Urticaria immunoglobulin

M6. Marder, R. J., Burch, F. X., Schmid, F. R., Zeiss, C. R., and Gewurz, H., Low molecular weight Clq precipitins in hypocomplementemic vasculitis-urticaria syndrome Partial purification and characterization as immunoglobulin. J. Immunol. 121, 613-618 (1978). 

Skin reactions to intravenous immunoglobulin are rare (52,93-95). Other reported reactions include urticaria, maculopapular rashes, petechiae, eczema, and erythema multiforme (31,96). 

The administration of equine or other immunoglobulins is associated with a considerable risk of adverse effects and can produce virtually any type of early or late hypersensitivity reaction, ranging from asthma and urticaria to serum sickness and fatal anaphylaxis (103-106). Encephalitis (107), myocarditis (108), nephritis (109), and uveitis (110) can all be manifestations of such reactions. In one case, leukocytoclastic vasculitis was attributed to human immunoglobulin (96). 

Infusion of intravenous immunoglobulin 0.14 g/kg in 17 patients with autoimmune diseases, in whom circulating immunoglobulins had been depleted, was associated with a high incidence of serious adverse effects (94). Treatment was terminated in four patients because of adverse effects, including urticaria, severe hypotension, arthralgia, and chest discomfort. 

The allergen, whether it is a drug, pollen or dust mite, causes production of immunoglobulin E (IgE) antibodies on first exposure. These antibodies attach themselves to mast cells. On subsequent exposure to the same allergen the combination of IgE and allergen causes the mast cells to release a variety of chemicals including histamine. The effects of this can be local, for example hay fever, asthma and urticaria, or systemic causing whole body oedema and anaphylactic shock. 

Other adverse reactions include lightheadedness [40 ], fainting [39 ], and self-limiting aseptic meningitis, which occurs occasionally 48-72 hours after the first dose [30 ]. One patient with chronic spontaneous urticaria developed symptoms of aseptic meningitis on day 3 of a 5-day cycle of intravenous immunoglobulin the immunoglobulin was withdrawn and the urticaria returned to baseline in 2 weeks [56 ]. 

Skin Cutaneous reactions that are associated with intravenous immunoglobulin include erythema at the injection site, rashes, urticaria [40 ], and eczema [43 ]. 

Mitzel-Kaoukhov H, Staubach P, Muller-Brenne T. Effect of high-dose intravenous immunoglobulin treatment in therapy-resistant chronic spontaneous urticaria. Ann Allergy Asthma Tmmnnol 2010 104(3) 253-8. 

In these patients, the specific immunoglobulin E (IgE)-mediated immediate sensitisation from DGEBA with a MW of 340 Da was revealed. Recently, Sasseville (1998) reported on a patient who presented with contact urticaria while working in an aircraft factory. On patch testing, at the 30-min reading, he suffered urticarial reactions to epoxy resin (1% pet), phenylglycidyl ether (0.25% pet) and cresylglycidyl ether (0.25% pet). No delayed reactions were seen. Similarly, Miyamoto and Okumura (1998) reported on contact urticaria confirmed by a 15-min open test and a 15-min closed patch test for epoxy resin at 1% in petrolatum. 

Despite the increasingly more frequent reports of allergic contact dermatitis (ACD) to natural latex, the exact chemical nature of the allergen(s) remains unknown. In contrast, proteins present in latex obtained from the Hevea brasiliensis tree are the cause of the immunoglobulin (Ig)E-mediated hypersensiti-vity/allergic contact urticaria (ACU) to natural latex rubber. Since Hevea brasiliensis accounts for more than 99% of natural rubber used worldwide, ACU to latex is a significant problem. 

The contact sensitivity to grains in atopic bakers is associated with immunoglobulin-E-laden dendritic cells, suggesting a similar process [208]. Some grain-sensitive patients experience aggravation of atopic eczema, some contact urticaria [209], some contact... 

Omalizumab, a recombinant humanized monoclonal antibody that inhibits the binding of human IgE to its high-affinity receptor FceRI by selectively binding the immunoglobulin in solution, has been used as a successful treatment of intractable allergic asthma. The efficacy of the monoclonal antibody treatment was therefore investigated in patients with chronic autoimmune urticaria who remained symptomatic on antihistamine therapy. Of the 12 patients treated, seven showed complete resolution of the urticaria, four responded with a decrease in the urticaria activity score but the urticaria persisted, and one patient showed no improvement. 

Skin Cutaneous reactions associated with intravenous immunoglobulin are uncommon, but include pruritus, non-specific eruptions, erythema, urticaria, eczema, pompholyx, pete-chiae, and skin hemorrhage [53, 54 , 55 , 57 , 59 ]. 

Antimicrobial residues can cause serious illness, and therefore present a hazard to public health. Drug allergies are mediated by a number of different immunological mechanisms, including type 1 immediate immune response mediated through Immunoglobulin E (IgE). Symptoms include anaphylaxis, skin-rashes, urticaria and angioedema (FAO/OIEAVHO, 2006). The antibiotics used in aquaculture, either for prophylactic or therapeutic purposes, often accumulate in the tissue of aquatic animals. 

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