Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol.

Background: Venom immunotherapy (VIT) is considered to be the gold standard treatment for patients with hymenoptera venom allergy. This treatment induces systemic reactions (SR) in a significant number of patients.

Objective: To evaluate the outcome of VIT in patients with known risk factors for VIT-induced SR and to compare rush VIT (RVIT) and conventional VIT (CVIT).

Oral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity.

Background: Penicillins are the drug family most commonly associated with hypersensitivity reactions. Current guidelines recommend negative skin tests (ST) before re-administering penicillins to patients with previous nonimmediate reactions (NIR).

Objective: The objective of this study was to examine whether ST are necessary before re-administering penicillin to patients with NIR.

Rush Venom Immunotherapy in Children.

Background: Rush venom immunotherapy (VIT) is highly effective in Hymenoptera venom allergy. Still, specific data regarding its safety and efficiency in children are rather sparse.

Objectives: The objective of this study was to better evaluate the safety and efficiency of rush VIT in this specific age group.

The Importance of Amoxicillin and Amoxicillin-Clavulanate Determinants in the Diagnosis of Immediate Allergic Reactions to β-Lactams.

Background: Immediate allergic reactions to β-lactam antibiotics are considered to be one of the most important drug hypersensitivities. A positive skin test (ST) with a combination of major and minor penicillin determinants is usually sufficient to recommend avoidance of the culprit drug, whereas a negative ST is usually followed by an oral challenge test (OCT). Recently, concern has been raised regarding the role of amoxicillin (AMX) ST in the diagnosis of AMX allergy.

Carboplatin hypersensitivity: evaluation and successful desensitization protocol.

Aim: Carboplatin-induced immediate hypersensitivity reactions are relatively common among patients with gynecological malignancies. Once this occurs, the patient might be at risk for future carboplatin-induced reactions. This study evaluated the efficacy of allergic consultation, carboplatin skin testing and desensitization as a single intervention strategy in this population.

Life-threatening angioedema induced by angiotensin-converting enzyme inhibitors: characteristics and risk factors.

Background: Angioedema induced by angiotensin-converting enzyme inhibitors (ACEIs) is a well-known phenomenon and roughly accounts for one-third of angioedema cases presenting to the emergency departments. This study aimed to characterize the patients with severe reactions that required hospitalization and tried to identify the risk factors for these life-threatening events.

Methods: The records of all patients hospitalized with the diagnosis of "angioedema" over a 10-year period were retrospectively analyzed.

Drug allergy in hospitalized perioperative patients: the contribution of a structured questionnaire for accurate diagnosis.

Aims: History of drug allergy is a major cause for deviation from standard of care, as well as prescribing expensive medications. We aimed to evaluate drug allergy-related history taking by surgery interns and compare it with history taking by an allergist and an anesthetist using a simple, structured questionnaire.

Methods: Patients with a declared drug allergy were prospectively recruited from surgical wards.

Rank-based genome-wide analysis reveals the association of ryanodine receptor-2 gene variants with childhood asthma among human populations.

Background: The standard approach to determine unique or shared genetic factors across populations is to identify risk alleles in one population and investigate replication in others. However, since populations differ in DNA sequence information, allele frequencies, effect sizes, and linkage disequilibrium patterns, SNP association using a uniform stringent threshold on p values may not be reproducible across populations. Here, we developed rank-based methods to investigate shared or population-specific loci and pathways for childhood asthma across individuals of diverse ancestry.

Immunotherapy with commercial venoms is efficacious for anaphylactic reactions to Vespa orientalis stings.

Background: Vespa orientalis (VO) stings occasionally induce anaphylaxis. In the absence of commercial VO venom, allergists use commercial venoms for immunotherapy, despite having no indication regarding efficacy. We attempted to examine the effectiveness of immunotherapy with commercial venoms in patients with VO allergy and to identify the venom accountable for this effect.

Drug allergy in hospitalized patients: the contribution of allergy consultation and a structured questionnaire.

Background: Hospitalized patients with an alleged history of drug allergy pose medical and economic concerns when selecting medications for treatment, possibly leading to deviations from standards of care and the use of expensive agents. Accurate history taking and clear documentation of drug allergy are essential for preventing subsequent administration of the offending drug and overdiagnosis of drug allergy. We aimed to evaluate drug allergy-related history taking by internists compared to allergists and to prospectively assess the effect of a simple, structured questionnaire on the accuracy of drug allergy diagnosis.

Chronic urticaria and autoimmunity: associations found in a large population study.

Background: Chronic urticaria (CU) is a common disease in which most cases were considered to be idiopathic. Recent evidence indicates that at least a subset of cases of chronic idiopathic urticaria are autoimmune in origin.

Objective: We aimed to characterize the association between CU, autoimmune diseases, and autoimmune/inflammatory serologic markers in a large unselected population.

Three days rush venom immunotherapy in bee allergy: safe, inexpensive and instantaneously effective.

Background: Rush venom immunotherapy (VIT) is highly effective in vespid venom allergy, but comparable data regarding bee venom (BV) allergy are sparse. We evaluated its safety, efficacy and cost in BV-allergic patients.

Methods: Conventional or rush VIT were offered to all patients with systemic reaction to insect sting.

