Allergy Ebook

51 Ways to Reduce Allergies

51 Ways to Reduce Allergies

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Allergy Relief

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Primary Prevention Of Allergy

Prospective intervention studies of allergy prevention have so far at best only shown modest effects. There are as many studies showing slightly reduced incidence of allergy among breast fed infants as compared to formula fed babies as there are studies showing no effect, or even more allergy in the former infants36 39. Efforts to prevent allergy in infancy and early childhood through substituting regular cow's milk based infant formulae with extensively hydrolysed products have only shown a slight reduction in the incidence of cow's milk allergy, while there was no effect on respiratory allergies47. Studies have also been devoted to the prevention of childhood allergy through manipulation ofthe maternal diet during pregnancy and the lactation period. The conclusion of these studies is that allergen avoidance during pregnancy44 does not seem to have any effects on allergy incidence in the offspring, nor did a maternal diet rich in cow's milk increase the likelihood oftolerance...

Allergy And Hypersensitivity

An important undesirable side effect of immunity is the development, under some conditions, of allergy or other types of immune hypersensitivity. There are several types of allergy and other hypersensitivities, some of which occur only in people who have a specific allergic tendency. Allergy Caused by Activated T Cells Delayed-Reaction Allergy Delayed-reaction allergy is caused by activated T cells and not by antibodies. In the case of poison ivy, the toxin of poison ivy in itself does not cause much harm to the tissues. However, on repeated exposure, it does cause the formation of activated helper and cytotoxic T cells. Then, after subsequent exposure to the poison ivy toxin, within a day or so, the activated T cells diffuse from the circulating blood in large numbers into the skin to respond to the poison ivy toxin. And, at the same time, these T cells elicit a cell-mediated type of immune reaction. Remembering that this type of immunity can cause release of many toxic substances...

Dermatologic allergy

Contact dermatitis, industrial dermatoses, atopic eczema, and drug eruptions are included in this chapter because of their obvious allergenic factors. (However, some cases of contact dermatitis and industrial dermatitis are due to irritants.) Nummular eczema is also included because it resembles some forms of atopic eczema and may even be a variant of atopic eczema.

Breastfeeding And The Development Of Cows Milk Protein Allergy

Key words Cow milk, colostrum, breast-feeding, food allergy, infant, IgE, transforming growth factor- P1 Abstract Early feeding with cows' milk (CM) may cause cows' milk allergy (CMA). Food allergies, particularly cows' milk allergy (CMA), develop during the first months oflife in infants in whom both the non-specific and specific defence mechanisms ofthe gastrointestinal tract are undeveloped. A positive atopic heredity is a known risk factor for food allergies,1 but very little is know about the other factors predisposing to CMA.

Occupational dermatoses

It is not possible to list the thousands of different chemicals used in the hundreds of varied industrial operations that have the potential of causing a primary irritant reaction or an allergic reaction on the skin surface. Excellent books on the subject of occupational dermatitis are listed in the bibliography at the end of this chapter.

Health Effects Of Indoor Fungal And Bacterial Growth

Mycotoxin exposures and health effects have been widely reported,31 their impact is controversial within the medical community.25 Gram-negative bacteria are producers of endotoxins, which have a wide range of health effects, from mild fever and flulike symptoms to death in extreme exposure conditions. Some medical clinicians question health effects other than allergy-related diseases from such exposures. Nonetheless, the American Industrial Hygiene Association took the position that the significant presence of fungi in indoor air that are not present or are a minor component of the outdoor air is unacceptable from a health (and building performance) perspective.10'11

Pre And Postnatal Development Of Immune Responses To Allergens

Immune responses to allergens are characterised by a cross-regulation between competing IFNy-secreting T helper 1 (Th1)-like cell populations and IL-4-producing Th2-like cell populations. As already mentioned, pregnancy is associated with a strong skewing towards Th2 type immunity and if this does not occur in time, there is an increased risk for abortion2. As a consequence neonatal immunity is Th2-skewedand allergen specific T-cell responses are common already at birth3. Probably, these responses are normal and do not indicate future allergy. In contrast, recent studies show that the atopic phenotype is associated with a prolonged period of Th2 type immune responses to allergens early in life318. Thus, the maturation process seems to proceed at a slower pace in infants with an atopic family history and or who develop allergic disease, as compared to non atopic babies. The findings confirm on the T cell level the previous observations showing that humoral immune responses to food and...

Mucous Membrane Candidiasis

A noncandidal, clinically similar condition is commonly seen in elderly persons with ill-fitting dentures in whom the corners of the mouth override. Oral candidiasis is also to be differentiated from allergic conditions, such as those due to toothpaste or mouthwash. It is to be differentiated from an allergic condition or from trichomonal or chlamydial vaginitis.

Preoperative Evaluation

Preoperative evaluation of the sinus patient begins with a complete otolaryngologic history and physical examination 20 . The typical complaints that a patient with hyperplastic rhinosinusitis presents with polyposis are nasal obstruction and anosmia 24 . A significant number of patients will have a history of repeated sinus infections, headache, and may have a medical history significant for asthma and aspirin sensitivity 11 . Environmental allergy may also be prevalent 1 . Since the major complaint associated with hyperplastic rhinosinusitis and nasal polypo-sis is subjective in nature, many institutions advocate the use a preoperative sinonasal questionnaire. Many different questionnaires exist in the literature and all are focused on defining the baseline symptomatology of the disease as well as the level of exacerbation of the disease process 13 . Begins with an allergy screening 17 . Many different allergy-screening tests exist from the radioal-lergosorbent test (RAST) to the...

Antiedema sympathomimetics

Naphazoline is used in severe rhinitis associated with colds, allergic reactions, and severe and chronic inflammatory conditions, in particular for inflammation of the antrum of Highmore as well as for stopping nosebleeds. Synonyms of naphazoline are nafazair, sanorin, rinazin, and privine.

Preventing Thyroid Exposure from Radioactive Fallout

Difficult to do unless an accident or incident is predicted in advance, or the air path of a specific accident is tracked and therefore anticipated. And potassium iodide is not designed as a long-term therapy because of side effects that occur with prolonged use. Complications include serious allergic reactions, skin rashes, and thyroid disorders (aggravating Hashimoto's thyroiditis or worsening hyperthyroidism). In pregnant women, long-term use of potassium iodide can also cause the fetus to develop a goiter however, the short-term use would protect the fetus against radioactive iodine isotopes.

Sample Preparation For Spore Count

The information from a spore count is the total number of fungal spores and other fungal elements, whether viable or nonviable, present at that particular moment and at that particular location. The results are presented as fungal structures (or spores) m3 of air. This information is crucial for evaluating allergy related indoor air quality and to address relevant health concerns. The two reasons for using a spore count technique are (1) both viable and nonviable fungal spores and fragments are potentially allergenic and (2) some fungi are not able to produce asexual sexual spores conidia in culture (e.g., most members of the basidiomycota and all obligate phyto-pathogenic fungi, such as rust fungi). The major drawback of a spore count is that most fungal spores can be presumptively identified only to groups or genera since the spores are separated from the fruiting structures that are necessary to properly identify them. In most cases, it is possible to identify the spores only to...

