Newswise — Investigators are presenting abstracts on preliminary findings in disease management for allergies to drugs, food, insect stings and other immunologic disorders at the ACAAI Annual Meeting, Nov. 12-17, in Boston. Following are highlights of some key investigations.
ANAPHYLAXIS
1:30 pm, Nov. 14: "The Recognition, Evaluation, and Treatment of Anaphylaxis in the Childcare Setting" (Abstract #11) " P.J. Bansal, Addison, Ill., et al. " This intervention program significantly increased childcare staff's ability to recognize, evaluate and treat anaphylaxis, prevalent in an estimated 6 percent of preschool children. The study included: an initial questionnaire completed by childcare center directors and teachers; followed by their participation in an allergy seminar on anaphylaxis avoidance, recognition, evaluation and treatment; and a post-seminar questionnaire. Before the seminar completion, only 24 percent of centers would administer EpiPen for a severe allergic reaction. Following the seminar, 77 percent of centers would administer the EpiPen, and staff also significantly improved their knowledge of typical allergy symptoms and of the correct method of EpiPen administration.
Noon " 1 pm, Nov. 13 & 14: "The Use of Injected Epinephrine by Emergency Medical Services (EMS) Following Passage of Senate Bill No. 213 by the Indiana Legislature" (Abstract #P33) " M. Holbreich, et al, Indianapolis, Ind. " A bill introduced to the Indiana Legislature by The Indiana Allergy Asthma and Immunology Society and the Emergency Medical Services Commission of Indiana took effect on July 1, 2003, permitting all first responders to administer injected epinephrine without restrictions. Once the legislation passed, it became the responsibility of the medical director of each ambulance service in the state to implement the change. Investigators found only 25 percent of them were unaware of the legislation. Among those that implemented changes, 52 percent permitted use by Basic EMTs only.
Noon " 1 pm, Nov. 13 & 14: "The Safety of Epinephrine in the Acute Treatment of Anaphylaxis" (Abstract #P40) " L. Posner, et al, Napa, Calif. " Epinephrine, the drug of choice for the treatment of anaphylaxis, is frequently underutilized. One possible reason is the fear of adverse cardiac effects. This retrospective analysis found that the administration of epinephrine is safe and effective for the treatment of acute anaphylaxis in an out-patient setting. Authors encourage its use to treat non-cardiac or elderly patients who have anaphylactic reactions.
DRUG HYPERSENSITIVITY
1:00 pm, Nov. 14: "Carboplatin Hypersensitivity: A 6-Hour 12-Step Protocol Effective in 35 Desensitizations in Patients with Gynecological Malignancies (Abstract #9, Clemens von Pirquet Award) " C. Lee, et al, Boston " The incidence of hypersensitivity reactions is increased in patients treated with multiple courses of carboplatin. Investigators demonstrate the safety and effectiveness of carboplatin desensitization through a 6-hour, 12-step protocol. The treatment allows patients who are sensitive to the life-saving drug to successfully complete their required therapy.
2:30 pm, Nov. 14: "Female Gender Maybe a Risk Factor for a Penicillin Allergy" (Abstract #15) " M.A. Park, et al, Rochester, Minn. " According to investigators, this is the first report showing that a greater risk for a positive skin test to penicillin exists in association with female gender. Of the 1,759 patients with a history of penicillin allergy who were skin tested for penicillin, 3.6 percent had a positive skin test. Of these, 83 percent were females and 17 percent were males. Authors conclude that further studies are needed to identify other possible confounding factors and/or mechanisms that can explain this risk.
Noon " 1 pm, Nov. 13 & 14: "Dilantin Hypersensitivity Syndrome" (Abstract #P42) " H. Yarmohammadi & A. Nowak-Wegrzyn, New York " Investigators present two cases of anticonvulsant hypersensitivity syndrome, a potentially fatal drug reaction. According to investigators, in most cases, the symptoms include fever, rash and lymphadenopathy are accompanied by multi organ-system abnormalities. Fatal outcomes are most often associated with liver failure. Recognition of the syndrome, which may have variable presentations, is the key to prompt discontinuation of the drug, close monitoring and management.
