The role of allergy in asthma

Allergic triggers remain vitally important for a large proportion of asthmatics. Increasing evidence indicates that allergic sensitivity may not only cause ongoing asthmatic symptoms with bronchial hyperreactivity and airway inflammation but may also serve as an inducer of the asthmatic condition. Patients with a history and clinical setting suggestive of allergic sensitivity should be evaluated carefully. Whenever possible, allergen avoidance should be encouraged strongly in allergen-sensitive patients with a strong emphasis on patient education. In those patients who continue to be symptomatic with good avoidance measures and appropriate pharmacotherapy, allergy immunotherapy should be considered as an additional treatment measure.     

Rhinitis

Rhinitis is a problem causing significant morbidity. The etiology of rhinitis is varied. The pathophysiology of rhinitis is just beginning to be elucidated. Allergic rhinitis is primarily understood as an inflammatory disease with a neurogenic component. Disease states such as responses to cold dry air are primarily considered to be neurogenic in origin, but inflammatory cells and mediators play a significant role in the development of symptoms in these patients. Our understanding of these complex interactions is reflected in the pharmacologic interventions currently available. Most rhinitis therapy addresses the symptoms of rhinitis not the underlying disease state. Future research in the field of rhinitis should increase our knowledge of the pathophysiology and therefore assist in new drug development.     

Delayed type allergic reaction to red azo dye in tattooing

Allergic reactions in tattoos are comparatively rare. In most cases the reactions are caused by different red pigments. While in the past these reactions have been ascribed to mercury salts (cinnebar) and cadmium sulphide, now synthetic inorganic azo dyes have also been found to be responsible for such reactions. A 42-year-old man presented with an allergic reaction in the red parts of his tattoos. Histologically a chronic granulomatous, partly fibrous inflammation with transfollicular elimination of pigment granules was found. Spontaneous regression in a part of the inflammatory reaction was observed, simultaneously with depigmentation and scarring of the overlying skin. The pigment used for tattooing was found to be an aromatic azo derivative. In addition to a positive cutaneous reaction to the dye, the patient also showed a positive patch test to Napthol AS, used for the coupling of different dyes in the textile industry.     

Wasp and bee venom allergy

To diagnose insect venom allergy a good patient history is important. Allergological tests (skin test, specific IgE titre) confirm the diagnosis. Patients are advised on preventive measures (e.g. with respect to clothing and use of perfume). They are also instructed on medical treatment (antihistaminics, epinephrine) in case they are stung again. In patients having had a serious systemic reaction immunotherapy should be considered. Immunotherapy leads to complete protection in more than 98% of patients with wasp (yellow jacket) venom allergy and in 75-80% of patients with bee venom allergy. Serious adverse reactions to immunotherapy are rare. Immunotherapy lasts at least 3 to 5 years. After cessation of immunotherapy the frequency of systemic reactions to the sting of a wasp or bee is in the range of 5-15%. There are insufficient data on the long-term effect of immunotherapy.     

Chronic rhinosinusitis in children: evolution of concepts

The concept of chronic rhinosinusitis in children has been recently individualized. The diagnosis is based upon the clinical history. It may be part of a diffuse inflammatory disease of the respiratory tract. Allergic and environmental polluting factors are possibly involved and must be looked for. Drainage of the rhinopharynx and local steroids are usually the first line treatment. In case of failure, a CT-scan of the sinuses should be performed looking for an obstructive anomaly of the sinuses requiring functional endoscopic sinus surgery.     

Delayed and immediate orofacial reactions following contact with rubber gloves during dental treatment

Allergic reactions during or after dental examination are uncommon. However, such reactions may be serious and distressing. Allergy to local anaesthetics and dental materials may be considered, but reactions to rubber in gloves worn by the dentist should be remembered. Two patients are reported who experienced symptoms following contact with rubber gloves worn by their dentists, with skin tests subsequently showing an allergic reaction to glove constituents, and in one case latex. With the increasing use of rubber gloves by dental and medical personnel, reactions in sensitised patients are likely to become more common. In patients with a history of symptoms related to dental work, it is important to remember delayed and immediate reactions to rubber.     

