allergy
Is it safe to use carbapenems in patients with a history of allergy to penicillin?

Sodhi M, Axtell SS, Callahan J, Shekar R.

Infectious Diseases, Huron Hospital, Cleveland Clinic Health System, East Cleveland, OH, USA.

OBJECTIVES: The purpose of this retrospective study was to ascertain the clinical safety of administering carbapenems, namely imipenem/cilastatin and meropenem, in patients with a history of penicillin allergy compared with administering carbapenems in patients with no reported penicillin allergy. Carbapenems are similar in chemical structure to the penicillins and therefore are associated with a risk for allergic cross-hypersensitivity. Carbapenems are commonly avoided in patients with a reported penicillin allergy on the basis of a potential cross-hypersensitivity with penicillin, however, very few studies have been conducted describing the incidence of cross-hypersensitivity between penicillin and carbapenems. METHODS: A retrospective review was conducted in a total of 266 patients who were administered either imipenem/cilastatin or meropenem. The patients were admitted to the Cleveland Clinic Health System--Eastern Region Hospitals during the years 2001 and 2002. RESULTS: Fifteen of the 163 patients (9.2%) with reported penicillin allergy developed a hypersensitivity reaction to meropenem or imipenem/cilastatin whereas 3.9% of the 103 patients without penicillin allergy developed a hypersensitivity reaction to meropenem or imipenem/cilastatin. These results are not statistically significant. CONCLUSIONS: Based on this study and other similar studies, the true incidence of cross-hypersensitivity reactions between penicillin and carbapenems may be lower than previously reported. Carbapenem use may be reasonable for penicillin allergic patients if caution is exercised.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15486083&dopt=Abstract allergy medicine



allergy
Is there a causative role for tetanus toxoid vaccination in the development of allergy-like symptoms and in the increasing prevalence of atopic diseases?

Mari A.

Allergy Unit, National Health Service, Rome, Italy. a.mari panservice.it

Allergic diseases are a worldwide health problem. They mainly affect people living in developed countries where an increasing prevalence of allergy symptoms has been recorded in the last 20-30 years. The cause of this increase is still disputed, and, among others, the "hygiene hypothesis" supported the concept that relevant changes in lifestyle could have a relationship with the phenomenon. More recently the recorded parallel increase in autoimmune diseases has suggested to consider the "hygiene hypothesis" as a cause of a more general disregulation of the immune system leading to both allergy and to autoimmunity. Here are reported a series of observations, evidence, and data from the literature leading to a different hypothesis. The key points are: (1) the presence of two subsets of patients having allergy symptoms based on an IgE-mediated mechanism or not; (2) the positive results obtained with the autologous serum skin test in either cutaneous or respiratory affected subjects, mainly in children and adult females; (3) the presence of IgG autoantibodies against the alpha-chain of the high affinity IgE receptor (FcepsilonRIalpha) in non-IgE-mediated urticaria and even in respiratory subjects; (4) the cross-reactivity between epitopes of the tetanus toxoid molecule and the FcepsilonRIalpha detected by means of an alpha-chain affinity purified IgG fraction; (5) the positive skin reactivity obtained using IgG anti-tetanus toxoid preparations in allergic and non-allergic volunteers. The presence of IgG autoantibodies actively generated by the population-based vaccination with tetanus toxoid could induce both mediator release from activated mast cell and Th2 cytokine production early in life. There are epidemiological evidences that tetanus toxoid vaccination could be linked with an increased tendency to have allergy symptoms. The different epidemiological distribution of non-IgE-mediated symptoms, mainly affecting young infants would be in agreement with the present hypothesis. The prevalent mother-to-child relationship in terms of risk for allergy symptoms could be explained with the trans-placenta transfer of IgG. A similar transfer could also take place through the mother milk during breast feeding. It may thus be hypothesized that the increased prevalence of allergic diseases could be caused by the generalized tetanus toxoid immunization procedure, progressively extended to most of the countries worldwide in the last 30-40 years. Both the induction of non-IgE-mediated symptoms caused by the mast cell activation via the anti-FcepsilonRIalpha IgG and the long lasting Th2 inflammation of affected tissues would be the inducing mechanisms. This hypothesis would re-configure part of the allergic diseases as a Th2 phenotypic expression of an autoimmune disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15488663&dopt=Abstract allergy medicine



allergy
[Survey of awareness and current state of latex allergy among all health care workers at a university hospital]

[Article in Japanese]

Kano H, Yagami A, Suzuki K, Akita H, Akamatsu H, Matsunaga K, Ono Y.

