Robert Gomez

Safety of chitosan bandages in shellfish allergic patients.

BACKGROUND In 2005, the Office of the Surgeon General mandated that every soldier carry a HemCon bandage. Made from chitosan, a polysaccharide derived from shrimp shells, this bandage effectively stops bleeding. There are no studies reporting the safety of this bandage in shellfish allergic patients. METHODS Patients who reported shellfish allergy were recruited. Initial assessment included a detailed history, IgE skin prick testing (SPT), and serum testing to shellfish allergens. Participants who demonstrated specific shellfish IgE underwent a bandage challenge. RESULTS Nineteen participants were enrolled; 10 completed the study. Seven (70%) were male and the average age was 44.8 + 10 years. Nine (90%) reported a shrimp allergy history and five (50%) reported multiple shellfish allergies. All participants completing the study had positive SPT and serum IgE testing to at least one shellfish; eight (80%) had shrimp positive SPT and ten (100%) demonstrated shrimp-specific IgE. No participant had a positive SPT to chitosan powder or experienced an adverse reaction during bandage challenges. No protein bands were visualized during gel electrophoresis analysis of chitosan powder. CONCLUSION All participants tolerated the HemCon bandage without reaction. This is the first study demonstrating the safety of this bandage in shellfish allergic subjects.

Ovalbumin content in 2009 to 2010 seasonal and H1N1 monovalent influenza vaccines

In summary, we demonstrate that UV-B irradiation of human keratinocytes supplemented with 7-DHC triggers the synthesis of hormonally active calcitriol, which then differentially affects expression of AMPs cathelicidin and HBD2. Furthermore, we propose an explanation for the differences observed in AMP regulation in vitro and in vivo on UV-B treatment. Mark Peric, PhD Bodo Lehmann, PhD Gabriela Vashina, MD Yvonne Dombrowski, PhD Sarah Koglin Michael Meurer, MD Thomas Ruzicka, MD J€urgen Schauber, MD From the Department of Dermatology and Allergology, Ludwig-Maximilians-Universität Munich; and the Department of Dermatology, Carl Gustav Carus Medical School, Dresden University of Technology, Germany. E-mail: juergen.schauber@ med.uni-muenchen.de. J.S. has received grants from the Deutsche Forschungsgemeinschaft (Emmy Noether Programm; Scha 979/3-1; http://www.dfg.de) and the Fritz Thyssen Stiftung (http:// www.fritz-thyssen-stiftung.de). B.L. has received a grant from the Gesellschaft der Freunde und Förderer des Universitätsklinikums Dresden. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article. Disclosure of potential conflict of interest: M. Meurer is on the speakers’ bureau for Novartis Pharma and is an advisor for Basilea Pharma. The rest of the authors have declared that they have no conflict of interest.

Fixed food eruption caused by peanut and cashew: A case report and review of the literature

