Kris G. McGrath

An earlier age of breast cancer diagnosis related to more frequent use of antiperspirants/deodorants and underarm shaving.

Breast cancer incidence suggests a lifestyle cause. A lifestyle factor used near the breast is the application of antiperspirants/deodorants accompanied by axillary shaving. A previous study did not support a link with breast cancer. If these habits have a role in breast cancer development, women using antiperspirants/deodorants and shaving their underarms frequently would be expected to have an earlier age of diagnosis than those doing so less often. An earlier age of diagnosis would also be expected in those starting to use deodorants and shaving at an earlier age. This is the first study to investigate the intensity of underarm exposure in a cohort of breast cancer survivors. Four hundred and thirty-seven females diagnosed with breast cancer were surveyed. Once grouped by their frequency of underarm hygiene habits, the mean age of diagnosis was the primary end point. Secondary end points included the overall frequency of these habits, and potential usage group confounding variables were evaluated. All statistical tests were two-sided. Frequency and earlier onset of antiperspirant/deodorant usage with underarm shaving were associated with an earlier age of breast cancer diagnosis. Combined habits are likely for this earlier age of diagnosis. In conclusion, underarm shaving with antiperspirant/deodorant use may play a role in breast cancer. It is not clear which of these components are involved. Reviewed literature insinuates absorption of aluminium salts facilitated by dermal barrier disruption. Case-controlled investigations are needed before alternative underarm hygiene habits are suggested.

Corticosteroid therapy in an additional 13 cases of Stevens-Johnson syndrome: a total series of 67 cases.

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that can be a life-threatening emergency. Previously, we have reported our favorable experience in treating 54 patients with SJS with systemic corticosteroids. We continued our prospective analysis of consecutive patients with SJS treated with corticosteroids. Possible etiologic factors and clinical outcomes of the patients are described. All 13 patients improved with initiation of systemic corticosteroid therapy. There was no mortality or permanent sequelae attributable to SJS. Drugs were the offending agents in all 13 cases. There was one death unrelated to SJS. In conclusion, prompt treatment with systemic corticosteroids reduces morbidity and improves outcome of SJS patients. This analysis extends our series to 67 consecutive patients with SJS who were treated with corticosteroids and had a favorable outcome.

Allergic reactions to streptokinase consistent with anaphylactic or antigen-antibody complex-mediated damage☆

Streptokinase used as a thrombolytic agent may produce immunologic drug reactions. We report a second case of IgE-mediated anaphylaxis and a late reaction to streptokinase. This late reaction was consistent with an IgG-mediated antigen-antibody disease with transient renal involvement, fever, and cutaneous lesions. The second case responded to prednisone therapy.

Undifferentiated somatoform idiopathic anaphylaxis: Nonorganic symptoms mimicking idiopathic anaphylaxis

BACKGROUND Northwestern Universitys Division of Allergy and Immunology has had experience with the diagnosis and treatment of more than 350 patients with idiopathic anaphylaxis (IA). In 1992 we reported a group of patients with IA whose presentations mimicked IA, but IA and other organic causes were later excluded. Psychologic factors were suspected as the underlying problem. These patients were classified as IA-variant. Management of these cases was extremely difficult. There was significant morbidity and high and unnecessary costs. OBJECTIVE We aim to distinguish the nature of this disease and to highlight the evaluation and treatment of this group of patients. METHODS Their cases are reviewed and reported. RESULTS Common features included (1) presenting symptoms mimicking IA, (2) no objective findings that correlated with 1, (3) no response to the therapeutic regimen for IA, (4) meeting the Diagnostic and Statistical Manual of Mental Disorders criteria for undifferentiated somatoform disorder, and (5) significant wasted health care expenditure. CONCLUSIONS This group of patients were better defined as having undifferentiated somatoform-IA. An algorithm was proposed to expedite the diagnosis of the disease so that with early recognition of the disease, unwarranted repetitive consultations, tests, and inappropriate therapy can be avoided.

The relationship of airborne trimellitic anhydride concentrations to trimellitic anhydride-induced symptoms and immune responses

Eighteen workers exposed to trimellitic anhydride (TMA) powder were evaluated in 1979. Twelve of these workers were available for longitudinal study until 1982. Annual clinical evaluations and serum radioimmunoassays for total antibody binding and specific IgE binding to 125I-TM-HSA were performed. In 1979, five workers had antibody against TM-HSA. Of these, three workers were diagnosed with the late respiratory systemic syndrome (LRSS) and one worker with TMA-induced allergic rhinitis. The LRSS workers had significantly elevated total antibody binding of 125I-TM-HSA and the worker with rhinitis had significantly elevated specific IgE binding of 125I-TM-HSA per milliliter of serum. Although TMA handling was intermittent throughout the year, average airborne dust concentrations from 1974 to 1978 at job stations of the two heaviest TMA-exposed occupations, operator and assistant operator, were 2.1 and 0.82 mg/m3, respectively. After local exhaust ventilation had been improved, average airborne dust concentrations of TMA at the two latter job stations fell to levels of 0.03 and 0.01 mg/m3, respectively, in 1982. The decrease in TMA exposure coincided with a gradual fall in total antibody binding of 125I-TM-HSA per milliliter in 1982 and symptomatic improvement in the three individuals with the LRSS. The continuous low-level exposure of the worker with TMA rhinitis was sufficient to elicit a rise in specific IgE against TM-HSA from 1.1 ng of 125I-TM-HSA bound per milliliter in 1979 to 2.12 in 1982.(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatric idiopathic anaphylaxis : Experience with 22 patients

