allergy
Prevalence, severity, and natural history of jack jumper ant venom allergy in Tasmania.

Brown SG, Franks RW, Baldo BA, Heddle RJ.

Department of Emergency Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.

BACKGROUND: The jack jumper ant (Myrmecia pilosula) is responsible for greater than 90% of Australian ant venom allergy. However, deaths have only been recorded in the island of Tasmania. OBJECTIVES: We sought to determine the prevalence, clinical features, natural history, and predictors of severity of M pilosula sting allergy in Tasmania. METHODS: We performed a random telephone survey supported by serum venom-specific IgE analysis, review of emergency department presentations, and follow-up of allergic volunteers. RESULTS: M pilosula, honeybee (Apis mellifera), and yellow jacket wasp (Vespula germanica) sting allergy prevalences were 2.7%, 1.4%, and 0.6% compared with annual sting exposure rates of 12%, 7%, and 2%, respectively. Similarly, emergency department presentations with anaphylaxis to M pilosula were double those for honeybee. M pilosula allergy prevalence increased with age of 35 years or greater (odds ratio [OR], 2.4) and bee sting allergy (OR, 16.9). Patients 35 years of age or older had a greater risk of hypotensive reactions (OR, 2.9). Mueller reaction grades correlated well with adrenaline use. During follow-up, 79 (70%) of 113 jack jumper stings caused anaphylaxis. Prior worst reaction severity predicted the likelihood and severity of follow-up reactions; only 3 subjects had more severe reactions. Venom-specific IgE levels and other clinical features, including comorbidities, were not predictive of severity. CONCLUSIONS: Sting allergy prevalence is determined by age and exposure rate. M pilosula sting exposure in Tasmania is excessive compared with that found in mainland Australia, and there is a high systemic reaction risk in allergic people on re-sting. Prior worst reaction severity (Mueller grade) and age predict reaction severity and might be used to guide management.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12532117&dopt=Abstract allergy medicine



allergy
Prevalence and methodology of evaluation for latex allergy among allergists in the United States: results of a cross-sectional survey.

Farrell AL, Warshaw EM, Zhao Y, Nelson D.

University of Minnesota Medical School, The Department of Dermatology, University of Minnesota, Minneapolis VA Medical Center, Minneapolis, MN, USA.

BACKGROUND: Natural rubber latex allergy is a potentially life-threatening, Type I, immediate allergic reaction. Despite great strides in identification of high-risk groups, methods for diagnosis remain limited in the United States. OBJECTIVE: The objective of this study was to estimate the prevalence of evaluation for latex allergy and methodologies used by allergists in the United States. METHODS: A cross-sectional survey of all US Fellows of the American Academy of Allergy, Asthma and Immunology was conducted. RESULTS: Of 1,239 questionnaires mailed, 519 (42%) were returned. Ninety-five percent of responding allergists reported evaluating patients for latex allergy. RAST and skin prick testing were the most commonly used tests. Sixty-two percent of respondents reported performing prick testing for latex allergy, with those in academic practices significantly more likely to do so. Whereas respondents practicing in the Northern United States were significantly more likely to evaluate for latex allergy than those in the Southern United States, no associations were found between practice location and prick testing for latex allergy. There was no association between practice type and evaluation for latex allergy. Only 6% of allergists reported ever witnessing a patient with anaphylaxis during latex allergy testing. CONCLUSIONS: Almost all responding allergists evaluated patients for latex allergy, with approximately two thirds utilizing prick testing. Copyright 2002, Elsevier Science (USA)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12478533&dopt=Abstract allergy medicine



allergy
The implications of nomenclature.