Pathophysiologic Changes Induced by Cytotoxic Therapy

Drug-related pulmonary disease may be the result of toxicity, allergy or idiosyncrasy 70 . Toxicity, with a dose response, has been shown for bleomycin, chlorambucil and the nitrosoureas. Pulmonary damage, likely mediated through allergic mechanisms, is caused by cyclophosphamide, methotrexate, procarbazine and bleomycin. Pulmonary disease has also been associated with mitomycin, cyto-sine arabinoside, the vinca alkaloids and alkylating agents.

Types of Treatment with Radioactive Iodine

Radioactive iodine, specifically I-131, has been used for treating thyroid disorders for more than half a century. It's used to treat cases of hyperthyroidism, when the thyroid is overproducing thyroid hormone (see Chapter 4). It's also the mainstay of thyroid cancer treatment, after the thyroid gland and the main thyroid cancer is removed by the surgeon. This is a remarkably easy treatment to take. I-131 is dissolved in water. Sometimes this is added to gelatin capsules and swallowed. My (Ken) preference is to give it in its liquid form, so that patients can sip it through a straw. The actual amount of iodine that is swallowed is rarely more than a couple of milligrams, although it's usually quite radioactive. In fact, an average cup of milk contains severalfold more iodine (nonradioactive) than is contained in a treatment dose of radioactive iodine. This is why people who are allergic to iodine or seafood can usually tolerate radioactive iodine treatment without activating an...

Allergic Contact Reactions

It may be that up to 1.5 billion dollars is spent per year in the United States for nail products and nail services. Considering the number of nail cosmetics used, contact dermatitis is not common and allergic reactions to nail cosmetics probably account for only 8 to 13 of all cosmetic contact dermatitis.

Splenectomy For Hematologic Disorders

Another modality for treatment is the administration of intravenous gamma globulin in a dose of 1 g kg day for 2 or 3 successive days. This regimen is of particular value in pregnant patients and in patients with refractory thrombocytopenia. However, although some increase in platelets is achieved frequently, the response is often transitory (3 to 4 weeks), and the cost of 2 g kg of gamma globulin continues to escalate. Infusion of immunoglobulin (Ig) G is initiated slowly to detect a possible allergic reaction to IgA, which may also be present in these solutions. Blood pressure and body temperature are monitored. If an allergic reaction occurs, subsequent infusions should be preceded by administration of diphenhydramine and intravenous hydrocortisone.

Summary and future considerations

It is clear that a better understanding of our immune system and the way it can differentiate between self-antigens and non-self-antigens will have a huge impact on different areas of clinical medicine. Such developments could help treatment of patients with cancer, infection, autoimmune diseases and allergies, as well as those patients undergoing organ transplantation or requiring aggressive forms of chemo- or radiotherapy.

And Preoperative Evaluation

In individual cases the following are useful lateral radiocephalogram objective wakefulness and vigilance tests allergy diagnosis imaging the upper airway tape recording of snoring noise at home. Summarizing the chances of proper patient selection for UPPP, we have to admit that this still remains a result of personal experience in many cases. The literature provides only a few prospective studies for SDB which suggest selection or exclusion criteria for UPPP.

Protection against Protein Allergens

Most type I sensitizations found in healthcare workers are not occupation-ally relevant 19, 28 35 of participants in a disease prevention programme for healthcare workers had a diagnosed type I allergy to seasonal allergens, 9.6 to natural rubber latex 19 . Due to an increased use of medical gloves for single use made from natural rubber latex during the last decade of the last century, a constant increase in the incidence of type I allergies could be observed in healthcare workers. Annual incidence rates of latex sensitization of as much as 3.8 10,000 healthcare workers were found 28 . In Germany, this increase stopped when in December 1997 powdered latex gloves were explicitly banned by law approved code of practice TRGS 540 (sensitizing substances) as sensitizing substance from the work environment 28, 32 . Latex allergens bound to powder particles constitute occupational inhalative allergens that are easily propagated by air and may cause airway sensitization by inhalation 33 ....

Iiihsps As Th2activating Antigens And Allergens

Another link between eosinophilic inflammation and hsps concerns the complex processes involved in antigen and or allergen uptake and presentation, activation of specific immune responses (T cells and antibodies) and inflammation. We are currently considering the possibility that hsps, which are immunodominant antigens of a still growing number of bacteria (21), also are IgE-stimu-lating parasites' antigens and or plant allergens. Such a possibility would provide a link between parasitic diseases and allergy, both of which are characterized by eosinophilic inflammation and elevated IgE. The possibility of plant stress proteins to act as allergens has been established for profilins (22). Hsp 70 is an immunodominant antigen in many species and grass pollens and other allergens are likely to contain hsp 70 (23,24). Hsps may have the potential to activate both TH1 and TH2 cells, leading to the production by B cells of hsp-specific IgE isotype antibodies as well as of IgG and IgM isotype...

Additional Information

Narcotic (opioid) analgesics (morphine, meperidine) and phenobarbital cause a marked increase in biliary tract pressure. The increase of intraluminal common bile duct pressure by morphine (50-60 ) has been used to differentiate between acute and chronic cholecystitis. Morphine-augmented cholescintigraphy has been considered superior to conventional hepatobiliary scintigraphy in assessing cystic duct patency because diagnostic results are obtained faster. The increase in common bile duct pressure is sufficient to overcome the resistance to bile flow caused by a sludge-filled gallbladder, so that the radiotracer may penetrate the cystic duct into the gallbladder. A dose of 0.04 mg kg morphine sulfate diluted to 10 ml with saline is administered intravenously over 3 min, when the gallbladder has not been visualized within 60 min after the administration of the 99mTc-IDA complex. Serial images are then obtained at 5-min intervals for 30 min. In the case of persistent nonvisualization of...

General Properties and Possible Metabolic Functions

Except for the possibility that individuals with a nickel allergy may be sensitive to intakes of soluble nickel after fasting, there is no evidence that associates exposure to nickel through consumption of a normal diet with adverse effects on humans. The FNB,51 however, did set an UL of 0.017 mg Ni kg body weight day this translates into about 1.0 mg day of soluble nickel salts for adolescents aged 14-18 years and adults. The UL (mg day) set for children 1-3 years was 0.2, 4-8 years was 0.3 and 9-13 years was 0.6. The basis for the UL was a NOAEL of 5 mg kg body weight day for rats and an uncertainty factor of 300.

Anaphylactic Shock and Histamine Shock

Anaphylaxis is an allergic condition in which the cardiac output and arterial pressure often decrease drastically. This is discussed in Chapter 34. It results primarily from an antigen-antibody reaction that takes place immediately after an antigen to which the person is sensitive enters the circulation. One of the principal effects is to cause the basophils in the blood and mast cells in the pericapillary tissues to release histamine or a histamine-like substance. The histamine causes (1) an increase in vascular capacity because of venous dilation, thus causing a marked decrease in venous return (2) dilation of the arterioles, resulting in greatly reduced arterial pressure and (3) greatly increased capillary permeability, with rapid loss of fluid and

Other Effects of Cortisol

Cortisol Blocks the Inflammatory Response to Allergic Reactions. The basic allergic reaction between antigen and antibody is not affected by cortisol, and even some of the secondary effects of the allergic reaction still occur. However, because the inflammatory response is responsible for many of the serious and sometimes lethal effects of allergic reactions, administration of cortisol, followed by its effect in reducing inflammation and the release of inflammatory products, can be lifesaving. For instance, cortisol effectively prevents shock or death in anaphylaxis, which otherwise kills many people, as explained in Chapter 34.