Idiopathic anaphylaxis in the pediatric population is being increasingly recognized, with symptoms (and therefore classifications) the same as those described in adults. We present a series of 22 patients with special attention to considerations relatively unique to the pediatric population. Prednisone, hydroxyzine, and albuterol were used to control symptoms and induce remission. No deaths occurred during treatment. One adolescent who presented with corticosteroid-dependent idiopathic anaphylaxis was diagnosed with undifferentiated somatoform-idiopathic anaphylaxis. Local physician reluctance to participate in management complicated care for some patients.

Apocrine sweat gland obstruction by antiperspirants allowing transdermal absorption of cutaneous generated hormones and pheromones as a link to the observed incidence rates of breast and prostate cancer in the 20th century

Breast and prostate cancer share similarities and likely represent homologous cancers in females and males, respectively. The role of hormones such as testosterone and estrogen in carcinogenesis is well established. Despite worldwide research efforts, the pathogenesis of these diseases is largely not well understood. Personal care products containing estrogens or xenoestrogens have raised concern as a breast cancer risk, especially in young African-American women. In the United States (US) there is a parallel rise in the incidence in breast and prostate cancer compared to selected non-hormone dependent tumors. Observed US and global breast and prostate cancer incidence increases were occurring before exogenous hormone replacement and xenoestrogen exposure were commonplace. An unintentional, inadvertent, and long term hormone exposure may occur from transdermal absorption of sex hormones and pheromones (androgens) from axillary apocrine sweat gland obstruction by aluminum-based antiperspirants. The global rise in antiperspirant use parallels rises in breast and prostate cancer incidence and mortality rates. A multi-disciplinary literature based set of evidence is presented on how such a link is possible, to prompt confirmatory investigations in the pursuit of unmet needs in breast and prostate cancer etiology and prevention.

Malignant Cough Equivalent Asthma: Definition and Case Reports

BACKGROUND Cough equivalent asthma is a cause for chronic cough and usually responds to corticosteroid therapy. Oral corticosteroids are employed in a diagnostic-therapeutic trial and inhaled corticosteroids are employed in maintenance therapy. In certain cases the cough may be especially severe and require escalated doses of oral corticosteroids for initial control. This is labeled malignant cough equivalent asthma. OBJECTIVE To define malignant cough equivalent asthma, provide two case reports, and identify features that should alert physicians to consider the possibility of malignant cough equivalent asthma. CASE REPORTS We report two patients who presented complaining of chronic cough that was disruptive of sleep and normal activities, and in one patient prompted an emergency room visit and later hospitalization. The patients underwent evaluation with history, physical examination, and laboratory testing as indicated. Other causes for chronic cough were ruled out by appropriate testing, or were treated, and patients did not respond to usual corticosteroid treatment for cough equivalent asthma. These patients were considered to have a more severe form of cough equivalent asthma and did respond to treatment with higher doses of oral corticosteroids. CONCLUSION Malignant cough equivalent asthma is a cause of chronic cough that is disruptive to sleep or normal activities, may lead to emergency room visits or hospitalization, and requires escalated doses of oral corticosteroids for initial control.

Allergic rhinitis jeopardizing the careers of professional singers, justifies intense therapy.

A series of three patients were evaluated and treated by the Northwestern University Section of Allergy. These patients had allergic disease that threatened their professional careers as performing artists. Although the clinical manifestations of allergic rhinitis were not unusually severe, these were sufficient to interfere with the performance of these professional singers. Because previous allergic diagnostic and therapeutic regimens had not controlled the voice related symptoms, career changes were reluctantly being considered. Unusually aggressive therapy including systemic corticosteroids was initiated as a diagnostic and therapeutic trial. The resultant improvement was then maintained with more standard allergic management and the three singers were able to perform satisfactorily. This report demonstrates how allergic disease affecting three performing artists justified intense therapy to prevent job loss and the potential financial, emotional and social consequences.

Immunologic Responses to Intravenous Streptokinase in Dogs

Streptokinase is used worldwide as a thrombolytic agent. Allergic reactions to streptokinase have been reported, but the immunologic mechanisms have not been well characterized. To develop a canine model of streptokinase immune responses analogous to human responses, four dogs received intravenous streptokinase infusions. Significant rises in IgG, IgA and IgM antibody levels occurred after streptokinase administration in three of four dogs; a fourth dog developed significant increases in IgG and IgA antibody levels. Two dogs developed immediate-type cutaneous hypersensitivity to streptokinase. One dog developed subacute dermatitis with eosinophilic infiltrates which was possibly a manifestation of an allergic reaction to streptokinase.