Enhanced in vitro tumor cell retention and internalization of antibody derivatized with synthetic peptides

Human IgG subclasses play a major role in the physiological regulation and functions of the immune system. There "personality" is obvious. However, the determination requires appropriate reagents and technology. For the IgG1, IgG2, IgG3 subclasses, the radial immunodiffusion technique may be sufficient. For the IgG4 subclass determination and measurement, more elaborate techniques are required. These measurements of existing proteins are of major interest in congenital as well as acquired immune deficiencies more often, besides the total subclass deficiency, these are of utmost interest to evaluate the specific response of a given subclass to a specific antigen. The IgG4 allergen specific subclass has been considered to be involved both in allergic reactions and associated with the appropriate response to allergen-specific immunotherapy. It is now accepted that IgG4 does not play an discernable role in the acute inflammatory response of type I hypersensitivity; it has also been demonstrated that a number of patients who demonstrate elevated levels of allergens specific IgG4 are not protected against allergenic exposure, and conversely, a number of patients who have been heated by immunotherapy without demonstrating any significant increase in their serum levels of allergen specific IgG4 are indeed very well protected. In the field of allergy, the IgG4 determinations remain a matter of controversy and research.     

Quality of life analysis of patients undergoing immunotherapy for allergic rhinitis

Allergic rhinitis has been conservatively estimated to affect 35 million Americans, with an annual US expenditure of more than $2 billion for treatment. Immunotherapy is generally administered to patients with allergic rhinitis when avoidance is impossible or impractical, when pharmacotherapy provides insufficient relief, and/or symptoms span more than one season. Immunotherapy based on quantified testing (e.g., dilutional intradermal testing [SET] or in vitro methods [RAST, ELISA]) allows administration of antigens in a manner that achieves therapeutic antigen doses more rapidly, yet more safely than immunotherapy administered through a schedule that mixes all antigens at the same concentration and advances on an empirical basis. Sixty patients who received at least one year of quantified testing-based immunotherapy were evaluated using a quality of life questionnaire and individual interviews. Changes in physical, social and emotional well-being were determined. Also investigated were changes in productivity and medication usage. The majority of patients noted significant improvement in all areas within four to six months of initiating immunotherapy, and an overwhelming majority felt that such treatment represented a worthwhile investment of their time and money.     

The role of chemokines such as RANTES in allergic disease

Much attention has recently been focused on the role of allergic inflammatory reaction in asthma. Eosinophils are considered to be the major type of inflammatory cell involved in bronchial asthma, since eosinophil-specific granule proteins can damage bronchial mucosal cells. Chemokines related to the beta subfamily, the so-called platelet factor 4 (PF4) superfamily have been shown to stimulate human eosinophils or basophils, and are considered to be important mediators of inflammation. RANTES may be released from activated platelets and is considered to play an important role in various immune and allergic disorders. RANTES is a potent chemoattractant for various inflammatory cells such as eosinophils, as well as for memory T cells and monocytes, thus potentially recruiting these cells from the circulation to an inflamed focus. Involvement of eosinophils and T cells in bronchial asthma has also been reported. To extend our understanding of the participation of eosinophils, T cells, and RANTES in the pathogenesis of allergic disease, we demonstrated the important roles of chemokines such as RANTES in allergic disease.     

Factors affecting the mobility of pediatric dentistry faculty

A 66-year-old female underwent uneventful removal of parasagittal meningioma. At surgery, a piece of Biobond-soaked oxycellulose was applied to the lateral wall of the superior sagittal sinus for hemostasis. Her early postoperative course was complicated by focal but severe brain edema, which was adjacent to the hemostatic agent. Unlike foreign body granuloma previously reported, this complication was considered to be attributed to inflammatory reaction of Biobond, because of the early onset and fulminant edema despite of small volume of the mass lesion. Although there have been no previous reports of this complication, it should be kept in mind that intracranial application of Biobond may induce fulminant inflammatory reaction as seen in this patient.     

Hyperfractionation in the reirradiation of head and neck cancers. Result of a pilot study

Surgical resection of primary lesions and single metastasis can be curative, but surgery, used as the only therapeutic option, is not unanimously accepted in patients with multiple metastasis and, apart from other considerations, there are no established clinical criteria to allow us to predict which patients will benefit from a metastectomy. This study evaluates four patients with advanced RCC. Three had multiple pulmonary metastasis at the time of diagnosis and one presented retroperitoneal mass at 36 months of follow-up. All patients were nephrectomized and received adjuvant immunotherapy with an association of IL-2 and 2b alpha-IFN subcutaneously, obtaining partial response of the disease after two treatment courses. Later, the patients underwent debulking surgery. Two patients are still alive and have no evidence of disease progression at 28 months and 8 months of follow-up. This data and that contrasted with other authors, suggests that surgical management would be a reasonable option in patients who have partially responded to immunotherapy, even though the selection of both candidates and surgical strategy should be considered on an individual basis.     

