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Background: Allergy to Anisakis simplex (s.) is spreading due to the increased consumption of raw, smoked or marinated fish. In man, Anisakis s. can directly attack the gastrointestinal mucosa, provoking a parasitosis known as anisakiasis, or giving rise to the formation of IgE and, finally, inducing IgE-mediated reactions like urticaria, angioedema and anaphylactic shock. During recent years, a dietary approach to Anisakis s. infestation has also been addressed., Methods: A total of 620 patients with urticaria, angioedema, or both and a history of anaphylaxis following consumption of raw, smoked or marinated fish were recruited, evaluated for specific IgE levels to Anisakis s. and subjected to Skin Prick test. Following 18 month fish-free diet, patients were reevaluated at 6, 12 and 18 months, respectively. Patients undergoing diet were selected among those who had a clinical history with multiple accesses to first aid., Results: After 6-month fish-free diet, we recorded an improvement of symptoms and a remarkable reduction of specific IgE levels. The extension of the diet over 6 months in some cases resulted in a further reduction of specific IgE levels., Conclusion: Data obtained confirm the importance of a fish-free diet in patients with severe symptoms since a new antigenic exposure coincides with a relapse of symptoms and increased IgE levels. This last point should be kept in mind and carefully evaluated in patients at risk for anaphylaxis or angioedema., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Catamenial or cyclical anaphylaxis is a complex clinical syndrome with poorly reported incidence and prevalence in the literature review. The underlying mechanism is still a myth although a few proposed hypotheses are stated. Early recognition of these symptoms will bring optimal treatment and prevent unnecessary intubation and complications. Here, we present a 48-year-old woman without significant medical and family history with recurrent angioedema in the setting of catamenial anaphylaxis or cyclical anaphylaxis in the setting of progesterone hypersensitivity., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives/hypothesis: To evaluate the etiology and risk factors for severe manifestation and recurrent episodes of angioedema; to evaluate efficacy of short-term and long-term management strategies for angioedema among a high-risk population., Study Design: Institutional review board-approved retrospective review of a large, urban population., Methods: Data from 875 adult patients treated from January 2008 to December 2013 with the diagnosis of angioedema were obtained using the Clinical Looking Glass utility and review of medical records. Demographic and clinicopathologic risk factors were recorded. The major outcomes evaluated were hospital admission, need for airway intervention, and recurrent episodes of angioedema following the first presentation. Initial treatment strategy and follow-up recommendations were also recorded., Results: The most common cause of angioedema was angiotensin converting enzyme inhibitor (ACEi)-induced (496 [56.6%]). Significant risk factors for severe cases of angioedema included older age, Hispanic race, ACEi-induced angioedema type, American Society of Anesthesiologists class III or above, coexistent cardiopulmonary disease, and a positive smoking history. A total of 17.2% of patients experienced recurrent attacks of angioedema; of those patients, 25.9% were still taking an ACEi at subsequent presentation. Risk factors for recurrent episodes included older age, idiopathic angioedema type, and coexistent cardiopulmonary disease. Only 54.1% of patients who experienced ACEi-induced angioedema had electronic medical record documentation of these allergies., Conclusions: Knowledge of risk factors for severe and recurrent episodes of angioedema and improved education for both healthcare providers and patients, specifically related to ACEi use and allergy documentation, may significantly decrease the burden and morbidity of angioedema among high risk populations., Level of Evidence: 2b., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Soft tissue infections and angioedema from insect bites and stings may be difficult to differentiate by inspection. We present sonographic findings of 4 cases of soft tissue swelling from insect bites and stings suggestive of angioedema. Sonographic features of soft tissue angioedema consist of thickened subcutaneous tissue layers with multiple linear, horizontal, striated, and hypoechoic lines following the tissue planes between soft tissue layers. In addition to the history and physical examination, sonographic findings may assist in differentiating between local allergic reactions and cellulitis in patients with insect bites and stings. Further study is warranted for clinical application., (© 2014 by the American Institute of Ultrasound in Medicine.)

