Current opinion in allergy and clinical immunology
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Both atopy and diseases from the spectrum of dermatitis and eczema are among the most frequent clinical problems worldwide; nevertheless, they are still poorly defined and too frequently misdiagnosed. In the present review, studies pertinent to this topic were systematized and critically assessed with particular attention to definitions of relevant diseases. ⋯ The interplay between atopy and diseases from the spectrum of dermatitis and eczema is not fully understood; nevertheless, their coexistence and overlapping are not rare. Therefore, every patient with eczema - regardless of age, sex or atopic status - should undergo an extensive diagnostic programme including each atopic eczema, irritant contact dermatitis, allergic contact dermatitis, and protein contact dermatitis. Better definitions and well designed studies are necessary to achieve detailed information on the complex relationships between each atopy, atopic eczema, and the three contact dermatitides.
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Mastocytosis in adults is associated with a history of anaphylaxis in 22-49%. In addition, monoclonal mast cell activation syndrome has been described presenting with anaphylaxis, especially in patients with hymenoptera venom anaphylaxis. Data on patients with drug hypersensitivity and mast cell diseases are scarce. ⋯ The association between immediate drug hypersensitivity and undetected mast cell diseases appears to be moderate, but nevertheless basal serum tryptase determination and examination for skin signs of mast cell disorders are recommended. An ongoing European multicenter study by the European Network for Drug Allergy will provide more information on this topic.
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Curr Opin Allergy Clin Immunol · Aug 2012
ReviewHypersensitivity reactions in the anesthesia setting/allergic reactions to anesthetics.
Immediate hypersensitivity reactions are an important cause for mortality and morbidity in anesthesia. The present review considers reports covering epidemiology, diagnosis, and treatment of these reactions. ⋯ Hypersensitivity reactions remain a major cause of concern in the perioperative setting. Although largely under-reported, their incidence is higher than previously reported. NMBAs remain the most frequently incriminated drug, followed by latex and antibiotics. The number of reactions involving new allergens like vital dyes or nonsteroidal anti-inflammatory drugs is rapidly increasing. The mechanism of sensitization to NMBAs could be influenced by as yet unidentified environmental factors. The possible role of pholcodine is under investigation. Several guidelines concerning the diagnosis and management of immediate hypersensitivity reactions in anesthesia are now available.
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Egg allergy is one of the most common food allergies of childhood and no interventional therapy is currently approved by the Food and Drug Administration. Much recent research has focused on the safety, efficacy, and mechanism of oral immunotherapy (OIT) as a disease-modifying treatment. ⋯ Egg OIT is a promising modality for providing temporary protection from reactions caused by accidental egg exposure. However, the overall strength of the evidence in favor of egg OIT is limited by small sample sizes and the lack of controls, both of which are important considerations given the spontaneous resolution expected in egg allergy. More high-quality studies are necessary before egg OIT can be recommended as a viable treatment option.
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Bronchial thermoplasty, which involves the delivery of radio frequency energy to the airways to reduce airway smooth muscle mass, has been recently introduced for the treatment of severe asthma. This review summarizes the preclinical development, efficacy and adverse effects of bronchial thermoplasty. In addition, the potential mechanisms of action and place in management of severe asthma are discussed. ⋯ Bronchial thermoplasty has a role in the management of patients with severe asthma who have uncontrolled symptoms despite current therapies. Future studies need to identify factors that predict a beneficial clinical response.