The adverse reactions of anti-tuberculosis drugs and its management

This paper reviews adverse reactions to anti-tuberculous drugs. Hepatotoxicity occur with isoniazid, rifampicin, pyrazinamide and ethionamide. Risk factors include high age, malnutrition and high alcohol consumption. Liver function should be followed every two weeks to prevent serious hepatotoxicity. If this occurs drugs should be stopped until improvement of liver functions. Fulminant hepatitis has poorer prognosis in regimen with pyrazinamide than without. The Combination of pyrazinamide and ethionamide is frequently hepatotoxic and should be avoided. Gastric reactions occur frequently. Elderly persons are highly intolerant to rifampicin. Peripheral neuritis is reported with isoniazid, ethambutol and ethionamide, but effectively prevented with pyridoxine. Allergic reaction including fever or rash occur with many anti-tuberculosis drugs. If necessary desensitization to re-introduce the drugs. Ocular toxicity due to ethambutol occur infrequently with a dose of 15 mg/kg. Drug interactions are frequent in tuberculosis treatment. Rifampicin reduce serum the concentration of such drugs as Methadone, Corticosteroid, and Theophylline.     

Inflammatory myofibroblastic tumor in children

The authors presented the cases of two children with inflammatory myofibroblastic (IMF) tumor and reviewed the literature to facilitate the preoperative recognition, delineate the clinical features, and describe the natural history of this entity. The first child had IMF tumor arising from the mesentery of the small intestine. He presented with an abdominal mass associated with severe inflammatory response manifested by fever, impaired growth, thrombocytosis, and microcytic, hypochromic anemia. After surgical resection, his fever resolved and his growth rate and the laboratory abnormalities normalized. Five months after initial diagnosis, the fever, anemia, and thrombocytosis recurred along with two tumors arising from the omentum and the abdominal soft tissue. After the second surgery, he remains free of recurrent disease for 30 months. The second child presented with a lung mass that was radiologically indistinguishable from pulmonary sequestration. After surgical resection, she remains free of recurrent disease for 18 months. IMF tumor should be considered in any solid tumor that occurs in association with a chronic inflammatory response. IMF tumor should also be considered in the differential diagnosis of pulmonary sequestration.     

Periodontal inflammatory and cystlike lesions in BDF1 and B6C3F1 mice

Periodontal inflammatory and cystlike lesions were detected in aged BDF1 and B6C3F1 mice. Lesions were unilateral, single, and located in the labial region of the incisor teeth. The largest cystlike lesion deformed the skull. Histologically, the cystlike lesions were classified into three types: predominantly an inflammatory reaction, predominantly a cyst formation, and a mixed lesion. These periodontal inflammatory and cystlike lesions were pathogenetically similar and were considered sequential changes; the lesions showing both cyst formation and inflammatory reaction seemed to be intermediate along a path toward formation of large cysts. The cysts probably were derived from periodontal tissue and developed as a result of inflammatory reaction to foreign bodies, including hair. The term "murine periodontal cyst" is proposed for this lesion. Detailed pathogenetic studies on murine odontogenic cystic lesions may be warranted.     

Allergen immunotherapy and avoidance

Since its introduction almost a century ago, immunotherapy continues to be an effective method of managing allergic rhinitis, allergic asthma, and insect anaphylaxis. Confusion and misinformation on the part of physicians and the public lead to the inappropriate use of this treatment. Before immunotherapy is started, appropriate avoidance techniques and pharmacotherapy should be instituted (except for insect anaphylaxis, where immunotherapy is a part of the initial treatment.) When these measures fail, or significant side effects are encountered, immunotherapy can be beneficial. This article eliminates as much as possible the ambiguity surrounding immunotherapy to help the clinician understand more clearly the appropriate use of immunotherapy and the treatment of allergic diseases.     

Study on the relation between HPV and tumors of the throat and larynx

Several experiments have suggested that the pineal hormone melatonin (MLT) may regulate cancer growth by exerting both oncostatic and immunomodulating effects. In particular, MLT would stimulate the anticancer immunity induced by interleukin-2 (IL-2). Recent studies seem to suggest that the activation of the inflammatory response may counteract the anticancer efficacy of IL-2 immunotherapy because of the immunosuppressive action of inflammatory-related cytokines, mainly IL-6. At present, it is still unknown whether MLT may influence host immune antitumor defences by modulating the inflammatory response. To analyze this hypothesis, we have evaluated the effects of a chronic administration of MLT on some of the commonly used markers of inflammation, including erythrosedimentation rate (ESR), IL-6, neopterin and SIL-2R, in patients with evidence of activation of the inflammatory response due to advanced solid neoplasms or auto-immune diseases. The study included 14 patients (solid tumors: 9; autoimmune diseases: 5). MLT was given orally at 20 mg/day during the dark phase of the day for 7 consecutive days. Mean serum levels of IL-6, neopterin and SIL-2R significantly decreased in both groups of patients. ESR values also decreased on therapy, without, however, significant differences. This preliminary study shows that the pineal hormone MLT may inhibit the acute inflammatory reaction. Therefore, because of the immunosuppressive section of inflammation-related cytokines, this study could suggest that MLT may contribute to the generation of the immune reaction against cancer at least in part by removing the immunosuppression related to the activation of the inflammatory response.     

