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Biomedical subjects

D Czarny

Publications and source records attributed to D Czarny.

At least 19 recordsLinked to original sources
PubMed2001

Adverse events associated with rush hymenoptera venom immunotherapy.

OBJECTIVES: To determine the incidence and nature of adverse events associated with the induction of rush Hymenoptera venom immunotherapy. DESIGN: Retrospective descriptive case study. SETTING: The asthma and allergy unit at a major metropolitan teaching hospital, between 1 January 1989 and 30 June 1999. PATIENTS: All patients with anaphylaxis to stings of Hymenoptera insects who received rush venom immunotherapy as inpatients. OUTCOME MEASURES: Hypersensitivity reactions to venom administration, including angioedema, skin rashes, hypotension and asthma, as well as any other adverse events related to the inpatient stay. RESULTS: 68 venom-allergic patients received 73 courses of rush immunotherapy; 89% were desensitised to honey bee venom, 10% to yellow jacket wasp venom, and one to paper wasp venom. Hypersensitivity reactions occurred after 36 subcutaneous injections (3.8% of all injections given) in 26 patients (38%). CONCLUSION: In our cohort, immunotherapy was accompanied by a high incidence of adverse systemic events during the induction phase. Immunotherapy should only be given by experienced staff in centres where there are facilities for resuscitation.

Adult↗
PubMed1998

Allergy in the airway.

BACKGROUND: Airway disease is responsible for significant morbidity worldwide and the role of allergies in the cause and persistence of airway symptoms is becoming increasingly appreciated. OBJECTIVE: The exposure of the airway to allergens depends on the size of inhaled particles. Common allergens encountered in Australia include grass pollens, house dust mites and animal danders and sensitivity to each leads to a different clinical pattern of disease. The diagnosis of allergy requires a history of symptoms related to exposure to an allergen, together with detection of allergen-specific IgE. The evidence for the role of allergens in contributing to allergic airway disease is extensive. DISCUSSION: Airway allergies are an important factor in the genesis of asthma and allergic rhinitis. There is increasing evidence that modification of exposure to allergens can improve allergic symptoms and may prevent allergic diseases. Methods of allergen avoidance are discussed.

Allergens↗
PubMed1997

Prevalence of IgE-mediated allergy to latex in hospital nursing staff.

BACKGROUND: IgE-mediated hypersensitivity to latex proteins has become a significant clinical problem over the last decade. Nursing and medical staff are at risk because of their occupational exposure to latex. AIMS: To determine the prevalence of type I hypersensitivity to latex allergens in the nursing staff of an Australian hospital. METHODS: A questionnaire which asked about symptoms associated with the use of latex gloves was completed by 140 nurses working in the Alfred Hospital (72 in general medical wards, 68 in intensive care units). Skin prick tests with eluates of five different types of latex glove as well as common aeroallergens (rye pollen and house dust mite) and banana extract were performed. RESULTS: Thirty-one nurses (22%) were skin prick test positive to at least one of the five latex glove eluates. All of these nurses were atopic, having positive skin prick tests to rye pollen or house dust mite. Symptoms of local dryness, itch and erythema associated with glove use were reported by more than half the study group, but not more frequently by those who were skin prick test positive to latex. Urticaria associated with glove use was reported more frequently by those with positive latex skin prick tests (13% vs 4%, p = 0.05). Eighty-seven per cent of the nurses who were latex skin test positive were also positive to banana extract. CONCLUSIONS: IgE-mediated hypersensitivity to latex is common in nurses working in an Australian hospital. Glove associated symptoms were frequently reported, but in most cases the symptoms were more typical of irritant or contact dermatitis rather than type I hypersensitivity reactions. However, the extent of subclinical sensitisation to latex found in this study suggests that symptomatic latex allergy is likely to emerge as an increasing problem for nursing staff in this country.

Adult↗
PubMed1997

Stinging insect allergies. Assessing and managing.

BACKGROUND: Mortality secondary to insect sting anaphylaxis, though uncommon in this country, is a genuine risk to patients with venom hypersensitivity. A number of non specific and specific preventive measures are available to minimise this risk. They include proper patient counselling regarding sting avoidance and the use of self injectable adrenaline, as well as venom specific immunotherapy. OBJECTIVE: This article attempts to review the spectrum of insect sting reactions, their appropriate assessment and subsequent management. Anaphylaxis is particularly emphasised with regard to first aid treatment and subsequent prevention. DISCUSSION: The most common causes of insect stings in Australia are bees and wasps. Insect sting reactions cover a spectrum of responses, from normal to anaphylactic. Immunotherapy is indicated in those patients who experience anaphylactic responses. The presence of venom specific IgE must be demonstrated before commencing immunotherapy. Venom sensitive patients should be educated in anaphylaxis first aid with adrenaline self injectable syringes.

Adrenergic Agonists↗
PubMed1996

Asthma and anaphylaxis induced by royal jelly.