Laboratory Variations In

Secondary complications of unilateral trunkal edema, such as unilateral jaundice, may occur when the accumulated fluid is ascitic in origin (56). This phenomenon occurs because ascitic fluid is high in albumin concentration and because bilirubin binds to albumin. Subcutaneous dissections of ascitic fluid in which the albumin concentrations is high, tend to be brightly jaundiced if the serum bilirubin concentrations are elevated whereas collections of edema fluid in patients with heart disease or nephrosis, in which the albumin concentrations are low, do not. Edema associated with burns or allergic reactions have a high albumin concentration and appear jaundiced. Indeed, this is the basis of the histamine wheal test for jaundice, in which wheals induced by subcutaneous injections of histamine appear jaundiced whereas the surrounding tissue does not. This rare syndrome is of little clinical importance. Eosinophilic ascites, i.e., ascitic fluid with a high concentration of eosinophilic...

Spirulina And The Innate Immune System

Inflammatory responses have a vital role in the protection of an organism against invading pathogens. However, many of the substances released during inflammatory responses harm not only invading microbes but also surrounding host cells, and prolonged (chronic) inflammation is generally associated with major tissue damage. Therefore, it is desirable to have substances that can minimize or prevent chronic inflammatory processes as well as inappropriate inflammatory reactions, such as those resulting from allergies against innocuous substances.

Localized pruritic dermatoses

Lichen Simplex Chronicus Scalp

This disorder is unrelated to allergies in patient or family, thus differing from atopic eczema. Atopic people are more itchy, however. RELATED TO EMPLOYMENT. Recurrent exposure and contact to irritating agents at work can lead to lichen simplex chronicus. DIFFERENTIAL DIAGNOSIS 1. Many cases of acute ear dermatitis are aggravated by an allergy to the therapeutic cream, such as Neosporin, or the ingredients in the base. Toilet care Harsh toilet paper contributes greatly to the continuance of this condition. Cotton or a proprietary cleansing cloth (Tucks) must be used for wiping. Mineral oil or Balneol lotion can be added to the cotton if necessary. Rarely, an allergy to the pastel tint in colored toilet tissues is a factor causing the pruritus.

Rosenbach History Of Tetanus 1886

Improved wound management and routine antitoxin use developed, the rate fell to 1.5 per 1,000 wounded. World War I patients, perhaps because the antitoxin produced a forme fruste, had a syndrome of local tetanus - not fatal, and usually confined to one extremity. U.S. forces, entering the war in 1917, had the advantage of the experience of their allies and thus had an incidence of only 0.16 per 1,000 wounded. Allergic reactions to horse serum occurred, more commonly after repeated doses of antitoxin.

Type III Endonasal Median Drainage

Howarth Lynch Operation

The endonasal median drainage (type III) is indicated after one or several previous sinus operations have not resolved the frontal sinus problem, including an external frontoethmoidectomy. It is also justified as a primary procedure in patients with severe polyposis and other prognostic risk factors affecting outcome, such as aspirin intolerance, asthma, Samter's triad (aspirin hypersensitivity, asthma and allergy), Kartagener's syndrome, mucoviscidosis and ciliary dyskinesia syndrome. Its use in patients with severe polyposis without these risk factors is undetermined and needs to be evaluated. It seems that patients with generalized polyposis but who still show in the periphery of the sinuses along the skull base air on a coronal CT scan (halo sign) have a comparatively better prognosis than those without, and can be managed by a more conservative technique. It is useful also for removal of benign tumors in the frontal sinus

Physical Irritant Contact Dermatitis

Physical irritant contact dermatitis (PICD) is a common occupational dermatosis with multiple types and many mechanisms involved in its development 1 . The diagnosis is primarily based on a history of exposure to a known irritant and negative patch test results to exclude contact allergy.

The First Line Of Body Defence

Small protein hormones that can stimulate or inhibit many normal cell functions but are less specific and more localized than endocrine hormones (Table 8.2). Cytokines can be divided into several families, including interleukins, interferons, tumour necrosis factors, colony stimulating factors and chemokines, which regulate the migration of cells between and within tissues. For example, there are around 22 different interleukins (ILs), numbered IL-1 to IL-22. Of these, IL-1 is secreted by macrophages and monocytes and can stimulate an inflammatory response and activate lymphocytes (Table 8.2 and Figure 8.2). IL-2 is produced by T-helper lymphocytes and stimulates the proliferation of T-helper cells, cytotoxic T-cells and B-lymphocytes, and activates NK cells. On the other hand, IL-10 and transforming growth factor- (TGFP) are immunosup-pressants and inhibit the cytotoxic response of the immune system (T-cells and macrophages) against the antigens from tumours and infectious agents...

Spirulina In Adaptive Immune Responses

Another study examined whether a hot water extract of S. platensis could affect experimental food allergy.28 Note that the previous data from these investigators suggest that hot water extracts contain less protein and possibly higher concentrations of polysaccharides compared to whole Spirulina.8 One group of mice received S. platensis one of two concentrations of the extract in their drinking water before they were immunized with, and then orally exposed to, shrimp extract. Another group was given Spirulina extract concomitantly with immunization and antigen stimulation. Concurrent Spirulina treatment did not significantly affect total and antigen-specific IgE concentrations in serum, indicating that it did not enhance the allergic response to this food antigen.28 At the higher dose, Spirulina treatment significantly enhanced total serum levels of IgG1, the most common subclass of IgG, whereas the increase in antigen-specific IgG1 did not reach statistical significance. It also...

The Analogs of Somatostatin as Radiopharmaceutics

Because the time of disappearance of somatostatin is short (1-2 minutes), it was necessary to find the somatostatin analogs with much prolonged half-life time in plasma and tissues. The use of analogs has several advantages they have the fast clearance, the fast penetration into the tumors, they do not cause allergic reactions and they are quite simply synthesized and modified. However, in contrary to the native somatostatin, they have the different binding affinities for the particular subtypes of somatostatin receptors. Each analog has its own characteristic and the decision which analog should be used is crucial for the scintigraphy. In the diagnostic tests analogs with the high binding affinity for somatostatin receptors sst2, sst3 and sst5 are used.

Effect of Removing the Primary Visual Cortex

Perimetry Chart For Vision

Abnormalities in the Fields of Vision. Occasionally, blind spots are found in portions of the field of vision other than the optic disc area. Such blind spots are called sco-tomata they frequently are caused by damage to the optic nerve resulting from glaucoma (too much fluid pressure in the eyeball), from allergic reactions in the retina, or from toxic conditions such as lead poisoning or excessive use of tobacco.

Regulatory Activities On Immune System Of Spirulina

Antibody productions of IgA and other classes, such as IgE and IgG1, in mice as possible evidence of the protective effects of Spirulina toward food allergy and micro-bial infection. An increase of IgE antibody level in the serum was observed in the mice that were orally immunized with crude shrimp extract as an antigen (Ag group). The antibody level however, was not further enhanced by treatment with Spirulina extract (SpHW). IgG1 antibody, on the other hand, which was increased by antigen administration, was further enhanced by Spirulina extract. It was noted that the ISA antibody level in the intestinal contents was significantly enhanced by treatment with Spirulina extract concurrently ingested with shrimp antigen, in comparison with that of the Ag group treated with shrimp antigen alone. It was reported that intraperi-toneally injected polysaccharides of a hot-water extract of Spirulina increased the percentage of peritoneal phagocytic cells besides increasing the hemolysin...

