Clinical reactions

The most frequent symptoms of anaphylaxis in patients with mastocytosis are decreased blood pressure and tachycardia. Also observed are dizziness, dyspnea, flushing, nausea and diarrhea [4]. Severe reactions are typical for patients with mastocytosis. In 55 patients with insect sting allergy and confirmed mastocytosis, 81% of patients experienced severe anaphylaxis with shock or cardiopulmonary arrest, whereas clinical reactions of this severity occurred in only 17% of 504 patients without evidence for mastocytosis and normal tryptase levels [29]. In another study in... 

The application and development of new in vitro diagnostic techniques aims to enable physicians to reach an allergy diagnosis with no risk for the patient. This is particularly desirable in the case of serious reactions such as anaphylaxis, by confirming the existence of an anaphylactic reaction and differentiating between individuals which present with sensitization but no cUnical symptoms following exposure to the allergen from those that show a serious clinical reaction. 

History. This includes the severity grading of the clinical reaction, the time of administration and onset of symptoms, the concomitant use of other drugs, foods or compounds (latex), previous history of drug allergy, atopy in the personal or family history, other underlying conditions such as mastocytosis or Cl esterase inhibitor deficiency. The actual preparation in its galenic identity should be stored or at least listed. 

The only common side effect associated with IFN-y is the characteristic flu-like symptoms. However, in rare instances and at high doses, adverse clinical reactions have been noted. These have included heart failure, central nervous system complications (confusion disorientation, Parkinsonian-like symptoms), metabolic complications (e.g. hyperglycaemia), and various other symptoms. 

Clinical decision points indicating greater than 95% likelihood of reactions were established for the most common food allergens. The measurements are indicative of greater than 95% chance of clinical reaction (Chapman et al., 2006) (Table 3.3.8). 

Clinical Reaction Egg Milk Peanut Fish Soy Wheat PPV%... 

When the food to which the patient is sensitized is removed from the diet for 2-4 weeks (depending on symptoms), reintroduction can induce the same clinical reaction (reproducibility and repeatability of symptoms) (Kaczmarski et al., 1997 Sampson, 1999a Sicherer and Sampson, 1999 Burks, 2000). 

Observation time should be 24 h for expected early clinical reactions and 48 h for expected late-phase reactions (patients with AD). 

The 2S albumin family is an important class of common allergenic proteins in seeds. Their presence in almost all edible seeds must be taken into account because of the high incidence of possible clinical reactions occurring in sensitized people and because of the actual possibility of cross-reactivity among different proteins of the same class. 

Recombinant a,-PI produced in yeast has also been clinically evaluated. This material is essentially identical to a -PI purified from human serum with respect to its protein sequence and its ability to inhibit neutrophil elastase however, it contains no carbohydrates. As such, one would suspect that the elimination rate following intravenous administration would be similar to that described for desialylated a -PI as described above [225]. In monkeys r-a,-PI disappeared from circulation with a half-life of 69 3 min. compared to a half-life of 2.4 0.2 days for a,-PI isolated from human serum [230], Rapid elimination following parenteral administration does not, however, preclude aerosol administration of the recombinant material. Aerosol administration of yeast-produced r-a,-PI, in doses ranging from 10 to 200 mg, resulted in a dose-dependent elevation of both antigenic recombinant a,-PI and EIC of BALF from apPI deficient individuals. Four hours after administration of a 200 mg dose of recombinant aj-PI, EIC was increased 40-fold over pre-treatment levels. Twenty-four hours post-dose, levels had declined to a 5-fold elevation relative to base-line levels. Modest increases of serum a,-PI levels were observed 24 h post-inhalation of the 200 mg dose [231], In this study, no adverse clinical reactions or evidence of sensitization to recombinant a,-PI were reported. 

Of 1004 patients assessed at least 14 days after starch administration, using a highly sensitive enzyme-linked immunoadsorbent assay technique, one had a low titer (1 10) of etherified starch-reactive antibodies of the immunoglobulin M (IgM) class. Despite repeated infusions, no clinical reaction could be detected in this patient. The authors concluded that antibodies to etherified starches are extremely rare and that they do not necessarily cause anaphylaxis. This low antigenicity of etherified starches might explain their excellent tolerance, compared with other plasma expanders (52). 

Formaldehyde-releasing preservatives, such as quater-nium-15, diazolidinyl urea, and imidazolidinyl urea, are widely used in cosmetics and topical medications and are well-known contact sensitizers. In spite of positive patch test reactions to these preservatives in a number of patients, only some of these patients will react when they use the corresponding commercial formulations. This is because the concentrations of preservatives in the commercial products are often below the threshold necessary to produce a clinical reaction. This finding confirms the importance of using commercial formulations of topical agents in estimating the clinical relevance of patch test results (10). 

Edelman R, Wasserman SS, Kublin JG, Bodison SA, Nardin EH, Oliveira GA, Ansari S, Diggs CL, Kashala OL, Schmeckpeper BJ, Hamilton RG. Immediate-type hypersensitivity and other clinical reactions in volunteers immunized with a synthetic multi-antigen peptide vaccine (PfCS-MAPlNYU) against Plasmodium falciparum sporozoites. Vaccine 2002 21(3-4) 269-80. 

Relatively safe doses for skin testing, provided that one begins with a prick test, are 25 nmol/ml of peniciUoyl-polylysine and purified benzylpenicillin. Positive skin tests of the immediate type with peniciUoyl-polylysine are usually obtained 2 weeks to 3 months after the clinical reaction (185). 

Information on immunological effects in humans after dermal exposure to 2,4-DNP is limited. Three methods of skin testing were performed on 157 people, 117 of whom were patients with hay fever, asthma, or urticaria (Matzger 1934). For the patch test, 10 mg of sodium 2,4-DNP was applied to the forearm or back under waxed paper. For the scratch test, 2 mg sodium 2,4-DNP in saline or 2 drops of a 2% aqueous solution was rubbed on a scarification. For the intradermal test, 0.01-0.02 ml of 0.001%, 0.01%, 0.1%, or 1% sodium 2,4-DNP was introduced in the upper arm. In the indirect or passive transfer test, blood serum from a patient with a violent clinical reaction to DNP was introduced intradermally in nonallergic subjects. After 24 hours, the sites of passive transfer were tested intradermally with 2,4-DNP. The direct tests and the passive transfer test were negative. 

Two hepatitis B vaccines, Recombivax HB and Engerix-B, were marketed in 1986 and 1989 respectively. Both are derived from a hepatitis B surface antigen and are produced in yeast cells. The primary difference between the two appears to be in exact dosing regimens. The immunization regimen consists of three injections initial, at 1 month, and at 6 months. The immune response and clinical reactions for both intramuscular and subcutaneous administration are... 

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