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Query: UMLS:C0042109 (urticaria)
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Allergic diseases affect at least 15% of the population and are the cause of much ill-health. 'Clinical immunology and allergy', the term used by the Department of Health in England and Wales for this area of specialization, is recognized as a separate specialty of medicine under the National Health Service. Many organ-based hospital consultants (e.g. chest physicians) have allergy as a special interest or subspecialty. Allergists deal largely with 'itch, sneeze, cough and wheeze' and so are experts in: summer hay fever (seasonal, allergic, conjunctivorhinitis); perennial rhinitis (symptoms of a 'permanent cold'); allergic asthma (including occupational asthma); allergy to stinging insects (especially wasps and bees); allergy to drugs; allergy-related skin disorders, i.e. urticaria, angioedema, atopic eczema and contact dermatitis; food allergy and food intolerance; anaphylaxis (acute generalized allergic reaction); evaluating the role of allergy in non-specific/polysymptomatic illness. Children with allergic disease should be under the overall care of a paediatrician since the progression of allergies in children differs from that in adults. Good allergy practice involves teamwork by doctors, nurses and dietitians. The investigation of allergy patients includes skin tests and challenge procedures (e.g. food allergy tests) as well as various specialized laboratory investigations. Good clinical practice by providers and the effective use of allergy services by purchasers should improve prognosis and cut costs of treatment in allergic disease.
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PMID:Good allergy practice--standards of care for providers and purchasers of allergy services within the National Health Service. Royal College of Physicians and Royal College of Pathologists. 852 Nov 76

Food allergy and intolerance (FAI) is undoubtedly a controversial subject surrounded by a great deal of publicity. One of the most confusing issues arises when considering the value of allergy prevention programmes. Although prevention strategies have now been extensively studied the results are still inconclusive. In childhood, atopic disorders eg asthma, eczema, dermatitis, urticaria, rhinitis and gastrointestinal related symptoms are relatively common with estimates of their prevalence ranging from two to 20 per cent (Mallet & Henocq, 1992). In addition, the proportion of young children with allergies seems to be increasing, although the extent to which food allergens contribute remains unclear (Hide, 1991; Croner, 1992; DoH, 1994). In many of these cases, prevention of unpleasant, socially and psychologically disruptive and sometimes life threatening symptoms can be achieved by dietary modification. If atopic and gastrointestinal symptoms can be prevented growth failure may not be a problem, children may miss less schooling, and if long term prevention is achieved there may be a substantial reduction in the cost of medical care these children would otherwise require. Before prevention programmes are introduced, however, careful thought should be given to the implications of dietary treatment. The programmes are difficult to administrate in terms of both resources and expense. Specifically, from a nutritional point of view, the diets employed are often socially disruptive which inevitably leads to problems with compliance. Nutritional adequacy may also be difficult to achieve unless there is close supervision by a dietitian who is experienced in the management of the complex dietary manipulations involved. Unfortunately the dietetic resources essential for the safety of the programmes may be lacking in many hospitals. Preventive practice may be aimed at either the general population or at specially identified group who are considered to be at a greater risk of developing atopic disorders. Dietary intervention studies looking at prevention in this 'at risk' group have considered maternal dietary modification during pregnancy and lactation, the use of soya and hydrolysed protein feeds and the weaning diet. The nutritional consequences of these methods of dietary manipulation will be discussed in more detail.
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PMID:'Prevention programmes'--a dietetic minefield. 864 69

Food hypersensitivity includes adverse reactions to food which are most often mediated by IgE. Food allergy is the first atopic disease. Food-sensitized individuals can develop allergic reactions such as atopic dermatitis, urticaria, angioedema, rhinitis, asthma or digestive symptoms. Anaphylactic shock is the most severe reaction of immediate hypersensitivity. The prevalence of food allergy has drastically increased during the last years. Numerous food products can be involved, with special emphasis on masked allergens in processed foods. The diagnosis of food hypersensitivity is based on clinical history, analysis of patient's food intake, skin tests and placebo-controlled food challenge tests. Oral food-challenge tests allow a distinction between food sensitization and true food hypersensitivity. Treatment consists in avoidance of the offending food allergen associated with adjunctive therapy by antihistamines and disodium cromoglycate. The prescription of a first-aid kit is required in case of anaphylaxis. Specific immunotherapy seems to be an interesting therapeutic prospect. Prevention remains essential.
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PMID:[Food hypersensitivities]. 876 32

