Asthma deaths outside the hospital in an urban community from 2004 to 2008.

Background: Several studies have been performed reviewing medical examiner's autopsy reports of asthma deaths. None, to our knowledge, have focused on the characteristics of asthma deaths in the urban community alone.

Objective: To characterize factors related to asthma deaths occurring outside the hospital setting in an urban community.

Hypersensitivity pneumonitis and related conditions in the work environment.

Hypersensitivity pneumonitis can occur from a wide variety of occupational exposures. Although uncommon and difficult to recognize, through a detailed work exposure history, physical examination, radiography, pulmonary function studies, and selected laboratory studies using sera and bronchoalveolar lavage fluid, workers can be identified early to effect avoidance of the antigen and institute pharmacologic therapy, if necessary. A lung biopsy may be necessary to rule out other interstitial lung diseases.

Occupational asthma secondary to enzymes used in cheese production.

Occupational asthma (OA) accounts for 5-10% of all asthma in adults. Although OA secondary to enzymes has been reported, it is rare in the context of food preparation. In the cheese production industry, multiple powdered enzymes are used to soften and flavor cheese.

Adverse reactions to orthodontic appliances in nickel-allergic patients.

Nickel allergy (NA) is common and causes more cases of allergic contact dermatitis (ACD) than all other metals combined. Many orthodontic appliances (ODAs) contain nickel but their clinical relevance in nickel-allergic patients is unclear. We aimed to characterize the relationship between NA and ODAs because the medical literature investigating this is controversial.

Occupational asthma: what can be done to prevent it?

Occupational asthma (OA) accounts for at least 10% of cases of adult asthma and presents as intermittent asthma occurring at the workplace and remitting on weekends and holidays, or persistent asthma, especially if the diagnosis and early intervention is delayed. OA is under-recognized, challenging and time-consuming to diagnose, difficult to confirm with currently available tests and complex in terms of legal implications of disability and impairment. Over 400 agents have been identified as causing OA with allergic triggers accounting for 80-90% of cases.

Yacht-maker's lung: A case of hypersensitivity pneumonitis in yacht manufacturing.

We present a case of hypersensitivity pneumonitis in a 46-year-old female working at a yacht manufacturing company. She reported a 2-month history of progressive dyspnea, chest tightness, and daytime, nocturnal, and exertional cough in temporal relationship to work where she was exposed to chemicals involved in the manufacture of yachts. Treatment with systemic antibiotic therapy, inhaled bronchodilators, and inhaled corticosteroids provided minimal relief of symptoms.

Recurrent respiratory papillomatosis in children: masquerader of common respiratory diseases.

Background: Recurrent respiratory papillomatosis in children is an uncommon but potentially life-threatening benign tumor of the respiratory tract with laryngeal predilection. The diagnosis of recurrent respiratory papillomatosis may be challenging unless there is a high index of suspicion and awareness of the variable presentations.

Methods: We reviewed the medical charts of children with recurrent respiratory papillomatosis treated at a tertiary children's hospital.

Severe allergy to chicken meat.

Introduction: While allergic reactions to poultry products in the form of feathers and eggs are common, allergic reactions to chicken meat are rare. Despite the popularity of chicken in today's healthy diet, severe reactions after ingesting chicken meat are rarely described. This report describes a patient who developed chicken meat anaphylaxis without experiencing allergy to eggs or feathers.

New-onset rheumatoid arthritis after anthrax vaccination.

Background: Anthrax vaccine was licensed in 1970 and is used to protect individuals exposed to biological warfare and those who may come in contact with Bacillus anthracis in infected animals or in laboratory settings. The current adsorbed anthrax vaccine is regarded as effective and safe. Adverse effects reported include fever, chills, myalgia, arthralgia, and nausea.

Hypersensitivity pneumonitis.

Hypersensitivity pneumonitis (HP) or extrinsic allergic alveolitis is a non-IgE mediated hypersensitivity disease initiated by inhalation and subsequent sensitisation to organic antigens. These diseases have been described in different occupational groups and present in acute, subacute or chronic forms based on the exposure to antigens and host response. Clinical features are dependent upon the stage of the disease and can include fever, chills, cough, dyspnoea, and weight loss.