Background: There has been no separate study investigating angioedema without urticaria (Aw/oU) exclusively in children so far. The purpose of this study was to investigate the frequency, clinical presentation, etiology, management and follow-up of Aw/oU in children., Methods: This is a prospective study that included all consecutive patients with a history of Aw/oU referred to our clinic between January 2011 and May 2012. A standard diagnostic and therapeutic algorithm was applied to all patients., Results: The frequency of Aw/oU was found to be 1.6% during the study period. An etiological factor could be found in only 45 patients (49%). The causes of Aw/oU were infection (21%), allergy (14%), thyroid autoimmunity (TA)-related (8%) and nonsteroid anti-inflammatory drug hypersensitivity (6%), and idiopathic angioedema (51%). There was no hereditary type I, II or acquired type of angioedema or rare syndromes associated with Aw/oU. The median follow-up was 16 months (range: 12-30 months). Antihistamine prophylaxis was initiated at therapeutic doses in 20 patients with frequently recurrent angioedema due to idiopathic and euthyroid TA-related Aw/oU for 3 months. These patients responded to antihistamine prophylaxis for 3 months. Four patients relapsed after cessation of prophylaxis at the end of 3 months. Antihistamine prophylaxis was prolonged to 6 months in three patients and to 9 months in one patient., Conclusions: Angioedema without urticaria in children is a rare condition and no etiology can be identified in half of them. Antihistamine treatment alone is sufficient, and prognosis is good in recurrent non hereditary cases in a short-term follow-up period., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Hypersensitivity or allergic reactions can occur after transfusion of any kind of blood products. They represent the second or third causes adverse events related to labile blood product administration. This review summarizes their physiopathology, and the current guidelines regarding their diagnosis and treatment., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

A rare case of sudden fatal anaphylactic shock is described in a 50 year-old woman after secondary lidocaine blockade to relieve lumbar pain (the first blockade was performed 4 days before by the same physician after the negative skin test). The patient had the history of multiple allergic reactions to drugs, pollen, home dust, and citrus fruits (repeated Quincke's oedema). In the preceding period, lidocaine was several time administered without side effects during out-patient visits to a surgeon and dentist. The signs of anaphylactic shock appeared within 2 min after injection of 4 ml of 2% lidocaine solution (no other injections were made between the two blockades). Comprehensive emergency measures had no effect. The diagnosis was confirmed at autopsy; microscopic study of soft tissues revealed mast cell degranulation and characteristic changes in internal organs. A literature review of anaphylactic shock symptoms is presented. The fulminant development of this condition after lidocaine administration may be regarded as a fatal coincidence of circumstances that could not be foreseen by the physician. Caution is needed when prescribing medications to polyallergic patients.

Angioedema indicates acute subcutaneous edema that characterizes improperly restricted cutaneous or mucous membrane swelling, which can occur only once or be relapsing. Edema usually occurs in the periorbital area, lips, tongue, extremities and intestinal wall. It has turned out that angioedema is usually caused by the use of angiotensin-converting enzyme inhibitors (ACE) or allergies to certain allergens (allergic or IgE-mediated angioedema), followed by C1 inhibitor deficiency (hereditary and acquired angioedema), or the cause is unknown (idiopathic angioedema). It has been shown that patients with angioedema often have urticaria, which is noted in approximately 50% of cases. Usually there is a type I allergic reaction to some food allergens or drugs or insect stings. The most common causes of allergic angioedema are bee and wasp stings, reactions to medications or injections for sensitivity testing, and certain foods (especially eggs, shellfish and nuts). In diagnostic terms, it is important to determine the potential allergen, which is commonly performed with cutaneous tests, such as prick test, etc. The main risk of angioedema is swelling of the tongue, larynx and trachea, which can lead to airway obstruction and death, therefore tracheotomy is indicated in such cases. The initial treatment of patients with most forms of angioedema included administration of antihistamines and glucocorticoids, while epinephrine is given if there is fear from laryngeal edema.

A 67-year-old male patient twice developed severe angioedema after enjoying a meal and an after-dinner snuff. The cause for these allergic reactions was a type I allergy to tobacco contained in the snuff. In addition to positive prick tests to tobacco, specific serum IgE antibodies (CAP-FEIA) to snuff were found, while prick tests and RASTs for suspected foods were negative. Tobacco belongs to the family Solanaceae which includes tomatoes and potatoes and comes from South America. Whenever allergic reactions together with tobacco snuff use occur, a possible type I allergy should be considered and investigated.

Allergy is quite frequent and ENT syptoms are usually the visible part of a general disease. Questioning remains the most important part of the enquiry for clinical examination is usually poor if notdesapointing. Biological testings detailed in this paper may be of some help; In Africa, test-treatements using cheap and unharmfull drugs give often the best evidence of allergy. Seldom, ENT allergy may be or become life-threatening. Its detection and appropiate actions are briefly mentioned.

