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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anaphylaxis is an acute fatal or potentially fatal hypersensitivity reaction. Anaphylaxis represent a clinical diagnosis based on history and physical examination and includes symptoms of airway obstruction, generalized skin reactions, particularly flushing, itching, urticaria, angioedema cardiovascular symptoms including hypotension and gastrointestinal symptoms. These symptoms result from the action of mast cell mediators, especially histamine and lipid mediators such as leukotrienes and platelet activating factor on shock tissue. The shock tissue includes blood vessels, mucous glands, smooth muscle, and nerve endings. Anaphylaxis follows the typical immediate hypersensitivity time course, with a reaction beginning within minutes of antigen exposure. A late-phase reaction hours after the initial reaction may occur. Mast cell mediator release can be triggered by both IgE and non--IgE-mediated factors. Therefore, anaphylaxis may be termed anaphylaxis (IgE mediated) or anaphylactoid (non--IgE mediated). The most common IgE-mediated triggers are drugs, typically penicillin or other beta-lactam antibiotics, foods, most commonly nuts, peanuts, fish and shellfish, or hymenoptera stings. Non-IgE-mediated causes include factors causing marked complement activation such as plasma proteins or compounds which act directly on the mast cell membrane, such as vancomycin, quinolone antibiotics, or radiographic contrast media. The pathophysiology of some trigger factors, such as aspirin, remains unclear. Therapy of anaphylaxis revolves around patient education, avoidance, desensitization or pharmacologic pretreatment when agents causing anaphylaxis need to be readministered, and early recognition and prompt therapy of reactions should they occur.
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PMID:Anaphylaxis and Anaphylactoid Reactions: Diagnosis and Management. 1186 83

In children, as in adults, H1-antagonists are useful in the treatment of allergic rhinoconjunctivitis. Level 1 evidence for their efficacy in this disorder has been obtained in many well-designed pediatric studies. The widespread use of H1-antagonists in upper respiratory tract infections or otitis media in children is not supported by a strong scientific rationale. H1-antagonists are not harmful in children with asthma and, indeed, may have some beneficial effects in children with mild asthma. Their role in delaying or preventing asthma from developing in high-risk infants and toddlers is currently an important area of clinical investigation. The evidence base for their use in children with urticaria or atopic dermatitis still contains large gaps. First-generation H1-antagonists are presumed to be safe for use in infants and children. While they have undoubtedly been administered without apparent harm to millions in this age group, they impair CNS function far more commonly than is generally realized. Their use should be restricted to two uncommon situations: children with urticaria or atopic dermatitis whose pruritus is so severe that the sedation produced by an old H1-antagonist, such as hydroxyzine, is a benefit rather than a risk; and children with anaphylaxis who require intravenous diphenhydramine as adjunctive treatment to epinephrine and other modalities. Apart from these exceptions, in patients of all ages, second-generation H1-antagonists free from CNS adverse effects are clearly the medications of choice. Pediatric formulations of the new H1-antagonists cetirizine, fexofenadine, and loratadine are now available for use.
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PMID:H1-antihistamines in children. 1211 26

Allergic reaction to insulin preparations seemed to have decreased since the introduction of contaminant-free, human preparations. The role of protamine sulfate in decreasing the prevalence of allergy is unclear. This study examines the causative components of insulin allergy along with the value of skin tests for diagnosis. Eleven patients with insulin allergy and 53 patients receiving insulin but without an insulin allergy were included as controls. Intradermal skin tests were conducted using preparations containing various concentrations of insulin [Neutral protamine Hagedorn (NPH) insulin, regular insulin (RI)] and protamine sulfate. Of the 11 patients studied, 3 had anaphylaxis and 8 displayed localized reactions. All of the patients reacted positively during skin testing. Five patients showed positive intradermal skin test reactions to protamine sulfate, and 4 reacted to insulin. Two patients that were not tested with protamine sulfate reacted positively to NPH insulin. In the case of protamine sulfate, 4 patients with localized symptoms displayed positive reactions at concentrations of 10 microg/ml, 3 microg/ml or 0.3 microg/ml. One patient with anaphylaxis reacted positively to a concentration as low as 0.03 ng/ml. In the case of insulin protein, 3 patients reacted positively to a 100-fold dilution (1 UI/ml). Eight of the 53 controls experienced pruritus and/or skin lesions. However, none of the controls reacted at a concentration of NPH insulin of less than 10 U/ml or to protamine sulfate at less than 30 microg/ml. Allergic reactions to protamine sulfate are common and should not be ignored. This study shows a good correlation between clinical manifestations and skin test reactions for insulin allergy.
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PMID:Insulin-induced drug eruptions and reliability of skin tests. 1212 38

