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Biomedical subjects

A J Bircher

Publications and source records attributed to A J Bircher.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Cutaneous diphtheria in returning vacationers--mirror of inappropriate vaccination practice?].

The causative agent for diphtheria is Corynebacterium diphtheriae, which is transmitted from person to person from the throat of carriers or from patients with active cutaneous diphtheria. The disease occurs in preexisting ulcers, but it may also appear on apparently normal skin. Although primary cutaneous diphtheria starts as a vesicle or pustule, most patients feature a reddish ulcer with undermined borders. The lesion is tender but hypesthesia develops after 2 weeks. The clinical diagnosis is based on the history of travelling in endemic regions and bacteriological studies. The current increase of diphtheria in the Western world is partly caused by rising tourism and a decline of booster vaccination in adults. After trauma with ulcerations of the skin we suggest to perform a booster vaccination not only for tetanus but also for diphtheria. In addition, persons travelling to endemic regions should receive a booster vaccination for tetanus and diphtheria, which is available as a combined preparation.

Adult↗
PubMed1998

Delayed-type hypersensitivity to a nonionic, radiopaque contrast medium.

BACKGROUND: True allergic reactions to iodinated radiocontrast media are rare, and only a few well-documented cases of delayed-type hypersensitivity reactions caused by contrast media have been described. METHODS: We report a 61-year-old patient in whom percutaneous transluminal coronary angioplasty (PTCA) was performed with iopamidol, a nonionic contrast medium. Seven days later, the patient developed generalized maculopapular exanthema. Repeated patch tests with several iodinated agents were performed. RESULTS: A first patch test with iopamidol was positive. Repetition of the patch tests showed positive results to iopamidol as well as to iohexol and ioversol, two other nonionic contrast media, but not to other iodinated substances. Three months later, PTCA was repeated, and iopamidol was used again. Despite premedication, pruritic macular exanthema developed 1 day later. Whether iopamidol or trometamol -- an additive substance in the contrast medium -- was causative could not be determined, since a third set of patch tests was negative. CONCLUSIONS: Delayed-type hypersensitivity reactions to iodinated contrast media are rare. We recommend that patients with delayed exanthematous reactions undergo patch or intradermal tests with different contrast media and their additives, and that readings be performed immediately and later at days 2 and 3.

Angioplasty, Balloon, Coronary↗
PubMed1997

Drug-induced hepatocellular liver injury due to benzylpenicillin with evidence of lymphocyte sensitization.

BACKGROUND/AIMS: Reports on drug-induced liver injury due to benzylpenicillin are scarce and predominantly describe cases of intrahepatic cholestasis. To our knowledge, no immunologically documented case of hepatocellular liver injury due to benzylpenicillin has been reported so far. CASE REPORT: A previously healthy man required long-term therapy with benzylpenicillin because of vertebral spondylitis. After 4 weeks of treatment, liver tests showed a marked increase in transaminases associated with high peripheral eosinophil counts. Discontinuation of benzylpenicillin resulted in gradual recovery. INVESTIGATIONS: Levels of eosinophil cationic protein were elevated, indicating eosinophil activation and the presence of an immunoallergic reaction. Skin tests and assays for specific Ig E-antibodies to benzylpenicillin were negative, but lymphocyte transformation tests demonstrated T-cell sensitization to benzylpenicillin. CONCLUSIONS: According to current causality assessment schemes, our report constitutes a probable case of drug-induced hepatocellular liver injury due to benzylpenicillin.

Humans↗
PubMed1997

Angiotensin-converting enzyme inhibitor-induced angioedema: late onset, irregular course, and potential role of triggers.

Angioedema is a rare but potentially life-threatening adverse effect of angiotensin-converting enzyme inhibitors (ACEI) which usually occurs within the first weeks of therapy. We report three patients in whom ACEI-induced angioedema began with a late onset of 12-33 months, and who had an irregular, unpredictable course under ACEI therapy. In two patients, other drugs or trauma appeared to trigger some of the episodes. After withdrawal of the ACEI, the trigger drugs were well tolerated in provocation tests and upon re-exposure. To avoid putting some patients unnecessarily at risk for long periods, one should consider this irregular pattern of ACEI-induced angioedema and regularly monitor patients for this adverse effect.