Personal Protective Equipment

Barrier creams are used as both primary and secondary prevention from exposure to allergens in the workplace. Their functional intent is to provide a nonpermeable barrier, separating the skin from potential irritating, noxious and or allergenic substances to which a worker may be exposed. There are three types of nonspecific barrier creams, water repellant, oil repellant and silicone based. Water-repellant barrier creams contain hydrophobic substances. They are used in wet work professions and to prevent exposure to water-soluble irritants and allergens. Oil-repellant barrier creams contain lipophobic substances, which are intended for use by individuals exposed to oils, greases or other oil-soluble substances. Silicone-based creams are useful for general protection from both water-soluble and organic agents. oil from reaching the skin. Another intriguing barrier cream is a 'topical skin protectant' developed by the US military for protection against chemical warfare agents. This is a...

Dermatosis caused by arthropods

Methotrexate Skin Rash Pictures

The mite's location is in a burrow in the stratum corneum where it deposits its eggs. An allergic sensitization to the mite and or its products causes the clinical picture. Itching appears 2 to 4 weeks after the infestation and is classically more severe at night. As a clinical finding the burrow is pathognomonic and diagnostic. The remaining lesions are secondary to scratching, secondary infections, and allergic reaction. Nodular scabies consists of brown or red firm nodules on the penis, scrotum, or buttocks and may persist for months despite specific antimite treatment. It is a delayed allergic reaction with no mite present.

Monoclonal Antibodies That Are Currently Used In Cancer Therapy

In September 2006, the FDA approved the fully human anti-EGFR antibody panitumumab for the treatment of patients with EGFR expressing non-curable metastatic colorectal carcinoma (Gibson, Ranganathan and Grothey, 2006). As panitumumab is a fully human anti-EGFR monoclonal antibody, patients receiving this antibody will run a reduced risk of developing an allergic reaction, compared to those receiving the chimeric anti-EGFR antibody cetuximab.

The Development Of Anterior Open Bite

Anterior open bite can develop as a result of genetic and or environmental factors. Environmental factors include finger and thumb habits (Fig. 6.24), tongue posturing and thrusting problems, and respiratory concerns related to conditions such as allergies, adenoids and tonsils, and mouth breathing.

Preoperative Assessment of Liver Function

Preoperative Lab Testing Form

Tests that measure the serum value of hepatic enzymes are commonly defined standard liver function tests and reflect the hepatocytes' integrity or the presence of cholestasis. Albuminemia and prothrombin time are related to the functioning hepatic mass, but are not specific to hepatopathy 20 although not unanimously recognised, a predictive value to the standard liver function test is not given until nowadays 21 . Child score, an indicator of excretion and synthesis function and portal hypertension utilised in the surgery of the cirrhotic liver, is not useful in cholangiocarcinoma in the non-cirrhotic liver. Many qualitative tests have been proposed using different substrates (Table 1) in spite of being precise, they are impractical in a clinical setting for various reasons such as excessive cost, need for multiple samples and prolonged catheterisation, and risk of allergic reaction.

Directed Neurological Examination

Essential components of the directed physical examination include a neurological evaluation emphasizing the cranial nerves and orbital contents (to direct attention to lesions of the skull base) as well as a general evaluation of the ears, upper respiratory tract, and head and neck. Although much can be gained by evaluating the nose using anterior rhinoscopy, nasal endoscopy allows a more thorough assessment. With this procedure, the rhinologist can often directly visualize the olfactory neuroepithelium and establish whether airflow access to the epithelium is blocked. In the nasal examination, the nasal mucosa is evaluated for color, surface texture, swelling, inflammation, exudate, ulceration, epithelial metaplasia, erosion, and atrophy. Discovery of purulent rhinorrhea, especially its site of origin, is considered significant if it is present throughout the nasal cavity, rhinitis is suggested. If rhinorrhea is present in the middle meatus, maxillary or anterior ethmoid sinusitis is...

Allergens in the Workplace

So-called universal precautions resulted in the marked increase in use of latex gloves as personal protective equipment. Since then, the rate of NRL allergy, especially type I allergy, has increased. While approximately 1 of the general population is sensitized to latex, it is now believed that 10-17 of healthcare workers have a type I allergy to NRL allergenic proteins 6, 7 . However, these numbers may be inflated by self-reported allergy assessments. In a study by Allmers 8 , it was found that 63 of healthcare workers self-reporting sensitivity to NRL had negative results (hives, pruritus etc.) when exposed to NRL in an occupational use type of situation. Many other professions use gloves on a daily basis for the perceived benefit of protection from irritant and allergy-provoking exposures. While protecting themselves to some degree, individuals using latex gloves may be exposed to other glove additive allergens (i.e. thiurams and carbamates) that result in delayed-type...

Epidemiological Aspects

The increasing prevalence and severity of atopic diseases seen in industrialised countries are in marked contrast with the low prevalence of allergy among children in the formerly socialist countries of Europe with a life style similar to that prevailing in Western Europe 30-40 years ago9-11. These and other regional differences were recently confirmed in two large epidemiological surveys. In the European Community Respiratory Health Survey (ECRHS) the prevalence ofasthma related symptoms were studied in young adults aged 20-44 years, mainly in Europe. Carefully validated questionnaires were used in populations who were selcected in an identical manner in all the study centred12. The findings were confirmed by lung function tests and analysis of IgE antibodies to allergens in representative subpopulation13 The International Study of Asthma and Allergy (ISAAC) comprised almost 800,000 children aged 6 7 and 13 14 years in over 150 centres in over 50 countries over the world14-17 Both...

Sudden infant death syndrome SIDS

A common feature is a failure of arousal from sleep in the presence of a difficulty with respiration 5 . The failure to arouse may be due to a neurological developmental abnormality, possibly determined pre-natally. Abnormalities of cardiac autonomic control probably contribute. The respiratory stimulus may be a chest infection or possibly an allergic reaction within the lungs 6 , but may often be obstructive sleep apnoeas.

Complaint And Noncomplaint Zones

Occupant complaints in buildings may be environmentally based (dampness, water leaks, visible mold growth, MVOCs, etc.), health-related (e.g., upper respiratory irritation, allergy, infection), or both of these. It should be recognized that results of microbial sampling alone cannot be used to determine whether adverse health outcomes have occurred (microbial PELs or TLVs are unavailable). However, careful inspection of a building for dampness moisture damage can lead to a microbial sampling strategy, the results of which can provide useful information to a physician or epidemiologist in associating environmental conditions with occupant health complaints.

Diseased Compromised Skin and Solvent Selection

Erupted skin surface will allow increased water loss from the body. Psoriasis is a chronic recurring non-infectious scaling skin condition characterised by erythe-matous plaques covered with silvery scales. For topical therapy the loss of skin barrier integrity has been shown to be valuable for targeting drugs to the required site of action while minimising side effects (Anigbogu et al., 1996). Lichenoid eruptions are characterised by intensely itchy flat-topped papules while eczema is a further non-infectious eruptive condition, in which blistering occurs. Contact dermatitis can result from a direct irritant action of a substance on the skin (irritant contact dermatitis) or further exposure, following previous sensitisa-tion of the skin, from a contact allergen (allergic contact dermatitis). Irritant dermatitis is the more common of the two manifestations, and can be caused by many chemicals, solvents and detergents sodium lauryl sulphate was used to induce irritant dermatitis before...