Adverse reactions to contrast agents range from a mild inconvenience, such as itching associated with hives, to a life-threatening emergency. Renal toxicity is a well known adverse reaction associated with the use of intravenous contrast material. Other forms of adverse reactions include delayed allergic reactions, anaphylactic reactions, and local tissue damage. Previous allergic reactions to contrast material, asthma, and allergies are factors associated with an increased risk of developing an adverse reaction. Pretreatment of patients who have such risk factors with a corticosteroid and diphenhydramine decreases the chance of allergic reactions, including anaphylaxis, renal failure, or a possible life-threatening emergency. Awareness of the different types of risk factors and prescreening for their presence allows for early recognition and prompt treatment. Prophylactic treatment before administration of contrast material can prevent potential adverse reactions. If such reactions do occur, prompt recognition allows them to be treated immediately. Using the smallest amount of contrast material possible and low-molecular, nonionic agents also decreases the relative risk of reactions. Renal insufficiency induced by contrast material may be prevented by ensuring adequate hydration and discontinuing other nephrotoxic medications before the procedure. Low-osmolar, nonionic agents are helpful in patients with known conditions associated with adverse reactions.
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PMID:Adverse reactions to contrast material: recognition, prevention, and treatment. 1560 54

The effects of conjugated linoleic acid (CLA) against anaphylaxis and allergic pruritus were investigated using a in vivo assay. Inhibitory effects of CLA were observed on the immediate (type 1) hypersensitivity reaction, with CLA significantly suppressing the decrease in blood pressure (BP) and blood flow (BF) induced by the hen egg-white lysozyme (HEL)-anaphylactic reaction in ddY mice. After oral administration, CLA showed antipruritic activity, with significant inhibition of scratching behavior induced by compound 48/80 (COM), a histamine-release agent. When painted onto the skin, CLA also inhibited COM, platelet-activating factor, and protease-induced scratching behavior, and COM-induced vasodilation of the skin. CLA offers promise as a drug for the treatment of allergic and inflammatory pruritus not only as an oral but also a topical agent. The present findings demonstrate that CLA can be effective for the prevention and treatment of allergic disease with severe pruritus.
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PMID:Effects of conjugated linoleic acid on anaphylaxis and allergic pruritus. 1249 60

A total of 135 obstetric patients who were first-time transfusion recipients at the University of Maiduguri Teaching Hospital were studied with respect to the incidence and clinical severity of urticarial transfusion reactions (UTR) in relation to the number of previous pregnancies. The overall incidence of UTR was 12.6%. Analysing the data with respect to the number of previous pregnancies the incidence of UTR were 0%, 0%, 3.8%, 8.3%, 21.7% and 37.5% among patients with 0.1, 2, 3.4 and 5 previous pregnancies respectively. However, all cases of UTR in the affected patients were clinically mild, manifesting with urticarial rashes and pruritus without any features of anaphylaxis. This data would suggest that the risk of UTR increases with the number of previous pregnancies. Therefore, multiparous patients need closer observation during transfusion therapy.
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PMID:Urticarial reactions in obstetric transfusion in Maiduguri, north east Nigeria. 1250 85