Management of patients with known drug hypersensitivity in an emergency department in Israel.

Background: Drug hypersensitivity (DH) is potentially life threatening. Its management in the emergency department (ED) is not always satisfactory. Previous studies have evaluated the management of allergic reactions in the ED, but none has specifically addressed patients with known DH.

Allergen immunotherapy-induced biphasic systemic reactions: incidence, characteristics, and outcome: a prospective study.

Background: An anaphylactic reaction is one of the alarming adverse effects of allergen immunotherapy. Although a systemic reaction can follow a biphasic course, its incidence, its outcome, and the risk factors for its development are unknown in patients treated with immunotherapy.

Objective: To record the incidence, characteristics, and outcome of immunotherapy-inflicted biphasic reactions (BRs).

Debilitating beliefs and emotional distress in patients given immunotherapy for insect sting allergy: a prospective study.

Patients who receive venom immunotherapy (VIT) for systemic reactions (SRs) to insect stings are advised that once they reach the maintenance dose they are almost 100% protected against future SRs. However, initial evidence indicates that some patients continue to perceive themselves as highly debilitated by the allergy and are preoccupied with the allergic event. These factors have significant impact on their emotional well-being and allergy-related quality of life (ARQOL).

Skin testing and oral penicillin challenge in patients with a history of remote penicillin allergy.

Background: Penicillin administration is usually contraindicated in penicillin-allergic patients with positive skin test results.

Objective: To examine whether penicillin oral challenge for patients with a history of remote non-life-threatening allergic reaction to penicillin can be well tolerated irrespective of skin test results.

Methods: In a prospective open-label trial, 8,702 individuals were screened between November 1998 and January 2000.

Effectiveness of maintenance bee venom immunotherapy administered at 6-month intervals.

Background: Extension of the intervals at which maintenance venom immunotherapy (MVIT) is administered has been attempted for many years. However, published evidence on its effect, especially in intervals of longer than 3 months, is sparse.

Objective: To examine whether the administration of a bee venom (BV) maintenance dose at 6-month intervals is safe and efficacious.

Variability of venom skin tests.

Purpose Of Review: Venom skin tests constitute the cornerstone in establishing the diagnosis of venom allergy. In spite of their fundamental role, data regarding their reproducibility and variability are rather sparse. This paper is an overview of our current knowledge on the extent of variability in venom skin testing, the possible causes for this phenomenon and its clinical implications.

Anaphylaxis to omeprazole: diagnosis and desensitization protocol.

Background: Omeprazole is an inhibitor of the parietal cell enzyme H+/K+ adenosine triphosphatase. Immediate-type hypersensitivity reactions, such as urticaria, angioedema, and hypotension, induced by omeprazole and other proton pump inhibitors are rare.

Objectives: To confirm the immediate-type mechanism of recurrent anaphylactic reactions to the repeated administration of omeprazole using skin testing and to enable safe administration of the drug after successful oral desensitization.

Reproducibility of skin testing and serum venom specific IgE in Hymenoptera venom allergy.

Background: The decision regarding an immunotherapy regimen for venom-allergic patients is based on the results of skin testing and serum venom specific IgE measurements. However, their reliability has been questioned, and their reproducibility has not been examined.

Objective: To evaluate the reproducibility and reliability of the results of skin testing and serum venom specific IgE measurement in venom-allergic patients.

Ketotifen induced inhibition of histamine release in a non-IgE model of middle ear effusion.

The inhibitory effects of ketotifen, a histamine H1-receptor antagonist and mast cell stabilizer, were examined on a non-IgE experimental model of middle ear effusion. Thirty rats were divided into three groups. Group A (n = 9) was subjected to mechanical stimulation of the external auditory canal (EAC); group B (n = 11) was pre-treated with intraperitoneal administration of 0.

[And wine maketh glad the heart of man: is it so?--allergy to alcoholic drinks].

Adverse reactions to alcoholic drinks are common, especially in asthmatic patients. Since these drinks are the end product of a long process consisting of multiple ingredients, many factors may induce such reactions. This is a case study of a woman who has suffered from recurrent episodes of cutaneous eruption and dyspnea.

Successful desensitization of methylphenidate-induced rash.

Objective: Methylphenidate is a cornerstone of attention-deficit/hyperactivity disorder (ADHD) treatment. Cutaneous adverse reactions resulting from methylphenidate may prohibit its usage. We sought a way to continue this therapy in a patient who developed a rash twice following methylphenidate administration.

Successful carboplatin desensitization in patients with proven carboplatin allergy.

Background: Carboplatin is one of the most useful and well tolerated cytotoxic drugs for gynecologic malignancies. Hypersensitivity to carboplatin is not rare among patients receiving multiple recurrent treatments with this drug. The aim of the current study was to offer a safe and convenient carboplatin desensitization strategy to patients with a proven allergic reaction to this drug.

Safe administration of contrast media: what do physicians know?

Background: Radiographic contrast media (RCM) are among the most commonly used materials in medicine. Nevertheless, there seems to be a little agreement between current practice and accepted guidelines regarding their adverse reactions, the indications for premedication, and use of low-osmolar contrast agents (LOCAs). Misconceptions exist regarding the relationship between hypersensitivity to RCM and foods and medications that contain iodine.