BACKGROUND: Asthma, together with, in some cases, anaphylaxis, was observed in seven subjects following ingestion of royal jelly, a secretion of honey bees which is used as a health tonic. OBJECTIVE: To determine if reactions were IgE-mediated and to identify allergenic components of royal jelly. METHODS: Skin-prick tests, immunoassays for specific IgE antibodies and protein blotting studies using patients' sera and anti-IgE second antibodies were employed. RESULTS: Immunoassays detected IgE antibodies to royal jelly proteins in sera of subjects who reacted to the substance. A total of 18 different IgE-binding components were detected on blots following electrophoretic separation of royal jelly under dissociating conditions. Examination of 63 sera from subjects allergic to bee venom showed that there is no direct relationship between IgE antibody reactivity to bee venom allergens and to royal jelly proteins although 38% of the sera reacted with a royal jelly solid phase. IgE antibody reactivity to royal jelly proteins was also detected in 52% of 75 subjects with allergies to inhalant and/or food allergens. Antibody binding of blotted royal jelly proteins was most marked in the molecular weight region 25-55 kDa and one component of MW approximately 55 kDa was detected by all of the reactive sera from royal jelly-allergic and control allergic subjects. CONCLUSIONS: Symptoms of asthma and anaphylaxis seen in subjects following ingestion of royal jelly were true IgE-mediated hypersensitivity reactions. The clinical significance of the antibodies found in the sera of control subjects is not known but they may arise in response to common inhalant allergens that show allergenic cross-reactivity with royal jelly.

Adult↗
PubMed1996

Risk factors for asthma among young adults in Melbourne, Australia.

Asthma is more prevalent in Australia than in Europe or North America. As part of the European Community Respiratory Health Survey (ECRHS), we investigated exposure to risk factors for asthma among young adults in Melbourne. During this study, 553 randomly selected and 204 symptomatic participants aged between 20 and 44 years completed a detailed respiratory questionnaire, of whom 675 underwent measurement of bronchial hyperreactivity (BHR) by methacholine challenge and 745 had skin prick tests for atopy. Current asthma, defined as BHR and wheeze in the preceding 12 months, was present in 25.5% of those tested. A family history of asthma was a risk factor for current asthma (maternal asthma odds ratio [OR] 2.4, paternal asthma OR 2.1). Current smokers were 1.7 times more likely to have current asthma. A serious respiratory infection before 5 years of age increased the risk of current asthma 2.3-fold. Atopy on skin testing was also strongly associated with current asthma (OR 5.9). The greatest risks were associated with positive skin tests to Cladosporium, house dust mite, cat and rye grass pollen. We conclude that female gender, maternal asthma, smoking, hayfever, early respiratory infection, occupational exposure and atopy are important risk factors for asthma in young adults.

Adult↗
PubMed1996

The prevalence of asthma and respiratory symptoms among young adults: is it increasing in Australia?

The objective of this study was to determine the prevalence of self-reported asthma and respiratory symptoms among young adults and whether there had been any change since a previous survey. A cross-sectional postal community survey was conducted in three parliamentary electorates in the inner South East region of Melbourne, Australia. A total of 4500 individuals aged between 20 and 44 years were randomly selected from the electoral roll. After three mailings and telephone follow-up, an adjusted response rate of 79% was achieved. No intervention was performed. Self-reported asthma and respiratory symptoms were recorded from the European Community Respiratory Health Survey screening questionnaire. Respondents were most likely to report nasal allergies (41%), nocturnal cough (28.6%), and wheeze in the last 12 months (28.1%). Nocturnal cough was more common in females than males. The prevalence of wheeze, nocturnal chest tightness, and use of asthma medications decreased with age. An attack of asthma in the last 12 months was reported by 9.7% of young adults, and this fell to 8.2% after correction for nonresponse bias. The prevalence of current asthma had not increased significantly since a previous postal survey in 1990. However the prevalence of nocturnal chest tightness, nocturnal cough, and use of asthma medications had increased significantly over a 2-year period. Further research is required to investigate why asthma is so prevalent in Australia and why some features are increasing in prevalence.

Adult↗
PubMed1995

T cell response to grass pollen allergens: correlation with skin test reactivity and serum IgE levels.

T cell proliferative responses to rye and Bermuda grass pollen allergens have been studied in a series of 51 atopic and 18 non-atopic subjects. Mean T cell responses were higher in the atopic group than in the non-atopic group (P < 0.001), and there was a strong correlation between the magnitude of reaction in the T cell assay and in the skin test (rye P < 0.01, Bermuda P < 0.05). A similar association was shown between T cell reactivity and serum levels of allergen-specific IgE (rye P < 0.05, Bermuda P < 0.05), but no relationship was found between serum allergen-specific IgG levels and any other parameter studied. T cell reactivity was not found in three cord blood samples tested. Discordance between positivity for T cell responses and skin test reactions in some cases might reflect reactivity by T cell subsets that promote IgG antibody or cell-mediated responses without IgE antibody production. A precise knowledge of T cell recognition of grass pollen allergens will provide exciting new prospects for more effective and safer immunotherapy strategies for allergic diseases including asthma.

Adult↗
PubMed1994

Asthma, allergy and atopy in Asian immigrants in Melbourne.

