An introduction to immunology and immunopathology.

Beyond structural and chemical barriers to pathogens, the immune system has two fundamental lines of defense: innate immunity and adaptive immunity. Innate immunity is the first immunological mechanism for fighting against an intruding pathogen. It is a rapid immune response, initiated within minutes or hours after aggression, that has no immunologic memory.

Allergen immunotherapy in pregnancy.

Background: Allergic diseases such as asthma and allergic rhinitis constitute a significant burden of disease among women of childbearing age and those who are pregnant. Adequately managing these conditions is paramount in reducing negative fetal outcomes as well as maternal complications during pregnancy. However, the potential for harm to both the mother and fetus demands carefully balancing efficacy and safety of treatment.

Venom allergy testing: is a graded approach necessary?

Background: Many institutions recommend a stepwise approach to intradermal testing for venom allergy. This is costly and uncomfortable for the patient. The rationale for this approach is the risk of potential adverse reactions to testing with the maximal dose alone.

Children under 15 kg with food allergy may be at risk of having epinephrine auto-injectors administered into bone.

Background: The Epipen® Jr and Allerject® 0.15 mg are currently the most commonly prescribed epinephrine auto-injectors (EAIs) for the management of anaphylaxis in pediatric patients in North America and Canada. To ensure rapid absorption, it should be administered intramuscularly into the anterolateral aspect of the thigh.

Auto-injector needle length may be inadequate to deliver epinephrine intramuscularly in women with confirmed food allergy.

Background: Epinephrine auto-injectors are the standard first aid treatment for anaphylaxis. Intramuscular delivery into the anterolateral aspect of the thigh is recommended for optimal onset of action of epinephrine. The most frequently prescribed auto-injector in North America and Canada is the EpiPen(®), which has a needle length of 15.

Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections.

Background: Allergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders. Ideally, it should be administered into the subcutaneous space in the mid-posterolateral upper arm. Injections are commonly given using a standard allergy syringe with a needle length of 13 mm.

The utility of using fiberoptic rhinoscopy in the diagnosis of nasal polyps.

Background: Symtomatology of nasal polyps (NP) is relatively non-specific and other nasal conditions that cause nasal may be mistaken for NP. The purpose of this study was to evaluate the accuracy otoscopic (OT) examination in detecting presence of NP by using fiberoptic rhinoscopy (FR) as the gold standard to confirm diagnosis of NP.

Methods: Charts from a single allergy clinic were reviewed for any patient having NP diagnosed by FR.

CSACI position statement: safety of topical calcineurin inhibitors in the management of atopic dermatitis in children and adults.

Atopic dermatitis (AD) is a condition frequently encountered in medical practices across the country. Arming ourselves with appropriate and safe treatment modalities to provide relief for this chronic and relapsing inflammatory condition is of utmost importance to our patients and their families. Utilizing topical calcineurin inhibitors (TCIs) for the treatment of AD not responsive to high-potency corticosteroids, or low-potency corticosteroids and localized to the face, eyelids, and skin folds of patients >2 years, is reasonable to include in common practice.

Skin prick testing with extensively heated milk or egg products helps predict the outcome of an oral food challenge: a retrospective analysis.

Background: Cow's milk and hen's egg are the most frequently encountered food allergens in the pediatric population. Skin prick testing (SPT) with commercial extracts followed by an oral food challenge (OFC) are routinely performed in the diagnostic investigation of these children. Recent evidence suggests that milk-allergic and/or egg-allergic individuals can often tolerate extensively heated (EH) forms of these foods.

An introduction to immunology and immunopathology.

In basic terms, the immune system has two lines of defense: innate immunity and adaptive immunity. Innate immunity is the first immunological, non-specific (antigen-independent) mechanism for fighting against an intruding pathogen. It is a rapid immune response, occurring within minutes or hours after aggression, that has no immunologic memory.

Omalizumab: Practical considerations regarding the risk of anaphylaxis.

Omalizumab has demonstrated efficacy among patients with moderate to severe persistent allergic asthma, whose symptoms are inadequately controlled with other controller agents. This therapy is generally well tolerated, but there are some safety considerations, the most important of which is the rare, but potentially life-threatening, occurrence of omalizumab-associated anaphylaxis.In Canada, data from the manufacturer of omalizumab indicate that the frequency of anaphylaxis attributed to Xolair in post-marketing use is approximately 0.

Skin prick testing in patients using beta-blockers: a retrospective analysis.

Rationale: The use of beta-blockers is a relative contraindication in allergen skin testing yet there is a paucity of literature on adverse events in this circumstance. We examined a population of skin tested patients on beta-blockers to look for any adverse effects.

Methods: Charts from 2004-2008 in a single allergy clinic were reviewed for any patients taking a beta-blocker when skin tested.

An unusual case of bilateral auriculotemporal syndrome presenting to an allergist.

Background: Auriculotemporal syndrome (AS) is an uncommon disorder that may present with facial erythema with chewing food.

Methods: We report a patient referred to an allergist to rule out allergy as a reason for food-associated bilateral facial flushing. She was subsequently found to have bilateral AS.