ALCAT Test results were the base for elimination diet treatment in several ailments regarded as the result of food allergy (intolerance) in 72 patients (45 children and 27 adults). The best results were achived in arthritis, urticaria, bronchitis, gastroenteritis (83%, 75%, 70% of improvement in treated patients respectively). Worse results were observed in children hypereactivity, rhinitis and atopic dermatitis (32%, 47%, 49% of improvement respectively). Less satisfactory effects of the elimination diet treatment based on the ALCAT Test results in the two latter diseases may result from the considerable involvement of IgE-mediated mechanism in the pathology of the skin and nose, which are under a great influence of external environmental factors other than food. In 57% of patients skin prick tests were positive (in 35% with inhalants and foods, 12% with inhalants only, in 9% with foods only).
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PMID:ALCAT Test results in the treatment of respiratory and gastrointestinal symptoms, arthritis, skin and central nervous system. 877 17

In this study we evaluated antigen-specific in vitro responses of peripheral blood lymphocytes to lipopolysaccharide (LPS)-depleted food allergens in children who reacted to food challenge (cow's milk or hen's egg) with a deterioration of their atopic dermatitis (AD). Some of the children showed immediate symptoms (urticaria, bronchial asthma or gastrointestinal symptoms) as well. The proliferation of casein-stimulated lymphocytes from children reacting to cow's milk (age 0.7-5.9 years) was significantly higher (P < 0.01) than the proliferation of lymphocytes from 15 children with AD without milk allergy (age: 2.1-9.1 years). Twenty-eight T-cell clones (TCC) were established from the blood of three children sensitized to cow's milk and hen's egg who reacted to double-blind, placebo-controlled oral food challenge both with a deterioration of AD and with immediate symptoms. Surprisingly, 16 of 28 casein- or ovalbumin-specific TCC were CD8+. All TCC produced high amounts of IFN-gamma upon stimulation with concanavalin A. In addition, 75% of the CD4+ TCC and 44% of the CD8+ TCC secreted IL-4. Our results indicate that: (i) food-specific proliferation of blood lymphocytes can be detected in patients with clinically relevant food allergy with LPS-depleted allergens in vitro and (ii) circulating food-specific lymphocytes are CD4+ and CD8+ T cells with the capacity of producing both type 1 and type 2 cytokines.
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PMID:The role of circulating food antigen-specific lymphocytes in food allergic children with atopic dermatitis. 897 15

It is known that patients with pollinosis may display clinical characteristics caused by allergy to certain fruits and vegetables, but subjects allergic to Artemisia seem to show particularly peculiar characteristics. The clinical features of 84 patients with rhinitis, asthma, urticaria, and/or anaphylaxis whose inhalant allergy was exclusively to Artemisia vulgaris were studied and compared with a control group of 50 patients monosensitized to grass pollen. The mean age for the beginning of symptoms was 30.2 years, and this was higher than in the control group (P < 0.05). We found the main incidence to be in women (70.2%). Some 42.3% had family history of atopia, lower than in the control group (P < 0.05), while the prevalence of asthma and urticaria was significantly higher (P < 0.05). Food hypersensitivity was reported by 23 patients (27.3%) allergic to Artemisia. The foods responsible (with respective numbers of cases) were honey (14), sunflower seeds (11), camomile (four), pistachio (three), hazelnut (two), lettuce (two), pollen (two), beer (two), almond (one), peanut (one), other nuts (one), carrot (one), and apple (one). None of the patients monosensitized to grass had food allergy. CAP inhibition experiments were carried out on a single patient. Results showed the existence of common antigenic epitopes in pistachio and Artemisia pollen for this patient. We concluded that mugwort hay fever can be associated with the Compositae family of foods, but that it is not normally associated with other foods.
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PMID:Allergy to foods in patients monosensitized to Artemisia pollen. 902 Apr 22

