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Biomedical subjects

A J Bircher

Publications and source records attributed to A J Bircher.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Therapy of allergic rhinitis].

Allergic rhinitis is a common disease with a prevalence of 10-20% in western countries. Allergic rhinitis may be complicated by the possible restriction of quality of life and can lead to sequelae like sinusitis, headache or even allergic asthma. The treatment of allergic rhinitis is mainly based on allergen avoidance, pharmacological treatment and specific immunotherapy. For mild symptoms of seasonal or perennial allergic rhinitis topical or nonsedating second generation oral H1-antihistamines or chromones are advised. If the patient presents symptoms of long duration or nasal obstruction is dominant, intranasal steroids should be used, which have proved to be an effective and safe form of therapy for allergic rhinitis. A combination of oral antihistamines and steroids are possible and recommended if one of these agents alone does not provide sufficient relief. If necessary this regimen is supplemented with topical antihistamines or chromone eyedrops. In cases of severe nasal obstruction, a short course of oral steroids or topical decongestants, which both should not be given longer than ten days, is recommended. Intramuscular corticosteroids should not be given, due to the suppression of adrenal glands. In addition it is important to prevent exposure to the allergen. If the treatment is not effective, further investigations should be done to exclude other nasal diseases (polyposis nasi, anatomical anomalies, chronic sinusitis). This article summarizes the recommended medications with their possible side-effects and their place in therapy management of allergic rhinitis in adults and children.

Administration, Intranasal↗
PubMed2000

[Eosinophilic esophagitis associated with recurrent urticaria: is the worm Anisakis simplex involved?].

Anisakis simplex, a fish parasite of the nematode family, typically infects marine mammals such as whales, dolphins and seals. Human anisakiasis, which is acquired by eating raw or insufficiently heated fish or squid, has gained world-wide importance. Infestation with living larvae caused by eating parasitised fish results in acute upper abdominal pain, nausea and vomiting and may be confused with acute abdomen due to appendicitis and other inflammatory abdominal disorders. Extraintestinal organ manifestations are rare. Endoscopically, inflammation, oedema, erosions and ulcerations may be found. The parasite can been found in up to 50% of patients. Histologically, an eosinophilic inflammation is typical. Acute anisakiasis may be prevented by thorough cooking or deep-freezing the parasitised fish for at least 48 h. IgG-antibodies specific for Anisakis simplex are thought to represent an immunological host reaction against parasitic antigens. More recently, allergic reactions to Anisakis ingestion or exposure, such as urticaria, anaphylaxis and even occupational asthma, have been reported. These allergic reactions may also occur when the fish has been properly cooked, and hence these allergens are thought to be heat-stable. Such cases may be diagnosed by skin tests and the determination of specific Anisakis-IgE. However, the specificity of IgE is low, since they may also be present in exposed asymptomatic individuals. Since the eliciting allergens are temperature-stable, prophylactic dietetic measures are indicated. We report a case from Switzerland acquired during a holiday in Portugal. The patient suffered from recurrent dysphagia and urticaria, and histologically eosinophilic oesophagitis was found. IgG-antibodies and a positive skin prick test to Anisakis simplex support its aetiologic role for the symptoms.

Adult↗
PubMed2000

Severe hypersensitivity syndrome to lamotrigine confirmed by lymphocyte stimulation in vitro.

BACKGROUND: The anticonvulsant lamotrigine has been associated with severe adverse events such as the hypersensitivity syndrome and severe bullous reactions. So far, specific immunologic tests have rarely been performed to demonstrate specific sensitization. METHODS: A 36-year-old man suffering from epilepsy was concomitantly treated with high doses of sodium valproate and lamotrigine. About 1 month later, a severe hypersensitivity syndrome occurred affecting skin, lymph nodes, and liver. Three months later, skin tests and lymphocyte stimulation tests with anticonvulsants were performed. RESULTS: Skin tests were negative with all drugs; lymphocyte stimulation tests were twice positive with lamotrigine. Later re-exposure to sodium valproate was tolerated. CONCLUSIONS: Lamotrigine may elicit a severe hypersensitivity syndrome. Particularly high initial doses and concomitant treatment with sodium valproate increase the risk of cutaneous reactions. The lymphocyte stimulation test was used to identify the culprit drug. Lymphocyte sensitization to the drug or a metabolite may be involved in the pathogenesis.

Adult↗
PubMed2000

Airborne contact dermatitis from methylchloroisothiazolinone in wall paint. Abolition of symptoms by chemical allergen inactivation.

Preservatives such as isothiazolinones in paints have been reported to cause airborne contact dermatitis. The patients whom we report experienced acute dermatitis on air-exposed skin and respiratory symptoms after staying in recently painted rooms. Kathon (methylchloroisothiazolinone/methylisothiazolinone) added as preservative to the wall paint was identified as causative agent. In one individual symptoms rapidly disappeared after treatment of the painted walls with inorganic sulfur salt, which leads to inactivation of the allergenic properties of methylchloroisothiazolinone/methylisothiazolinone. We describe the patients, the clinical course and review the literature pertinent to such cases. In addition we report on the chemical analyses of the decorating paints used, and on experiments on emission and air concentration of methylchloroisothiazolinone/methylisothiazolinone from a painted surface before and after inactivation by sodium bisulfite.