The dissemination of research findings

Proposals approved by ethics committees or institutional review boards in Oxford,45 Sydney,46 and at the Johns Hopkins School of Medicine47 and School of Hygiene and Public Health in Baltimore.47 For each cohort of research proposals the principal investigators were contacted several years later in order to determine the publication status of each completed study. The rates of full publication as journal articles ranged from 49 to 67 (Table 3.2). Similarly, 20 of trials funded by the National Institutes of Health (NIH) and 45 of trials on HIV infection funded by the National Institute of Allergy and Infectious Diseases (NIAID) were still unpublished several years after completion.48-50 The fact that a substantial proportion of studies remains unpublished even a decade after the study had been completed and analysed must be of concern as potentially important information remains hidden from reviewers. Making things worse, the dissemination of research findings is not a random process...

The Influence Of Maternal Immunity

Maternal IgG antibodies are transplacentally transferred via an active transport, providing a passive protection for infections in the baby. High levels of cord blood IgG antibodies to P -lactoglobulin have been reported to protect against the development ofcow's milk allergy, although this was not confirmed in another study33 Low levels of IgG antibodies to cat and birch in cord blood are associated with an increased prevalence of sensitvityto cat, as well as asthma at 8 years of age34 .If high levels of maternal allergen-specific IgG antibodies indeed are protective, this may be an alternative explanation to the observations in several epidemiological studies showing an increased risk for allergy to seasonal allergens in children born before the relevant pollen6-7. Birth at this time of the year would provide low levels of cord serum IgG antibodies. Furthermore, high levels of IgG anti-IgE antibodies in cord blood are associated with less allergy during the first 18 months of life,...

Team And Individual Expertise

Many assessments and investigations are often initiated by complaints or reports of illness related to the indoor environment. More recently, surveys for fungal and microbial contamination have become routine as a part of due diligence in real estate transactions, whether residential, commercial, or industrial. If health complaints, personal injury, or health-related issues are alleged, medical and public health professionals, including physicians, must be included in the team. Specialty board-certified physicians, such as occupational health physicians, allergists, immuno-logists, pulmonolgists, infectious disease specialists, and epidemiologists, are some of the medical experts considered. Most physicians have limited experience in diagnosing patients with mold or microbial exposure. In fact, the University of Connecticut Health Science Center published a document titled Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture...

Prevention of Skin Barrier Breakdown Postexposure Skin Care

And perpetuation of allergic skin reactions. Skin barrier breakdown allows greater penetration of allergenic substances, thus increasing the opportunity for sensitization. Good skin care such as the use of appropriate barrier creams, bland emollients and avoidance of wet work or macerating gloves all can decrease skin irritation and transepidermal water loss in experimental settings. Good skin care and prevention of irritation should be an integral part of preventing ACD in the worker.

Business Object Model Design

The model describes patient state information by providing a class and set of methods that make patient state information, e.g., results of various tests, therapies, allergies and contraindications, available to the rules engine. The model also contains classes which represent classes corresponding to complex tests such as a liver panel result and methods that retrieve information specific to those tests, e.g. methods for retrieving creatinine clearance and total bilirubin. The methods defined in the object model are executed by the rules engine which results in invocation of services on the clinical data repository for retrieval of patient data. OR Fibric Acid Allergy e the_patient.has_allergy()) THEN the_patient.set_therapy(Zetia Lipid Management Protocol) 2. The second condition is a complex combination of conditions that check whether a patient has contraindication to Fibric Acid. This is done by checking whether the patient has an abnormal liver panel or an allergy to Fibric Acid.

Postoperative Care

Careful and close follow-up in the postoperative period will help ensure surgical success. Packing may be replaced to help avoid middle turbinate lateralization. Repeat courses of either an oral steroid or antibiotics can be key adjuncts to maintenance of a patent and a healthy nasal cavity. Attenuation of allergic responses with oral or inhaled allergy medication can also prevent recurrence of the hyperplastic response. In most patients with hyperplastic rhinosi-nusitis with nasal polyps, continued use of a nasal inhaled steroid is required for prevention of recurrent disease 31 .

Personal and Environmental Hygiene

Use of proper ventilation in closed systems and automation that leads to a no-touch technique can be part of a successful primary prevention strategy. These methods and immediate cleaning after spills or personal exposures can help prevent contamination of the workplace and sensitization of the worker. If the allergen can be found on surfaces that the workers contact without protection, it is challenging to prevent sensitization and allergic reactions. Education of the worker and simple efforts and methods of re-education are also a critical aspect of avoiding or minimizing environmental contamination and subsequent unintended exposures.

Identification of Allergens

An awareness and understanding of the chemicals that a worker is exposed to in the workplace are of the utmost importance for protecting the worker from exposures to substances that may induce ACD. Predictive tests such as the Draize test and the open epicutaneous test use animal models to help predict allergenic compounds. Other tests available use adjuncts, such as Freund's complete adjuvant test, the optimization test, the split adjuvant test and the guinea pig optimization test 13 . Allergens identified by these processes should be used with caution in the workplace.

Gloves as Barrier Protection

Many workers use gloves, believing that they are protecting themselves from allergy-provoking chemicals and skin irritation. However, protection from gloves is not always the case. Skin irritation can be a significant problem from occlusion, sweating and maceration that occurs with prolonged glove use. Gloves themselves can produce ICD from bacterial endotoxins from gamma radiation used in sterilization and due to ethylene oxide 28, 29 . Surprisingly, allergens can penetrate many types of gloves in minutes to hours after exposure to the glove surface. Additionally, gloves themselves are the source of sensitizing chemicals other than latex, which may be erroneously blamed. In many patients, ACD caused by glove exposure is secondary to exposure to rubber accelerators, antioxidants and vulcanizing agents used in NRL and nitrile glove production. These agents are added to shorten production time, optimize glove quality and reduce effects of weathering and aging of the glove 30 . Von...

Glove Protection from Epoxy Resins

Epoxy resins are two-part adhesives used commonly in industry allergy to epoxy resins can be a significant dermatological problem. The bisphenol A type resins are low-molecular-weight oligomers that are frequent contact sensitizers 21 . Workers exposed to epoxy resins in a wind turbine factory were more likely to be epoxy sensitive with longer durations of work. In these workers, 3 layers of protective gloves were mandatory (cotton on the skin, thin nitrile gloves and thick black rubber gloves on the outside). Despite protective measures of gloves and personal protective clothing, 20 of workers were patch test positive to an epoxy chemical found in their work environment 35 . In this situation, exposure through gloves and failure of the protective clothing both could play a role in allowing sensitization. In a separate study, Blanken et al. 36 examined 10 workers with allergy to bisphenol A epoxy resins. Each was patch tested with controls and samples of 6 different gloves (rubber,...