Department of Dermatology, Fujita Health University School of Medicine. hisaoka fujita-hu.ac.jp

For the first time in Japan, a large-scale survey to investigate awareness of latex allergy was carried out, targeting all health care workers at Fujita Health University School of Medicine (total 1512 people). At first, we used questionnaires to collect information regarding the level of awareness of latex allergy as well as the incidence of clinical symptoms when using natural rubber products. The results of the survey revealed that approximately 85% of respondents were aware of latex allergy. Among all respondents, approximately 19% had actual experience with clinical symptoms. As a result of skin tests conducted on respondents who had acknowledged clinical symptoms, 44 people (total 3.3%) were diagnosed with latex allergy. In addition, the results revealed that people who were diagnosed with latex allergy tended to suffer atopic dermatitis and hand eczema. Furthermore, it became evident that health care workers whose work environment involved frequent exposure to natural rubber products showed a higher incidence of latex allergy. We demonstrated that a specific IgE assay was not sufficiently sensitive for diagnosing latex allergy. However, skin tests such as prick and use tests were confirmed to be effective diagnostic measures for latex allergy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15492490&dopt=Abstract allergy medicine



allergy
[The national survey of immediate type of food allergy]

[Article in Japanese]

Imai T.

Department of Pediatrics, Showa University School of Medicine. takanori-i med.showa-u.ac.jp

There are not so many epidemiological data for food allergy in Japan due to lack of relevant investigation. Therefore we are to study the reality of the immediately type of food allergy by utilizing IgE and CAP-RAST data investigated in 1998 and 1999 by the Research Group of Public Welfare Ministry of Labor. The survey was conducted in cooperation with 2689 domestic hospitals which have pediatrics and more than 100 beds. We focused on patients who had the symptoms of allergy within 60 minutes after the intake of any offending food. The questionnaire was returned by 498 hospitals (collect rate 60.4%), which reported 1420 cases. We did not find clear relation between serum IgE and frequency of food allergy symptom and admission rate. On the other hand, we recognized that CAP-RAST had significant differences in the frequency of shock disease caused by the intake of milk products whereas there were no differences in any other major antigens. We concluded that both serum IgE value and CAP-RAST Class cannot indicate the severity of the immediate type of food allergy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15492494&dopt=Abstract allergy medicine



allergy
[Hypersensitivity to pollen of Olea europea in patients with pollen allergy in the area of Zadar and Dubrovnik]

[Article in Croatian]

Skitarelic N, Sindik N, Skitarelic N, Mazzi A, Vuletic A, Misulic J.

Opca bolnica Zadar.

Olive pollen is one of the most important causes of inhalant allergy in countries around the Mediterranean sea. Due to the lack of information on hypersensitivity to the pollen of Olea europea from Croatian coast, the aim of this investigation was to establish the frequency of hypersensitivity to the pollen of Olea europea in pollen allergic patients in Zadar and Dubrovnik. Also, we compared two areas of Dalmatia regarding the number of patients and expression of allergy to the Olea europea. A total of 810 patients, children and adults, with pollen allergy were examined in both areas, Zadar and Dubrovnik. In the area of Zadar we examined 546 participants and in the area of Dubrovnik 264 participants. The patients were assessed by anamnestic data, clinical examination, measurement of pulmonary function (adults and children older than 7 years), skin prick test and enzymo-immunologic UniCAP test for measurements of specific IgE antibodies. For statistical analysis we used chi square test. Hypersensitivity to the allergy of Olea europea occurred in 66/810 (8.15%) assessed participants with pollen allergy. The comparison between the two areas didn't show any statistical difference in the number of affected participants with hypersensitivity to the Olea europea. Also, we didn't show any statistical difference in comparison of skin prick tests, immunologic measurements of specific IgE antibodies, or clinical manifestations between participants in the two investigated areas. The most prevalent clinical manifestation was rhinitis registered in 39/66 (59%) patients with hypersensitivity to the olive pollen. The majority of patients with hypersensitivity to olive pollen 51/66 (77%) live in towns. Only 3/66 (4%) participants live on an island. Rhinitis was the most prevalent clinical manifestation in our patients with hypersensitivity to allergen of Olea europea. Hypersensitivity to olive pollen was higher in participants who lived in towns. The hypersensitivity to Olea europea didn't show any difference between the two investigated areas of Dalmatia.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15506266&dopt=Abstract allergy medicine



allergy
Food allergy to apple and specific immunotherapy with birch pollen.