We investigated the spontaneous scratching by NC/Nga mice to design a new method for evaluating the itch of subjects with atopic dermatitis. The numbers of scratchings in various strains of mice were classified based on the duration of the scratching. Prolonged scratching was frequent in skin-lesioned NC/Nga mice, but not in ICR, BALB/c and non-lesioned NC/Nga mice. Pretreatment with dexamethasone or tacrolimus significantly suppressed long-duration scratching in NC/Nga mice but did not suppress short-duration scratching induced by ovalbumin active cutaneous anaphylaxis in BALB/c mice and in ICR mice subcutaneously injected with histamine. In contrast, pretreatment with chlorpheniramine or ketotifen significantly suppressed short-duration scratching induced by ovalbumin active cutaneous anaphylaxis in BALB/c mice and in ICR mice subcutaneously injected with histamine, but not long-duration scratching seen in NC/Nga mice. These findings indicate that the mechanism of spontaneous scratching in NC/Nga mice differs from that induced by several pruritogen injections. This new method shows good correlation with the therapeutic activity of drugs in cases of atopic dermatitis in humans and may serve as a useful model for evaluating antipruritic drugs and for studying mechanisms involved in atopic dermatitis.
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PMID:Analysis of the spontaneous scratching behavior by NC/Nga mice: a possible approach to evaluate antipruritics for subjects with atopic dermatitis. 1282 42

Platelet-activating factor (PAF) may be an important mediator in allergic conjunctivitis. In this study, apafant, a potent PAF antagonist, was evaluated for topical ocular anti-PAF activity in PAF and antigen stimulated conjunctivitis models. PAF, when injected into parpebral conjunctiva, provoked an acute increase, measured as dye leakage, in conjunctival vascular permeability. Apafant inhibited this response in a dose-related manner, and the inhibitory action of 0.1% apafant lasted for at least 6 hours duration. PAF, when instilled into the conjunctival sac, induced itch-scratching behavior and clinical symptoms, such as conjunctival redness and edema. These were inhibited by pretreatment with apafant ophthalmic solution. In a passive conjunctival anaphylaxis model in guinea pigs, significant inhibition of the allergic response was observed following topical ocular administration of apafant 5 and 15 minutes prior to the antigen challenge. We have demonstrated that PAF plays an important role in the development of allergic conjunctivitis. These results clearly indicate that apafant has potential as a topical ocular anti-PAF for treating allergic conjunctivitis.
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PMID:The role of platelet activating factor and the efficacy of apafant ophthalmic solution in experimental allergic conjunctivitis. 1296 56

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

Furosemide, one of the most used diuretic drugs, rarely induces type-1 allergic reactions It is included in the non-aromatic sulfonamides but a cross-reactivity mechanism between this group and the sulfonamides antibiotics, has not been clearly demonstrated. A 24-year-old woman, 10 minutes after the intake of one pill of Seguril 40mg experienced oral itching, generalized urticaria, facial angioedema, dyspnea and hypotension. She recovered after the administration of parental adrenaline, methyl-prednisolone and dyphenhydramine. An skin prick test with furosemide (10 mg/ml) was negative. The intradermal skin tests were positive to furosemide (1 %) as well as sulfamethoxazole (0.03 mg/ml), with 10 atopic and non-atopic negative controls. The patient rejected the performance of an oral challenge test with sulfamethoxazole. IgE-mediated reactions to furosemide are infrequent, but it could be the cause of life-threatening reactions. We have reported a case of anaphylaxis after the oral administration of furosemide with a demonstrated hypersensitivity mechanism through the positive intradermal skin test. The previous administration of the drug could probably the mechanism of sensitization, but the positive intradermal test to sulfamethoxazole would open the hypothesis of a cross-reactivity between non-aromatic and antimicrobial sulfonamides. It could be necessary an oral challenge test with furosemide in allergic patients to sulfamides.
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PMID:Anaphylaxis to oral furosemide. 1467 Feb 91


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