Noon " 1 pm, Nov. 13 & 14: "Case Report: Insulin Allergy in a Hospitalized 66 Y.O. Diabetic Female" (Abstract #P64) " R.K. Merchant, Kansas City, Kan. " Although past allergic reactions to insulin occurred more frequently with porcine and bovine preparations, recent allergic reactions have been reported in less than 1 percent of patients treated with human insulin preparations. Since insulin allergy may be manifested as an immediate-type 1 IgE-mediated reaction, delayed type hypersensitivity or as serum sickness, authors conclude it is necessary to obtain a thorough history and document all of the patient's reactions to determine what type of event occurred.
FOOD ALLERGY
2:45 pm, Nov. 14: "Children Allergic to Cows Milk Tolerate a Rice Hydrolysate Formula (RHF)" (Abstract #16) " A. Fiocchi, Milan, Italy, et al " Cow milk substitutes for children allergic to cow milk proteins include soy-based formula and cow's milk hydrolysates, but these also have a sensitization risk. This investigation demonstrates that children with cow milk allergy will tolerate both rice and RHF as an alternative protein source, even despite frequent sensitization to rice.
1:15 pm, Nov. 14: "Kiwifruit Anaphylaxis in an Infant After Breastfeeding" (Abstract #18) " L. Terracciano, et al, Milan, Italy " Kiwifruit allergy in children has seldom been reported and the observed reactions are usually mild. This study documents a case of an infant who developed anaphylactic symptoms within minutes of his mother eating two kiwifruits and initiating breastfeeding. Authors note that this case indicates nursing may represent a hidden source of exposure.
Noon " 1 pm, Nov. 13 & 14: "Hypersensitivity to Black Gram and Other Lentils: A Case Report and Literature Review" (Abstract #P39) " C.S. Taylor, Getzville, N.Y., and S. Ramesh, Buffalo, N.Y. "Presenting a case where a patient reacted to more than one lentil, investigators note that there are many different types of lentils that can cause allergic reactions and even anaphylaxis. Little research has been done to distinguish different types of lentils and their various hypersensitivities which have been reported in Asia and the Mediterranean area, including black gram (Phaseolus mungo), mung bean and split chick peas (Bengal gram).
Noon " 1 pm, Nov. 13 & 14: "Cow's Milk Protein Allergy in the Neonatal Period" (Abstract #P55) " D. Hambrook & M. Levy, Milwaukee, Wis. " Investigators in this case study report that the incidence of cow's milk protein allergy is approximately 2-3 percent primarily during the first year of life, but IgE-mediated reactions, such as urticaria or angioedema are unusual and may be misdiagnosed. They note that physicians should be aware that these reactions may occur so that early recognition and management may be initiated.
Noon " 1 pm, Nov. 13 & 14: "Unnecessary Dietary Restrictions Resulting From Food Allergy Diagnosed by Electrodermal Skin Testing" (Abstract #P118) " J. Ko & A. Nowak-Wegrzyn, New York " In this case study, investigators demonstrate the unreliability of electrodermal skin testing, commonly used by Complementary and Alternative Medicine (CAM) practitioners, compared to skin prick testing. Authors note that since allergies and asthma are the second most common reason for CAM use in the United States, physicians should be aware that the use of electrodermal skin testing has not been proven to detect allergen sensitivity.
INSECT STING ALLERGY
2:15 pm, Nov. 14: "Fire Ant Stings Indoors: Comparison of Reports in the Medical Literature and Those in the Press (Abstract #14) " R. deShazo, Jackson, Miss. " The medical histories of 10 individuals who experienced massive sting attacks from indoor foraging fire ants have been published in the medical literature. Finding another 10 cases of massive fire ant stings not published in the medical literature through a search of newspaper archives, this investigator concludes that the presence of fire ants inside health care facilities and homes is a harbinger for fire ant attacks of disabled or infant occupants.