Candida is presented. Systemic immunotherapy with a Tricophyton/Candida vaccin was completely cleared the urticaria/angioedema and decreased specific IgE from more than 100 KUA/I to 7.6 to Tricophyton and from 4.5 KUA/I to 0.7 KUA to Candida after immunotherapy.

Urticaria, angioedema and anaphylaxis are life threatening skin diseases. Allergological emergencies are common; drugs, food, food ingredients/additives, insects, and many other factors have been reported to elicit anaphylactic reactions. The severity of symptoms ranges from pruritus to generalized skin eruptions, gastrointestinal, bronchial problems to systemic anaphylaxis and cardiovascular emergencies. The pathomechanisms and treatment of urticarias, angioedema and anaphylaxis are described. In some situations emergency kit: antihistamines, steroids, betamimetics and adrenaline is needed. Familiarity with the early diagnosis and correct management should be acknowledegable for dermatologists to recognize these allergic reactions and must be prepared to administer emergency kit.

The author believes that allergy plays an important role in the field of laryngology. Not every patient has significant allergic problems, but the allergic factor in laryngeal problems should not be underestimated. The insights and technology for research have never been better. Many cause-and-effect relationships have been suggested and often provide the working basis for current therapeutics. Many current models of operation need to be verified, explored further, and modified through research. It is hoped that new technologies will achieve a higher degree of sensitivity without sacrificing specificity. Better specificity is particularly needed in allergy testing and in testing thyroid and pulmonary function. The author hopes that the contemporary laryngologist/otolaryngologist will use this overview to formulate a complete and orderly approach to laryngeal problems. Because of the complexity of laryngeal problems, referral to other specialists may be necessary. The laryngologist, however, should be able to orchestrate the appropriate use of technologies and health care specialists to address these problems.

Allergic and pseudo-allergic reactions to vaccines frequently involve the skin, and can be generalized systemic symptoms (urticaria/angioedema, serum sickness, flares of eczema) or localized at the sites of vaccination (persistent nodules, abcesses, granulomas). Diagnosis of Arthus-type reactions is based on clinical history and specific IgM/IgG anti-toxoid determination. For other local reactions, diagnostic value of non-immediate responses in skin tests varies with clinical symptoms and substances involved. Immediate responses in skin tests and specific IgE determination have good diagnostic and/or predictive value in anaphylaxis and immediate/accelerated urticaria/angioedema to toxoid-, pneumococcus-, and egg- and gelatin-containing vaccines. Diagnosis of reactions to dextran in BCG is based on specific IgM/IgG determination. Most non-immediate generalized reactions result from non-specific inflammation, except for gelatin-containing vaccines, but the diagnostic value of immuno-allergological tests with the vaccines and gelatin are controversial. Withholding booster injections is advised if specific IgM/IgG levels are high. If the levels are low, sequential injections of vaccines containing a single vaccinating agent are usually tolerated. However, injections of the vaccine should be performed using a " desensitization " procedure in patients reporting anaphylaxis and immediate/accelerated urticaria/angioedema.

Urticaria, a clinically distressing disorder, is dermal oedema resulting from vascular dilatation and leakage of fluid into surrounding tissue, often in response to histamine (and other mediators) released from mast cells. A clear history of events surrounding the onset, together with laboratory investigations, in some cases allows us to find a cause and eliminate it.

Background: Skin testing is a common diagnostic tool in allergy. It is considered a safe procedure, although systemic reactions have been reported., Objective: To identify the systemic reaction rates of allergy skin tests and to determine the clinical outcome of such reactions., Method: This retrospective study used a computerized database at the Mayo Clinic to identify patients who developed systemic reactions to skin tests. Altogether 497,656 skin tests were performed on 18,311 patients from January 1992 to June 1997. Skin puncture tests were performed on 16,505 patients. Skin puncture and intradermal skin tests were performed on 1,806 patients. Systemic reactions were evaluated and treated by physicians., Results: There were 6 systemic reactions, an overall rate of 33 systemic reactions per 100,000 skin tests. All six patients had asthma. The systemic reaction rates for latex skin testing was 152 or 228 reactions per 100,000 latex skin tests, to penicillin and antibiotics 72 reactions per 100,000 penicillin and antibiotics skin tests, and to aeroallergens 15 or 23 reactions per 100,000 aeroallergen skin tests. The systemic reaction rate for skin puncture test was 30 reactions per 100,000 skin puncture tests, for skin puncture and intradermal skin tests, the rate was 55 reactions per 100,000 skin puncture and intradermal skin tests. All 6 patients were treated and dismissed within 1 hour after treatment., Conclusion: The systemic reaction rate to skin tests was very low. Systemic reactions were mild and all patients recovered fully within 1 hour.

