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Query: UMLS:C0042109 (urticaria)
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This report describes six children with spina bifida who have experienced a total of 13 episodes of generalized hives, angioedema and in two cases, anaphylactoid reactions immediately following saline enema infusions. The enemas were administered using a kit comprised of a plastic bag, tubing, and rectal end-piece. The reactions always occurred with the first use of new kits. A third child developed a systemic reaction with only the rectal end-piece in situ and without infusion of fluid. An in-hospital challenge using a new end-piece in one patient, who was clinically the most sensitive, produced an acute anaphylactoid reaction implicating the end-piece as the most likely source of the problem. The definitive mechanism(s) of the reactions and the agent(s) responsible for them presently remain unknown.
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PMID:Anaphylactoid and systemic reactions following saline enema administration. Six case reports. 351 78

Food allergy (hypersensitivity) is a form of adverse food reaction in which the reaction is caused by an immunological response to a food. The majority of immediate allergic reactions to food are IgE-mediated. Although the true prevalence of food allergy is unknown, it is said to be higher in children than in adults. Data suggest that the prevalence in the general population is about 1%. In children the most common foods eliciting an allergic reaction are cow's milk, eggs, fish, peanuts and soy. In adults celery, fish, nuts, peanuts and shrimp are the major source of food allergy. Usually, food-allergic adults are sensitized to pollen, e.g. in the frame of the celery-carrot-mugwort-spice syndrome. There is some evidence that antigenic similarity exists between pollen and food proteins. Clinical signs and symptoms due to food allergy are cutaneous, respiratory, gastrointestinal reactions such as urticaria, laryngeal edema, asthma or diarrhea. Food anaphylaxis is the most severe generalized and sometimes fatal reaction. History, physical examination, skin tests and laboratory tests (RAST) provide the basic tools for identifying a food allergy. However, the "gold standard" for diagnosing allergic food reactions is the double-blind, placebo-controlled food challenge. The predictive accuracy of positive skin tests is less than 50%, as demonstrated by double-blind, placebo-controlled food challenges. The only proven form of management in food allergy is strict elimination of the offending food. Food-allergic individuals must be provided with an emergency kit containing an oral antihistamine of the second generation and a corticosteroid.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Food allergy]. 814 11

Recognition of sulfite sensitivity by the practicing dermatologist has become increasingly important. A wide spectrum of anaphylactoid reactions can occur after ingestion of sulfite additives in foods and medications. We report the case of a 47-year-old man with severe acute intermittent urticaria. A placebo-controlled oral challenge test with 50 mg sodium disulfite resulted in an acute urticaria attack. A biopsy taken 5 h after the appearance of the urticaria demonstrated a leukocytoclastic vasculitis with eosinophilia. Avoiding foods and drugs containing sulfites is often difficult due to its widespread use. Therefore, the patient should be equipped with a medical emergency kit.
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PMID:Disulfite-induced acute intermittent urticaria with vasculitis. 827 92

Within the past decade, anaphylaxis from latex products has been a recognized clinical crisis. Immediately after contact with latex, the patient can experience urticaria, nasorhinitis, conjunctivitis, asthma, hypotension, and shock. Health care workers, children with spina bifida, patients with a history of urogenital procedures, and employees of rubber manufacturing plants have the highest incidence. The most common denominators include frequent contact with latex and a history of allergies, although cases without these components have been reported. The increased incidence is linked to the increase of glove and condom use in preventing the spread of the HIV virus. Sensitization to the natural rubber protein is the allergen, although the specific protein has not been isolated. A thorough medical and surgical history and a history of previous allergies and allergic events should be collected on all patients with complaints of any latex contact symptoms. Latex-sensitive patients should wear a Medic Alert bracelet and carry an epinephrine autoinjector kit. Health care providers must be alert for the possible occurrence of latex sensitivities in their patients.
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PMID:Latex allergy: recognition and management of a modern problem. 827 93

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

Exercise-induced urticaria and anaphylaxis have become increasingly recognized during the past 2 decades as more people participate in physical activities. These syndromes can be categorized as cholinergic urticaria or exercise-induced anaphylaxis based on the clinical manifestation. Newer subsets such as food-dependent and familial exercise-induced anaphylaxis have also been recognized. Further studies are needed to characterize the variables involved in mast cell activation and mast cell mediator release in these syndromes. The management strategy for patients who have exercise-induced syndromes with skin manifestations only differs from the management for those with systemic symptoms. Currently, antihistamines, as a single agent or in combination with other agents, may be helpful prophylactically in both groups. Avoidance of precipitating factors, modification of exercise, and use of a self-injectable epinephrine kit are recommended for patients with anaphylaxis.
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PMID:Exercise-induced urticaria and anaphylaxis. 903 47