OBJECTIVES: To compare the prevalence of asthma, hay fever and atopy in Asian immigrants in Melbourne with that in Australian-born non-Asians and Australian-born Asians, and to investigate the association of these conditions with atopic status, length of stay in Australia and IgE levels in Asian immigrants. DESIGN: We performed a cross-sectional study by telephone interviews, using standard questionnaire items on respiratory and allergic symptoms. A random sample of 636 recent Asian immigrants of ethnic Chinese origin, 109 Australian-born Asians and 424 Australian-born non-Asians were selected from the 1991 Melbourne Telephone Directory, using a presumptive surname list. Skin tests to determine atopic status were performed on 269 Asian immigrants and 167 of these also had serum levels of total and specific IgE estimated. RESULTS: In the under 20 years age group the prevalence of wheeze or asthma ever was higher in Australian-born non-Asians and Australian-born Asians than in Asian immigrants (P < 0.001), and the prevalence of hay fever was higher in Asian immigrants and Australian-born Asians than in Australian-born non-Asians. In those older than 20 years, hay fever was almost twice as common in Asian immigrants as in Australian-born non-Asians (P < 0.001 for 20-40 years age group; P < 0.01 for > 40 years). The prevalence of hay fever and, to a lesser degree, asthma in Asian immigrants increased significantly with length of stay in Australia, independent of age at arrival, sex and atopic status (trend test: P < 0.001 for hay fever; P = 0.05 for asthma). Atopy was more common in Asian immigrants and Australian-born Asians than in Australian-born non-Asians (P < 0.001) and was very strongly associated with both hay fever and asthma, irrespective of length of stay. Pollen and mite sensitivities were more common in Asian subjects (twice as common for Asian-born and 1.5 times for Australian-born) than non-Asian subjects (P < 0.01). Among Asian immigrants, elevated total IgE level (> 100 IU/mL) was strongly associated with a history of hay fever (P < 0.01) and wheeze or asthma ever (P < 0.05), atopy (P < 0.001) and the presence of specific IgE antibodies to grass pollen, dust mite, cockroach and Ascaris antigens (P < 0.05 for all). CONCLUSION: We found substantial differences in the prevalence of asthma, hay fever and atopy between Asian immigrants, Australian-born Asians and non-Asians. The prevalence of hay fever and asthma in Asian immigrants was strongly associated with length of stay in Australia, suggesting that environmental factors are important in the pathogenesis of these diseases.

Adolescent↗
PubMed1994

Allergies, upper respiratory tract infections, and asthma.

The aims of this study were (1) to quantify the prevalence of aeroallergen hypersensitivity in presentations for emergency treatment of asthma and (2) to determine the strength of association between viral upper respiratory tract infections (URTIs) and admission for treatment of asthma. A series of 209 asthmatic patients presenting to the Emergency Department (ED) of the Alfred Hospital over 6 months underwent skin prick testing and venipuncture for serum IgE and rye grass pollen (RGP) RAST. A case-control study of 38 asthmatic inpatients and 90 controls admitted for road trauma or endoscopy underwent nasopharyngeal aspiration for viral culture and immunofluorescence (IF). Eighty-four percent of ED asthmatic patients had one or more positive skin tests to common aeroallergens, 57% had a positive skin test, and 45% had a positive RAST to RGP. Viral cultures or IF studies were positive in 8 asthmatic patients and 2 controls. Asthmatic inpatients were 6 times more likely to have a viral URTI than were controls. It is concluded that aeroallergen hypersensitivity is present in most asthmatic patients presenting to the ED, and that there is a strong association between viral URTIs and admission for asthma.

Adolescent↗
PubMed1993

Asthma and allergy. What is the connection?

Although asthma is a multi-factorial disorder, allergy (immediate hypersensitivity) is the most frequent and important factor in initiating airway inflammation in young people and is relevant in 94 per cent of asthmatics with an onset before the age of 30. After the age of 60, it is a factor in 30 per cent of asthmatics. Allergy to the mite, pollens and moulds has been shown to be a major risk factor for: development of asthma; chronic persistent asthma; acute attacks of asthma; and respiratory arrests due to asthma. All asthmatics must be investigated for the presence of allergy. Assessment on the basis of history is not accurate enough. Allergy tests are cheap and easily carried out. The demonstration of allergy opens up therapeutic strategies that are otherwise inappropriate. The simplest and most rational strategy is allergen avoidance. If carried out correctly, it is effective. Immunotherapy is an option in specifically and carefully selected cases. Anti-allergy measures should be seen as an adjunct, not a replacement, to traditional drug therapy. The anti-allergy strategies are largely preventive and are a logical component of asthma treatment in those asthmatics with evidence of immediate hypersensitivity. The widely used regimen of bronchodilator and anti-inflammatory agents should be continued with, but is obviously not having the desired impact on morbidity and mortality rates. Rational intervention in asthma should combine the two therapeutic approaches.

Adult↗
PubMed1992

Paracetamol anaphylaxis.

We describe four cases of anaphylaxis to paracetamol without co-existing aspirin intolerance and review the Australian experience in paracetamol anaphylaxis. Paracetamol sensitivity may differ in the mechanism from sensitivity to aspirin and other non-steroidal anti-inflammatory drugs as previously believed.

Acetaminophen↗