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Biomedical subjects

G Kanny

Publications and source records attributed to G Kanny.

At least 127 records · Page 7Linked to original sources
PubMed1994

[Alimentary anaphylactic shock: implication of penicillin residues].

The case of a 64 y.o. female is reported. She experienced formerly four anaphylactic shocks. Two shocks occurred after ingestion of pork and beef meat. Any food allergy to animal proteins was discarded. A high degree of sensitivity to penicillin G was proved by a positive prick test to penicillin G 1 Ul/ml, which induced a systemic reaction. RAST to penicillin G was class 4. The leucocyte histamine release test showed a high level of spontaneous histamine release. A double blind, placebo controlled, oral challenge with penicillin mixed to milk induced wheezing and a fall of blood pressure at the cumulative dose of 20 Ul. The hypothesis of food induced anaphylaxis, linked to penicillin residues in meats, is highly plausible. The significance of the phenomenon of spontaneous histamine release is discussed. It might point to frequent ingestions of hidden penicillin residues in the diet.

Anaphylaxis↗
PubMed1994

Occupational rhinitis and asthma to latex.

Occupational allergic rhinitis to proteins is increasing in importance. Two cases of latex-induced rhinitis are reported in a nurse's aid and a laboratory technician. A crossed food allergy is quoted. Positive prick-tests and specific IgE to latex have been demonstrated in both cases. A double-blind nasal challenge test has been performed with the rinse fluid from a brand of latex gloves. Clinical manifestations with endoscopic modifications of the nasal mucosa have been observed. A rise in nasal secretory eosinophilia has been demonstrated. The authors wish to draw attention to this new aetiology of occupational rhinitis insofar as it precedes the onset of work-related asthma as shown in one case. The eviction of wearing gloves is not sufficient as latex allergens are airborne. The eviction of ordinary latex gloves must be extended to all other workers in the same place and the use of powder-free gloves is advisable.

Adult↗
PubMed1994

[Occupational allergic rhinitis].

The frequency of occupational allergic rhinitis has grown with the development of new allergens and the prodromic characteristic of occupational asthma. The clinician must carefully assess the often unimpressive symptomatology with a characteristic work/non work cycle. The nasal mucosa is examined rhinoscopically to eliminate a possible tumoural origin. The diagnosis is based on the results of the allergy tests (skin tests, laboratory tests, nasal allergen tests) and on knowledge of the patient's work environment. The diagnosis of occupational rhinitis requires eliminating the allergen(s). A report of an occupational disease is required. In the future, informing atopic subjects early, improving working conditions and modifying industrial techniques should lead to a reduction in the prevalence of allergic rhinitis and occupational pulmonary disease.

Endoscopy↗
PubMed1994

Allergy and intolerance to flavouring agents in atopic dermatitis in young children.

The role of flavouring was studied in eleven children under five years of age suffering from severe atopic dermatitis. In all cases, the dietary questionnaire showed the high daily intake of natural vanilla, vanillin, natural and artificial flavouring. Double-blind oral provocation tests were carried out with balsam of Peru (225 mg), natural vanilla (50 mg), artificial vanillin (12.5 mg). Nine children out of eleven presented eczematous reactions, one a Quincke's oedema. Two challenges remained negative. The eviction of food flavouring agents brought about a clear improvement in six children. The authors point out the risk of increasing consumption of flavouring agents, and bring into question the traditional attitude of considering food flavouring agents as innocuous.

Allergens↗
PubMed1993

Prospective study of risk factors in natural rubber latex hypersensitivity.

