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Biomedical subjects

H J Malling

Publications and source records attributed to H J Malling.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Adrenaline for self treatment of anaphylactic reactions. Indications, available preparations and prescription rules].

Adrenaline is the drug of choice for the treatment of anaphylaxis. The indications, available formulations, and rules for prescribing adrenaline for self treatment of anaphylactic reactions in allergic subjects are summarized in this paper. Emergency kits containing adrenaline must be prescribed only to patients with a definite history of anaphylactic reactions or laryngeal oedema. A kit containing Adrenaline DAK 1 mg/ml in a traditional glass ampoule together with a 1 ml syringe and an i.m. cannula is the cheapest solution, and a usable alternative in the patient who after sufficient training feels safe to prepare his own injection. Ana-guard injector is recommended for the allergic adult due to its easy handling and the fact that it contains two doses of adrenaline 0.3 mg. For both children and adults with a low bodyweight, the Epi-Pen automatic injector is recommended. It contains one dose of adrenaline (0.15 or 0.30 mg) and requires no preparation before use. The Adrenalin Medihaler is recommended for the treatment of laryngeal oedema and threatened airway obstruction. Due to the low and unpredictable absorption after inhalation, adrenaline injection is recommended for the treatment of systemic symptoms. Prescribing adrenaline in semi-or automatic injectors requires special permission from the Danish Health Authorities.

Adult↗
PubMed1996

Antihistamine premedication in specific cluster immunotherapy: a double-blind, placebo-controlled study.

BACKGROUND: Specific immunotherapy treatment in allergic diseases involves a risk of systemic side effects. A double-blind, placebo-controlled study was performed in 45 patients allergic to pollen to determine whether pretreatment with loratadine could reduce the number and severity of systemic reactions during the dose-increase phase of cluster immunotherapy. METHODS: The patients received cluster immunotherapy with a standardized birch (Betula verrucosa) or grass (Phleum pratense) pollen extract adsorbed to aluminum hydroxide. The immunotherapy schedule involved seven visits and 14 injections to reach a maintenance dose of 100,000 standardized quality units. Loratadine, 10 mg, or placebo tablets were administered 2 hours before the first injection at each visit. RESULTS: A total of 720 injections were given (309 injections in 21 patients receiving loratadine and 411 injections in 24 patients receiving placebo). The median numbers of injections to reach maintenance dose were 15 (range, 14 to 18) in the loratadine group and 16 (range, 14 to 23) in the placebo group (p = 0.037). The numbers of patients with systemic reactions were seven (33%) and 19 (79%) in the loratadine and placebo groups, respectively (p = 0.002). Twenty-five reductions caused by systemic reactions were observed in the placebo group in contrast to nine in the loratadine group (p = 0.047). No life-threatening systemic reactions were observed in either group. Systemic reactions were, however, more severe in the placebo group, mainly because of a significantly higher incidence of urticaria (10 vs 1, p = 0.022). CONCLUSION: Pretreatment with loratadine seems to reduce both the number and severity of systemic reactions in specific cluster immunotherapy.

Adult↗
PubMed1994

Time of onset of action of acrivastine in the skin of pollen-allergic subjects. A double-blind, randomized, placebo-controlled comparative study.

The purpose of this study was to assess the time of onset of action of acrivastine in suppressing the wheal response to histamine (10 mg/ml) and allergen (10,000 and 100,000 BU/ml) in the skin prick test. Ten subjects with a well-documented allergy to pollen received single doses of 8 mg of acrivastine and placebo according to a randomized, double-blind, placebo-controlled, crossover treatment design. Duplicate skin prick tests were performed 0, 15, 20, 25, 30, and 60 min after medication. The results demonstrated a statistically significant suppression of the wheal reactions 15-20 min after medication, depending on the reaction producers used. The sum of all three producers showed a statistically significant effect on the wheal reaction 15 min after medication. The upper 95% confidence limit for time lag from dosing of acrivastine until reduction from placebo level commences was 6.5 min. The study substantiates that orally administered acrivastine has a rapid onset of action in the skin of allergic subjects. The results indicate that allergen SPT is a more sensitive tool for studying antihistaminergic activity than histamine SPT.

Administration, Oral↗
PubMed1994

Prevalence of basidiomycete allergy in the USA and Europe and its relationship to allergic respiratory symptoms.