Kelso first coined the term “fixed food eruption” (FFE) in 1996, when describing a fixed lesion triggered by strawberry ingestion.We report the case of a 22-year-old patient with a similar reaction to peanuts and cashews. For the past 2 years, immediately after eating peanuts and cashews, the patient developed a red, raised pruritic wheal and flare on his right inner thigh and left volar forearm at the site of an angiolipoma biopsy scar (Figure 1). The symptoms resolve shortly after taking loratadine, and he has never had any other cutaneous or generalized symptoms with ingestion of these or any other foods. Skin prick testing was nonreactive to almond, brazil nut, cashew, hazelnut, pecan, pistachio, black walnut, and peanut, with appropriately responding positive and negative controls. Patch testing to peanut butter and crushed peanuts in white petrolatum (read at 10, 20, 30minutes, and at 48 and 96 hours) also was negative. The patient’s total IgE measured 16.7 kU/L. Further in vitro testing yielded negative results: peanut, cashew, birch tree, and oak tree specific fluoroenzyme immunoassays were negative (<0.35 kU/L), whereas peanut component testing alsowas unremarkable (<0.10 kU/L for Ara h 1, 2, 3, 8, and 9). Open oral challenge to peanut butter resulted in an approximately 10-mm nonpigmented wheal with surrounding erythema over his left forearm scar approximately 10minutes after ingestion. There was no skin reaction on his thigh, and no delayed lesions developed. A punch biopsy specimen of the forearm wheal elicited by oral challenge revealed an unremarkable epidermis, mild dermal edema, and superficial and mid dermal perivascular and interstitial mixed infiltrate mainly composed of neutrophils and a few eosinophils. Immunoblot analysis of the patient’s serum against raw peanut, cashew, and almond samples (Figure 2) revealed IgE binding at 15, 17, and 20 kDa for peanut, with weaker binding for peanut, at 8, 9, 25, 30, 37, and 42 kDa. The patient also had weak IgE binding at 42 kDa for almond. No IgE binding was detected for cashew. Six months after initial presentation and biopsy, the patient still eats peanuts and cashews, and his skin reactions continue on his right thigh and left forearm, now over his new scar. In the English scientific literature, 10 other foods have been reported as FFE triggers (Table I), with a variety of clinical presentations; prick, patch, and food-specific IgE testing results; and biopsy reports. The common theme for all reactions is a fixed lesion that occurs after food ingestion, similar to the fixed drug eruption sometimes seen with medications. Fixed eruptions, both drug and food, all have in common recurring lesions at the same location. However, the variable nature and timing of FFE lesions described in the literature suggests differing mechanisms, whereas fixed drug eruptions, which usually involve macular lesion(s) that develop hours after drug exposure and result in residual hyperpigmentation, are typical of a delayed type hypersensitivity reaction. Our patient’s reaction involved an urticarial lesion that occurs immediately after food exposure, without residual hyperpigmentation, which more likely

A side-by-side comparison of Rotorod and Burkard pollen and spore collections

BACKGROUND The Rotorod sampler and Burkard spore trap are 2 devices commonly used to quantify airborne particles. OBJECTIVE To evaluate the differences in collections between the 2 devices for a wide range of plant pollens and fungal spores. METHODS Pollens and spores were collected simultaneously with each device on 167 days during a 1-year period. RESULTS The Burkard yielded significantly higher total and individual mold spore counts. It yielded statistically higher total grass, total weed, and Urticaceae daily pollen counts, although the absolute differences were small. Daily counts were positively correlated between the 2 devices for the most abundant pollens and mold spores. CONCLUSION The Burkard spore trap collects many more mold spores than the Rotorod over a wide variety of species. The Burkard also yielded higher total grass, total weed, and Urticaceae daily pollen counts. Despite these differences, however, either device can be used to follow trends in the most abundant pollen and mold spores.

Allergy to local anesthetics: specific IgE demonstration to both amides and esters in a single patient.

time byDBPCFC and further supported by the subsequent good tolerance of more than 10 fish species not belonging to the Salmonidae family. Our IgE immunoblotting and mass spectrometry results suggest a specific epitope recognition pattern of Salmonidae parvalbumins, which is supported by the fact that the sequence identity between salmon and trout parvalbumins is higher than with the counterparts of cod, hake, sole, tuna, and whiting, fish species tolFigure 1. Salmon and trout IgE immunoblot. T indicates trout extract; S, salmon extract; C, pooled control serum; and P, patient’s serum. Trout (lane 1) and salmon (lane 2) extracts were incubated with a pooled serum of 15 nonallergic controls. Trout (lane 3) and salmon (lane 4) extracts were incubated with the patient’s serum.

Clinical and immunologic assessment of a cluster method during allergen immunotherapy refill dosing

During a typical 3 to 5eyear course of aeroallergen immunotherapy (AIT), refills are required every 6 to 12 months when the manufacturer’s serum expires. Current guidelines for the new refill vial is to reduce the initial dose by 50% to 90%. Patients then generally return weekly to reach their maintenance dose. Although cluster AIT studies focused on the build-up phase, there are no studies that assessed the use of a cluster method during refill dosing. Although results of several studies found similar systemic reaction (SR) rates that compared cluster and conventional immunotherapy build-up schedules, others have noted an increased frequency. Overall, SRs with build-up cluster methods has varied from 3% to 50% of patients (0.15%3.3% of injections).