Elimination Replacement of Harmful Exposures

Elimination or replacement of known sensitizing allergens can be a useful method to prevent ACD. Successful identification of a common allergen, chro-mate, and replacement with another nonsensitizing agent is well described in Denmark. In 1981, at manufacture, the chromate content of cement in Denmark was lowered to less than 2 parts per million of water-soluble chromate. This was accomplished by replacing chromate with ferrous sulfate at an added cost of approximately 1 . By this substitution, hand eczema decreased from 11.7 to 4.4 of workers 14 . Chromate allergy also decreased from 10.5 to 2.6 of workers examined. Irritant dermatitis rates did not change 14 . In a separate study, Avnstorp 15 compared the workers sensitized to chromate prior to the change in 1981 with younger workers who were employed after the decrease in cement chromate concentration. The older workers with chromate allergy appeared to show no improvement after 6 years, despite the reduction of chromate in the...


Eric Gershwin, MD is a distinguished professor of medicine as well as the Jack and Donald Chia professor of medicine. He is also chief of the division of allergy and clinical immunology at the University of California School of Medicine in Davis. Dr. Gershwin graduated from Stanford Medical School in 1971 and subsequently trained in internal medicine and then immunology at Tufts University-New England Medical Center and the National Institutes of Health. He joined the UC Davis faculty in 1975 and has been division chief since 1982. Dr. Gershwin has been continuously funded by NIH since 1975 and currently has published more than 20 books, 600 experimental papers, and 200 book chapters or review articles. He is editor of the Journal of Autoimmunity and Clinical Reviews in Allergy and Immunology and on the editorial board of multiple other journals. His major contributions revolve around the theme of autoimmune disease. Dr. Gershwin was the first individual to clone an autoantigen and...


As is often true of helminthic infections, low worm-loads may cause few or no symptoms. Large numbers of larvae in the lungs may produce ascaris pneumonitis, with symptoms resembling pneumonia. Allergic reactions can cause asthma attacks. Larvae can reach atypical (ectopic) sites such as the brain, eye, or kidney, where they may produce grave, life-threatening conditions, but such events are fortunately rare. Adult worms in the intestine can cause fever, abdominal discomfort, diarrhea, and allergic reactions to their proteins. Fever may induce worms to wander to the larynx, where they can cause suffocation, or to exit the mouth or nostrils. Heavy infection robs the host of nutrients, and tangled masses of worms can result in fatal intestinal obstruction if not treated promptly. Intestinal ascariasis is especially serious in young children. In the Third World, ascariasis may produce signs of protein-energy malnutrition in many children and often...

Sampling Strategy

The most important step prior to microbial sampling is development of a plan on how the analytical results of sampling will be interpreted. This is necessary because of the absence of numerical guidelines for microbial agents. Whereas numerical guidelines are well known for many chemical agents OSHA personal exposure limits (PELs), ACGIH Threshold Limit Values registered trademark (TLVs) , scientific studies correlating the dose of microbial agents with health effects are unavailable. Reasons for an absence of numerical guidelines7-9 include (1) the many thousands of fungal and bacterial species, (2) the capacity of microorganisms (whether dead or alive) or their components (e.g., glucans, endotoxins, allergens) to cause disease by various mechanisms (e.g., allergy, infection, toxicity, or irritation), (3) variation in human susceptibility to microbial agents, and (4) an absence of standard sampling and analytical procedures for the development of dose-response relations.

Study Design

Data for this report came from the Tucson Children's Respiratory Study (CRS), a prospective longitudinal study ofrisk factors for the development ofasthma in childhood. Healthy newborns (n 1246)and their families, not selected for allergy history, were enrolled at birth from 1980-1984.7 Data on parental characteristics (ethnicity, education, physician diagnosed asthma, smoking) was obtained by questionnaire at enrollment. Infant feeding information was obtained prospectively, from forms completed by physicians at well child visits, and retrospectively, from parent completed questionnaires when the child was 1.6 years old. Prospective data were given priority. Children were categorized with regard to duration of exclusive breastfeeding (never breastfed, breastfed exclusively < 4 months, breastfed exclusively> 4months).


Hyperplastic rhinosinusitis with nasal polyps represents a reactive, inflammatory disease that results in nasal obstruction, hyposmia, recurrent sinus infection, recalcitrant sinus infections, headache, and asthma exacerbations. Allergies as well as conditions like cystic fibrosis and Samter's triad can all play a role in the hyperreactive disorder. Medical therapy can provide relief in some patients, but a considerable number of patients require surgical intervention to establish a patent sinonasal cavity. Surgical intervention requires careful planning and attentive surgical technique. Preservation and identification of normal anatomic structures is essential. Success rates with a single surgery and adequate postoperative medical therapy can approach between 85 and 90 .


The mast cells and basophils play an exceedingly important role in some types of allergic reactions because the type of antibody that causes allergic reactions, the immunoglobulin E (IgE) type (see Chapter 34), has a special propensity to become attached to mast cells and basophils. Then, when the specific antigen for the specific IgE antibody subsequently reacts with the antibody, the resulting attachment of antigen to antibody causes the mast cell or basophil to rupture and release exceedingly large quantities of histamine, bradykinin, serotonin, heparin, slow-reacting substance of anaphylaxis, and a number of lysosomal enzymes. These cause local vascular and tissue reactions that cause many, if not most, of the allergic manifestations. These reactions are discussed in greater detail in Chapter 34.


It is normal for infants to wake at night, but by around 6 months many children can sleep through the night. Sleepiness and crying in infants may also be due to 'colic', food or cow's milk allergy, gastro-oesophageal reflux, or chronic middle ear infections, which may not be readily apparent. Most children are able to sleep through the night after the age of 6 months without requiring feeding. Frequent waking at night requiring feeding to fall asleep again is usually due to a conditioned reflex rather than a physiological need. The frequency of night-time feeds should be gradually reduced.


In addition to their prime role in fighting infectious agents, it is clear that the immune system plays an important role in a number of pathological conditions, e.g. abnormal immune responses against a harmless substance (e.g. food, pollen) or self-antigens have been associated with allergies and autoimmune diseases. In contrast, normal immune responses against a tissue or organ transplantation from an incompatible individual are associated with transplant rejection (Buckley, 2003). The immune cells in transplanted organs and tissues may also attack and destroy the tissues of the host causing graft-versus-host disease (Gulbahce et al., 2003).


Unlike glucocorticoids, mineralocorticoids have an insignificant effect on carbohydrate volume. They do not exhibit any anti-inflammatory or anti-allergy properties. They are used for chronic adrenal insufficiency, as well as for raising tonicity and work capacity of muscles.


In cooperation with The Institute for Genome Research (TIGR) and the National Institute of Allergy and Infectious Disease (NIAID, Rocky Mountain Laboratories), genome sequencing of serven C. burnetii isolates is in progress (Table 1). Comparison of obtained sequence data may reveal strain-specific variations responsible for differences in virulence and pathogenicity.


Growth and survival in response to TGF-beta. Nat Immunol 2 242-247 Kusunoki T, Sugai M, Katakai T, Omatsu Y, Iyoda T, Inaba K, Nakahata T, Shimizu A, Yokota Y (2003) TH2 dominance and defective development of a CD8+ dendritic cell subset in Id2-deficient mice. J Allergy Clin Immunol 111 136-142

Getting a Diagnosis

TED is frequently misdiagnosed as an allergy or pinkeye (conjunctivitis). One easy way to confirm TED is to request that your thyroid be checked and also to request a thyroid-stimulating antibody test. If you have noticed vision problems, you should also request screening for type 2 diabetes. Diabetes-related eye disease is also a common problem for people over age forty-five, in particular. Imaging tests such as CT (computerized tomography), ultrasound, or MRI (magnetic resonance imaging) may be used to view the orbit or eye tissues.