Dreborg S.

sten.dreborg telia.com

BACKGROUND: To be able to draw the right conclusions from clinical research, it is essential that words have the same meaning to all researcher and clinicians. OBJECTIVE: To present the new nomenclature for allergy and discuss its influence on conclusions drawn from clinical studies with one example illustrating that conclusions change with the use of definitions and nomenclature. METHODS: To review one recent study at odds with the new allergy nomenclature. Atopy is defined as a personal or familial tendency to produce immunoglobulin (Ig)E antibodies in response to low doses of allergens, usually proteins, and to develop typical symptoms such as asthma, rhinoconjunctivitis, or eczema/dermatitis. Allergy is defined as a hypersensitivity reaction initiated by immunologic mechanisms and divided into IgE-mediated and non-IgE-mediated allergy. What has been called atopic diseases, eg, infantile eczema, can be caused by both IgE-mediated allergy (atopy) and non-Ig-mediated mechanisms. In the study, two groups of mothers/infants were given either Lactobacillus GG or placebo with the incidence of infantile eczema as primary outcome parameter. RESULTS: The study analyzed concludes that probiotic bacteria supplied to mother and child prevents infantile eczema development caused by both IgE-mediated (atopy) and non-IgE-mediated allergic mechanisms. The study also shows that IgE sensitization was similar in the two groups. Thus, "atopic disease" was prevented (subjective evaluation), whereas atopy, ie, IgE induction was not prevented. CONCLUSIONS: Nomenclature is of utmost importance to interpret results in allergy research. If preventive measures, such as oral treatment with Lactobacilli, have an effect, this should be tested against a single mechanism of disease rather than against a disease caused by several mechanisms. However, in the study Lactobacilli are said to prevent atopic disease, and also that Lactobacilli do not hinder development of IgE sensitization, one of the mechanisms causing this disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12487211&dopt=Abstract allergy medicine



allergy
Contact allergy and allergic contact dermatitis in adolescents: prevalence measures and associations. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS).

Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE.

Department of Dermatology, Odense University Hospital, Denmark. mortz imbmed.ou.dk

The aims of this cross-sectional study were to establish the prevalence measures of contact allergy and allergic contact dermatitis in 8th grade schoolchildren (aged 12-16 years) in Odense, Denmark, and to examine the associations with atopic dermatitis, inhalant allergy and hand eczema. Contact allergy to a standard series allergen was found in 15.2% of schoolchildren. The point prevalence of allergic contact dermatitis was 0.7% and the lifetime prevalence 7.2%, predominantly in girls. The most common contact allergens were nickel (8.6%) and fragrance mix (1.8%). Nickel allergy was clinically relevant in 69% and fragrance allergy in 29% of cases. A significant association was found between contact allergy and hand eczema while no association was found between contact allergy and atopic dermatitis or inhalant allergy. In the future this cohort of schoolchildren will be followed with regard to the course and development of atopic diseases, hand eczema and contact dermatitis. Key words: school-

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12430734&dopt=Abstract allergy medicine



allergy
Food allergies in children affect nutrient intake and growth.

Christie L, Hine RJ, Parker JG, Burks W.

Department of Pediatric Allergy and Immunology, University of Arkansas Medical Sciences and Arkansas Children's Hospital, Little Rock 72202,USA. christielynn uams.edu

OBJECTIVES: To identify if specific food allergies, elimination diets, or other variables associated with food allergies have an impact on the growth and nutrient intake of children with food allergies. DESIGN: Measurements of height, weight, and body mass index were used to determine potential growth problems. Estimates of energy and nutrient intakes were based on 3-day diet records. A questionnaire was used to determine number of food allergies and other variables. SUBJECTS: Ninety-eight children with food allergies (subjects, mean age 3.7 +/- 2.3 years) and 99 children without food allergies (controls, mean age 4.1 +/- 2.4 years) participated in this age-matched, consecutive sampling, cross-sectional study. STATISTICAL ANALYSIS PERFORMED: Cochran-Mantel-Haenszel statistics using general association and Fisher Exact Test, with 2-sided probability, were conducted. RESULTS: Children with two or more food allergies were shorter, based on height-for-age percentiles, than those with one food allergy (P<.05). More than 25% of children in both groups consumed less than 67% of the DRI (RDA or AI) for calcium, vitamin D, and vitamin E. More children with cow's milk allergy or multiple food allergies consumed dietary calcium less than age- and gender-specific recommendations compared with children without cow's milk allergy and/or one food allergy. The possibility of consuming a less than recommended intake of calcium and vitamin D in children with food allergy was less if the child received nutrition counseling (P<.05) or consumed a safe infant/toddler formula or fortified soy beverage. APPLICATIONS/CONCLUSIONS: Children diagnosed with food allergies need an annual nutrition assessment to prevent growth problems or inadequate nutrient intake. Children with milk allergies or multiple food allergies are at greater risk. Nutrition education needs to address how to avoid all forms of the allergen and incorporate alternative nutrient-dense foods. This population would benefit from the development and validation of a medical nutrition therapy protocol.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12449289&dopt=Abstract allergy medicine



allergy
Prevalence of skin test reactions to natural rubber latex in hospital personnel in Russia and eastern Europe.