Severe allergic reactions to guinea pig.

Background: Allergic sensitization and reactions to guinea pig (Cavia porcellus) have been well documented in laboratory animal handlers, primarily manifesting as rhinitis, conjunctivitis, and asthma. Severe allergic reactions, however, are rare.

Methods: We report two patients with severe allergic reactions following non-occupational exposure to guinea pigs.

Allergy and "toxic mold syndrome".

Background: "Toxic mold syndrome" is a controversial diagnosis associated with exposure to mold-contaminated environments. Molds are known to induce asthma and allergic rhinitis through IgE-mediated mechanisms, to cause hypersensitivity pneumonitis through other immune mechanisms, and to cause life-threatening primary and secondary infections in immunocompromised patients. Mold metabolites may be irritants and may be involved in "sick building syndrome.

Asthma is a risk factor for acute chest syndrome and cerebral vascular accidents in children with sickle cell disease.

BACKGROUND: Asthma and sickle cell disease are common conditions that both may result in pulmonary complications. We hypothesized that children with sickle cell disease with concomitant asthma have an increased incidence of vaso-occlusive crises that are complicated by episodes of acute chest syndrome. METHODS: A 5-year retrospective chart analysis was performed investigating 48 children ages 3-18 years with asthma and sickle cell disease and 48 children with sickle cell disease alone.

Toxic and other non-IgE-mediated effects of fungal exposures.

There are more than 100000 recognized species of fungi, comprising 25% of the biomass of the earth. Allergic, IgE-induced, manifestations of airborne fungi are common, whereas non-IgE manifestations are rare. Recently, much focus has been placed on the non-IgE-mediated effects of various molds, including hypersensitivity pneumonitis, infectious disease, and mycotoxicoses.

High dose cetirizine: a case report.

We report the case of a 46-year-old man who tolerated 50 mg per day of cetirizine for the treatment of chronic idiopathic urticaria. The patient denied any sedation or somnolence and had no difficulty performing routine daily functions including driving. He had tried other antihistamines, including fexofenadine, loratadine, and hydroxyzine without improvement.

Occupational lung disease related to cytophaga endotoxin exposure in a nylon plant.

Workers at a nylon plant developed pulmonary disease with systemic symptoms. Differentiating between humidifier fever and hypersensitivity pneumonitis (HP) is challenging. Cytophaga, an endotoxin-producing bacteria, was isolated from the plant air-conditioning system.

Occupational asthma.

Occupational asthma is a common yet all too frequently unnoticed form of adult asthma. Many agents can trigger disease by a variety of mechanisms, some of which are unknown. Awareness of high-risk occupations and knowledge that adults with persistent asthma may have an occupational trigger are vital in early identification and treatment of this population of patients where the stakes are high.

Safety of aprotinin use and re-use in pediatric cardiothoracic surgery.

Background: Hypersensitivity reactions to aprotinin have been reported in adult cardiac surgical patients undergoing initial and re-exposure to the medication. This study describes the incidence and impact of aprotinin hypersensitivity reactions in children undergoing cardiothoracic surgery.

Methods And Results: In this retrospective review of our entire experience with aprotinin (n=865), 681 first exposures, 150 second exposures, and 34 third or higher exposures were examined.

Severe tomato allergy (Lycopersicon esculentum).

Although tomatoes are a commonly consumed food, severe allergic reactions to tomatoes are unusual or rarely reported. Previously reported allergic manifestations to tomato include urticaria/angioedema, dermatitis, oral allergy syndrome, rhinitis, and abdominal pain. The aim of this study was to report two patients with significant immediate hypersensitivity reactions to tomato and characterize the responsible allergen.

The long-term outcome in acute, subacute, and chronic forms of pigeon breeder's disease hypersensitivity pneumonitis.

Background: Pigeon breeder's disease (PBD) is an avian-induced hypersensitivity pneumonitis. The limited data that exist on the long-term outcome for the disease are conflicting.

Objective: We sought to determine the long-term outcome of patients with PBD to evaluate the course of the disease.