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Background: Sensitization to common ragweed (Ambrosia artemisiifolia) is associated with a variety of risk factors, which are incompletely defined. Our aim was to evaluate the association of a variety of clinical, geographical and demographical variables with ragweed sensitization and also to determine its frequency in southern Bavaria. Methods: In this cross-sectional multicentre study, we enrolled 977 patients with a documented or suspected atopic disease or food allergy. Data were collected on aeroallergen sensitization, age, sex, type and history of allergic disease, place of residence and potential local ragweed exposure. For this last variable, county ragweed cover was taken as a surrogate variable. Relative rates were calculated with multiple additive logistic regression models. Randomly selected patients with ragweed sensitization had a conjunctival provocation test. Results: According to skin prick tests, 190 patients (19.5%) were sensitized to ragweed. The frequency of this finding increased significantly with a rising number of additional sensitizations. Other less important predictors for a ragweed sensitization were male gender, mugwort sensitization, food allergy and a maximum of complaints in September or October. County of residence, extent of local ragweed cover or type of residential area were without relevance. Of 48 sensitized patients, 26 (54.2%) had a positive conjunctival provocation test. Discussion: Patients with multiple sensitizations may be more readily sensitized to a new aeroallergen. Local geographic or environmental conditions are presumably of minor importance for becoming sensitized to ragweed. The frequency of ragweed allergy among sensitized patients might be high. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Despite their frequent use, systemic corticosteroids have rarely elicited immediate-type reactions. Objective: We report two male patients, aged 26 and 70 years, respectively, with severe immediate-type hypersensitivity secondary to the administration of corticosteroids esterified with succinate. Methods: Skin tests, basophil activation tests and challenge tests were performed for diagnostic evaluation. Results: In both patients, immediate-type skin test reactions were found to methylprednisolone sodium hemisuccinate (MSH) and prednisolone sodium hemisuccinate (PSH). In contrast, nonsuccinylated corticosteroids (including methylprednisolone and prednisolone in one patient) yielded no test reactions. Basophils from one patient exhibited a stimulated expression of the activation marker CD63 upon in vitro incubation with PSH or hydrocortisone sodium succinate, but not with hydrocortisone. Skin tests and basophil activation tests were negative in controls. One patient was challenged with the incriminated drugs. He developed flush, conjunctivitis, tachycardia and dyspnea 2 min after injection of MSH, and dyspnea shortly after intravenous administration of PSH. Oral and intravenous challenge tests with nonsuccinylated corticosteroids were tolerated well by both patients. Conclusions: These case reports should alert clinicians to rare, but severe immediate-type reactions to corticosteroids, related to the succinate moiety in our patients. In case of allergic reactions to corticosteroids, it is mandatory to identify the causative agent and find safe alternatives. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Severe anaphylaxis to honeybee or vespid stings is associated with a variety of risk factors, which are poorly defined. Objective: Our aim was to evaluate the association of baseline serum tryptase concentrations and other variables routinely recorded during patient evaluation with the frequency of past severe anaphylaxis after a field sting. Methods: In this observational multicenter study, we enrolled 962 patients with established bee or vespid venom allergy who had a systemic reaction after a field sting. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, and the number of preceding minor systemic reactions before the index field sting. A severe reaction was defined as anaphylactic shock, loss of consciousness, or cardiopulmonary arrest. The index sting was defined as the hitherto first, most severe systemic field-sting reaction. Relative rates were calculated with generalized additive models. Results: Two hundred six (21.4%) patients had a severe anaphylactic reaction after a field sting. The frequency of this event increased significantly with higher tryptase concentrations (nonlinear association). Other factors significantly associated with severe reactions after a field sting were vespid venom allergy, older age, male sex, angiotensin-converting enzyme inhibitor medication, and 1 or more preceding field stings with a less severe systemic reaction. Conclusion: In patients with honeybee or vespid venom allergy, baseline serum tryptase concentrations are associated with the risk for severe anaphylactic reactions. Preventive measures should include substitution of angiotensin-converting enzyme inhibitors. [Copyright &y& Elsevier]

There are very few reports on hypersensitivity reactions in association with titanium-based materials so that the existence of allergy to titanium is still put in question. We report on a patient in whom impaired fracture healing and eczema localized to the perioperative area developed upon titanium-based osteosynthesis. Patch testing gave no reactions to titanium nor to nickel, chromium, or cobalt. However, in the lymphocyte transformation test, the patient’s lymphocytes showed markedly enhanced proliferation in vitro to titanium. After removal of the titanium material, fracture healing was achieved and the eczema cleared. Parallel to this, in vitro hyperreactivity to titanium disappeared. Although contact allergic reactions to titanium have been very rarely reported, these findings support a diagnosis of titanium allergy in our patient. [ABSTRACT FROM AUTHOR]

