Perioperative management of asthma and idiopathic anaphylaxis.
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Anaphylaxis↗
Biomedical subjects
R Patterson
Publications and source records attributed to R Patterson.
Anaphylaxis and asthma in a scrimshander due to deer bone dust.
A boilermaker who engraved deer bone (scrimshaw) as his artistic vocation developed recurrent anaphylaxis while scraping deer bones. These bones has been boiled in NaClO and dried, leaving residual NaOH and altered deer protein. He had recurrent episodes of anaphylaxis when exposed to the bone dust. The anaphylaxis appears to be the result of exposure of traumatized skin to NaOH and antigen with sufficient absorption of antigen to result in anaphylaxis, although inhalation may have been contributory. The most severe, near fatal episode of anaphylaxis may have been worsened by captopril. The patient's reaction by prick test to protein extracted in buffered saline from the deer bones boiled in NaClO and NaOH but not to natural deer protein suggested IgE antibody against deer protein altered by boiling in alkali. The scrimshander is now working with deer bone after prophylactic therapy and control of exposure.
Anaphylaxis↗
Asthmatic patients with panic disorders: report of three cases with management and outcome.
Panic disorders, a subgroup of the primary anxiety disorders, have an estimated worldwide prevalence of 2.5% to 5%. Although the causes of these disorders have not been completely elucidated, it seems that environmental and genetic factors in addition to central nervous system biochemical abnormalities play important roles. Mild to moderate anxiety levels may prove advantageous in the management of asthmatics but when their anxiety level becomes maladaptive, as in the case of panic attacks, their medical care is placed in jeopardy. Herein are three case reports of asthmatics who also exhibited panic disorders and their clinical outcome. It is concluded that a team approach, involving the primary physician and psychologist or psychiatrist, is beneficial in the long-term management of these patients.
Adult↗
The allergic patient who is noncompliant and abusive: dealing with the adverse experience.
The field of Allergy-Immunology is involved with the care of patients with chronic illness. The care of these patients is enhanced when the physician has established good rapport with the patient. The noncompliant, disruptive behavior of some patients can try the patience of even the most understanding physicians and, in turn, impede the delivery of care. Interactions with this type of patient may leave the physician with feelings of guilt, frustration, and helplessness. We review such an encounter with the purpose of describing how to deal with this type of patient and to guide the physician in responding to this adverse behavior. Such patients will usually require limits to be set on behavioral acting out for their own best interest. Further, it is often necessary to make continued care contingent on compliance with the ground rules set. The physician must be aware of his or her adverse feelings toward the patient and be able to interpret the behavior in the context of the psychiatric disorder so that appropriate psychologic help for the patient can be provided.
Administration, Inhalation↗
The Le Fort fractures: René Le Fort and his work in anatomical pathology.
René Le Fort (1869-1951) was a French army surgeon who conducted a series of thorough, if somewhat macabre, experiments on the heads of cadavers. The results of his work gave rise to a system of classifying facial fractures, now known as Le Fort types I, II and III. Le Fort had a distinguished career in surgery and teaching and served in both world wars.
Facial Bones↗
Severe angioedema related to ACE inhibitors in patients with a history of idiopathic angioedema.
Angiotensin converting enzyme (ACE) inhibitors have been associated with the onset of angioedema in a small subset of treated patients. The angioedema commonly involves the face and oropharyngeal tissues and may result in life-threatening airway compromise. The mechanism by which ACE inhibitors precipitate angioedema has not been well-defined, and retrospective analysis of reported cases has failed to identify a group of patients at high risk. We report four cases of ACE inhibitor-related angioedema that required immediate medical intervention. All four cases occurred in patients with a prior history of idiopathic angioedema, an otherwise uncommon clinical entity. These observations suggest that patients with a history of idiopathic angioedema are at increased risk for the development of ACE inhibitor-related angioedema and should be treated cautiously with this class of drugs.
