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The entity 'sick building syndrome' is poorly defined and comprises of a set of symptoms resulting from environmental exposure to a work or a living environment. The symptoms are mainly "allergic"-like and include nasal, eye, and mucous membrane irritation, dry skin as well as respiratory symptoms and general symptoms such as fatigue, lethargy, headaches and fever. The Autoimmune [Auto-inflammatory] Syndrome Induced by Adjuvants (ASIA) is a wider term which describes the role of various environmental factors in the pathogenesis of immune mediated diseases. Factors entailing an immune adjuvant activity such as infectious agents, silicone, aluminium salts and others were found in association with defined and non-defined immune mediated diseases. The sick building syndrome and ASIA share a similar complex of signs and symptoms and probably the same immunological mechanisms which further support a common denominator.

Drug hypersensitivity is an adverse reaction that was brought-about by a specific immunologic response. Some of these reactions are Linked with significant morbidity and mortality. Nowadays, hypersensitivity reactions to most drugs can be well defined and the risk of re-exposure to the culprit drug and/or related drugs can be properly assessed. Medical history, skin, blood and challenge tests, conducted in an allergy clinic, enable the prediction and prevention of repeated events as well as unnecessary avoidance of needed compounds. Non-steroidal anti-inflammatory drugs [NSAID] are the second most prevalent group of drugs that provoke hypersensitivity responses occurring either immediately or later. Immediate type responses to NSAID could be divided into 2 groups, each related to a different mechanism. The most common reaction is not allergic but rather it is mediated by the inhibition of the cyclooxygenase I enzyme pathway. Accordingly, this reaction is not selective to a single chemical compound but rather cross-reacts with other members of this "family" of drugs, depending on their biochemical properties. The clinical distinction between those two subtypes of immediate reaction is hard and sometimes utterly impossible. Moreover, the clinical appearance of an immediate reaction may vary from rhinitis, asthma, new appearance or augmentation of chronic urticaria and up to overt anaphylaxis and death. Furthermore, delayed type reactions may also be life-threatening and typically appear 24 hours and up to days following initiation of therapy. In the current review, we present the recommendations of the Israel Association for Allergy and Clinical Immunology for the evaluation and treatment of patients suspected to suffer from hypersensitivity to NSAIDs.

Drug hypersensitivity is an adverse reaction that was brought about by a specific immunologic response, not related to the pharmacological components of the drug. Additionally, drug related pseudoallergic and anaphylactoid reactions have been encompassed under the umbrella of hypersensitivity. Some of these reactions are linked with significant morbidity and mortality. Nowadays, the hypersensitivity reactions of most drugs can be well defined and recurrence risk following exposure to the culprit drug and/or related drugs can be assessed. Medical history skin, blood and challenge tests, conducted in an allergy clinic, enable prediction and prevention of repeated events as well as unnecessary avoidance of certain compounds. For instance, most patients who report a prior reaction to penicillin are not allergic to beta-lactams upon allergic evaluation, while avoidance of penicillin based on self-reporting alone often leads to the use of an alternate antibiotic with greater cost or side effect profile. On the other hand, for patients who previously exhibited hypersensitivity to a compound which is currently required, premedication or a desensitization protocol can be recommended to allow the use of this compound. Drug hypersensitivity is most commonly attributed to beta-lactams antibiotics, contrast media reagents and non-steroidal anti-inflammatory drugs (NSAID). Hence, in the current review the recommendations of the Israeli Association for Allergy and Clinical Immunology for the evaluation and treatment of patients suspected to have hypersensitivity to beta-lactams and contrast media reagents are detailed. Recommendations regarding the evaluation of NSAID hypersensitivity will be published on the IMA website, together with those explicated herein.

Chronic rhinitis (CR) affects large populations worldwide, diagnosed in 40% of the population and is often associated with co-morbidities, such as asthma, sinusitis, rhinoconjunctivitis cognitive dysfunction, and leads to loss of work and school days. Recently, global clinical guidelines were proposed for allergic rhinitis (AR). Similarly, an Israeli expert panel, consisting of ENT and Allergy/Immunology specialists, was delegated to discuss the current approaches to CR (including allergic and non-allergic rhinitis) and to submit a consensus paper. The guidelines, briefly presented herein, describe the epidemiology, mechanisms, diagnostic procedures, treatment modalities and clinical-management algorithms. It is adapted to the Israeli health system and will be distributed to all physicians by the Israel Medical Association. The new clinical guidelines are expected to update current knowledge, improve communication between medical disciplines, provide medico-legal support and improve the management of CR.

Sarcoidosis is a systemic granulomatous disease which predominantly involves the lungs. Monoclonal gammopathy of undetermined significance (MGUS) characterized by clonal proliferation of plasma cells, can develop into multiple myeloma at a later stage. Although the cause of sarcoidosis remains unknown, the most likely etiology relates to chronic stimulation of the immune system that may result in polyclonal B cell proliferation. In some patients this polyclonal proliferation may develop into a monoclonal B-cell proliferation and induce the appearance of monoclonal gammopathy. In this article, a possible linkage between sarcoidosis and MGUS is raised, based on the case study of a 67-year-old woman and a review of the literature.

Combination antiretroviral therapy (HAART) restores protective immune response and reduces morbidity and mortality in human immunodeficiency virus (HIV) infected patients, however this life-long therapy withholds many complications. In a subset of patients' immune reconstitution, after initiation of therapy, it is associated with a pathological inflammatory response leading to a paradoxical short term morbidity and even mortality, defined as the immune reconstitution inflammatory syndrome (IRIS). IRIS presents as clinical deterioration caused by restoration of the capacity to mount an inflammatory response against infectious and non-infections antigens. The inflammatory response can result in a spectrum of presentations ranging from mimicking acute infection to worsening of a treated opportunistic infection, malignant diseases or even an autoimmune disease. The mechanisms of IRIS remains to be evaluated, however in many cases redistribution of memory T cells can be demonstrated. Currently there are no laboratory tests or accepted criteria for the diagnosis of IRIS, which remains a diagnosis of exclusion. Recently, numerous groups have published studies regarding incidence, timing of onset, risk factors and therapy options for IRIS. This large resource of evidence may enable physicians to diagnose and treat patients more accurately. A consistent finding from different studies is that IRIS develops in a substantial percentage of HIV-infected patients receiving HAART. As the use of HAART increases worldwide, the care for patients receiving HAART will need to incorporate monitoring for and treating complications of IRIS.