Described in the article are particular characteristics of allergoses encountered in patients with different forms of diphtheria. Allergic reactions were found to be presenting as anaphylactic shock urticaria and Quincke's edema type. The studies made showed that allergic reactions in treatment of patients with diphtherial infection develop on relatively rare occasions but they should be examined in a more thorough way.

Background: Anaphylactic reactions after consumption of snails by patients sensitized to house-dust mites have been reported several times., Case Report: Two 8- and 10-year old children sensitized to house-dust mites developed Quincke's oedema after eating snails. Immunoallergologic investigations including pricks-test, labial test, IgE Rast confirmed associated allergy between snails and house dust mites., Conclusion: Considering the potential severity of anaphylactic reactions, it is necessary to warn children allergic to house dust mites and their parents about the high risk of associated allergy with snails.

We report the case of a 39-year-old asthmatic patient who developed acute rhinoconjunctivitis, Quincke's edema, and asthma after repeated exposure to a raccoon (Procyon lotor) which a friend kept at home. Skin prick and scratch tests with native raccoon hair and epithelium, as well as RAST, were clearly positive. Elimination of contact with the raccoon and avoiding the home of his friend led to a cessation of the patient's acute exacerbations.

Fifty-seven children aged 1 to 14 years with pseudoallergic reactions were followed up. The reactions manifested in the form of eczema, neurodermatitis, urticaria, and Quincke's edema. All the patients showed different pathology associated with the above-indicated skin reactions. The infants presented with the hypertensive hydrocephalic syndrome whereas the elder children with vegetovascular dystonia, biliary and gastrointestinal diseases. The treatment of the revealed pathological process, that included administration of histaglobulin or zaditen, brought about well-defined positive clinical changes.

Since the more frequent use of highly permeable membranes and bicarbonate dialysate, hypersensitivity reactions are more often described during hemodialysis and raise the question of the entry of pyrogens from dialysate towards blood due to high permeability of membranes and to possible backfiltration. During dialysis sessions with such membranes, authors observed a severe collapse in a patient on bicarbonate fluid and a repeated Quincke's edema in another on acetate fluid. After exclusion of other causes of such hypersensitivity accidents, they discuss the role of bacterial contamination of dialysis fluid. They analyse the phenomenons of bidirectional high permeability and of backfiltration linked to these new membranes. They recall the different causes of dialysate contamination and give some means of avoiding these inconveniences which expose on one hand to acute severe reactions and on the other are prejudicial in the long term for the patients because of interleukin 1 production.

To detect the frequency of Giardia lamblia association with certain allergic syndromes as well as the most frequent allergens involved in this association, allergologic and parasitologic investigations were carried out in 434 patients with chronic urticaria, Quincke's edema, urticaria + Quincke's edema or urticaria + bronchial asthma. The greatest frequency of Giardia lamblia (62%), detected in chronic urticaria associated with Quincke's edema, was three times higher than the maximum percentages reported in Romania for the adult population. In the patients with an allergic syndrome and Giardia, the most frequently involved allergens were the microbial ones (Colibacillus, Staphylococcus) and the food proteins (especially pork). The intensely positive skin tests to histamine in very high dilutions, constantly obtained in the association allergic syndrome + Giardia, may be almost sure indication of infestation with this parasite.

We report of the case of a young woman with three hospitalizations and six emergency room visits for treatment of bronchospasm and angioedema first thought to be the result of Hymenoptera venom allergic reactions. Because several features of her illness were not consistent with the usual course of Hymenoptera anaphylaxis and because of a known history of anaphylactic-type reactions following aspirin ingestion, a presumptive diagnosis of factitious anaphylaxis was considered, the medical staff was alerted to evaluate this possibility, and the diagnosis was established. Serologic testing supported the diagnosis. This variant of Munchausen's syndrome is a third type described as an allergic emergency. The others are peanut anaphylaxis and self-induced laryngeal stridor.

A case of an anaphylactic type of allergy is reported with pruritus, mucosal edema, asthma and shock symptoms which developed in a 26 year old female against her husbands sperma fluid. Symptoms and test results are compared with those of six other published cases. Results of skin tests obtained with a fraction of sperma plasma separated by chromatography are indicating that the antigen is of protein nature with a molecular weight of about 14.100. A molecular weight between 12.400 and 24.00 has also been reported in the literature.