Concluding Remarks

With the progression of our knowledge on DC biology, it appears that DCs are central to the immune system. They are among the first cells to encounter a pathogen, together with epithelial cells, and their intrinsic properties as well as mode of activation have a great impact on the subsequent adaptive immune response. This central role is illustrated by the increasing number of disease situations where MDC function was found to be abnormally increased, such as allergy (Holt and Stumbles, 2000 Lambrecht et al., 2001 Soumelis and Liu, 2004) and autoimmunity (Pulendran et al., 2001c), or decreased, such as neoplasia (Banchereau and Palucka, 2005) or various immune deficiencies, including, but not restricted to, HIV. Although more recently described, pDCs have also been implicated in various pathologic conditions. pDC activation to produce type I IFNs could be a major factor in the pathophysiology of autoimmune diseases such as lupus erythematosus (Blanco et al., 2001 Lovgren et al., 2004...


Heroin has been associated with strokes with different etiological possibilities described, including emboli from bacterial or fungal endocarditis, ischemia due to overdose with associated hypoventilation, and drug allergy or vessel toxicity (171). As mentioned earlier, T's and Blues used intravenously (chronically) can cause pulmonary arteriovenous fistulas and subsequent embolic stroke(s) (136).

Fungal infections

Yeast Infection Anticubital Fossa

COCCIDIOIDOMYCOSIS OR SAN JOAQUIN VALLEY FEVER This disease is caused by Coccidioides immitis, a soil inhabitant. Infection in both humans and animals is acquired by the inhalation of fungus-laden dust particles or, rarely, through a primary infection of the skin. The severity of coccidioidomycosis can range from very mild, simulating a common cold, to an acute disseminated fatal disease, especially in patients with AIDS. An allergic reaction with erythema multiforme or erythema nodosum occurs in some cases. The basic symptoms of malaise and fever may suggest coccidioidomycosis if the patient has traveled through an endemic area. Diagnosis is made by KOH mounts of sputum or isolation of the fungus in a culture. Colonies of the coccidioidomycosis fast-growing phase are dangerous to handle, and the greatest care should be implemented while manipulating cultures. Treatment includes amphotericin B, ketoconazole, and itraconazole.

Biotic Factors

It is generally agreed that fungal spores of a wide variety are ubiquitous in nature as well as in the indoor environment. There is no reason to doubt their presence indoors. However, only certain spores may find the right indoor niches and conditions for growth. Fungal spores in the environment may be dead or viable, either in dormancy or ready to germinate and grow. The viability of fungal spores is associated with a number of factors, such as age, UV light, and extreme conditions. Dead spores, although they may still be allergenic and contain secondary metabolites, cannot germinate and grow. Therefore, they do not cause infections. Some viable spores, however, may be in dormancy. Dormant fungal spores are usually either physically or chemically restricted for germination. A physical barrier, such as a thickened spore wall, restricts absorption of water for spore germination. Some fungal spores contain inhibitors, which prevent spores from germination. Some spores germinate only...


Eosinophils also have a special propensity to collect in tissues in which allergic reactions occur, such as in the peribronchial tissues of the lungs in people with asthma and in the skin after allergic skin reactions. This is caused at least partly by the fact that many mast cells and basophils participate in allergic reactions, as we discuss in the next paragraph. The mast cells and basophils release an eosinophil chemotactic factor that causes eosinophils to migrate toward the inflamed allergic tissue. The eosinophils are believed to detoxify some of the inflammation-inducing substances released by the mast cells and basophils and probably also to phagocytize and destroy allergen-antibody complexes, thus preventing excess spread of the local inflammatory process.

Route ofExposure

Skin tolerance While in the first studies nitro musks showed little or no effects, clinical experiences soon revealed that musk ambrette is a photo contact allergen in man54. Further animal and human investigations showed that this is not true for other nitro musks6 55. In a study with 1323 persons using 25 fragrances most widely used in the US., an allergic reaction to a 0.1 solution of musk xylene in vaseline was determined in 2 persons Carcinogenicity, Genotoxicity In the only long-term animal study on carcinogenicity reported so far, musk xylene (75 and 150 ppm in the diet, i.e. ca. 90 and 170 mg kg d) significantly increased the incidence ofmalignant and benign liver cell tumors in mice13. In genotoxicity mutagenicity experiments only musk ambrette was positive in the Salmonella microsomeassay (Ames test)585960. Therefore and because of its photo-allergenic and neuro-toxic properties (see above), musk ambrette was banned by law in cosmetics in the European Community in 199561....

Taste Perception

This situation arises with people suffering from the common cold or from an allergy and who complain that they cannot taste. In fact, their taste sensations may not be impaired the olfactory mechanisms are affected because volatile components from foods are prevented from entering the olfactory system by mucus.


Some researchers support food allergies and proteinaceous aeroallergens as possible causes. Patients with atopic dermatitis are likely to acquire both bacterial and viral infections. Treatment is directed at skin hydration, corticosteroid administration, and antibiotics if secondary infections are present. Unfortunately,

Vasodilator Agents

Histamine is released in essentially every tissue of the body if the tissue becomes damaged or inflamed or is the subject of an allergic reaction. Most of the histamine is derived from mast cells in the damaged tissues and from basophils in the blood. Histamine has a powerful vasodilator effect on the arterioles and, like bradykinin, has the ability to increase greatly capillary porosity, allowing leakage of both fluid and plasma protein into the tissues. In many pathological conditions, the intense arteriolar dilation and increased capillary porosity produced by histamine cause tremendous quantities of fluid to leak out of the circulation into the tissues, inducing edema. The local vasodilatory and edema-producing effects of histamine are especially prominent during allergic reactions and are discussed in Chapter 34.


Ruptured Viscus

The patient under general anesthesia, it is highly desirable to have the patient's cooperation. Only mild sedation is required under such circumstances. Other contraindications are perforated viscus and a newly created esophageal, gastric, or duodenal anastomosis. Relative contraindications include active acute pancreatitis, cholangitis, pancreatic pseudocyst, and allergy to iodinated contrast. ERCP can be performed usually


Most cutaneous surgery requires only local infiltrative or regional block anesthesia. The standard agent, 1 lidocaine, is an effective and safe anesthetic in which allergic reactions are exceedingly rare. By the addition of epinephrine, systemic absorption of lidocaine is lessened, the duration of action is markedly prolonged, and a local hemostatic effect is achieved. It usually takes 15 minutes to achieve optimal vasoconstriction. The available commercial preparations usually combine lidocaine with 1 100,000 epinephrine. Some patients react to epinephrine with apprehension, body tremors, diaphoresis, palpitations, tachycardia, and increased blood pressure. These side effects may be decreased or eliminated by increasing the dilution of epinephrine to 1 200,000 or even to 1 400,000 without significantly changing its efficacy.


The dermatological examination of the hands was performed by dermatologists trained in allergy and occupational dermatology. Hand dermatitis was defined as mild when erythema and scaling appeared on the dorsal aspects and or interdigital folds of the hands, as moderate when infiltration and papules were seen and the affected area was enlarged and as severe when the palms and back of the hands were involved and vesicles and fissures appeared. Decisions about differential diagnoses were made from the clinical picture, course of the disease, personal history and pre-existing allergy tests. No further allergy tests were performed.