Hansen KS, Khinchi MS, Skov PS, Bindslev-Jensen C, Poulsen LK, Malling HJ.

Allergy Clinic 4222, National University Hospital, Copenhagen, Denmark. ksh dadlnet.dk

Conflicting results concerning the effect of specific pollen immunotherapy (SIT) on allergy to plant foods have been reported. The aim of this study was to investigate the effect of SIT using a birch pollen extract on food allergy with focus on allergy to apple. Seventy-four birch pollen-allergic patients were included in a double-blind, double-dummy, and placebo-controlled comparison of sublingual-swallow (SLIT) and subcutaneous (SCIT) administration of a birch pollen extract. Sixty-nine percent of these patients reported allergy to apple. The clinical reactivity to apple was evaluated by open oral challenges with fresh apple and a questionnaire. The immunoglobulin E (IgE)-reactivity was assessed by skin prick test (SPT), specific IgE, and leukocyte histamine release (HR). Forty patients were included in the final evaluation of the effect of SIT. The challenges were positive in 9 (SCIT), 6 (SLIT), and 8 (placebo) patients after treatment compared to 10, 4, and 10 patients, respectively, before SIT. The symptom scores to apple during challenges decreased in all groups, but only significantly in the placebo group (p = 0.03). As evaluated by the questionnaire, the severity of food allergy in general did not change and there were no differences between the groups. In spite of a significant effect on seasonal hay fever symptoms and use of medication and decrease in IgE-reactivity, SIT was not accompanied by a significant decrease in the severity of allergy to apple compared to placebo. Therefore, oral allergy syndrome (OAS) to apple should not be considered as a main criterion for selecting patients for birch pollen immunotherapy at present.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15508179&dopt=Abstract allergy medicine



allergy
Meniere's disease and allergy: allergens and cytokines.

Keles E, Godekmerdan A, Kalidag T, Kaygusuz I, Yalcin S, Cengiz Alpay H, Aral M.

Department of Otorhinolaryngology, Firat University Medical Faculty Elazig, Kahramanmaras, Turkey. keleserol yahoo.com

The aim of this article is to evaluate the role of allergy in the pathogenesis of Meniere's disease by means of cytokine profiles, allergic parameters and lymphocyte subgroups. A total of 46 patients aged between 26-68 years diagnosed with Meniere's disease between 1993-2002 were recruited to this study. The control group consisted of 46 healthy volunteers who were from the same age group, living in the same region and possessing similar socioeconomic indicators. Lymphocyte subgroups were measured from the peripheral blood by employing Becton Dickinson (BD) monoclonal CD4, CD8, CD23 antibodies. IFN-gamma, IL4, total IgE levels, and specific IgE levels pertaining to tree, fungus, fruit, egg-white, cow's milk, wheat flour, corn flour, beef, and rice allergens, in all seasons, were measured and compared in the patient and control groups. In patient serum samples there were positive correlations between CD23 and IgE, CD8 and IgE, CD4/CD8 and IgE, and CD23 and CD8 (p <0.01). There were negative correlations between IL-4 and IFN-gamma, IFN-gamma and IgE, and a positive correlation between IL-4 and IgE. Total IgE levels were above the normal values in 19/46 (41.3 per cent) of the patient group, but the ratio was nine out of 46 (19.5 per cent) in the control group. A history of allergy was found in 31/46 (67.3 per cent) when the patients were questioned. The ratio of a history of allergy was 16/46 (34.7 per cent) in the control group. When specific IgE levels were evaluated the ratio of patients with all the panels negative was eight out of 46 (17.9 per cent), but it was 31/46 (67.3 per cent) in the control group. This study found that the prevalence of allergy was higher in patients with Meniere's disease than in the control group. Thus the authors suggest that allergy should be taken into account when patients with this disease are treated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15509365&dopt=Abstract allergy medicine