Current allergy and asthma reports
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Although most food-allergic reactions occur after ingestion of nonpackaged food products, the food industry has been subjected to increasing scrutiny of their allergen controls; the resulting impact on the industry has been remarkable. Undeclared food allergens have been responsible for many food product recalls during the past 13 years, and the food industry has made significant investment, effort, and improvements in allergen control during this time. ⋯ Labeling initiatives have been pursued to make ingredient listings more easily understood by food-allergic consumers, but further improvements could still be made. Additional research to determine eliciting doses for allergenic foods is needed to enable science-based risk assessment and risk management.
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Whether we are hiking in the back country or playing in our backyard, we run the risk of exposure to offending arthropods. Papular urticaria is a very common hypersensitivity reaction to the bites, stings, and contact with critters such as mites, ticks, spiders, fleas, mosquitoes, midges, flies, and even caterpillars. Children seem to be at greatest risk, although adults are also vulnerable. ⋯ Severity is often related to the host response to the salivary or contactant proteins. Our understanding of the immune mechanism continues to improve; however, our approach to therapy has remained essentially unchanged. Although this review admittedly reaches beyond papular urticaria, it is with the intention of improving the reader's recognition of the offending arthropods, the characteristics of reactions, and the current therapeutic approaches.
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Epinephrine is the cornerstone of anaphylaxis management. Its administration should be immediate upon evidence of the occurrence of anaphylaxis. ⋯ Patients with known anaphylactic reactivity should be prescribed an epinephrine auto-injector to be carried at all times for treatment of potential recurrences. Education of the patient or parent regarding the proper use of this tool is paramount.
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Fungal rhinosinusitis presents in five clinicopathologic forms, each with distinct diagnostic criteria, treatment, and prognosis. The invasive forms are acute fulminant, chronic, and granulomatous ("indolent") invasive fungal sinusitis. The noninvasive forms are fungal ball ("sinus mycetoma") and allergic fungal sinusitis (AFS). ⋯ Treatment requires surgery and aggressive postoperative medical management with close follow-up. Medical treatment includes allergy medications, allergen immunotherapy, and in many cases the addition of oral corticosteroids. Although medical management clearly improves patient outcomes, more studies are needed because AFS recurrence rates remain high.