A total of 701 adults living in the USA or Western Europe who had symptoms of allergic respiratory disease were skin prick tested with extracts prepared from eight basidiomycetes species and four Fungi Imperfecti species. In these subjects, the presence of asthma, rhinitis, or both was determined by questionnaire. Overall, 178/701 (25.4%) of the participants reacted to at least one basidiomycete extract. There was no difference in the prevalence of reactivity detected in the USA and Europe (P < 0.005); however, the prevalence of reactors in individual centers from both areas varied significantly. Psilocybe cubensis was the most potent allergen source in both the USA (12.3% reacted) and Europe (16.0%). Pleurotus ostreatus was second overall (10.6%) and in the USA (10.7%), and third in Europe (10.3%). Pisolithus tinctorius and Coprinus quadrifidus produced the least potent allergens, with only 5.4% of the population reacting. There was a significant relationship (P < 0.005) between basidiospore reactivity and the presence of atopy, asthma, and asthma and rhinitis. Basidiospore reactivity was not associated with the presence of rhinitis alone (P = 0.312). These results suggest that basidiomycetes are important sources of aeroallergens in geographically disparate regions and may be particularly important in patients with asthma.

Adult↗
PubMed1993

Precise area determination of skin-prick tests: validation of a scanning device and software for a personal computer.

When skin-prick tests (SPTs) are used quantitatively, the circumference of the weal and/or the flare is outlined using a felt tip pen, and transferred to paper by adhesive tape. The aim of the study was to develop and validate a procedure, objectively and precisely determining these areas after transfer to paper. A system was developed enabling the drawing of the area of weal or flare to be read by a hand-held scanner and calculated on a personal computer. Areas in the 5-500 mm2 range could be determined with day-to-day and interoperator coefficients of variation (CVs) of 3.1% and 1.8%, respectively. Accuracy was determined in two ways: by correlation to cutting/weighing of four times enlarged SPT areas (r2 = 0.999, P < 0.001) and by measuring standardized areas (deviations less than intra-assay CV, i.e. 1-2%). For comparison, CV of alternative methods were also determined: eight different areas (9-76 mm2) were evaluated in quadruplicate using the SPT-scanner (CV = 1.4%), by cutting/weighing of paper (CV = 2.3%), by digitizing (CV = 4.4%) or by measuring longest and orthogonal diameters (CV = 13.6%). In conclusion, the scanning device and software provides an objective and reproducible procedure for rapid determination of SPT areas. When areas are determined by scanning, digitizing or cutting/weighing the variations in area determination becomes negligible compared to the variations of the entire skin test procedure.

Diagnosis, Computer-Assisted↗
PubMed1991

[Allergy to insect stings].

Components in the insect venom and probably also in their saliva may have direct toxic effects or may cause sensitization and may result in allergic reactions to subsequent stings. In Denmark, only the stings of honey bees and wasps (yellow jackets) are of clinical significance and it is important to be aware that these insects contain separate allergenic components. Clinical manifestations following stings are observed from all of the organ systems on the whole. The commonest are itching of the skin, urticaria, possibly angioedema and slight generalized symptoms with vertigo, headache and fatigue. Life-threatening reactions may also occur and one or two fatal cases are registered annually in Denmark. It may be difficult to decide whether an allergic or a toxic reaction is involved on the basis of the symptoms. Possible IgE-sensitization must therefore be assessed by means of a prick test and measurement of specific IgE. The main treatment in cases of acute systemic reactions is adrenaline which may possibly be supplemented with antihistamine and corticosteroid. In cases of massive local reactions and urticaria, antihistamines will, as a rule, prove sufficient. Hyposensitization with insect venom preparations eliminates the future risk for systemic insect sting reactions practically entirely and this must be recommended for patients with demonstrated IgE-sensitizing and generalized reactions. At present, treatment should be continued for three to five years and protection lasts for a series of years after cessation of treatment.

Humans↗
PubMed1991

Emergency treatment of allergic reactions to Hymenoptera stings.

Allergic reactions to Hymenoptera stings are frequently observed all over Europe. Rarely they may induce long-standing morbidity or even be fatal. Several investigations have shown that the emergency treatment given to these patients is often inadequate. Cutaneous symptoms respond well to antihistamines and also to adrenaline. Adrenaline is the mainstay for outside hospital treatment of more severe reactions involving the respiratory tract (bronchial asthma, laryngeal oedema) and the cardiovascular system (anaphylactic shock). Inhaled adrenaline is especially useful in respiratory symptoms, while parenteral application of adrenaline is prefered for shock treatment. All patients with severe respiratory or cardiovascular reactions must be hospitalized, treated under intensive care conditions and observed for at least 24 hr. Emergency medications including adrenaline for inhalation or for self-injection must be given to all patients with a history of systemic allergic reactions to hymenoptera stings. These patients must also get instructions for safety measures to avoid further stings. They should be referred to an allergist in order to evaluate the indication for venom immunotherapy.

Anaphylaxis↗