Adult↗
Idiopathic anaphylaxis. A clinical summary of 175 patients.
One hundred seventy-five patients with idiopathic anaphylaxis, treated by the same team of physicians, were retrospectively evaluated. The diagnosis of idiopathic anaphylaxis was made only after a careful evaluation had failed to identify an allergen or underlying disease. Before our care of these patients, there were a total of 76 hospital admissions, including 21 intensive care unit admissions and 291 emergency department visits. Prophylactic treatment with maintenance antihistamines and prednisone was appropriate for frequent episodes, and short-term treatment was given for infrequent episodes. No fatalities were reported from idiopathic anaphylaxis in the 124 patients who were available for follow-up. With the appropriate treatment, remissions can be induced in a substantial number of patients. Significant reductions in the frequency of emergency department visits and hospitalizations have been shown, which, in turn, are accompanied by decreases in overall medical costs. In this disease, the period before treatment serves as a control period for comparison after therapy.
Adolescent↗
Clinical and serologic follow-up of four children and five adults with bird-fancier's lung.
We report the clinical and serologic findings in four children and five adults with chronic avian hypersensitivity pneumonitis. All subjects were treated with corticosteroids and bird exposure was reduced or eliminated. After a variable period, ranging from 6 months to 10 years, their clinical and serologic findings were reassessed. In terms of symptomatology, chest findings, and pulmonary functions, all four children improved and four adults improved, whereas one adult had a progressive clinical deterioration, ultimately resulting in her death 5 years later. In terms of serologic data, precipitating antibody tended to persist, and antibody to avian antigens, as determined by ELISA, remained positive, although the titer declined. We conclude that, while serologic positivity remains, the prognosis for children and adults with chronic avian hypersensitivity pneumonitis is very good, provided that irreversible damage has not already occurred at the time of diagnosis.
Adult↗
The use of an immunoassay index for antibodies against isocyanate human protein conjugates and application to human isocyanate disease.
Serum IgG and IgE to isocyanate haptenized human serum albumin (HSA) were estimated by ELISA in 55 isocyanate workers who underwent isocyanate inhalation challenge studies in Montreal, Canada. The challenges were negative in 29 workers and positive in 26 workers. Isocyanate antibodies were estimated by ELISA index. The mean IgG indices were found to be significantly higher in the challenge-positive workers, and there was a similar trend for the IgE indices. Antibody specificities for toluene diisocyanate-HSA, diphenylmethane diisocyanate-HSA, and hexamethylene diisocyanate-HSA were determined by inhibition studies with a variety of isocyanate haptenized carriers. The other isocyanate substituted carriers were either noninhibitory or caused only partial inhibition as contrasted with the complete inhibition achieved by HSA conjugated to the isocyanate to which the worker was exposed. We interpret these specificity studies as indicating that the inhalation of isocyanates results in production of antibody that recognizes new antigenic determinants that develop from the coupling of isocyanates to homologous proteins.
Antibodies↗
Clinical trials: the role of the neuroscience nurse.
Participation in clinical drug trials is becoming a common expectation of many neuroscience nurses. Prior to assuming responsibilities associated with a research study, the roles, rights and responsibilities involved must be thoroughly understood. The effective neuroscience nurse brings to the research arena a thorough knowledge of the drug under study, outstanding skills as a clinician and a commitment to ensure the safety and comfort of the participant as the search is made for better and more effective drug regimens.
Clinical Trials as Topic↗
Rhesus monkey airway responses to substance P.