Nolte H, Babakhin A, Babanin A, Bakhutashvili V, Beloglazov V, Bezruchenko O, Blaziene A, Chuchalin A, Drannik G, Endre L, Khaitov R, Khanferyan R, Kowal K, Kowalski M, Markov A, Petrov R, Puchlik B, Rosovenko A, Sepiashvili R, Stepka K, Titov L, Tsybulkina V, Yashina L, Zakirova I, DuBuske LM.

Asthma & Allergy Unit, Department of Internal Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.

BACKGROUND: Allergic reactions to natural rubber latex have increased during the past 10 years, especially in many health care workers (HCWs) who have high exposure to latex allergens. The prevalence of skin test reactions to natural rubber latex in Russia, the Commonwealth of Independent States (CIS), and eastern Europe is unknown. OBJECTIVE: The purpose of this study was to determine the prevalence of skin test reactivity to natural rubber latex in a population of HCWs exposed to latex. METHODS: Nine hundred one HCWs regularly exposed to latex were evaluated using an allergy history questionnaire. Subjects were tested for latex allergy by titrated skin prick test with a biologically standardized latex extract. The diagnosis of latex allergy was defined by the presence of clinical symptoms when exposed to latex along with a positive skin prick test to latex. RESULTS: Forty-nine (5.4%) HCWs were skin test-positive to latex. Seventeen (1.9%) HCWs were classified as latex-allergic based upon positive skin tests to latex associated with allergy symptoms with exposure. Seven of 901 HCWs had experienced anaphylactic reactions to latex. The most frequently reported symptom related to latex exposure was contact urticaria. CONCLUSIONS: The prevalence of latex allergy among HCWs in Russia, the CIS, and adjacent eastern European countries is considerably less than reported in HCWs exposed to latex in western Europe and the United States. The low prevalence of latex allergy in Russia and the CIS suggests that lessened exposure to natural latex powdered gloves may diminish the prevalence of latex sensitization in HCWs in Russia and the CIS.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12452201&dopt=Abstract allergy medicine



allergy
Health care costs of allergic rhinitis-associated conditions vary with allergy season.

Crystal-Peters J, Neslusan CA, Smith MW, Togias A.

The MEDSTAT Group, Washington, DC 20008, USA. jodi.peters medstat.com

BACKGROUND: Studies have documented how allergic respiratory symptoms vary with allergen levels, but the impact of allergen levels on health care expenditures for allergy-related conditions has never been shown using actual data on outdoor allergen levels. Evidence linking respiratory allergy to comorbid conditions has also been scanty. OBJECTIVE: To investigate the link between respiratory allergy and presumably associated conditions by documenting seasonal patterns in their severity and co-occurrence, and to suggest a plan for future research. METHODS: A retrospective, cross-sectional analysis of medical claims data from 1995 to 1996 were linked to monthly data from federal counting stations on outdoor allergen levels. Participants were employed persons and their dependents, living within 15 miles of an allergen-counting station, continuously enrolled in a health plan for 1995 and 1996, and identified through medical claims data as having asthma, allergic rhinitis (AR), migraines, sinusitis, tonsillitis, otitis media, depression, or anxiety disorder. RESULTS: All conditions studied were more likely to occur during allergy season than during nonallergy season. For persons with health care claims for a condition of interest in both seasons, total health care costs during allergy season were significantly higher than during nonallergy season. Predicted condition-related expenditures were higher in allergy season for every condition even after controlling for the effect of AR. CONCLUSION: Allergy effects appear to extend beyond AR symptoms. Other conditions may be affected by outdoor allergen levels even in the absence of AR symptoms, implying that these conditions may be etiologically related to allergy, irrespective of their co-existence with allergic rhinitis, further implying that allergic sensitization can independently affect different parts of the respiratory tract as well as the brain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12452202&dopt=Abstract allergy medicine