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We report a case of food-induced anaphylaxis caused by ingestion of royal jelly. After taking royal jelly and several other medicinal products, a 33-year-old Japanese male developed severe facial pruritus and erythema, followed by vertigo, numbness in his fingers, generalized pruritus, wheals, dyspnea, wheezing and impaired consciousness. He was treated with corticosteroid and fluid therapy, and his symptoms subsided. Upon allergy testing, his only positive reaction was to royal jelly. Given the clinical symptoms and the positive prick test to royal jelly, a diagnosis of anaphylaxis due to the ingestion of royal jelly was made. In this paper, we describe this case and review the relevant published work.
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PMID:Food-induced anaphylaxis caused by ingestion of royal jelly. 1670 Aug 35

Anaphylaxis is a life-threatening allergic reaction, and food is one of the most common responsible allergens in the outpatient setting. The prevalence of food-induced anaphylaxis has been steadily rising. Education regarding food allergen avoidance is crucial as most of the fatal reactions occurred in those with known food allergies. The lack of a consensus definition for anaphylaxis has made its diagnosis difficult. Symptoms affect multiple organ systems and include pruritus, urticaria, angioedema, vomiting, diarrhoea, abdominal cramps, respiratory difficulty, wheezing, hypotension, and shock. Prompt recognition of anaphylaxis is essential as delayed treatment has been associated with fatalities. Although epinephrine is accepted as the treatment of choice, timely administration does not always occur, partly due to a lack of awareness of the diagnostic criteria. Several novel tools are currently being investigated, which will potentially aid in the diagnosis and treatment of food-induced anaphylaxis.
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PMID:Food anaphylaxis. 1745 12

The so-called emerging allergens have gained particular interest as causes of atopic diseases, and among these the cypress pollen. In fact, several allergens derived from the Cupressaceae family have appeared for the first time in new environments, thus causing unexpected phenomena. From May 2002 to May 2003 we have examined 560 patients who sought medical attention at the Center for allergic diseases in children. The patients came from various towns and villages from Southern Sardinia and all had undergone prick tests for inhaled allergens, irrespective of their complaints. The presenting symptoms were either respiratory (wheezing cough, rhinitis, asthma), cutaneous (eczema, nettle rash, angioedema) or ocular (conjunctivitis). All patients had a prick test for pollens (cypress, olive, wall pellitory, rag weed, composite, mix gross pollen), acari (Dermatophagoides farinae, Dermatophagoides pteronyssimus), dog and cat hair, and fungi (alternaria alternata, aspergillus fumigatus). Thirteen percent of patients (73/547) resulted allergic to cypress pollen, and three of them had a mono-allergy (4,1%). Among these, one suffered bronchospasm, rhinitis and asthma more severe in January-February associated with recurring small eczematous lesions. Another one suffered bronchial asthma during winter months and the last one complained of rhinitis and nasal itching also during winter months.
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PMID:[Epidemiologic investigation of the pollen allergy to Cupressaceae in a population at risk for atopy]. 1753 3

The aim of the study is to evaluate the prevalence of respiratory and skin symptoms among bakers in the district of Verona by means of two standardized questionnaires, a clinical one administered to the bakeries employees, either directly exposed to flour dust or not exposed, and one concerning the characteristics of the bakery environment. The study involved 613 bakery workers, 401 bakers and 212 sales personnel employed in 152 bakeries. Bakers exposed to flour dust reported nasal symptoms in 29.2% of cases, ocular symptoms in 13.2%, cough, shortness of breath, chest tightness, wheezing respectively in 8.7%, 7%, 4.5% 6.2% of cases, itch and skin burning with paleness respectively in 9.7% and 8.5%. A significantly lower prevalence of these symptoms, except skin paleness, was reported among the sales personnel. In bakers, a significant correlation was found between ocular-nasal and respiratory symptoms and family or self-reported history of atopy (p = 0.001). Reported flour dust air pollution at the workplace correlated with occupational ocular-nasal and respiratory symptoms (p = 0.001). Flour dust on skin and clothes correlated with crusts and excoriations (p = 0.01). Our study confirms the high prevalence of allergic symptoms among bakers and the need of clinical assessment.
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PMID:[Prevalence of occupational allergic symptoms among bakers of Verona]. 1840 62

Relatively little is known about the characteristics of patients who visit the emergency department for acute allergic reaction. The earliest symptoms are swelling of tissues, sweating, restlessness, itching, nausea, vomiting, diarrhoea, coughing or wheezing. Hypotension, circulatory failure and cardiac arrest may occur suddenly, often associated with bronchial spasm or laryngeal oedema. The objective of this review is to describe the child with severe acute allergic reaction in emergency department.
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PMID:[Recognizing anaphylaxis in the emergency department]. 1849 74

Hypersensitivity to inulin (polyfructan) is a rare event; two cases of food allergy and some patients presenting with allergy and hypersensitivity after inulin infusion have been reported. An 11-year-old boy suffering from severe immunoglobulin (Ig)A nephropathy (IgAN) experienced both anaphylactic reaction and concomitant relapse of his nephropathy following inulin infusion, used for measuring glomerular filtration rate (GFR) 2 years after the appearance of his initial symptoms. Pruritus, wheezing and cough were observed during a first renal function test; results of prick and intradermal tests were negative for inulin. The patient presented with pallor, asthenia and oliguria when a second inulin infusion was performed under dexchlorpheniramine, leading to the immediate cessation of the infusion. He was readmitted 2 days later because of fatigue and nausea related to acute renal failure. A drug-induced acute interstitial nephritis was first suspected. However, due to the presence of macroscopic haematuria and proteinuria, a renal biopsy was performed and showed acute proliferative relapse of IgAN. The underlying mechanism of inulin hypersensitivity is not well known. We can hypothesize that inulin had activated the innate immune system. Inulin may, thus, have been the initiating event of the renal relapse, acting like an infection, in a patient with IgA-mediated immunological dysregulation.
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PMID:'Renal hypersensitivity' to inulin and IgA nephropathy. 1853 47

