Search

This primer focuses on the diagnosis and treatment of urticaria. All forms have in common the release of histamine with resultant pruritis. Causes include allergies, medications, infections, cold, heat, and pressure with many being defined as idiopathic. Most diagnoses require only a history and physical examination. Treatments normally include non-sedating antihistamines and avoidances but may require systemic steroids, H2 or leukotriene blockers, immunosuppressants, or anti-IgE therapy. While some forms are short lived, many are recurrent for years. Relief from the pruritis should be expected., (Copyright© South Dakota State Medical Association.)

Introduction: Allergic rhinitis (AR) impacts around 25% of the worldwide population. However, cost, safety, and a high dissatisfaction rate with numerous conventional medications continues to be an issue in the largest patient surveys, due primarily to a lack of efficacy on nasal congestion. Our previously published randomized trial demonstrated a significant reduction in cold and flu-like symptoms, and a secondary potential observation of a decrease in nasal congestion with an oral yeast-derived compound; therefore, the objective of this study was to test the effects of this same product on nasal congestion and other notable AR symptoms., Methods: A 12-week, randomized, double-blind, placebo-controlled clinical trial of 96 healthy subjects with a recent clinically documented history of seasonal allergies and AR was conducted. Participants received once-daily supplementation with 500 mg of a dried, modified Saccharomyces cerevisiae oral fermentation product (EpiCor, Embria Health Sciences, Ankeny, Iowa, USA) or placebo during the 12-week period of the highest recorded concentrations of total pollen counts for this Midwest geographic area. Clinical outcome measurements included in-clinic examinations, validated questionnaire and standard diary, and serologic analysis at baseline, 6 and 12 weeks., Results: During the highest pollen count period (weeks 1-6), EpiCor significantly reduced the mean severity of specific AR symptoms, including a significant reduction in nasal congestion (P=0.04), rhinorrhea (P=0.005), and a nonsignificant reduction in ocular discharge symptoms. A significantly (P=0.04) reduced total number of days with nasal congestion (12.5 fewer days) favored EpiCor compared with placebo, as did the nasal congestion section of the quality of life questionnaire (P=0.04). Subjects receiving the intervention also experienced significantly (P=0.03) higher salivary IgA levels. Adverse events were similar to placebo., Conclusion: This yeast-derived product appeared to be safe and efficacious, and should receive more clinical research with and without standard medications to reduce the impact of seasonal allergies, especially AR-induced nasal congestion.

Secondhand smoke (SHS) is commonplace in South Dakota. It is casually linked to an increased incidence and severity of childhood and adult asthma; lower respiratory tract infections; symptoms of cough, wheeze, phlegm; acute and chronic otitis media; sudden infant death syndrome; cancers; prematurity; and cardiovascular disease. At this time, the development of specific allergy cannot be causally linked. As there is no risk-free level of secondhand smoke, tobacco smoking cessation is the only effective treatment and should be actively pursued at every opportunity.

Latex allergy has become a major problem nationally and in South Dakota. It manifests itself with a range of presentations including anaphylaxis, asthma, allergic rhinitis, and contact urticaria. This is an immunoglobulin E mediated disease. Healthcare workers, spina bifida patients, and others with a high exposure to latex are at the greatest risk of developing this allergy. In South Dakota, 1,170 healthcare workers are likely afflicted. Diagnosis is mainly by a history of symptoms with exposure. Confirmatory allergy testing is now available. Avoidance of latex products is essential and is the main treatment. This predominantly will involve the patient, co-workers and healthcare providers using non-latex gloves. Patients must be identified in their records and with MedicAlerts. As do patients with other allergies, they may also need medical care involving epinephrine, bronchodilators, corticosteroids and antihistamines. Physicians have a dual role in latex allergy--recognizing it in patients and, potentially, being patients themselves.

To determine the quantity, variability, and mean aerodynamic diameter of latex aeroallergens in a large medical center, we collected air samples from work sites by using area and personal breathing zone air samplers, and we measured latex allergens by an inhibition assay with IgE antibodies from latex-sensitive individuals. Latex aeroallergen concentrations in 11 areas where powdered latex gloves were frequently used ranged from 13 to 208 ng/m3, and in areas where powdered latex gloves were never or seldom used, concentrations ranged from 0.3 to 1.8 ng/m3. Installation and use of a laminar flow glove changing station in one work area did not reduce latex aeroallergen levels. Large quantities of allergen were recovered from used laboratory coats and anesthesia scrub suits and from laboratory surfaces. Latex allergen concentrations in personal breathing zone samplers worn by health care workers in areas where powdered gloves were frequently used ranged from 8 to 974 ng/m3. Exposure likely occurs when gloves are changed and as a result of resuspension from reservoirs of powder in the room and clothing. Latex allergens were found in all particle sizes but were predominant in particles greater than 7 microns in mass median aerodynamic diameter. Results of electrophoretic immunoblotting showed that the aeroallergens are primarily the higher molecular mass components of the latex glove proteins. Measures to control exposure can be monitored by both area and personal air sampling with this immunochemical approach. Use of gloves with low allergen content or powder-free gloves appears to be more effective than use of a laminar flow glove changing station in reducing aeroallergen levels.

With the emergence of the acquired immunodeficiency syndrome (AIDS) epidemic and the practice of protecting health-care workers from all body fluids, the use of rubber gloves has increased, as has occupational allergy to latex among health-care workers. During 1991, 49 Mayo Medical Center employees sought assessment and treatment of rhinitis, conjunctivitis, contact urticaria, contact dermatitis, asthma, or eczema thought to be related to exposure to latex. Most of these persons had a history of atopy and worked in areas where rubber gloves were used and changed frequently. Of the 49 subjects, 34 had positive results of skin tests to latex products, and the sera from 19 of 35 persons tested contained increased latex-specific IgE antibodies. Employees with sensitivity to latex (and co-workers in the immediate areas) should use vinyl gloves and should notify their own health-care providers of their sensitization. Changes in job assignment may be necessary for some persons.

We investigated the incidence and types of liver biopsy complications in our first 160 consecutive liver transplantations. A significant complication was identified by the need for therapeutic intervention (for example, hospitalization, transfusion, intravenous fluids, chest tube, surgery or antibiotic therapy). A total of 950 percutaneous hepatic allograft biopsies were performed in 136 patients (mean = 6.9 biopsies/graft; range = 1 to 29). A significant complication was reported after 17 (1.8%) liver biopsies in 13 (9.6%) patients. Bleeding complications occurred in 11 patients and serious infection developed in 6 patients, but all patients recovered with appropriate therapy. Of special interest was that five of six patients with infectious complications had undergone Roux-en-Y choledochojejunostomy as part of the transplantation operation. The incidence of infectious complications related to a series of biopsies was significantly greater in patients who underwent choledochojejunostomy (12.5%) than in patients who underwent duct-to-duct biliary anastomosis (1%) (p less than 0.01). Furthermore, all septic events in patients who underwent choledochojejunostomy were related to enteric organisms. This investigation reaffirms the safety and low incidence of complications related to percutaneous liver biopsy even in this unique patient population. However, we did identify a subgroup of patients with biliary-enteric anastomoses who appear to be at increased risk of septic complications after liver biopsy. Antibiotic prophylaxis at the time of liver biopsy may be appropriate in this high-risk subgroup to decrease the frequency of infectious complications.