Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042109 (urticaria)
 6,569 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study describes the probably eleventh case, mentioned in literature, of acquired heat contact uticaria in an otherwise healthy young woman. With regard to true contact induction heat contact urticaria clearly differs from the more common cholinergic uticaria. On the other hand, heat contact urticaria is completely analogous to cold uticaria because of the exposure area, reversible blocking by unphysiological prolonged heating of the skin, sensitivity to antihistamines and resistance to corticosteroids. In this case, whealing of the skin occurred on exposure to heating of 39 degrees C for 5 min. With a temperature of 44-46 degrees C, The shortest time for wheal induction was 3-5 sec. At 70 degrees C, the shortest time for maximal reaction was only a split second. An "optimal temperature" for wheal induction could not be determined. Local anaesthesia with 2% Xylocain caused a considerable blocking of wheals. Histamine and cholinergic drugs showed normal skin reactions after intradermal injection. Antihistamines administered parenterally or perorally were highly effective. Corticosteroids, however, given systemically in high doses proved to be ineffective. During our observations, a spontaneous remission appeared with a clinical symptom-free state; on unphysiological high temperature stimulus, however, contact uticaria could still be demonstrated. The pathogenetic uniformity of sporadic heat contact urticaria and problems of therapeutical controls are discussed.
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PMID:[Clinical and experimental observations on idiopathic urticaria due to the contact with heat]. 0 89

Morphological changes in cutaneous nerve endings were investigated electron microscopically in patients suffering from certain kinds of urticaria with associated itching and in normal skin in which wheals and local itching were induced either by application of nettle hairs or by intracutaneous injections of a timothy pollen extract. Skin samples were obtained with a high speed dermal punch without anesthesia from the wheal areas. It was found that some subepidermal free nerve endings derived from non-myelinated nerve fibers (penicillate endings) showed accumulations of extra-cytoplasmic glycogen which was localized in the distended spaces between the axolemma, the Schwann cell membrane and the nerve basement membrane. In some cases, the glycogen was found to be so abundant that it occupied most of the cross sectional area of the ending. No morphological changes were observed in the pappilary endings, in nerve endings of the hairs or in the autonomic terminals. The conducting segments of all cutaneous nerve fibers showed normal morphology. The unusual morphological changes that occur in some penicillate nerve endings during the wheal development indicate that these endings are involved in the skin reaction and therefore they may be the specific end organs that are associated with itch, at least in urticaria.
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PMID:Fine morphological changes in the penicillate nerve endings of human hairy skin during prolonged itching. 86 27

Epidural analgesia for caesarean section is increasingly used and is gradually replacing general anaesthesia. Hypotension is one of the main risks: preloading of the maternal circulation is used to prevent maternal hypotension and its consequences. For this, various colloid and crystalloid solutions are used. We report a case of maternal anaphylactoid reaction with apparent death in a neonate after dextran administration to the mother. After 100ml of a dextran 40 solution administered intravenously, immediately before an epidural blockade, the mother fainted and developed urticaria and mild respiratory disturbances, without hypotension. At that point dextran infusion was stopped. An apparently dead neonate was rapidly delivered. Immediate and vigorous cardiopulmonary resuscitation was successful. Clonismus appeared 12h later, followed by 3 general epileptic fits treated by phenytoin infusion and subsequently oral phenobarbital. No aetiology was found. After 2 months of treatment, barbiturates were stopped following clinical and electroencephalogram (EEG) improvement. Several similar cases of neonatal disorders resulting from preventive dextran administration during delivery were studied in a national pharmacovigilance survey in France. There were 32 cases reported with moderate maternal anaphylactoid reaction associated with severe acute fetal distress; it is probably advisable to take a cautious approach and avoid preventive fluid preload by dextran administration. Gelatins or crystalloid solutions should be preferred, with intravenous vasopressive amine administered promptly and repeated if necessary should significant maternal hypotension occur during epidural anaesthesia.
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PMID:Fetal risks with dextrans during delivery. 137 90

