Xolair®-induced recurrent anaphylaxis through sensitization to the excipient polysorbate

Omalizumab is an anti-IgE humanized IgG1 monoclonal antibody, indicated for the treatment of moderate-to-severe allergic and uncontrolled asthma. Anaphylaxis was found to occur in 0.1 to 0.2% of patients taking Xolair®, the commercialized form of omalizumab1, with no known underlying mechanism. Although it has been very difficult to develop a reliable assay to detect clinically significant anti-omalizumab IgE, a recent report suggested that Xolair®-induced anaphylaxis is not mediated by IgE sensitization to the monoclonal antibody (mAb) omalizumab itself2.

http://ift.tt/2sQKFJL

Cow's milk-associated chronic food protein-induced enterocolitis syndrome (FPIES) exacerbated by extensively hydrolyzed formula

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy predominantly seen in infancy or early childhood. While its incidence has been steadily increasing over the past two decades, it is still often misdiagnosed due to lack of awareness.1 It presents in two forms: acute and chronic.

http://ift.tt/2Cj8xcQ

Concurrent IgE-mediated NMBA-allergy in systemic mastocytosis

Mastocytosis is a rare clinical condition characterized by an abnormal increase in tissue mast cells, which can be limited to the skin (cutaneous mastocytosis) or infiltrate the bone marrow and other organs with or without skin involvement (systemic mastocytosis). Systemic mastocytosis (SM) is reported primarily in adulthood, where indolent SM is the most common form. We report an unusual case consistent with IgE-mediated neuromuscular blocking agent (NMBA) allergy evidenced in a patient with previously unsuspected mastocytosis.

http://ift.tt/2sR42T6

Evaporative coolers are not associated with dust mite or mold sensitization in large pediatric cohort

The primary species of house dust mites (HDM), Dermatophagoides farinae and Dermatophagoides pteronyssinus, are associated with asthma, atopic dermatitis, and allergic rhinitis1. Mold exposure is also implicated in allergic disease, most prominently with asthma2. HDM survival is dependent on a relative humidity of greater than 55-75%3, and most species of fungi grow at a relative humidity greater than 60% 4. Evaporative (or swamp) coolers (ECs) are used as a low-cost air conditioning alternative in arid and semi-arid climates.

http://ift.tt/2CgFUwS

Relationship between traffic related air pollution particle exposure and asthma exacerbations: association or causation?

Clinicians are often asked about articles in the media proclaiming new and unexpected causes of disease. Often, these headlines are based not on randomized clinical trials but rather on associations discovered in observational studies. Most clinicians realize that a p-value less than 0.05 does not prove causation but do not necessarily know how to critically judge whether a reported association should be considered to be a true cause of the disease. In 1965, Austin Bradford Hill published "The Environment and Disease: Association or Causation?" 1.

http://ift.tt/2sOLC5g

A case of neuropathic pain in monoclonal mast cell activation syndrome

Neuropathic pain is an uncommon symptom associated with mast cell disorders but can significantly impact quality of life. Mast cells are known to be gatekeepers of nociception and play an important role in the development of neuropathic pain in the central and peripheral nervous system1. Although musculoskeletal pain has been associated with mast cell disorders2, neuropathic pain associated with mast cell disorders and its management has not been well described in the literature. We present a patient with neuropathic pain associated with monoclonal mast cell activation syndrome (MMAS) and review the agents used in his treatment.

http://ift.tt/2F39VkQ

Relying on allergy skin test results

We appreciate the comments related to our recent publication, "Reliability of allergy skin testing". The author writes, "Reliability (precision, repeatability) and validity (accuracy) are two completely different methodological issues". We agree that other titles such as, "Accuracy of allergy skin testing" may have fit more pedantic epidemiological definitions. However, this would not have emphasized the clinical concerns any greater. We had chosen to use the lay term for reliability as it appears in the Oxford English dictionary where it is defined as, "the degree to which the result of a measurement, calculation, or specification can be depended on to be accurate1."

http://ift.tt/2sLLGmA