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Biomedical subjects

Andreas J Bircher

Publications and source records attributed to Andreas J Bircher.

15 recordsLinked to original sources
PubMed2006

Immediate hypersensitivity to rifampicin in 3 patients: diagnostic procedures and induction of clinical tolerance.

BACKGROUND: Desensitization with drugs may be indicated in some clinical situations. Apart from large experiences with beta-lactam antibiotics and cotrimoxazole in HIV infection, experience with other drugs is limited. Rifampicin may elicit exanthema and urticaria, and their pathomechanisms are not known in detail. Since therapy with rifampicin may be indispensable in mycobacterial infections or against multiresistant Staphylococcus aureus, desensitization may be indicated in some patients. OBJECTIVE: Report of immediate hypersensitivity to rifampicin and description of diagnostic and desensitization procedures. METHODS: We report 3 patients with immediate urticarial reactions to rifampicin. Diagnostic procedures included skin and in vitro tests (specific IgE, lymphocyte transformation test, LTT, and CAST). The non-irritant cutoff concentration was evaluated in 24 volunteers. A 7-day desensitization procedure was used. RESULTS: Only intradermal tests at a dilution of at least 1:10,000 (concentration of rifampicin approximately 0.006 mg/ml) were true positive, whereas in vitro tests (IgE, LTT and CAST) did not correctly identify hypersensitive patients. Two patients had positive accidental reexposure. All patients were successfully desensitized with rifampicin according to a slow 7-day protocol. CONCLUSIONS: Rifampicin rarely elicits immediate hypersensitivity symptoms which may be diagnosed by intradermal skin tests. In vitro tests did not contribute to the diagnosis. Therefore, an IgE-mediated mechanism remains to be proven. Desensitization with rifampicin using different protocols has been reported. In our 3 cases, clinical tolerance to rifampicin was achieved using a 7-day protocol.

Adult↗
PubMed2006

Anaphylaxis to isosulfan blue and cross-reactivity to patent blue V: case report and review of the nomenclature of vital blue dyes.

BACKGROUND: Blue dyes used for lymphatic mapping in sentinel lymph node biopsy cause intraoperative anaphylactic reactions in up to 2.7% of patients. With increasing implementation of this technique, the incidence of anaphylaxis to these dyes can be expected to increase. In the literature, the chemically often unrelated and inconsistently designated dyes have been confused, adding to other inconsistencies in the nomenclature. OBJECTIVE: To demonstrate the nomenclature, chemical and physiologic differences, and allergenicity of the various blue dyes used in a medical context. METHODS: We describe a patient with an intraoperative grade IV anaphylactic reaction to isosulfan blue. Immediate-type hypersensitivity was proved by positive skin test reactions and CD63 expression to isosulfan blue and cross-reactivity to patent blue V. RESULTS: A review of the literature clarified the exact nomenclature of the blue dyes and the possible pitfalls of confusing nomenclature in the context of structurally closely related dyes with different allergenic properties. For the detection of type I hypersensitivity, intracutaneous tests are valuable tools. An IgE-mediated mechanism has been shown recently. In most cases, sensitization exists without known previous exposure in a medical context. This may be due to the widespread use of such dyes in objects of everyday life. Preoperative antiallergic medication use does not prevent anaphylactic reactions but apparently reduces their severity. CONCLUSION: For better comparison and precision, the Chemical Abstracts Service number of the respective dye should always be given.

Aged↗
PubMed2005

Symptoms and danger signs in acute drug hypersensitivity.

Early and rapid recognition of severe adverse drug reactions is essential. Prompt withdrawal of the offending drug is the most important action to minimize morbidity and mortality. Dependent on the type of reaction, e.g. in immediate type reactions instant withdrawal and therapy are mandatory, whereas in delayed reactions diagnosis as early as possible may be life-saving. The skin is an important herald organ and may early signal a severe evolution of a cutaneous reaction or involvement of circulating blood cells or internal organs. A synthesis considering all factors should be made to obtain an early and correct diagnosis.

Acute Disease↗
PubMed2005

Hypersensitivity reactions to fluoroquinolones.

Fluoroquinolone antibiotics cause immediate and delayed hypersensitivity reactions, and may also affect internal organs and circulating blood cells. The underlying pathomechanisms are only partly understood. The extent of cross-reactivity among different quinolones depends on the type of clinical manifestation and its underlying mechanism. Despite recent advances, reliable diagnostic tests are still lacking. Recent studies have shown quinolone-specific IgE in vitro in more than 50% of patients with immediate-type reactions and a considerable cross-reactivity with related compounds. In maculopapular drug exanthems from ciprofloxacin, specific T-cell clones were identified, and cross-reactivity to related compounds was detected in approximately 50% of the clones. From re-exposure studies in patients with exanthems, cross-reactivity appears to be lower. Cellular tests such as lymphocyte transformation tests are currently not very useful. For prick and intradermal skin tests, widely divergent nonirritant test concentrations have been recommended. Desensitization may be possible in selected patients.

Adult↗
PubMed2005

Systemic immediate allergic reactions to arthropod stings and bites.

