but no diplopia, ophthalmoplegia or dysphagia. Although anti-nicotinic acetylcholine receptor antibody was negative, edrophonium test was positive and 54% waning in the thenar muscles was observed on Harvey-Masland test. Thus, he was diagnosed as limb-girdle type MG. IgE level in his serum elevated (1,818 U/ml). After thymectomy, the muscle weakness markedly improved as well as waning in the thenar muscles (11%). Simultaneously, AD markedly improved and serum IgE level was decreased (1,245 U/ml). Thus, MG and AD in this case may be derived from some common immunological aberrancy in the thymus.
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PMID:[A patient with limb-girdle type myasthenia gravis and atopic dermatitis, both of which improved after thymectomy]. 1096 63

Anisakis simplex, a fish parasite of the nematode family, typically infects marine mammals such as whales, dolphins and seals. Human anisakiasis, which is acquired by eating raw or insufficiently heated fish or squid, has gained world-wide importance. Infestation with living larvae caused by eating parasitised fish results in acute upper abdominal pain, nausea and vomiting and may be confused with acute abdomen due to appendicitis and other inflammatory abdominal disorders. Extraintestinal organ manifestations are rare. Endoscopically, inflammation, oedema, erosions and ulcerations may be found. The parasite can been found in up to 50% of patients. Histologically, an eosinophilic inflammation is typical. Acute anisakiasis may be prevented by thorough cooking or deep-freezing the parasitised fish for at least 48 h. IgG-antibodies specific for Anisakis simplex are thought to represent an immunological host reaction against parasitic antigens. More recently, allergic reactions to Anisakis ingestion or exposure, such as urticaria, anaphylaxis and even occupational asthma, have been reported. These allergic reactions may also occur when the fish has been properly cooked, and hence these allergens are thought to be heat-stable. Such cases may be diagnosed by skin tests and the determination of specific Anisakis-IgE. However, the specificity of IgE is low, since they may also be present in exposed asymptomatic individuals. Since the eliciting allergens are temperature-stable, prophylactic dietetic measures are indicated. We report a case from Switzerland acquired during a holiday in Portugal. The patient suffered from recurrent dysphagia and urticaria, and histologically eosinophilic oesophagitis was found. IgG-antibodies and a positive skin prick test to Anisakis simplex support its aetiologic role for the symptoms.
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PMID:[Eosinophilic esophagitis associated with recurrent urticaria: is the worm Anisakis simplex involved?]. 1113 Jan 47

Idiopathic eosinophilic oesophagitis is a rare differential diagnosis in patients with recurrent dysphagia. In the light of a case report and a literature review the patient's symptoms are compared with those discussed in the literature. The patient's main symptom was years-long recurrent dysphagia, sometimes with obstruction. An atopic disorder combined with peripheral eosinophilia or an elevated IgE level are found in most patients. The clinical findings are non-specific. Biopsies of the whole oesophageal mucosa produced the diagnostic histology and showed extensive infiltration by eosinophilic granulocytes. The symptoms respond well to steroid therapy.
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PMID:[Idiopathic eosinophilic esophagitis: case report]. 1114 28

We report a patient with motor neuron syndrome similar to amyotrophic lateral sclerosis (ALS) and with spontaneous recovery. At the age 40, the woman developed progressive muscular weakness, atrophy and fasciculation in extremities. She also noted a dyspnea, tongue atrophy and dysphagia. A neurological examination 6 months after onset revealed i) a tongue atrophy and fasciculation, ii) diffuse muscule weakness and atrophy in face, neck and extremities, and iii) marked hyperreflexia in the four limbs and bilateral Babinski reflex, but iv) neither sensory disturbance nor ophthalmoplegia. Electromyogram (EMG) detected such denervation potentials as fibrillation potentials, fasciculation potentials, positive sharp waves and polyphasic or giant MUPs diffusely in the limb muscles. Peripheral nerve conduction study detected neither conduction block nor delay. Thus, she was diagnosed as suffering from ALS. However, since approximate 1 year after onset, her muscle weakness has gradually been getting better. Simultaneously, the dyspnea and dysphagia gradually improved. Two years after onset, an EMG examination detected chronic denervation potentials in the left musculus sternocleidomastoideus and a few on-going denervation potentials in the left musculus extensor carpi radialis, but no denervation potentials in other limb muscles. Fasciculation potentials were found in tongue muscles. Thus, the present case was thought to have a reversible motor neuron syndrome clinically quite similar to ALS. A mild increase in IgE (346 U/ml) and a low-titer IgM-class anti-GM1 antibody were found in her serum though its pathological significance was uncertain. Any immunological aberrance may account for the pathogenesis. It should be noted that clinically diagnosed cases of ALS may rarely recover spontaneously.
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PMID:[A patient with motor neuron syndrome clinically similar to amyotrophic lateral sclerosis, presenting spontaneous recovery]. 1133 88

Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive esophageal symptoms (11 male), median age 5 years, and identified to have eosinophilic esophagitis with > 5 eosinophils per high-power field (eos/hpf) are reported. Of these, four had strictures, six had impactions, and two had only dysphagia. A diagnostic evaluation included esophagogastroduodenoscopy with biopsies in all and upper gastrointestinal series, IgE, radioallergosorbent tests, and skin tests for food allergies in some cases. Esophageal histology specimens were independently analyzed for eosinophil density by two authors. Four of five children with > 20 eos/hpf responded to elimination diets/steroids. The fifth child responded to a fundoplication. Seven children had 5-20 eos/hpf and three of them with no known food allergies responded to antireflux therapy alone. Three others in this group with positive food allergies responded to treatment with elimination diets and/or steroids. The seventh patient in this group was lost to follow-up. In conclusion, on the basis of response to therapy, eosinophilic esophagitis can be subdivided into two groups: those with likely gastroesophageal reflux disease if < 20 eos/hpf and no food allergies, and others with allergic eosinophilic esophagitis associated with food allergies and often with > 20 eos/hpf.
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PMID:Eosinophilic esophagitis: strictures, impactions, dysphagia. 1264 86

Grape allergy is particularly rare in spite of the vast extension of Vitis vinifera cultivation on all continents. We report on the case of a 28-year-old woman who presented with allergic systemic reaction after eating white grapes (Vitis vinifera). She complained of two severe episodes of anaphylaxis after eating grapes, with generalized pruritus, acute generalized urticaria, facial swelling, lip and oropharingeal angioedema, and dysphagia. Both the episodes were treated at the Emergency Room level, with parenteral administration of corticosteroids and antihistamines. Skin prick tests with commercial extract of grapes provided a negative result, while prick by prick procedure performed with white grapes and white grape juice yielded a positive result. Grape-specific serum IgE were also detected. We conclude that in the diagnosis of grape allergy the currently available commercial extracts might not be completely reliable and the prick-by-prick procedure with fresh grapes should always be performed.
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PMID:Grape anaphylaxis. 1463 73

Human seminal plasma hypersensitivity has to be differentiated from allergic reactions to latex, spermicidal agents, local anesthetics or components of lubricants. The present review article discusses IgE-mediated allergic reactions (type I) to specific components of the seminal plasma. Such incidents are rare, even though there seems to be a considerable number of unreported cases. Since the first publication in 1958, human seminal plasma allergy has been increasingly recognized, and approximately 80 cases have been described. Most affected women are younger than 40 years, presenting with an atopic family history. Anaphylaxis to components of the seminal plasma is not always associated with infertility. Complaints occur immediately or within 1 h after contact with seminal plasma. Local reactions include itching, burning, erythema and edema in the vulvar region or other sperm contact sites. Systemic reactions are experienced as dyspnea, dysphagia, rhinoconjunctival complaints, generalized urticaria, angioedema, gastrointestinal symptoms, exacerbation of existing atopic eczema or anaphylactic shock. Recently, it has been reported that human seminal plasma anaphylaxis may also present as 'vulvar vestibulitis syndrome' or 'burning semen syndrome'. These symptoms may occur during the first sexual intercourse. Some results are indicative of allergens originating from the prostate, prostate-specific antigen being clinically relevant. The diagnosis of human seminal plasma allergy is based on history, demonstration of specific IgE antibodies in the serum and skin tests. Therapeutic options include allergen avoidance by use of condoms and attempts at desensitization.
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PMID:IgE-mediated allergy against human seminal plasma. 1612 42

Eosinophilic esophagitis (EE) is a clinical-pathological disorder which is being increasingly diagnosed. It is etiologically associated with hypersensitivity to airborne allergens and/or dietary components. However, immediate hypersensitivity to foods has rarely been proven as the etiologic cause of the disorder. Two patients are presented with a history of rhinoconjunctivitis, allergic asthma, atopic dermatitis and food allergies which are currently under control and who show specific IgE to pulses and chicken respectively. These patients developed acute dysphagia and vomiting immediately after ingesting these foods and following appropriate examination were diagnosed as suffering from EE. The study also showed signs of blood hypereosinophilia while the esophageal manometry revealed a motor disorder characterized by aperistalsis and non-propulsive simultaneous waves affecting the lower two-thirds of the organ composed of smooth muscle. Topical treatment with fluticasone propionate was administered over a period of 3 months, in addition to a diet abstaining from the aforementioned foods and this led to remission of dysphagia and normalization of the endoscopic, histological and manometric studies of the esophagus. This situation remained stable for a considerable length of time after steroid treatment was discontinued, which showed that exposure to foods seemed to be the cause of the esophageal disorder. Similarly, allergies to inhalants and other digestive symptoms which appear upon immediate ingestion of the foods involved would not justify the sudden onset of dysphagia. We offer a pathophysiological explanation for the mechanisms of the disease based on the activation of eosinophils and mast cells by IgE and their ability to disturb the dynamic behavior of the neural and muscle components of the esophageal wall.
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PMID:Food allergies and eosinophilic esophagitis--two case studies. 1706 99


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