Immunology and allergy clinics of North America
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Immunol Allergy Clin North Am · Aug 2009
ReviewThe variable clinical picture of drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms in relation to the eliciting drug.
Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening adverse reaction characterized by skin rashes, fever, leukocytosis with eosinophilia or atypical lymphocytosis, lymph node enlargement, and liver or renal dysfunction. The syndrome develops 2 to 6 weeks after initiation of administration of a specific drug. It has been demonstrated that various herpesvirus reactivations, in addition to human herpesvirus 6, contribute to internal organ involvement and the relapse of symptoms observed long after discontinuation of the causative drugs. A better understanding of the interplay in the development of DIHS/DRESS has implications for safer and more efficient treatment of this syndrome.
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Immunol Allergy Clin North Am · Aug 2009
ReviewImmediate and delayed reactions to radiocontrast media: is there an allergic mechanism?
Radiocontrast media can cause immediate (1 hour) and nonimmediate (>1 hour) hypersensitivity reactions that remain unpredictable and a cause of concern for radiologists and cardiologists. Immediate hypersensitivity reactions resemble anaphylaxis, whereas nonimmediate ones clinically are predominated by exanthemas. ⋯ It may have an important role in the selection of a safe product in previous reactors, although validation data are still lacking. In vitro tests to search for contrast media-specific cell activation are currently under investigation.
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The epidemiology of asthma and outdoor air pollution has shown that respiratory health effects can vary in relation to different emission sources, types of pollutants, underlying nutritional status, medication use, and genetic polymorphisms. Using sophisticated exposure assessment methods in conjunction with clinical tests and biomarkers that provide mechanistic information, the study of outdoor epidemiology and asthma has evolved into a complex multidisciplinary field. This article presents an overview of the mechanisms by which outdoor air pollution and traffic-related emissions lead to changes in respiratory health and lung function in subjects with asthma.
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Exhaled nitric oxide (FENO) is a noninvasive easily measurable biomarker that is proving to be an excellent surrogate for eosinophilic inflammation in the lungs of patients who have asthma. Although large-scale normative data are still awaited, preliminary studies have shown FENO to be helpful in diagnosing and assessing severity and control for asthma. FENO levels have also proven helpful in diagnosing and managing several other inflammatory lung diseases.
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Acute eosinophilic pneumonia, chronic eosinophilia, Churg-Strauss syndrome, and the hypereosinophilic syndrome are pulmonary eosinophilic syndromes characterized by an increased number of eosinophils in peripheral blood, in lung tissue, in sputum, in bronchoalveolar lavage fluid, or in all of these. These pulmonary eosinophilic syndromes generally are characterized by increased respiratory symptoms, abnormal radiographic appearance, and the potential for systemic manifestations. It is critical to exclude other causes of eosinophilia in patients who have lung disease, to make a quick diagnosis, and to treat aggressively with corticosteroids and other therapies to prevent long-term sequelae.