There are several types of immunological tests available for the diagnosis and management of Helicobacter pylori infection. Most commercially available serological kits use the enzyme linked immunosorbent assay (ELISA) test format. Originally the kits used crude antigen preparations although many of the newer kits use a more purified antigen preparation, with often increased specificity but lower sensitivity. Near patient test kits are based either on latex agglutination or immunochromatography. Generally they have low sensitivities compared with laboratory tests. Western blotting, ELISA, and recombinant immunoblot assays (RIBA) have also been developed into commercially available kits and can be used to indicate the presence of specific virulence markers. An antigen detection kit has been developed for the detection of Helicobacter pylori in faeces. Immunological reagents have also been combined with other diagnostic modalities to develop immunohistochemical stains and DNA immunoassays. Helicobacter pylori is now recognised as the cause of gastritis and most cases of peptic ulcer disease (PUD); its long term carriage increases the risk of gastric adenocarcinoma sixfold and it is designated as a class I carcinogen. H pylori has also been implicated as a cause of gastric mucosa associated lymphoid tissue lymphomas. Its relation to non-ulcer dyspepsia remains controversial. Additionally, long term carriage of the organism may be associated with short stature in young girls and, in the general population, as a possible risk factor for the development of vasospastic disorders and possibly skin immunopathology such as urticaria. With the recognition of H pylori as an important human pathogen, it has become one of the growing number of organisms to have its complete genome sequence mapped. Serology is an important method of determining colonisation status and can be used for diagnosis, as a screening procedure, or to follow the efficacy of eradication regimens. Most serological assays are in the ELISA format although some are based on the latex agglutination reaction. These latter are used principally as near patient assays. Most assays detect IgG in serum although some detect serum IgA. More recently developed assays detect IgA in saliva and the production of affinity purified antibodies has led to the development of an antigen detection assay for faecal specimens. Serological reagents have also been used in immunocytochemistry and to speed up the detection of amplified products of the polymerase chain reaction (PCR)-DNA immunoassays.
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PMID:New immunological assays for the diagnosis of Helicobacter pylori infection. 1045 32

Titres of parasite-specific IgE were investigated in 19 patients thought to have recurrent, acute urticaria caused by sensitization to Anisakis simplex (Dujardin, 1845), before and after they were placed on a fish-free diet. Patients with other allergic disease and those being treated with corticosteroids or antihistaminics were excluded. Skin-prick tests were carried out with A. simplex extract, and blue- and white-fish extracts. The CAP system (Pharmacia), a commercial test kit developed for the assay of food-specific IgE, was used to monitor serum concentrations of total IgE and antigen-specific IgE against Anisakis, Ascaris, Echinococcus, Toxocara, tuna, salmon, shrimp, mussel and cod. Before going on a fish-free diet, the 19 patients had CAP scores against A. simplex of 5 (three cases), 3 (seven) or 2 (nine). After a mean of 120 days on the diet, the scores against A. simplex were unchanged in 15 of the cases, reduced in three [from 5 to 4 (one case) or from 2 to 0 (two cases)] and increased in one (from 2 to 3). Most (16) of the patients no longer had any urticaria and the others reported significant reductions in the intensity and frequency of their symptoms.
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PMID:Specific and total IgE in patients with recurrent, acute urticaria caused by Anisakis simplex. 1088 71

Anaphylactic shock is a life-threatening allergic reaction with cardiovascular collapse. The cardiovascular collapse may occur suddenly without warning signs or may be preceded by symptoms such as pruritus, wheezing, dyspnea, urticaria, pallor, digestive symptoms, and weakness. Food allergens, injected drugs and hymenoptera stings are the main etiologies. Anaphylactic shock requires an emergency treatment with immediate intramuscular or subcutaneous epinephrine injection. Subsequent avoidance of the inciting allergens is mandatory together with the availability of a first aid kit including ready-to-use epinephrine syringes. Besides its absolute necessity in any doctor's office, such first aid kits should be available in any children's group.
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PMID:[Anaphylactic shock in the infant]. 1114 73

Physical urticaria includes a heterogeneous group of disorders characterized by the development of urticarial lesions and/or angioedema after exposure to certain physical stimuli. The authors present the case of a child with severe acquired cold urticaria secondary to infectious mononucleosis. Avoidance of exposure to cold was recommended; prophylactic treatment with ketotifen and cetirizine was begun and a self-administered epinephrine kit was prescribed. The results of ice cube test and symptoms significantly improved. Physical urticaria, which involves complex pathogenesis, clinical course and therapy, may be potentially life threatening. Evaluation and diagnosis are especially important in children. To our knowledge this is the first description of persistent severe cold-induced urticaria associated with infectious mononucleosis in a child.
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PMID:Cold urticaria and infectious mononucleosis in children. 1561 65


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