Noon " 1 pm, Nov. 13 & 14: "Multicolored Asian Lady Beetle Hypersensitivity: A Case Series" (Abstract #P38) " D. Albright, San Antonio, et al " Since the introduction of the multicolored asian lady beetle (Harmonia axyridis) into the United States 25 years ago, the infestation of homes across the Northeast, Southeast and Midwestern states with these insects during the Fall and Winter months has become increasingly common. Investigators of five case reports speculate that a wide range of IgE-mediated symptoms including urticaria, angioedema and anaphylaxis can occur by exposure to proteins by inhalation, direct contact and possibly by the bite or scratch of this beetle.
LATEX ALLERGY
Noon " 1 pm, Nov. 13 & 14: "Occupational Airway Allergy Among Health Care Workers (HCW) with Latex Allergy" (Abstract #P32) " M. Chelminska, et al, Gdansk, Poland " Health care workers are at risk for developing latex allergy, which can occur in different organs including skin, conjunctive, nose and bronchi. Investigators found a 43 percent incidence of occupational airway allergy in a group of 49 health care workers with latex allergy.
Noon " 1 pm, Nov. 13 & 14: "Anaphylaxis During Scuba Diving: A Hidden Source of Latex Hypersensitivity" (Abstract #P105) " T. Nsouli, Burke, Va., et al " This case report of anaphylaxis occurring during scuba diving resulting from an unsuspected hypersensitivity to a latex component of the divers suit illustrates the importance of a diligent search for hidden sources of latex products which can produce life-threatening allergic reactions in sensitized patients.
SEMINAL FLUID REACTIONS
1:00 pm, Nov. 14: "Treatment of Human Seminal Fluid Allergy with Rush Intravaginal Desensitization" (Abstract #17) " R.C. Cartwright & W. K. Dolen, Augusta, Ga. " Conventional treatment of human seminal fluid allergy includes abstinence, barrier protection, or subcutaneous immunotherapy. This case study describes a women with seminal fluid allergy treated with local intravaginal desensitization. Over the past year, the patient developed local symptoms if her exposure to seminal fluid was delayed past 5 days, emphasizing the need for frequent exposure to maintain desensitization. She became pregnant and has not had any pregnancy complications.
2:45 pm, Nov. 15: "Anaphylaxis to Ingestion of Cephalexin-Containing Semen" (Abstract #63) " A. J. Ham Pong, Ottawa, Canada, et al " Researchers document what they believe is the first case report of systemic reaction to ingested semen occurring in an atopic, penicillin-sensitive woman likely caused by cephalixin excreted in the semen or through urine contamination.
SKIN DISORDERS
Noon " 1 pm, Nov. 13 & 14: "Leprosy Masquerading as Urticaria and Angioedema" (Abstract #P124) " D. Moyer & K. Borirak, Oakland, Calif. " In a case study involving a patient originally from Laos misdiagnosed by his primary physician, investigators demonstrate that rare skin conditions such as leprosy need to be considered in the diagnosis of apparent urticaria and angioedema that is atypical in appearance or response to therapy.
Noon " 1 pm, Nov. 13 & 14: "Use of Probiotics in Infantile Form of Atopic Dermatitis: A Preliminary Study" (Abstract #P232) " S.V. Gerasimov, Lviv, Ukraine " Probiotics can be useful in the prevention and treatment of atopic dermatitis in children. Preliminary results of this study suggest that some probiotic treatments may have a corticosteroid-sparing effect and improve quality of life of infants with atopic dermatitis.
Noon " 1 pm, Nov. 13 & 14: "Risk Factors Severe Atopic Dermatitis in the First 6 Months of Life" (Abstract #P233) " W. Seo & K.M. Ahn, Seoul, South Korea " This study looks at risk factors of severe atopic dermatitis of infants in the first 6 months of life who were fed breasts milk or cow's milk formula, and no allergenic food except rice and some vegetables. Authors conclude that severe atopic dermatitis is associated with sensitization to food allergens in the first 6 months of life, although the infants are not fed with those foods.
The ACAAI is a professional medical organization, headquartered in Arlington Heights, Ill., comprising 4,700 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care. Preliminary research findings presented in abstracts should not be considered definitive until the papers have been published in a peer-reviewed medical journal.
RSS