Twenty-eight adults with a history of a generalized allergic reaction during anesthesia were investigated. The reactions were systemic in 23 adults, urticaria/angioedema in four, and bronchial obstruction in one adult. The study population and an additional 35 subjects with a history of use of thiopental during anesthesia but without reactions were investigated by methods including thiopental skin test, succinylcholine skin test, and IgE RAST for antibodies to thiopental, succinylcholine, or latex. Among the 28 patients with reactions, 17 had positive thiopental skin tests; 14/28 reactors and 1/35 of the control group had an IgE thiopental RAST value greater than 2 SD above the mean for control sera from ragweed-allergic subjects. The one control subject with a positive thiopental RAST also was the only control subject with a positive thiopental skin test. IgE succinylcholine RAST was negative in all 23 reactor sera tested. The IgE latex RAST was strongly positive in one reactor. In conclusion, evidence of allergy, particularly allergy to thiopental as a possible basis for the reactions, was obtained in greater than 50% of the patients who were investigated. No allergy to succinylcholine was found.
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PMID:Generalized allergic reactions during anesthesia. 154 98

Ten healthy male volunteers received intravenous regional anaesthesia of the upper limb on two separate occasions using 40 ml of 0.5% prilocaine or 40 ml plain 0.5% chloroprocaine by random allocation. Using a double-blind method, the onset and recovery of sensory block was tested (pinprick) in the four main nerve areas. The onset and recovery of motor block was measured by squeezing a rubber balloon connected to a manometer. The symptoms after deflation of the tourniquet were recorded. Seven volunteers in both groups developed total anaesthesia in 20 min. Complete motor block occurred in 12.3 min with prilocaine and 11.3 min with chloroprocaine. Sensation recovered in all areas in 7.6 min with prilocaine and 10.0 min with chloroprocaine (ns). Motor function recovered in 8.4 and 12.0 min respectively (p less than 0.01). Six volunteers in the chloroprocaine group showed signs of venous irritation and/or antecubital urticaria in the test arm for 30-45 min after the deflation. Four volunteers in the chloroprocaine group had increased in heart rate (greater than 20%) and one of them short periods of junctional rhythm during the first 2 min after tourniquet deflation. Mild, short-lived CNS side effects occurred in both groups.
Anaesthesia 1992 Jul
PMID:Intravenous regional anaesthesia with 0.5% prilocaine or 0.5% chloroprocaine. A double-blind comparison in volunteers. 162 79

A 62 year-old female developed bronchospasm after intravenous vecuronium administration. Vecuronium is reported to have major advantages over pancuronium due to the lack of significant histamine-releasing activity and cardiovascular side effects. However, macular rash, systemic collapse and bronchospasm have been reported before. The patient received cholecystectomy under general anesthesia. She had a history of urticaria when she had had a intravenous pyelography and showed positive skin test to antibiotic, ceftizoxime. During induction with thiopental plus vecuronium and on addition of vecuronium, bronchospasm was induced within five minutes in each time. Both episodes of bronchospasms were relieved with intravenous aminophylline and methylprednisolone. During the operation arterial blood gas samples were taken twice and showed no abnormal findings. Further blood samples were taken for complement C3, C4, plasma IgE and white blood cell counts. Skin test to vecuronium was also performed. In spite of these data, the mechanism of bronchospasm remained obscure. Careful attention should be paid to the use of vecuronium, especially for the patient who showed allergic response to some drugs.
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PMID:[Possible bronchospasm after administration of vecuronium]. 167 99

Numerous cases of immediate hypersensitivity to latex have been reported since 1979 involving household and surgical gloves, condoms, and sounds, usually with minor cutaneous symptoms; however, severe symptoms have also been reported during general anesthesia. A 34-year-old woman was hospitalized in October 1989 for Quincke's edema an generalized urticaria, accompanied by acute dyspnea, a few minutes after protected sexual intercourse. Clinical examination was normal with respect to respiration; however, an edema of the eyelids and generalized urticaria was found, which was treated with antihistamines and corticotherapy. The notion of a previous anaphylactic shock during an arteriography in August 1989 and contact urticaria of the hands when using surgical gloves was suggested, as she was an assistant pediatric nurse. Allergic tests indicated seasonal rhinitis. Cutaneous tests for pneumallergens according to the technique of Prick indicated polysensitivity to pollens, as papules of 4-4.5 mm size formed. Cutaneous test with a commercial latex extract was positive, producing a papule of 6 mm. Also tests with different latex-based products (surgical gloves, Durex and Trepharm brand condoms) were strongly positive, producing papules of 6.5 mm and 8.5 mm, respectively. The specific IgE (gamma-E globulin) to latex was of class 3 (8.3 PRU/ml). In the majority or cases reported, besides the positivity of skin tests, the specific IgEs were identified in the serum by the technique of RAST. The incriminated product was the latex derivative of Hevea brasiliensis. Therefore, the existence of allergy to latex was responsible for these symptoms of anaphylactic nature.
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PMID:[Anaphylactic manifestations during protected sexual intercourse disclosing allergy to latex]. 179 36

