Allergy and asthma proceedings :
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Real allergy to local anesthetic (LA) is very rare. This study was performed to report a case of anaphylaxis to multiple "caine." A 25-years-old atopic nurse developed a very severe anaphylactic reaction on her third infiltration for low back pain with bupivacaine, lidocaine, and methylprednisolone: she developed a vagal reaction, followed during the next 30 minutes by a pruriginous skin rash, followed by a tongue edema and a severe bronchospasm. Adrenalin was injected with a poor response. ⋯ She also complained of itchiness in the neck and shoulder, which resolved in the next 90 minutes. In the second session, a test with bupivacaine 0.0005% (group 2) gave a papule with a diameter of >5 mm, and a test with mepivacaine 0.001% (group 2) was negative: control, histamine, 3 mm; no subsequent tests with mepivacaine were done because she developed a cough and throat pruritus, voice modification, and a sensation of throat narrowing, that resolved with treatment. We reported a case of anaphylaxis to multiple LA (groups 1 and 2), possibly via an IgE-mediated mechanism.
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Allergy Asthma Proc · Jul 2007
Investigation of children with chronic nonspecific cough: any clinical benefit of bronchoscopy and bronchoalveolar lavage?
Chronic cough can be a complicated and frustrating diagnostic dilemma. The aim of this study was to identify the possible causes of chronic nonspecific cough in seemingly healthy children using fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). Eighteen children responded to criteria of selection for chronic cough. ⋯ In the HBN group, FOB showed endoscopic abnormalities in four patients, BAL culture was positive in three patients, and chest x-ray (CXRs) showed minimal densities in four. The IL-8 levels showed a significant increase with respect to the NBN group (p = 0.005). The combination of endoscopic anomalies, BAL culture, BAL IL-8 levels, and minor CXR changes can support the diagnosis of subclincal infection in seemingly healthy children with chronic nonspecific cough and HBN.
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This case illustrates a complexity of confounding and overlapping symptoms that can masquerade as another diagnosis. A 56-year-old African American man with persistent dyspnea and leg edema was hospitalized three times in a period of 6 months. ⋯ Complete clinical improvement was not observed. A careful review of his last admission and current admission clinical presentation and laboratory evaluation revealed a systemic manifestation and laboratory findings consistent with atypical systemic lupus erythematosus.
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Allergy Asthma Proc · May 2007
ReviewNot quite asthma: differential diagnosis of dyspnea, cough, and wheezing.
Every allergist will eventually encounter a patient who has a persistent cough, dyspnea, and wheezing, but few atopic references, and a limited response to conventional treatment. Is this asthma or something different? The conditions that are misleading can be fairly ordinary or they can be esoteric. This article reviews the characteristics of several of the more common, less common, and uncommon masqueraders of asthma, along with the differentiating features that can help physicians recognize them.
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Allergy Asthma Proc · Mar 2007
Multicenter Study Comparative StudyForced oscillometry is applicable to epidemiological settings to detect asthmatic children.
Forced oscillometry (FOT) has been reported as a simple method to detect respiratory resistance (Rrs) changes. The aim of this study was to evaluate FOT capacity to detect children with clinical characteristics of asthma in a school setting. One thousand thirty children, 6-7 years old, were investigated by questionnaire. ⋯ Prick test positivity and significant bronchoconstriction after exercise tests were significantly more frequent in group 1 than in group 2 (77% and 64% versus 8% and 12%, respectively; p < 0.001). In a school setting FOT changes after bronchodilator are able to detect airway obstruction in children with wheezing symptoms. Children with significant FOT variability present more significantly atopy and BHR and therefore more probable asthma.