Most of the encounters with biting and stinging insects result in more or less pronounced localized reactions. Typically, urticarial wheals and papular reactions are observed. Less often local bullous or hemorrhagic or disseminated papular reactions, particularly in children and immunologically naive adults, may be seen. With the exception of bee and wasp venom allergies, immediate-type allergic reactions to arthropod stings and bites are rare. Systemic IgE-mediated hypersensitivity has also been reported from additional hymenoptera species, e.g. hornets, bumble bees and ants. Rare are systemic reactions to mosquitoes, flies or kissing bugs and exceptional from ticks, bed bugs, moths, caterpillars and spiders. A major problem is the often lacking standardization of extracts for skin testing and for the determination of specific IgE. Some of the allergens have been characterized and few of them synthesized using recombinant techniques. Most investigations have been made with whole-body extracts or extracts from salivary glands, while desensitization has rarely been attempted. Currently, primary prevention by avoidance of stings and bites, and adequate instruction of sensitized individuals in the use of emergency drugs are mandatory.

Animals↗
PubMed2005

Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study.

BACKGROUND: Many people suffer from hay fever symptoms. Hypnosis has proved to be a useful adjunct in the treatment of conditions where allergic phenomena have an important role. METHODS: Randomised parallel group study over an observation period of two consecutive pollen seasons. Outcome data include nasal flow under hypnosis, pollinosis symptoms from diaries and retrospective assessments, restrictions in well-being and use of anti-allergic medication. We investigated 79 patients with a mean age of 34 years (range 19-54 years; 41 males), with moderate to severe allergic rhinitis to grass or birch pollen of at least 2 years duration and mild allergic asthma. The intervention consisted of teaching self-hypnosis during a mean of 2.4 sessions (SD 1.7; range 2-5 sessions) and continuation of standard anti-allergic pharmacological treatment. RESULTS: Of 79 randomised patients, 66 completed one, and 52 completed two seasons. Retrospective VAS scores yielded significant improvements in year 1 in patients who had learned self-hypnosis: pollinosis symptoms -29.2 (VAS score, range 0-100; SD 25.4; p < 0.001), restriction of well-being -26.2 (VAS score, range 0-100; SD 28.7; p < 0.001. In year 2, the control group improved significantly having learned self-hypnosis as well: pollinosis symptoms -24.8 (SD 29.1; p < 0.001), restriction of well-being -23.7 (SD 30.0; p < 0.001). Daily self-reports of subjects who learnt self-hypnosis do not show a significant improvement. The hazard ratio of reaching a critical flow of 70% in nasal provocation tests was 0.333 (95% CI 0.157-0.741) after having learnt and applied self-hypnosis.

Adolescent↗
PubMed2004

Systemically induced allergic exanthem from mercury.

Cutaneous reactions to mercury can manifest themselves in different forms. Apart from contact dermatitis, flare-up reactions, disseminated exanthem as well as skin symptoms in previously unaffected skin are known. Regarding systemic allergen application, 2 separate clinical patterns, namely acute generalized exanthematous pustulosis (AGEP) and symmetric flexural exanthem 'baboon syndrome' have been described. Systemic allergic reactions to mercury are most commonly provoked by the inhalation of metallic mercury vapours from a broken thermometer, often after previous sensitization to mercury compounds, e.g. Mercurochrome. Patch testing with mercurials yields positive reactions in approximately 80% of patients. We report 3 patients, 2 with flexural exanthem, and 1 presenting with AGEP, respectively. Positive patch tests to mercury derivatives could be demonstrated in all of them. Furthermore, non-toxic serum mercury levels were detected in 2 of the patients. The present review provides a survey of the literature on systemic allergic exanthem to mercury. However, plausible explanations for the distribution pattern of the skin manifestations in AGEP and flexural exanthem are still lacking.

Adult↗
PubMed2003

Unregulated alternative medicine.

Unconventional (i.e. alternative, traditional, or complementary) treatments are used by many individuals for a variety of symptoms and disorders. Reports on fraudulent products used for unconventional treatments are not uncommon. These include herbal remedies offered as "natural" while containing non-labeled synthetic pharmacological ingredients or even toxic agents, patients not being informed of active ingredients, products containing no active substances, or unqualified individuals or "clinics" delivering dangerous advice or treatment. Reports on tainted topical products remain rare due to the high analytical demands necessary to detect minimal traces of unknown ingredients, the fact that patients often use medications from different sources, and patient over-reliance on the effectiveness of folk remedies or advertised claims. The patients' assumption of receiving a safe and effective therapy by "natural" products has shown to be unreliable. The authors urge that quality standards for "natural" and pharmaceutical products should be the same and that only qualified professionals should deliver treatment and medical advice.

Animals↗
PubMed2002

IgE-mediated urticaria from formaldehyde in a dental root canal compound.

A patient had suffered twice from an acute urticaria after treatment with two different dental root canal compounds (RCC). Skin prick tests with the single components and formaldehyde 1%aq. were positive to formaldehyde 1%aq., but irritant with formaldehydeRCC. Specific IgE to formaldehyde were positive. Patch tests were positive to formaldehydeRCC only. In the literature 28 patients with immediate symptoms to formaldehyde containing RCC have been described.

Adult↗