Delayed hypersensitivity to rubber chemicals is well known, but there has been an increasing number of reports of immediate-type hypersensitivity due to latex causing contact urticaria, angioedema, bronchial asthma, and anaphylactic shock in adults. We report a 10-year-old boy who developed anaphylactic shock during surgery due to surgical gloves containing latex. The patient was atopic and had a history of neurodermatitis and localized angioedema on exposure to rubber. There had been two previous uneventful surgical procedures. Thirty-five minutes after induction of anesthesia and 5 min after laparotomy for appendectomy there was an acute onset of increased airway pressure, oxygen desaturation, and profound hypotension. The circulation and gas exchange stabilized after treatment with oxygen, intravenous fluids, epinephrine, H1 and H2 blockers, aminophylline, and methylprednisolone. A positive skin test and RAST revealed a latex allergy. Latex can cause life-threatening allergic reactions in patients with a history of rubber allergy or frequent exposure to latex products.
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PMID:[Intraoperative anaphylactic shock due to a latex allergy]. 186 73

Latex products have recently been identified as the cause of severe intraoperative anaphylactic reactions. We have identified a group of pediatric patients who appear to be at increased risk for such reactions. Fifteen patients with either spina bifida or congenital urologic abnormalities experienced 19 intraoperative anaphylactic reactions. All patients had frequent previous exposures to rubber materials since infancy as part of their management and/or investigative procedures. Seven of 15 patients had a previous history of local skin reactions to rubber. Only four patients were atopic. All patients had undergone multiple (two of 26) operative procedures before their reactions, the onset of which ranged from 40 to 290 minutes after induction of anesthesia. The reactions varied in intensity from urticaria to severe cardiorespiratory collapse. All these patients subsequently had positive allergy skin tests and positive RAST to latex antigen. We conclude that this group is at risk when they are exposed to latex intraoperatively as a result of frequent past exposure to these materials. Allergic evaluation for latex allergy may assist in the preoperative evaluation of similar patients. In sensitized patients, appropriate prophylactic measures, particularly the avoidance of latex, is required.
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PMID:Intraoperative anaphylaxis: an association with latex sensitivity. 200 17

Twenty-seven patients were referred for evaluation of anaphylaxis after induction of general anesthesia (GA) in which thiobarbiturates, muscle relaxants, or antibiotics were administered intravenously. Skin testing by the prick and intracutaneous methods was performed with dilutions of the thiobarbiturates and muscle relaxants; beta-lactam reagents were used in patients who had also received these drugs. No skin test reactivity was noted in 16 normal subjects. Skin tests were positive in 13 patients (thiobarbiturates in five, muscle relaxants in six, and antibiotics in two patients). Two patients were dermatographic and yielded indeterminate skin test results. Eleven of the 27 patients subsequently had GA; all patients received a premedication regimen of prednisone and diphenhydramine. Of three patients with negative skin tests, one experienced an arrhythmia, but no other signs attributable to anaphylaxis were noted. One patient with dermatographism had GA without a reaction. Positive skin tests implicated an agent that was avoided in seven patients; one of these patients experienced delayed urticaria/angioedema after the completion of GA. Thus, no patients developed anaphylaxis during subsequent GA for which agents producing positive skin tests were avoided, and a premedication regimen was used.
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PMID:Anaphylaxis during induction of general anesthesia: subsequent evaluation and management. 207 81


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