Five hundred sixty-nine subjects routinely underwent skin prick tests for latent sensitization to latex. The study of risk factors included skin tests to inhalant allergens, to diagnose atopy, and a questionnaire aimed at revealing frequent exposure to latex such as the wearing of gloves, multiple surgical procedures, or urinary catheterization. The subjects were categorized into five groups: group I, subjects with no risk factor (n = 272); group II, nonatopic subjects exposed to latex (n = 73); group III, atopic subjects not exposed (n = 180); group IV, exposed atopic subjects (n = 44); and group V, subjects with a history of intraoperative anaphylactic shock caused by latex (n = 13). Twenty-five subjects had spina bifida and were in either group II (14 subjects) or group IV (11 subjects). The questionnaire identified a probable allergy to latex in 18 subjects: 16 cases were confirmed by skin test, but responses were not informative in 23 patients who were sensitive to latex. Positive prick tests to latex were obtained in 0.37% of group I, 6.85% of group II, 9.44% of group III, and 36.36% of group IV. Of the children with spina bifida, 32% had positive skin test results. As risk factors, atopy and exposure were synergistic. We recommend predictive prick tests not only in children with spina bifida but also in any atopic subject or in any patient with a history of frequent exposure to latex. Latex could be considered a habitual allergen. The use of latex urinary catheters should be avoided in patients who are catheterized on a daily basis.

Adolescent↗
PubMed1993

[Severe anaphylactic shock with heart arrest caused by coffee and gum arabic, potentiated by beta-blocking eyedrops].

The case of a male patient who experienced four allergic accidents after drinking coffee is reported. Two serious anaphylactic reactions with cardiac arrest occurred after a continuous treatment with beta-blocking eye drops (timolol) was prescribed. Dual sensitivation to coffee and to the gum arabic coating roasted coffee beans was demonstrated by skin prick tests and by human basophil degranulation tests. Occupational allergy to green coffee has been widely described, but food sensitization to these two allergens has not yet been reported. This case also draws attention to the risk, inherent in beta-blockers, of immuno-allergic reactions. These drugs produce a loss of compensatory cardiovascular mechanisms and make those who take them resistant to the conventional treatment of anaphylactic shocks, which explains the serious accidents that occurred in this patient. The authors stress the usefulness of a thorough investigation for food allergy to a rare allergen in patients with idiopathic anaphylaxis.

Aged↗
PubMed1993

Abnormalities in histamine pharmacodynamics in chronic urticaria.

Histamine plays a key role in the pathogenesis of chronic urticaria (CU). The authors of this paper have studied the effects of ingested histamine in 25 patients with CU. A 120 mg dose of histamine, well-tolerated in the healthy subject, was instillated into the duodenum. Concomitantly, plasma histamine (H) levels and plasma and urinary methylhistamine (MH) levels were measured. Intraduodenal administration of histamine was responsible for the development of an attack of urticaria in 64% of patients, while control subjects were asymptomatic. Plasma histamine levels were significantly higher after digestive histamine challenge (DHC) in patients with CU compared with controls. An abnormal increase in plasma histamine was observed in 72% of them. Plasma MH exhibited the same kinetic behaviour with a usually delayed time-pattern. Urinary MH concentration was higher in patients presenting with early-onset urticaria during the first hour than in those with the late-onset type between 1 and 12 hr after DHC. The coefficient of methylation (plasma MH/MH+H) was not significantly different in patients presenting with an attack of urticaria following DHC and in other subjects. Urinary excretion of MH and urinary flow increased significantly in patients presenting with an attack of urticaria following DHC which corresponds to increased absorption of histamine during the 5-hr period following DHC and its role on excretion by the kidney via vasodilation which it induces. This study demonstrates the abnormal frequency of disturbances in the metabolism of exogenous histamine in patients with CU. Increased plasma H accounts for the abnormal passage of H across the intestinal barrier which can result either from intestinal hyperpermeability and/or a deficit in the enzymatic catabolism of histamine. The systems of methylation and urinary clearance of MH appear to be effective. It is thus postulated that there is a deficit in diamine oxidase (DAO) in the enterocyte. The lack of correlation between the kinetic behaviour of plasma H and the onset of urticaria draws attention to the extent of individual variability in skin reactivity to histamine.

Administration, Oral↗
PubMed1993

Case report: recurrent anaphylactic shock to radiographic contrast media. Evidence supporting an exceptional IgE-mediated reaction.