Adult↗
PubMed2000

Minocycline-induced lupus. A systematic review.

BACKGROUND: Minocycline has increasingly been associated with different adverse auto-immune reactions including drug-induced lupus. OBJECTIVE: To identify the scope of minocycline-induced lupus and to characterise its typical features. METHODS: Comprehensive Medline and Embase search of the English and non-English literature for case reports of minocycline-induced lupus. RESULTS: We included 57 cases of minocycline-induced lupus (mean age +/- SD at onset: 21.6+/-8.6 years, median time of exposure: 19 months, range 3 days to 6 years). All patients showed the clinical features of polyarthralgia/polyarthritis often accompanied by liver abnormalities. Twelve patients had evidence of dermatological manifestations (i.e rash, livedo reticularis, oral ulceration, subcutaneous nodules, alopecia). The ANA test was positive in all patients. CONCLUSION: Long-term exposure to minocycline may be associated with drug-induced lupus. Baseline and periodic liver function and ANA tests accompanied by appropriate clinical monitoring are suggested for patients receiving long-term minocycline therapy.

Adolescent↗
PubMed2000

Delayed generalized allergic reactions to corticosteroids.

A 37-year-old patient presented with a severe allergic local reaction upon inhalation of budesonide for asthma. Skin tests were positive for budesonide and amcinonide (group B) and elicited a strong local reaction and a disseminated macular exanthema. Corticosteroids from other groups were well tolerated. A 38-year-old male patient had first an allergic contact dermatitis to topically applied prednisolone acetate and then a disseminated eczematous exanthema upon oral intake of prednisone. A delayed-type sensitization to corticosteroids from group A such as hydrocortisone, prednisone and tixocortol pivalate was identified. A detailed diagnosis in patients with allergic reactions to corticosteroids is crucial with regard to their use in emergency therapy.

Adrenal Cortex Hormones↗
PubMed1999

Autonomic responses to suggestions for cold and warmth in hypnosis.

The goal of the present study was to investigate whether suggestions for cold or warmth during hypnosis affect fingertip skin temperature. Hypnosis without specific suggestions for cold or warmth ('neutral hypnosis') caused a drop in respiration frequency, however, pulse rate, fingertip skin temperature, and electrodermal activity were not affected. The cold and warmth suggestions decreased and increased fingertip skin temperature, respectively. Compared with the neutral trance phase, the other three autonomic variables measured were also affected by suggestions for cold. However, there was no association between the changes in autonomic variables induced by suggestions and hypnotizability scores measured by the 'Stanford Hypnotic Clinical Scale for Adults'. Fingertip skin temperature was mostly affected when the images used for the cold and warmth suggestions during hypnosis included experiences of physical temperature and psychological stress or relaxation, indicating that the psychological content of the imagery amplified the autonomic response.

Adult↗
PubMed1999

Drug-induced urticaria and angioedema caused by non-IgE mediated pathomechanisms.

Urticaria and angioedema may be elicited by a considerable number of drugs, particularly nonsteroidal antiinflammatory drugs, angiotensin converting enzyme inhibitors, radiocontrast media and antibiotics. Pathogenic mechanisms involved include pseudoallergy, idiosyncrasy and IgE-mediated hypersensitivity, occasionally also IgG antibodies. In this survey the common problems which still lack established diagnostic in vitro tests such as pseudoallergic reactions to analgesic drugs and idiosyncratic side effects to angiotensin-converting-enzyme inhibitors are presented. In addition some examples of drugs are given where, due to progress in research, instead of a pseudoallergic mechanism an immunological pathogenesis could be demonstrated.

Angioedema↗
PubMed1998

[Diagnosis of allergic diseases. Contribution of the Zurich Allergy Unit 1948-1998].

The term allergy has been defined at the beginning of the century, but is often used in a too general manner today. A prerequisite for an exact diagnosis is also the correct use of a term. The evaluation of a putative allergic disorder involves several steps: taking of a thorough history, objectivation of clinical signs, performance of skin tests measurement of allergen-specific and possibly total IgE and if necessary performance of provocation tests. The clinical importance of the test methods varies and their indication should be based on history and clinical findings. Only the synthesis of all results makes a complete diagnosis possible. Physicians, nurses and laboratory technicians who have worked between 1948 and 1998 at the Allergy Clinic in Zurich, have made considerable contributions to the development and the evaluation of allergy diagnosis. After a short introduction to the history of allergy, selected publications from the Allergy Clinic in Zurich are presented and discussed.

Allergy and Immunology↗