Allergic bronchopulmonary aspergillosis is a world rare disease with a prevalence between 1 and 2%. It presents in moderate-severe asthma and cistic fibrosis patients. The diagnosis is made in the basis of Rossenberg and Greenberg criteria that can be essential or non essential. We present the case of a 3-year-old boy with allergic bronchopulmonary aspergillosis without bronchiectasies and with a good response to corticosteroids. His mother complained of two years of nasal obstruction, purulent rinorrea, nasal pruritus, sneezing, chronic cough and recurrent wheezing, twice to thrice a month. He also occasionally had vomits and diarrhea in relation with strawberries, banana, cow's milk and chocolate. We made the diagnosis of asthma, allergic rhinitis, sinusitis, and probably food allergy. We treated him with step approach of ICS according to GINA 2006, albuterol PRN, and elimination diet, with bad response. Laboratory exams: Blood white cells with eosinophilia (6%), total serum IgE: 1684 ng/L, aspergillus skin prick test: 4mm, serum IgG-Aspergillus fumigatus: 2.3 mcg/mL, serum IgE-Aspergillus fumigatus: negative, chest roentgenographic parahiliar and apical infiltrates, and chest computed tomography without bronchiectasies. We added prednisone to the treatment for four months, and we observed a very good response; he is now in treatment as mild persistent asthma with ICS low doses. ABPA must be suspected in patients with moderate-severe persistent asthma and a skin prick test positive to Aspergillus fumigatus regardless the age. The treatment with oral corticosteroids is the mainstream of management, and most of the patients have a good response, as we observed with this patient.
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PMID:[Allergic bronchopulmonary aspergillosis. A report of a case and literature review]. 1905 90

Anaphylaxis is currently classified as an immunologically triggered response with reactions that are IgE-mediated and reactions that are not IgE-mediated. This immunologically mediated phenomenon can result in various clinical manifestations, including decreased blood pressure, generalized skin inflammation, such as hives and pruritus, and respiratory symptoms, such as wheezing or bronchospasm. The severity of anaphylaxis can range from a mild allergic reaction to a potentially fatal anaphylactic shock. Numerous causative agents trigger anaphylactic reactions, and some of the best described include food and bee sting allergens. Monoclonal antibodies, which are increasingly used in the treatment of various malignancies, also can cause anaphylaxis. In this review, the mechanisms governing anaphylaxis along with treatment strategies are reviewed. Diagnostic aids for anaphylaxis are also discussed. Increased awareness of the mechanisms, symptoms, and treatment of anaphylaxis can aid caregivers to make informed decisions when new agents, such as monoclonal antibodies, are introduced into the clinic.
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PMID:Anaphylaxis: implications of monoclonal antibody use in oncology. 1938 61

On June 30, 2009, the United States Food and Drug Administration (FDA) approved ferumoxytol (Feraheme injection, AMAG Pharmaceuticals), an iron-containing product for intravenous (IV) administration, for the treatment of iron deficiency anemia in adult patients with chronic kidney disease (CKD). The safety and efficacy of ferumoxytol were assessed in three randomized, open-label, controlled clinical trials. Two trials evaluated patients with nondialysis dependent CKD and a third trial assessed patients undergoing hemodialysis. Randomization was either to ferumoxytol or oral iron. Ferumoxytol was administered as two 510 mg IV injections, separated by 3-8 days. Oral iron, Ferro-Sequels, was administered at a dose of 100 mg twice daily for 21 days. In all three clinical trials, ferumoxytol administration increased the mean blood hemoglobin (Hgb) concentrations by approximately 1.0 g/dL over the 35 day period, a mean increase that was greater than what was observed in patients receiving oral iron. Patients receiving ferumoxytol also had increases in blood transferrin saturation (TSAT) and ferritin values. For the proposed ferumoxytol dosing regimen, 4.9% of patients had serum ferritin >or=800 ng/mL and TSAT >or=50% post-treatment. The most important ferumoxytol safety concerns were hypersensitivity reactions and/or hypotension. Anaphylaxis or anaphylactoid reactions were reported in 0.2% of subjects, and other adverse reactions potentially associated with hypersensitivity (e.g., pruritus, rash, urticaria, or wheezing) were reported in 3.7%. Hypotension was observed in 1.9%, including three patients with serious hypotensive reactions. Ferumoxytol administration may transiently affect the diagnostic ability of magnetic resonance imaging and the drug label provides further information regarding this effect.
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PMID:FDA report: Ferumoxytol for intravenous iron therapy in adult patients with chronic kidney disease. 2023 50

Exercise-induced anaphylaxis (EIA) is a syndrome in which patients experience the symptoms of anaphylaxis, which occur only after increased physical activity. It is characterised by a gradual development of symptoms: itching, erythema, urticaria, angioedema, anaphylactic shock (hypotension, syncope, loss of consciousness, shortness of breath, wheezing, nausea and vomiting), and at the end of the late phase prolonged urticaria and headache. The triggering factors for EIA are as follows: significant exposure to airborne allergens, insect sting, weather extremes, higher air humidity, taking nonsteroidal anti-inflammatory drugs. The most frequent causative nutritive allergens include wheat, crabs and shells. Prophylactic management for EIA comprises avoding the triggers. Exercise or other physical activity should be performed in proximity of medically trained companion.
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PMID:[Exercise-induced anaphylaxis--a review]. 2067 25


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