The law of additive reaction times in fluid-solid reactions

A law governing the rate of reaction of a solid particle with a fluid is proposed and verified for a wide range of systems. It is exact for the reaction of a nonporous solid and is a useful approximation in the case of a porous solid. The law states that the time required to attain a certain conversion is the sum of the time required to reach the same conversion in the absence of resistance due to the intrapellet diffusion of fluid reactant and the time required to reach the same conversion under the control of the intrapellet diffusion. The limitations are that the solid should be isothermal, the intrinsic kinetics should be at least approximately of first order with respect to the concentration of fluid reactant, and the effective diffusivity should remain unchanged during the reaction. Furthermore, with the appropriate definition of the fluid-solid reaction modulus, numeri-cal criteria for asymptotic regimes of chemical reaction and diffusion controls have been shown to remain identical for all systems considered. The law is valid not only in an inte-gral (conversionvs time) form but also in a differential form: The rate of reaction at a certain conversion can be obtained from the differential form of the law. The latter is valid even when the bulk temperature and concentration vary with time, which makes it possible to apply the solution directly to multiparticle systems such as packed-bed, moving-bed and fluidized-bed reactors.     

The law of additive reaction times in fluid-solid reactions

A law governing the rate of reaction of a solid particle with a fluid is proposed and verified for a wide range of systems. It is exact for the reaction of a nonporous solid and is a useful approximation in the case of a porous solid. The law states that the time required to attain a certain conversion is the sum of the time required to reach the same conversion in the absence of resistance due to the intrapellet diffusion of fluid reactant and the time required to reach the same conversion under the control of the intrapellet diffusion. The limitations are that the solid should be isothermal, the intrinsic kinetics should be at least approximately of first order with respect to the concentration of fluid reactant, and the effective diffusivity should remain unchanged during the reaction. Furthermore, with the appropriate definition of the fluid-solid reaction modulus, numerical criteria for asymptotic regimes of chemical reaction and diffusion controls have been shown to remain identical for all systems considered. The law is valid not only in an integral (conversionvs time) form but also in a differential form: The rate of reaction at a certain conversion can be obtained from the differential form of the law. The latter is valid even when the bulk temperature and concentration vary with time, which makes it possible to apply the solution directly to multiparticle systems such as packed-bed, moving-bed and fluidized-bed reactors.     

Microcirculation and hemostasis in inflammatory processes. Modulation by administration of physiologic protease inhibitors as a therapeutic approach

BACKGROUND: The course of an inflammatory process is based upon complex interactions between the vessel wall and the humoral or cellular compounds of the vascular content as a consequence of a defense reaction. There are no substantial differences between the pathophysiology of local or of whole body inflammation on the molecular and cellular level. Sepsis, which is clinically regarded as a systemic inflammatory process requires the broad therapeutical spectrum of nowaday intensive care medicine, but still has a high mortality. The pathophysiology and clinical examples for both systemic and local inflammatory reactions are presented in this paper. Thereby, similar interactions between the vascular endothelium, the mediator systems to which the hemostatic system has to be considered as a part of, and the microcirculation remain in the foreground at first. Based on that, the use of polyvalent protease inhibitors in the therapy of local or systemic inflammatory reactions of different origin will be discussed. The spotlight falls on physiological inhibitors of the hemostatic and complement system, antithrombin III and C1-esterase inhibitor, which may have a regulatory function within these systems because of their multiple targets. CONCLUSION: The possibility of an adjuvant therapy of local or generalized inflammatory processes with physiologic protease inhibitors seems to be very promising. Nevertheless, at yet the substantial mechanisms of action are not fully understood.     

Bilateral ruptured tubo-ovarian abscesses following bilateral tubal ligation several years earlier

The occurrence of pelvic inflammatory disease and tubo-ovarian abscesses previously has been regarded as essentially nonexistent in the patient who has undergone tubal sterilization, although there have been isolated reports in the literature. This case describes a patient who underwent tubal ligation approximately 6 years prior to presenting with bilateral ruptured tubo-ovarian abscesses. The patient underwent emergency surgery and had an uneventful recovery. Theoretically, although bilateral tubal ligation should preclude the development of pelvic inflammatory disease, it is a diagnosis that should be considered in the patient presenting with lower pelvic and abdominal pain.