Aged↗
PubMed1996

Adult onset of cow's milk protein allergy with small-intestinal mucosal IgE mast cells.

We report a female patient with adult onset of cow's milk protein allergy. For 1 year, she experienced repeated gastrointestinal symptoms and had a single exercise-induced anaphylactic reaction. In addition to positive skin tests and specific IgE to milk proteins and a positive challenge test, immunohistochemistry of the small intestine showed a marked increase of IgE-positive mast cells. This finding is highly specific and could provide an additional tool for diagnosing cow's milk protein allergy and possibly also other food allergies.

Adult↗
PubMed1996

Delayed-type hypersensitivity to subcutaneous lidocaine with tolerance to articaine: confirmation by in vivo and in vitro tests.

A 43-year-old woman suffered from recurrent localized swellings and an eczematous dermatitis starting 1 day after an injection of lidocaine. Intradermal patch and lymphocyte transformation tests revealed sensitization to lidocaine and cross-reactivity to the other aminoacylamide local anesthetics bupivacaine, mepivacaine and prilocaine, but not to articane. Contact allergy to the ester local anesthetics benzocaine, procaine and tetracaine, the quinoline or aminoacylamide cinchocaine, and the preservatives methylparaben and metabisulfite, was excluded. A subcutaneous challenge with articaine was well tolerated.

Adult↗
PubMed1996

Delayed-type hypersensitivity to cow's milk protein in Melkersson-Rosenthal syndrome: coincidence or pathogenetic role?

BACKGROUND: Intolerance to cow's milk protein is frequently seen in children and rarely in adults. Non-IgE-mediated hypersensitivity to cow's milk protein has been suspected in children based on in vitro evidence. Food intolerance may play a pathogenetic role in some cases of Melkersson-Rosenthal syndrome, which is often of unknown origin. OBJECTIVE: We describe an adult female patient who developed a Melkersson-Rosenthal syndrome and at the same time was found to have in vivo and in vitro evidence of a delayed-type hypersensitivity to cow's milk protein. METHODS: Allergic and immunologic examinations, including skin prick tests, patch tests, serology, lymphocyte transformation tests and biopsies were performed. RESULTS: A positive patch test to alpha-lactalbumin, a positive lymphocyte transformation test to whole cow's milk and an immunohistology with infiltration of CD4+ and CD8+ T cells were found. CONCLUSIONS: There is a possible pathogenetic relation between delayed-type hypersensitivity to cow's milk protein and Melkersson-Rosenthal syndrome in the patient presented.

Animals↗
PubMed1996

Delayed hypersensitivity reactions to corticosteroids applied to mucous membranes.

Despite the widespread use of corticosteroids on the mucous membranes of the nose, eye and bronchial tree, mucosal contact sensitivity has apparently been uncommon. However, since the introduction of new corticosteroids such as tixocortol pivalate and budesonide, mucosal contact sensitivity, particularly that affecting the nasal mucosa, has increasingly been reported. Contact allergy on other mucosal surfaces and in the bronchial tree is very rare. We report three women who had contact allergy to tixocortol pivalate or budesonide in nasal sprays, and one woman who had an allergic contact stomatitis from tixocortol pivalate in oral lozenges.

Administration, Intranasal↗
PubMed1995

Delayed hypersensitivity to one low-molecular-weight heparin with tolerance of other low-molecular-weight heparins.

We report a patient who developed infiltrated plaques at the sites of subcutaneous injection of a low-molecular-weight heparin. Skin tests and a lymphocyte transformation test revealed hypersensitivity to sandoparin and heparin sodium. The low-molecular-weight heparins nadroparin and dalteparin were subsequently tolerated without adverse effects. Possible risk factors for sensitization are discussed.

Drug Hypersensitivity↗