A rare case of anaphylaxis to iodinated contrast media is reported. The patient underwent two anaphylactic shocks to intravenous administration of radiocontrast agents. Specific IgE were suspected on the basis of positivity of intradermal tests and human basophil degranulation tests. The passive sensitization of basophils from donors was performed, comparing native and heated serum. Results agreed with the hypothesis of IgE antibodies, since heating 56 degrees C during two hours prevented the degranulation. Considering the chemical structure, iopamidol was thought to be innocuous. Two opacification procedures were further performed with iopamidol without any incident.

Aged↗
PubMed1993

Detection of antifood IgE by in vitro tests and diagnosis of food allergy.

The diagnosis of IgE-dependent food allergy relies on the demonstration of specific IgE by prick tests or biological tests. A radioimmunoassay (RAST Phadebas) is completed by several immuno-enzymatic methods: RAST Phadezym, FAST, MAST-CLA, AlaSTAT, etc. The allergen is bound to solid or liquid phases, by different binding agents. Various enzyme-substrate systems, and several systems for expression are used (RIA, fluorescence, chemoluminescence, colorimetry, etc.). Another aspect of modern technics is the trend towards high automated processes. A second group of tests aims to detect the release of mediators from sensitized basophils: leucocyte histamine release test, human basophil degranulation test and a leucocyte leukotriene release test. The specificity of tests for detection of anti-food IgE is lessened by numerous cross reactivities between pollens, fruit, and vegetable. The study of the sensitivity of such tests needs strictly standardized food challenge tests in order to firmly establish the diagnosis of food allergy. Multiscreen tests have to be assessed, in order to validate their efficacy for detecting frequency allergens. Whatever the test to be used, its positivity means only sensitization, and food challenge tests are mandatory to recognize true food allergy, as latent sensitization to food is a current phenomenon in atopic children. The possibility of reliable diagnosis of food allergy by using challenge tests makes now possible and advisable to set up quality controls for all biological tests applied to the detection of antifood IgE, thanks to the possibility to dispose of reference sera.

Adult↗
PubMed1993

Food specific IgE antibodies: a comparative study of AlaSTAT and Pharmacia RAST Phadebas CAP systems in 49 patients with food allergies.

Forty-nine sera from patients with food allergies confirmed by challenge and of 14 with suspected allergy were assayed with the DPC AlaSTAT liquid phase EIA and the Phadebas RAST CAP radioimmunoassay (RIA). Twenty-two foods were tested (four animals, 18 vegetables). Controls were performed on nonatopic subjects (N = 8). Specificity was 100%. Concordance RAST CAP/AlaSTAT was 79.6%; prick tests/AlaSTAT: 76%; prick tests/RAST CAP: 73.9%. AlaSTAT detected specific IgE even in sera with low total IgE (< 60 KU/L), while RAST CAP was inconclusive. Dilution studies and reproducibility were excellent. AlaSTAT EIA compares favorably with the Phadebas RAST CAP RIA for measurement of food-specific IgE antibodies.

Adult↗
PubMed1992

[Allergic asthma to latex, proven by a bronchial provocation test].

The authors report the case of a female cook who develops contact urticaria associated with rhinitis and asthma-type dyspnea when using rubber gloves in the course of her work. Allergy to latex was confirmed by a PRICK-test with latex, the presence of specific IgE in the serum, and the onset of contact urticaria after putting on gloves. A latex glove was rinsed with 10 cc of distilled water and the resulting solution, used as a spray, brought on a bronchospasm in the first two minutes. This bronchial provocation test proves that latex can cause asthma-type dyspnea when work involves contact with the substance. The speed of onset and intensity of the respiratory symptoms observed show that such a provocation test must be carried out with extreme care in patients with a marked sensitivity to latex. The future lies in the possibility of easily standardizing the latex protein concentration in order to be able to administer progressive doses without any systemic risk. This case draws attention to the probably underestimated possibility of latex-induced asthma in all subjects who are brought into repeated contact with latex, whatever their profession.

Adult↗
PubMed1992

[Anaphylaxis caused by carboxymethylcellulose: report of 2 cases of shock from injectable corticoids].