The tachykinin, substance P (SP), was used as a model to study airway and cutaneous responses in a group of normal rhesus monkeys or animals with IgE-mediated cutaneous reactions to Ascaris antigen (AA) alone or animals with both IgE-mediated cutaneous and airway responses to AA. Aerosolized SP (10 mg/ml) resulted in airway responses qualitatively similar in duration and pulmonary function abnormalities to AA. These SP airway responses were most closely associated with the presence of IgE antibody to AA and were not increased in animals with airway reactivity to AA. A dose response to aerosolized SP can be established. An enkephalinase inhibitor, thiorphan, did not potentiate SP airway responses but appeared to potentiate SP cutaneous responses in some animals. SP cutaneous reactions could be demonstrated and did not correlate with the IgE-mediated cutaneous dilution titers to AA.
Administration, Inhalation↗
Immunologic hemorrhagic pneumonia caused by isocyanates.
The occurrence of hemoptysis, dyspnea, and bilateral pulmonary opacities progressed to respiratory failure in a 34-yr-old man. Recovery occurred with corticosteroid therapy. In the absence of evidence for an infectious etiology, the possibility of immunologic trimellitic anhydride (TMA) hemorrhagic pneumonitis was considered when the lung biopsy excluded Goodpasture's and other diseases and because the patient was a spray painter. Serologic evaluation for antibodies against TMA was requested. Because the immunologic studies for TMA were negative, and because the patient was a spray painter, immunoassays for three isocyanates conjugated to human serum albumin (HSA) were carried out although there was no specific history of isocyanate exposure at that time. High levels of IgG and IgE antibodies were detected against hexamethylene diisocyanate (HDI)-HSA and toluene diisocyanate (TDI)-HSA. Further investigation documented exposure to spray paint that contained HDI and another isocyanate. The paint was sprayed on warm metal, and subsequently the worker developed an acute illness. Further plant studies were not possible. We propose that the pathogenesis of this case of hemorrhagic pneumonitis is immunologic because of uncontrolled exposure to HDI and TDI, is analogous to the immunologic hemorrhagic pneumonia caused by TMA, and should be considered as a possible cause of a similar acute lung disease after isocyanate exposure.
Acute Disease↗
Classification of immediate-type, life-threatening allergic or pseudoallergic reactions.
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Allergens↗
Erythema multiforme and Stevens-Johnson syndrome. Descriptive and therapeutic controversy.
Diagnosis and particularly the management of erythema multiforme and Stevens-Johnson syndrome are controversial in medical textbooks and thus in individual cases. In these diseases, fatalities may result from various causes, including secondary infection or visceral organ damage to lung, liver, or kidneys. We present a series of 13 cases managed by one group of physicians which demonstrates the controversy in certain cases, and we review the controversy in the medical literature. Corticosteroid therapy used in this series was considered beneficial in every case by the managing physician and lifesaving in some cases. There were no fatalities in this series. Although the summation may be considered as our opinion only, the frequently suggested "controlled trial of corticosteroid therapy" can probably never be done for ethical reasons, and series such as this will have to establish the standard of therapy.
Erythema Multiforme↗
Topical respiratory therapy.
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Administration, Inhalation↗
Insulin allergy: re-evaluation after two decades.
We reevaluated IgE-mediated insulin allergy using sera obtained 16 to 21 years ago and, 1 and 5 years ago. All antibodies had specificity for human and bovine insulin. We reevaluated Prausnitz-Kustner reactivity after 15 years and the IgE antibody and cutaneous reactivity appeared unchanged. IgE-mediated insulin allergy appears to be declining.
Antibodies, Anti-Idiotypic↗
Pulmonary haemorrhage and haemolytic anaemia due to trimellitic anhydride.
Two young men who had been exposed at work to epoxy resin powder containing trimellitic anhydride (TMA) presented with haemolytic anaemia and repeated haemoptyses. They did not return to work at the factory and the symptoms and the anaemia resolved spontaneously. Seven similar cases have lately been presented at meetings, so it seems that TMA, already known to cause respiratory syndromes such as asthma, can also lead to several extrapulmonary toxic effects, including haemoptyses and haemolytic anaemia. Studies on these patients' sera with TMA haptenised protein and cells pointed to an immunological mechanism.
Adolescent↗