Allergologia et immunopathologia
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The occurrence of allergic diseases depends on genetic and environmental factors. Genetic factors determine individual risk and these persons should undergo early detection. However, the methods currently available (mainly clinical history and IgE in umbilical cord blood) have poor predictive value so their use in the general population is not practical. ⋯ Therefore, several modes of action have been proposed, based mainly on prolonging breast-feeding (with the mother avoiding allergenic foods) and delaying the introduction of complementary foods considered to be a risk. Use of cow milk protein hydrolysates may have a preventive effect similar to that of breast-feeding, but their administration is not problem-free. The preventive effect of partial hydrolysates or soybean formulas is even more questionable.
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The prevalence of atopic dermatitis and other allergic diseases is increasing in industrialized countries. Today we know that atopy is conditioned genetically, but the development of the atopic phenotype requires environmental factors. It is believed that the genetic factors have not changed and that the increased prevalence is due to the increase in exposure to allergenic and non-specific environmental factors. ⋯ At present, pharmacological prevention is being studied, without overlooking environmental prevention, in children at high risk of atopic disease for the purpose of preventing chronic inflammations that will condition their future as adults. In our daily clinical experience, atopic dermatitis is responsible for 8% of visits to a pediatric allergology unit. We emphasize that 62.5% of our patients with dermatitis are referred when they already have bronchial asthma, which represents an important delay in diagnosis with respect to the onset of symptoms.
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Allergol Immunopathol (Madr) · Jan 1984
ReviewDiagnostic and predictive test procedures in patients with life-threatening anaphylactic and anaphylactoid drug reactions.
The main objective of the paper is to discuss the methods by which the severe anaphylactic and anaphylactoid reactions to drugs can be detected and mechanism of the abnormal response studied. Three main groups of drugs are discussed: Beta lactams antibiotics, anaesthetics and anaesthetic, adjuvants, and iodinated radiocontrast media. The principles of reaction, mechanisms and tests are discussed, and results of skin and in vitro blood tests compared.
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"Immunopharmacology" evolved as a field of research in its own right when it was appreciated that pharmacological methods can contribute to the understanding of immune mechanisms on the one hand or can be used to influence or even control immune reactions at all stages and levels. The best studied subjects of immunopharmacology are release and effects of the chemical mediator substances which are responsible for the reactions of effector cells thus causing the clinical symptoms in allergic or inflammatory diseases. In the type I allergic (anaphylactic) reactions the primary target cells are tissue mast cells or basophil granulocytes which discharge their granular contents upon interaction of immunoglobulin E fixed to their surface with the specific antigen or--in the anaphylactoid reaction--upon stimulation with an appropriate chemical substance (so-called histamine-liberator). ⋯ In those mainly cytotoxic effects of lipases and hydrolases are involved. cAMP active agents have, therefore, only limited modulating effects and steroid hormones are more effective in inhibiting the acute lesions in type II and III allergies. Only during the last decade the involvement of chemical mediators in type IV (cellular immunity) allergic reactions has been appreciated. 26 different factors called lymphokines have been discovered and classified as mediators of cellular immune reactions. However, rather little is yet known about their chemical nature and about the influence of drugs on their production or action.