Two cases of anaphylactic shock are reported, occurring after intra-articular injections of corticosteroids, containing carboxymethylcellulose (CMC), benzylic acid, polysorbate 80, and merthiolate. Skin tests and leukocyte histamine release are positive to CMC and negative to the other substances including the corticosteroids: prednisolone acetate and cortivazol . No cross-reactivity with hydroxypropylcellulose was demonstrated. These tests lead to incriminate CMC in these patients. Anaphylaxis to CMC seems exceptional, though CMC is widely used in agro-alimentary and pharmaceutical industries, as well as hydroxypropylcellulose. In one case, the possibility of a sensitization by CMC as a food additive is discussed, insofar as the patient has a fixed eruption which has been suspected to be owed to intolerance to food additives.

Anaphylaxis↗
PubMed1992

[Local immunologic system of the nose and paranasal sinuses].

The mucus membranes of the nasal chambers may be compared to a local immune system which has been called the NALT. The submucosa contains a lymphoid infiltration of T-helpers, T-suppressors and a set of plasma cells capable of synthetizing four IgG subgroups, IgM, IgA and IgD. The IgA plasma cells are most numerous. There is no local synthesis of IgE. Macrophages and langerhans' giant cells are present. The epithelium is an immunological entity which is composed, in addition to secretory cells, of uliated cells, lymphocytes, and M cells. The epithelium is able to synthesize secretory component and allows the transport of IgA and IgM into the secretions. The NALT has multiple immunological functions: antigenic information, humoral immune response, and expression of local cellular immunity. Modifications in T lymphocyte subpopulations are observed in allergic rhinitis. Secreted interleukins modify the local efflux and affluence of effector cells (mastocytes and eosinophils). Abnormalities of the NALT are characteristic of deficiency in humoral IgA and IgG subgroups. The possible presence of alterations of cellular immunity in chronic rhinosinusitis has been suggested.

Humans↗
PubMed1992

NARES: a model of inflammation caused by activated eosinophils?

Twenty patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 20% of total leucocytes in nasal secretions (NARES). Nasal endoscopy with biopsies from the middle turbinate and sinus CT were performed. Biopsies were processed for histological examination and for immunofluorescence. The clinical progress during treatment was scrutinized. An acute congestive aspect of the nasal mucosa was noted in 4 cases, and micropolyposis in 9 cases. Sinus CT showed opacity of the ethmoidal cells in 87% of cases (maxillary sinuses: 75%; frontal sinus: 46%; sphenoidal sinus: 31%). An eosinophilic infiltrate of the nasal mucosa was constituted in 9 cases: In 6 cases, the cells expressed the Fc epsilon RII receptor, recognized by the monoclonal antibody Bb10. Anti-H1 drugs usually failed to result in a clinical improvement and local eosinophilia was not changed. Local corticoids were more effective but not sufficient in some cases, so that oral corticotherapy was needed. Ethmoidectomy was performed in three cases. NARES seems to evolve in three stages: (1) migration of eosinophils from the vessels to the secretions; (2) retention of eosinophils in the mucosa which might be linked to activation of unknown origin; (3) nasal polyposis. Numerous interactions between irritation of the epithelium, release of substance P, and eosinophils, lead to the hypothesis of a neurogenic origin of NARES.

Adult↗
PubMed1992

[Hypersensitivity accidents to thrombin following the use of biological glues].

Biological adhesives are made of human plasma and bovine heterologous proteins. These entail a poorly documented risk of sensitization. We report about two allergic accidents caused by the injection of Tissucol in the pituitary mucosa of patients suffering from the Rendu-Osler-Weber disease. The clinical picture of the first case was that of a serum sickness, and leukocytoclastic vasculitis was demonstrated. The second case was a delayed hypersensitivity accident, which was confirmed by the subsequent allergological investigation. Although the responsibility of thrombin seems to be evidenced in these two cases, it nevertheless remains exceptional. However, the risk of sensitization following repeated injections of heterologous proteins in a mucosa with a particularly high immunological responsiveness must be well-known. The increasing use of these biological products will probably result in a growing number of accidents, and we must now contemplate the possibility of screening this sensitization before using biological adhesive. Finally, the possibility of latent sensitization by the ingestion of beef must also be considered.

Aged↗