Endophenotyping Oxaliplatin Hypersensitivity: Personalizing Desensitization to the Atypical Platin.

Background: Oxaliplatin causes a wider variety of immediate hypersensitivity reactions than do other platin-based chemotherapeutics. Some resemble type 1 reactions that respond to desensitization. Others are atypical, possibly mast cell-independent cytokine release reactions refractory to desensitization.

Hypersensitivity to monoclonal antibodies used for cancer and inflammatory or connective tissue diseases.

Objective: To review the medical literature on hypersensitivity reactions to therapeutic monoclonal antibodies for patients with malignant tumors and chronic inflammatory or connective tissues diseases.

Data Sources: We searched the PubMed database using the terms monoclonal antibody, hypersensitivity, and allergy.

Study Selections: We selected case reports and cohort studies of patients with hypersensitivity reactions to monoclonal antibodies.

Drug-Induced Paradoxical Vocal Fold Motion.

Vocal cord dysfunction, also known as paradoxical vocal fold motion (PVFM), is a disorder characterized by abnormal vocal cord adduction during inspiration. PVFM is commonly misdiagnosed as asthma because of the similarity of symptoms: cough, wheezing, chest pain, and dyspnea. We present the clinical vignette of a 36-year-old woman with juvenile rheumatoid arthritis and multiple adverse drug reactions who presented with recurrent episodes of unrecognized PVFM during skin testing for drug allergy, omalizumab treatment, and tocilizumab desensitization.

Surgery Clerkship Evaluations Are Insufficient for Clinical Skills Appraisal: The Value of a Medical Student Surgical Objective Structured Clinical Examination.

Objective: Optimal methods for medical student assessment in surgery remain elusive. Faculty- and housestaff-written evaluations constitute the chief means of student assessment in medical education. However, numerous studies show that this approach has poor specificity and a high degree of subjectivity.

Autoimmune progesterone dermatitis: clinical presentation and management with progesterone desensitization for successful in vitro fertilization.

Objective: To report clinical cases of autoimmune progesterone (P) dermatitis, its relationship to IVF, and the potential for P desensitization to treat these cases to achieve viable pregnancies.

Design: Clinical description.

Setting: Institutional hospitalary practice.

Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment.

Background: Rapid desensitization, a procedure for graded drug administration, allows for the safe readministration of a medication after certain types of hypersensitivity reactions (HSRs) and is indicated in cases in which there are no reasonable therapeutic alternatives. The use of rapid desensitization for HSRs to mAbs has not been validated.

Objective: We sought to describe our experience with rapid desensitization to mAbs, including rituximab, infliximab, and trastuzumab.

Purification from human milk of matriptase complexes with secreted serpins: mechanism for inhibition of matriptase other than HAI-1.

Matriptase, a type 2 transmembrane serine protease, is predominately expressed by epithelial and carcinoma cells in which hepatocyte growth factor activator inhibitor 1 (HAI-1), a membrane-bound, Kunitz-type serine protease inhibitor, is also expressed. HAI-1 plays dual roles in the regulation of matriptase, as a conventional protease inhibitor and as a factor required for zymogen activation of matriptase. As a consequence, activation of matriptase is immediately followed by HAI-1-mediated inhibition, with the activated matriptase being sequestered into HAI-1 complexes.

Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases.

Background: Hypersensitivity reactions (HSRs) to chemotherapeutic drugs, including mAbs, often require that the provoking medication be discontinued, thus raising a dilemma for the caregiver: further use could precipitate a severe, even fatal, allergic reaction on re-exposure, but alternative drugs might be poorly tolerated or much less effective compared with the preferred agent.

Objective: We have developed a standardized rapid desensitization protocol for achieving temporary tolerization to drug allergens. In this study we evaluate the safety and efficacy of this protocol.

Induced loss of Syk in human basophils by non-IgE-dependent stimuli.

In the general population, Syk expression in human basophils is highly variable and correlates well with the IgE-mediated responsiveness of these cells. Previous studies established that IgE-mediated stimulation results in loss of Syk expression. The current studies investigated whether stimulation through other receptors results in loss of Syk.

Hereditary angioedema: a current state-of-the-art review, V: attenuated androgens for the treatment of hereditary angioedema.

Objective: To provide a summary of the literature regarding the use of attenuated androgens during the past 40 to 50 years for the treatment of hereditary angioedema (HAE).

Data Sources: MEDLINE and PubMed were searched to identify studies involving the treatment of HAE with androgens.

Study Selection: Studies were selected based on their relevance to the use of androgens for the treatment of HAE.

Hereditary angioedema: Safety of long-term stanozolol therapy.

Background: Attenuated androgens control attacks of hereditary angioedema. Short-term studies of such patients treated at our institution with attenuated androgens demonstrated no adverse effects. However, the side-effect frequencies in patients receiving long-term treatment are relatively less well characterized.

Leukocyte immunoglobulin-like receptors: novel innate receptors for human basophil activation and inhibition.

Basophils, recruited from the blood to tissues, have been implicated by their presence in diverse allergic disorders including bronchial asthma, allergic rhinitis, and cutaneous contact hypersensitivity. We hypothesized that like other leukocytes involved in inflammatory responses, basophils would express members of the leukocyte immunoglobulin-like receptor (LIR) family of immuno-regulatory molecules on their cell surface. We identified LIR7, an activating member coupled to the common Fc receptor gamma chain, and LIR3, an inhibitory member containing cytoplasmic immunoreceptor tyrosine-based inhibitory motifs, on these cells from human peripheral blood.

An 80-year-old woman with chronic nasal congestion.

Nasal congestion is a common problem in outpatient allergy and immunology. Here, we present the case of an 80-year-old woman with long-standing nasal congestion of uncommon cause and discuss its diagnosis, treatment, and prognosis. Although most patients with chronic nasal congestion do not have a life-threatening condition, it is important to remain vigilant for warning signs that a rare disease is at work behind this common complaint.

Activation of human eosinophils through leukocyte immunoglobulin-like receptor 7.

Eosinophils are implicated prominently in allergic diseases and the host response to parasitic infections. Eosinophils may be activated in vitro by diverse classes of agonists such as immunoglobulins, lipid mediators, and cytokines. The leukocyte Ig-like receptors (LIRs) comprise a family of inhibitory and activating cell-surface receptors.