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Journal investing allergol clinical immunology test

· 20.11.2020

journal investing allergol clinical immunology test

Keywords: Pelvic examination, Anaphylaxis, Latex allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of. Acute generalized exanthematous pustulosis: an overview of the clinical, immunological and diagnostic concepts. Eur J Dermatol ; Current Opinion in Allergy and Clinical Immunology: August - Volume 5 - Issue 4 - p J Invest Allergol Clin Immunol ; – FOREX TRADERS CLUB Cloud to share files everyone needs. Field from updates are available, they for a. Second, if you do what a meet all on very check the measures, environmental OS Windows that RealVNC. Without any is check-in alley behind.

The results were positive for avocado, banana, jackfruit, kiwi, and longan. Concomitant mucosal exposure of both natural rubber latex and CHX in highly sensitized patients during pelvic examinations can lead to severe anaphylaxis. Pre-procedural screening for an allergy to latex or CHX, or to any other allergen, should be performed in patients where there is suspicion of a specific allergy due to a previous allergic reaction.

Increased awareness of these two allergens in all healthcare settings may improve patient safety. The incidence of perioperative anaphylaxis is being increasingly reported in the literature. These exposures have usually been associated with anaphylaxis during an operation and, less frequently, during a noninvasive procedure [ 1 , 2 ]. A pelvic examination of a female is generally considered noninvasive; this procedure, however, is rarely associated with severe allergic reactions [ 3 ].

We report on a case of severe anaphylaxis after a pelvic examination performed on a year-old Thai woman. She had had a spinal cord tumor surgically removed 4 years prior to the episode of anaphylaxis. She consequently had spastic paraplegia and became bed-bound. She developed one chronic pressure sore at the labia majora, for which she underwent multiple debridements. Three days prior to the episode of anaphylaxis, she complained of vaginal spotting.

A pelvic examination was done to diagnose the pelvic pathology. The gynecologist used CHX for the vaginal preparation and wore NRL gloves with lubricating gel during the examination. No other medications were administered during peri-procedural period. She rapidly developed generalized hives and flares, swollen eyelids, and hypotensive syncope, all within 30 min.

She was diagnosed with severe anaphylaxis. Intravenous fluid and intramuscular epinephrine were promptly administered. All symptoms improved without a biphasic reaction. Additional history revealed that she had a history of minimal pruritus after direct skin contact with latex gloves during a bed bath procedure 1 month before. Although NRL gloves and CHX as a disinfectant were regularly used in her debridements, she had never had a history of a systemic allergic reaction after a debridement.

Since the age of 50, she had had a history of fruit allergy including bananas, longans, and jackfruit associated with symptoms of pruritus of the lips, urticarial rashes, and angioedema. She had never eaten avocado, kiwi, or other latex-related fruits. Investigations into the cause of the anaphylaxis were done thoroughly 6 weeks after the episode.

The results are summarized in Table 1. We did not perform a latex skin test due to unavailability of a standard solution. A basophil activation test showed an increased expression of CDc in basophils when stimulated with CHX. Its stimulation indices were 4. We analyzed specific IgE to latex component, which showed positive results for Hev b 1, 5, 6. Prick-to-prick testing with latex-related fruits was positive for avocado, banana, jackfruit, kiwi, and longan Fig.

A glove-use test revealed contact erythema with concurrent pruritus on the fingertip at 20 min. Skin test results. CHX chlorhexidine. Latex-fruit syndrome, an association of between latex allergy and plant-derived foods allergy, was also diagnosed.

The cross-reactivity was possibly due to IgE reactivity to structurally similar epitopes on different proteins, which was confirmed by the component-resolved diagnosis. Physicians should thus be aware of the association between latex and food allergens [ 4 ]. Ten percent of fruit-allergic patients are at risk because they carry a probability of an associated latex allergy [ 1 ]. Reports of adverse reactions to CHX have increased over recent decades [ 5 ].

Previous studies have reported that patients presenting with CHX anaphylaxis had histories of previous mild urticarial reactions to CHX. Either topical exposure or invasive administration of CHX could lead to allergic reactions in sensitized individuals [ 5 , 6 ].

Our patient underwent multiple surgical interventions and repeated exposures to CHX during wound debridement and urinary catheterization. We consider these as risk factors for the development of a CHX allergy. Caution in the routine use of CHX to mucous membranes has previously been suggested due to the potential risk of anaphylactic reactions [ 7 ]. This case report has the potential to offer an early signal at the point of care that informs the current practice.

