Immunology and allergy clinics of North America
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Anaphylactic reactions to neuromuscular blocking agents during general anesthesia constitute a major cause of concern and a great source of debate among anesthesiologists. The authors' recent investigations, taking the striking differences of incidence between Norway and Sweden as the point of departure, have provided valuable insights into the pathogenetic mechanisms and the highly uneven geographical distribution of these rare, but dramatic and notoriously unpredictable, events. ⋯ This new knowledge led to the withdrawal of the drug from the Norwegian market and to the examination of the role of pholcodine-containing drugs in other countries. The present article is a brief summary of the research behind this development.
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Mast cells are tissue-resident allergic effector cells that cause many symptoms associated with IgE-mediated immediate hypersensitivity reactions. Beginning with allergen-specific therapy over a century ago, biologics have been used to target mast cells in patients in order to reduce allergic symptoms and reactions. This review discusses the history and current outlook of the use of biologics in mast cell-associated diseases and reactions.
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Exhaled breath condensate (EBC) is a promising source of biomarkers of lung disease. EBC research and utility has increased substantially over the past 2 decades. This review summarizes many of the factors regarding the composition of EBC, its collection, and analysis for the utility of both clinicians and researchers.
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Immunol Allergy Clin North Am · Nov 2017
ReviewMonoclonal Antibodies Hypersensitivity: Prevalence and Management.
The use of monoclonal antibodies (mAbs) has become broader because of their recognized effectiveness in the treatment of autoimmune, neoplastic, and inflammatory diseases. Consequently, hypersensitivity reactions (HSR) secondary to mAbs are being reported more often, and each mAb-related HSR presents specific features. This article discusses the main biological agents and associated HSR, the clinical presentation of such reactions, and the role of tryptase and skin testing in the diagnosis. Rapid drug desensitization procedures to mAbs enable selected allergic patients to receive full therapeutic doses in a safe manner and are also discussed.
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Ten percent of patients report penicillin allergy, but more than 90% of these individuals can tolerate penicillins. Skin testing remains the optimal method for evaluation of possible IgE-mediated penicillin allergy and is recommended by professional societies, as the harms for alternative antibiotics include antimicrobial resistance, prolonged hospitalizations, readmissions, and increased costs. ⋯ There is minimal allergic cross-reactivity between penicillins and cephalosporins. IgE-mediated allergy to cephalosporins is usually side-chain specific and may warrant graded challenge with cephalosporins containing dissimilar R1 or R2 group side chains.