Background: Immediate-type hypersensitivity to animal proteins is a common problem in people occupationally exposed to animals. Methods: A 19-year-old female working as a voluntary zookeeper in her off-time suffered from hives on her forearms following contact to the fur of a giraffe. For diagnostic evaluation, skin prick tests, assessment of specific serum IgE antibodies, and basophil activation tests were performed. Results: Skin prick tests with a standard series of common aeroallergens were positive for various pollens. Prick testing with native materials was positive for extracts of hair from two different giraffe subspecies in the patient, but not in control subjects. By CAP-FEIA, no specific serum IgE antibodies to dander of a large variety of animals were found in the patient. In the basophil activation test, expression of the activation marker CD63 was induced by extract of giraffe hair on the cells from the patient, but not on those from unaffected controls. Conclusions: This patient suffers from an ‘exotic’ immediate-type contact allergy to giraffe hair. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Discusses a study which assessed the extent to which peripheral blood mononuclear cells from nickel-allergic and from non-allergic individuals would proliferate in response to nickel stimulation in vitro. Manifestations of nickel contact allergy; Way in which delayed-type hypersensitivity to nickel is reflected; Methodology.

40 guinea pigs were sensitised with a 50% solution of 2,4-dinitro-1-chlorobenzene (DNCB) and challenged 14 days later with DNCB 0.05%. Four parameters were determined to evaluate the challenge reaction after 24, 48, 72 and 96 h: (a) intensity of erythema, (b) reaction area (product of the largest diameters of the reaction in vertical alignment), (c) increase in skinfold thickness and (d) reaction volume (product of the reaction area and the increase in skinfold thickness). The test reactions were read blind by 2 independent observers, yielding small but significant differences in all methods except determination of the reaction area. Further statistical analysis revealed a linear correlation between the intensity of erythema and the other 3 parameters determined, as welt as between the reaction area and the reaction volume. In contrast, the increase in skinfold thickness did not correlate linearly either with the reaction area or the reaction volume. When the results of the 24- and 48-h readings were compared, the characteristic crescendo reaction of contact allergy was demonstrable by all methods except the determination of the reaction area. After the 48-h reading, a continuous decrease of reactions was found with all methods. It is concluded that the determination of the reaction urea and consequently of the reaction volume are not suitable for exact measurement of epicutaneous allergic contact reactions in guinea pigs. The most precise results will be obtained by measuring the increase in skinfold thickness, whereas the determination of the intensity of erythema, which is easier to perform, may be sufficient for many purposes. Significant inter-individual variation of reading results obtained by different investigators is a critical factor in patch test studies in guinea pigs. [ABSTRACT FROM AUTHOR]

A standard patch test series was tested for 7 years (1917-1983) in a total of 11.962 patients. The annual frequency of positive reactions to the compounds tested was assessed for the total and for males and females separately. During the observation period, there were significant increases in positive reactions in the total group from 6.2% to 127% For nickel sulphate. from 5.3% lo 7.0% for balsam of Peru and from 3.8% to 6.5% for potassium dichromate, reflecting significant changes in both sexes. The frequency of positive reactions to wool alcohols. formaldehyde, neomycin sulphate, paraben mix and gentamycin sulphate significantly increased, while that of positive reactions to clioquinol, mercuric chloride and turpentine peroxide significantly decreased in either male or females. sometimes leading to significant changes in the total group. [ABSTRACT FROM AUTHOR]

There exists continuing controversy with respect to the spectrum of clinical manifestations of mercury allergy and to the clinical interpretation of patch test reactions to mercury compounds. A 20-year old woman presented with acute macular erythema on the face, neck and forearms, developing into eczema over the next few days. This reaction had developed, like 2 other eruptions in previous months, on handling powdery mercury chloride compounds during a laboratory exercise that was part of her university chemistry studies. She had not had any dental fillings nor been vaccinated in recent years. There was a past history of allergic rhinoconjunctivitis from cats and house dust.

Allergy to natural latex has become a major health problem. Individuals with an atopic diathesis and intense exposure to natural latex are particularly at risk for development of a sensitization to natural latex. Thus, allergy is frequent in certain occupational setting, especially among health-care workers, due to the use of rubber gloves, and among individuals producing articles containing natural latex, but also in patients with a history of repeated operations or frequent use of natural latex containing nursing articles.

In spite of the wide applications of dexpanthenol, contact allergy seems to be rare and has seldom been reported. A 33-year old woman with post-thrombotic syndrome since her second pregnancy 13 years ago, was referred with extensive leg ulcers and stasis dermatatis on both legs. Skin grafting was performed due to the extension of the ulcers and additional conservative local treatment given. The autologous grafts from the thigh were well accepted. However, the skin around the ulcers and the donor site at the thigh showed persistent erythema, vesicles and oozing.

Anaphylactic IgE-mediated reactions to Hymenoptera stings vary in their severity for reasons that are not clear. We investigated patients with a history of systemic anaphylatic reactions to honeybee or wasp stings. Nine (75%) of 12 patients with raised tryptase concentrations but only 28 (28%) of 102 patients with lower tryptase concentrations, had a history of severe sting reactions (p=0.004). Raised baseline serum concentrations of mast-cell tryptase and mastocytosis are potential risk factors for severe allergic reactions to Hymenoptera venom. [ABSTRACT FROM AUTHOR]