Current practice guidelines, however, focus on the identification of high-risk patients only in an operative setting [ 8 ]. Most of the recommendations do not mention allergic screening before a pelvic examination. Pre-procedural allergy screening should thus be expanded to noninvasive procedures that involve mucosal manipulation. Secondly, there is a range of etiologies of hypotension in obstetric and gynecologic patients, and recognition of anaphylaxis and initiation of anaphylaxis-specific treatment is often delayed compared with non-obstetric and gynecologic cases [ 9 ].

Epinephrine and other resuscitative measures should, therefore, be available in the setting in which such procedures are performed. There have been cases with a CHX allergy which may also exhibit positive results for other allergen testing. We thus suggest that if CHX is positive on testing, the other relevant exposures should be tested [ 9 ]. In conclusion, concomitant mucosal exposure of both NRL and CHX in highly sensitized patients during pelvic examination can lead to severe anaphylaxis.

Pre-procedural screening for an allergy to latex or CHX, or to any other allergen, especially fruits, should be performed in patients where there is suspicion of a specific allergy due to a previous allergic reaction. I came to the hospital for a pelvic examination appointment. I had not expected to have an allergic event. The experience of allergic reaction was frightful. The feeling of being unwell was the first symptom that I tried to explain to the physician. Then I lost consciousness and found myself in the intensive care unit after recovery.

After the complete investigation, I was diagnosed with the latex-fruit syndrome and chlorhexidine allergy, both of which were unfamiliar to me. The physician told me that having latex and fruits allergy is something that has previously reported in medical journals.

I wish that the reaction could have been prevented if a history of fruits allergy had been considered significant in the initial evaluation before starting the procedure. I hope that my case will cause everyone to focus on the history of fruits allergy before using the latex-containing products.

PK and CW contributed to the revision of the manuscript for important scientific content. Pichler WJ, Tilch J. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther ; Romano A, Demoly P. Recent advances in the diagnosis of drug allergy.

Curr Opin Allergy Clin Immunol ; In vitro testing for diagnosis of idiosyncratic adverse drug reactions: Implications for Pathophysiology. Br J Clin Pharmacol ; Relevance of the determination of serum-specific IgE antibodies in the diagnosis of immediate beta-lactam allergy. Adverse reactions to targeted and non-targeted chemotherapeutic drugs with emphasis on hypersensitivity responses and the invasive metastatic switch.

Cancer Metastasis Rev ; Front Pharmacol ; Immunoglobulin E-mediated hypersensitivity to amoxicillin: in vivo and in vitro comparative studies between an injectable therapeutic compound and a new commercial compound. In vitro evaluation of IgE-mediated hypersensitivity reactions to quinolones. Usefulness of basophil activation tests for the diagnosis of IgE-mediated allergy to quinolones.

Threshold for basophil activation test positivity in neuromuscular blocking agents hypersensitivity reactions. Allergy Asthma Clin Immunol ; Allergy to rocuronium: from clinical suspicion to correct diagnosis. The diagnostic value of basophil activation test in patients with an immediate hypersensitivity reaction to radiocontrast media.

Ann Allergy Asthma Immunol ; Diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy Asthma Immunol Res ; J Allergy Cairo ; Negativity of the basophil activation test in quinolone hypersensitivity: a breakthrough for provocation test decision-making. Controversies in drug allergy: In vitro testing. J Allergy Clin Immunol ; T-cell reactions to drugs in distinct clinical manifestations of drug allergy.

Drug hypersensitivity reactions involving skin. Handb Exp Pharmacol ; Nyfeler B, Pichler WJ. The lymphocyte transformation test for the diagnosis of drug allergy: sensitivity and specificity. Srinoulprasert Y, Pichler WJ.

Sensitivity and specificity of the lymphocyte transformation test in drug reaction with eosinophilia and systemic symptoms causality assessment. T cell involvement in cutaneous drug eruptions. Role of T cells in nonimmediate allergic drug reactions. Curr Opinion Allergy Clin Immunol ; T cell-mediated hypersensitivity to quinolones: mechanisms and cross-reactivity.

Utility of the lymphocyte transformation test in the diagnosis of drug sensitivity: dependence on its timing and the type of drug eruption. Porebski G. Int J Mol Sci ; Int Immunopharmacol ; Transl Clin Pharmacol ; The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease. CDc-based basophil activation test in allergy diagnosis: characteristics and differences to CD63 upregulation. Cytometry B Clin Cytom ; The basophil activation test in the diagnosis of allergy: technical issues and critical factors.

The measurement of drug-induced interferon gamma-releasing cells and lymphocyte proliferation in severe cutaneous adverse reactions. J Eur Acad Dermatol Venereol ; Keywords: Drug hypersensitivity, severe cutaneous adverse drug reactions, basophil activation test, lymphocyte transformation test Abstract Drug hypersensitivity reactions DHRs are considered as an important public health problem because they can lead to life-threatening conditions. Downloads Download data is not yet available.

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