Food allergy in adults is mainly due to cross-reactivity between inhalative and food allergens. IgE antibodies are induced against aero-allergens, which recognize a structurally similar component in certain foods. Not all patients with such food allergies have clinical symptoms of pollinosis, although a sensitization to the inducing aero-allergens is always found. Dependent on the main allergen, namely Bet v 1 or Bet v 2, different symptoms can be observed. Bet v 1 mainly causes mild symptoms localized around the area of the oropharynx (oral allergy syndrome). It is mainly caused by apples, cherries, peaches and plums, but can also be observed with other allergens which cause generalized symptoms. Sensitization to Bet v 2 is commonly associated with more generalized symptoms, in particular urticaria and angioedema (mugwort/celery syndrome). Recently, new cross-reactivities have been detected based on latex sensitivity or housedust mite sensitivity. Latex allergy can cause food allergy to avocado, banana and chestnut, housedust mite allergens to crustacea and snails. Knowledge of these cross-reactivities is important for the clinician, since the majority of food allergies are caused by such cross-reactive IgE-antibodies. Further characterization of these allergens may open up ways of inducing tolerance to these substances.
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PMID:[Important cross-reactive allergens]. 913 25

The atopic dermatitis is a multifactorial inheritable disease, in which pathogenesis in addition to environmental factors (climate, allergens, clothing) genetically determined multiplex metabolic differences (arachidonic acids, essential fatty acids) and immunologic alterations play an important role. Within immunologic findings the disturbances of balance in Th1 and Th2 subclasses, the increased degranulation activity of mast cells and the increased antigen presentation activity of Langerhans cells can be stressed. The clinical immunological alterations shown in the diseases, the increased production of IgE and so the type I. allergic reactions (urticaria, gastrointestinal manifestation of food allergy, allergic rhinitis, asthma bronchiale), the difference of cellular immunity of the skin can be explained by the above mentioned main immunological changes. In understanding of immunological origin of atopic dermatitis the IgE receptors expressed on the surface of Langerhans cells (connecting the immediate and delayed type of immune response) mean significant help.
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PMID:[Immunopathologic disorders in atopic dermatitis]. 915 34

Food allergy is clinically classified into two types, immediate and nonimmediate. Radioallergosorbent test (RAST) is a sensitive procedure for the diagnosis of IgE-mediated hypersensitivity but not for other types of hypersensitivity. There is not yet a sensitive blood examination for detection of allergens in nonimmediate types of food allergy. Of the total number of subjects in our study, twenty-two children had nonimmediate types of food allergy (hen's egg, cow's milk, soybean, or buckwheat flour), atopic dermatitis, allergic tension fatigue syndrome or pulmonary hemosiderosis. For these children, manifestations of the allergy did not appear earlier than 2 hours after ingestion of the offending food. Eighteen children in the study developed acute urticaria, angioedema, or bronchial asthma appearing within 2 hours of the challenge. Fifteen nonatopic healthy children were selected as controls. Proliferative responses of peripheral blood mononuclear cells (PBMCs) to food antigens were measured in nonimmediate types of food allergy. The proliferative responses of PBMCs to each offending food antigen in patients with nonimmediate types of food allergy were significantly higher than those of healthy controls and patients with immediate types of food allergy, respectively. Moreover, in each case with nonimmediate type, the proliferative responses to food antigens other than the offending food were not detected. When PBMCs were twice stimulated with the offending food antigen, the same results were obtained. These results indicate that the proliferative response of PBMCs to food antigens is specific to each offending food antigen in nonimmediate types of food allergy. Taken together, proliferative responses of PBMCs to each food antigen are useful for detection of allergens in nonimmediate types of food allergy.
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PMID:Proliferative responses of lymphocytes to food antigens are useful for detection of allergens in nonimmediate types of food allergy. 916 39

Food allergy is an immunologically mediated hypersensitivity reaction that occurs in 1% to 2% of the general population and in about 8% of children. Reactions mediated by IgE antibodies are the most common type of food allergy and can cause asthma, rhinitis, atopic dermatitis, urticaria, and anaphylaxis, which can be lethal. A proper diagnosis can be established through a careful history and physical examination, tests for IgE antibodies specific for food antigens, a favorable response to an allergen elimination diet, and, if necessary, blinded and controlled allergen challenge. The only effective therapy is avoidance of the problem foods. Resolution of the sensitivity over time is more common in younger patients than in adults and for some foods more than others. Most adverse food reactions are due to nonimmunologic intolerance and can be managed differently.
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PMID:Food allergy. 916 23


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