Physical Examination

Some of the key areas to evaluate are potential genetic predisposition (cystic fibrosis, cilia dysmotility, immunodeficiency, autoimmune), allergy assessment if clinical suspicion exists and environmental exposure to dust, molds, chemicals and smoke. Certainly, it is inadvisable to perform elective sinus surgery and especially revision sinus surgery in a patient who has not yet stopped smoking.

Barotitis Media

Barotitis media is the most common ear injury resulting from pressure. The eustachian tube provides the only route for air to enter or exit the middle ear. The normally functioning eustachian tube acts as a one-way valve, allowing excess pressures to vent passively from the middle ear while allowing air to enter only with active swallowing, yawning, or autoinflation (the patient holds nose and mouth shut, blows to puff cheeks, and swallows with cheeks puffed).8 When eustachian tube function is impaired by mucosal inflammation due to upper respiratory infection (URI), allergy, or trauma, the active movement of air into the inner ear is usually impaired first, with passive venting being impaired later in more severe cases. Thus a person with a URI flying in an airplane usually finds that ear pressures adjust on ascent, but pain increases during descent if swallowing or autoinflation maneuvers fail to pop the ears. Commercial airliners maintain cabin pressure equal to about 6000 to 8000...

Local Anesthetics

Local anesthetics are used for pain relief, soreness, itching, and irritation associated with disturbance of the integrity of the skin and mucous membranes (cuts, bites, wounds, rashes, allergic conditions, fungal infections, skin sores, and cracking). Upon formal examination, all of the commonly used anesthetics are made up of three parts an aromatic ring (lipophilic region), an intermediate hydrocarbon chain, and an amine region (hydrophilic group). A substitution in the aromatic ring and in the amine region changes both the solubility and the extent of binding of anesthetics to the receptors, which in turn determines the strength and duration of the action of the drugs. It is an accepted belief that the ability to cause allergic reactions, stability, and in a number of cases, toxicity, is determined by the structure of the connecting chain, which also determines the site of biotransformation and inactivation of the drug either by fermentative hydrolysis in the plasma (ester...

AT for memory

Other devices used by people with memory impairments include medical alert tags and personal emergency response systems. The medical alert tag conveys information, such as allergies, when the individual is unable to remember the information. The tag may also provide the person's name and phone number, which is useful if he or she becomes disoriented and lost. A personal emergency response system provides a quick link to help for a person with limited memory or problem solving abilities (Federal Trade Commission for the Consumer and American Association of Retired Persons, 2004). These systems typically include a button on a necklace or bracelet that the individual


The differential diagnosis of cervical nerve root pain includes cervical disc herniation, spinal canal tumor, trauma, degenerative changes, inflammatory disorders, congenital abnormalities, toxic and allergic conditions, hemorrhage, and musculoskeletal syndromes (e.g., thoracic outlet syndrome, shoulder pain).71,75 In cases of cervical radicu-lopathy unresponsive to conservative therapy, or in the presence of progressive motor deficit, investigation of other pathologic processes is indicated. Plain radiographs are usually not helpful because abnormal radiographic findings are equally common among symptomatic and asymptomatic patients. CT scan, myelography, and MRI each have a specific role to play in the diagnosis of cervical radiculopa-thy.73,74 CT scan is especially useful in delineating bony lesions, CT myelography can effectively demonstrate functional stenoses of the spinal canal, and MRI is an excellent noninvasive modality for demonstrating soft tissue abnormalities (e.g.,...

Protective Clothing

Protective or barrier clothing is often used by workers exposed to irritant or allergy-provoking chemicals. Materials used in these protective barriers include cloth, vinyl and rubber materials. As noted in the glove section above, many allergens are capable of passing through rubber or vinyl materials. These allergens, in small amounts, may be capable of producing ACD in the worker without any obvious degradation of the protective material. With exposure to allergens known to pass through these materials, double gloving and frequent changing has been suggested in some cases to obtain the desired level of protection. Irritants usually do not penetrate these types of materials in amounts sufficient to provoke an irritant skin response without first causing noticeable degradation of the material. Allergy may also occur due to the protective material itself or, more importantly, due to allergen trapping beneath the barrier clothing 12 .

Antihistamine Drugs

Drugs that competitively block effects of histamine on corresponding receptor regions are called antihistamine drugs. The discovery and synthesis of histamine was a great achievement in pharmacology, medicine, and immunology. This natural, powerful, biogenic amine is widely distributed in practically all tissues of mammals and is involved in various physiological processes. The body's reaction to histamine is characterized by contraction of smooth muscle, signs of inflammation, constriction of vessels, and symptoms characteristic of shock. It is certain that histamine plays a central role in allergic reactions, hypersensitivity reactions, and is part of the body's response mechanism in the inflammatory process.

Clinical History

The smoking history should be explored in light of evidence that the ability to smell decreases as a function of cumulative smoking dose and that cessation of smoking can result in improvement in olfactory function over time. 2 A history of allergy should be sought, as should a history of current or past nasal or paranasal sinus infections. Inquiry should be made about nasal or paranasal sinus operations or other treatments such as the use of topical intranasal medications. Importantly, the association of nasal obstruction, headache, facial pain, postnasal discharge, purulent or clear rhinorrhea, ear symptoms, and throat symptoms should be sought with specific questioning. The order in which the symptoms appeared and regressed is at times helpful. The duration of the problem is important in relation to the possibility of spontaneous recovery, which is generally assumed to be unlikely after 6 months if damage to the olfactory epithelium has occurred.

Organic Mercury

Management of mercury toxicity depends first on eliminating the exposure. Other remedies include the use of mercury-binding chelators such as D-penicillamine, BAL, or DMSA, which may accelerate the excretion of mercury. However, because chelation mobilizes mercury from bones, it may cause the clinical symptoms to become worse and allow further deposits of mercury into the brain (especially BAL). Penicillamine may be more effective in improving the CNS effects of mercury. However, the side effects of penicillamine treatment may include hematopoietic suppression, alterations in cognitive and renal function, symptoms of myasthenia gravis, occasional hepatitis, and allergic reactions such as pruritus and swelling. With chelation, blood concentrations usually begin to decline after approximately 3 days. In asymptomatic individuals with increased blood concentrations of mercury, administration of selenium and vitamin E may prevent the development of symptoms. In patients with...

Biological element

An important risk factor for poor outcome after percutaneous coronary interventions 37, 38 . Potential mechanisms include an upregulated inflammatory response that may result in chronic constrictive remodeling, an allergic reaction to the metallic elements of the stent, or a device design that may increase the amount of stent induced vascular wall injury 38, 39 .

Microbial Influences

Infections can have long-lasting non-specific systemic effects on the nature of the immune response to unrelated antigens. It has been suggested that recurrent infections during early childhood may protect against allergy, as suggested by several studies reporting an inverse relationship between the incidence of atopy and family size, particularly the number of older sibling23-25 It has also been suggested that vaccination against pertussis may be increasing the incidence of Th2-mediated disease, although in a recent prospective study this was shown not to be the case26. From an immunological point ofview, however, respiratory infections would not be expected to exert such continuous strong pressure on the maturing immune system as to induce immune deviation.