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Systemic Mastocytosis and Malignancy

A disorder characterized by excessive numbers of mast cells and tissue infiltration by these cells is systemic mastocytosis. In this condition, mutations of c-kit (Asp 816 Val mutation) occur (11,116-118), and a subsequent pathological infiltration of affected tissue by mast cells may be seen, resulting in many of the manifestations (119). The patients may present with skin lesions (pigmented macules that urticate with contact Darrier's sign ) or systemic symptoms arising from mast cell infiltration of solid organs, such as the liver, spleen, lymph nodes, and bone marrow (119,120). Cutaneous manifestations include urticaria pigmentosa, diffuse and erythematous mastocytosis, mastocytoma (mast cell deposits or tumors), and telangiectasia macularis eruptiva perstans (121). Some patients have skin limited and indolent, slowly progressive disease, whereas others develop rapidly progressive and fatal mast cell leukemia,

The Management of Side Effects

Glatiramer acetate has the fewest side-effects. Its daily subcutaneous injection usually causes some redness and itching at the injection site when treatment is initiated. That usually lasts about 20 minutes and often stops after a few weeks. Occasionally increased stiffness occurs. Hives sometimes indicate an allergic reaction. One unique side-effect does occasionally occur it is very infrequent and usually does not recur, but some people may experience a sudden warm or hot sensation throughout the body along with chest tightness, shortness of breath, and a feeling of depression. This lasts about twenty minutes and will abate. If an aggressive approach with emergency medicine is applied, increased problems occur thus, it is recommended that if this side-effect is present, rest for twenty minutes and do not panic.

Monitoring and Managing Adverse Reactions

Rash or hives to the primary health care provider because this may be a precursor to a severe anaphylactic reaction (see Chap. 7). In severe cases, the primary health care provider may discontinue the cephalosporin therapy. The nurse closely observes the patient for signs and symptoms of a bacterial or fungal superinfection (see Chap. 7). If any occur, the nurse contacts the primary health care provider before the next dose of the drug is due.

Adverse Reactions

Gastric upset, heartburn, nausea, vomiting, anorexia, and gastrointestinal bleeding may occur with salicylate use. Although these drugs are relatively safe when taken as recommended on the label or by the primary health care provider, their use can occasionally result in more serious reactions. Some individuals are allergic to aspirin and the other salicylates. Allergy to the salicy-lates may be manifested by hives, rash, angioedema, bronchospasm with asthma-like symptoms, and ana-phylactoid reactions.

Health Supplement Alert Melatonin

More, affecting any activity that requires mental alertness, such as driving. Although uncommon, allergic reactions to melatonin have been reported. The supplement should be stopped and emergency care sought if symptoms of an allergic reaction (eg, difficulty breathing, hives, or swelling of lips, tongue, or face) occur.

THE classical pathway

C1INH DEFICIENCY - HEREDITARY ANGIOEDEMA (HAE) First described in the 1880s, hereditary angioedema (HAE) is an autosomal dominant disease that results from the lack of a protein that inhibits the action of the first component of complement (C1INH). This serine protease inhibitor is a member of the Serpin superfamily and is involved in the regulation of the coagulation, fibrinolytic and contact (or kinin-forming) systems. Lack of C1 inhibitor results in a range of severe symptoms (Table 5.15) and biochemical defects reflecting the importance of this protein. Table 5.15 Clinical characteristics of hereditary angioedema Hereditary angioedema is classified as either Type I or Type II. Patients with Type I HAE (85 of affected individuals) have very low levels of C1 inhibitor (5 to 30 of normal plasma levels). In contrast to this, patients with Type II HAE have normal or elevated levels of C1 inhibitor. However, a large proportion of this protein is dysfunctional only a very low level of...

Allergic Reactions In The Skin

Urticaria is a short-lived, red, edematous lesion of the skin associated with itching. Nonimmunological and immunological mechanisms cause skin lesions. IgE-mediated immunological urticaria is more frequent in atopic subjects and is usually induced by penicillin or consumption of shellfish, soft fruits, and nuts (Anonymous, 1997). Nonimmunological urticaria can be elicited in healthy subjects by low-molecular-mass substances such as ammonium persulfate (Mahzoon et al., 1977), dimethyl sulfoxide (Odom and Maibach, 1976), and cinna-maldehyde (Kirton, 1978).

Diseases of the skin and subcutaneous tissue L00L99

Urticaria and erythema (L50-L54) Urticaria Excludes allergic contact dermatitis ( L23.- ) angioneurotic oedema ( T78.3 ) hereditary angio-oedema ( E84.1 ) Quincke's oedema ( T78.3 ) urticaria L50.0 Allergic urticaria L50.1 Idiopathic urticaria L50.2 Urticaria due to cold and heat L50.3 Dermatographic urticaria L50.4 Vibratory urticaria L50.5 Cholinergic urticaria L50.6 Contact urticaria L50.8 Other urticaria Urticaria recurrent periodic L50.9 Urticaria, unspecified

Acute severe drug reactions

Most drug reactions in anaesthesia are mild and transient, consisting mainly of localized urticaria as a result of cutaneous histamine release. The incidence of severe reactions to anaesthetic drugs is approximately 1 10000 drug administrations, and is more common in females. Of those reported to the Medicines Control Agency, 10 involved a fatality compared to 3.7 for drugs overall. This probably reflects the frequency with which anaesthetic drugs are given intravenously. Clinical features include (in order of frequency) urticaria angioedema, which may involve the airway

Ongoing Assessment

It is also important that the nurse monitor for any indication of hypersensitivity reaction. The nurse reports reactions, such as chills, fever, or hives, to the primary health care provider. When heparin is given to prevent the formation of a thrombus, the nurse observes the patient for signs of thrombus formation every 2 to 4 hours. Because the signs and symptoms of thrombus formation vary and depend on the area or organ involved, the nurse should evaluate and report any complaint the patient may have or any change in the patient's condition to the primary health care provider.

Monitoring and Managing Adverse Drug Reactions

If uncontrolled bleeding is noted or the bleeding appears to be internal, the nurse stops the drug and immediately contacts the primary health care provider because whole blood, packed red cells, or fresh, frozen plasma may be required. Vital signs are monitored every hour or more frequently for at least 48 hours after the drug use is discontinued. The nurse contacts the primary health care provider if there is a marked change in one or more of the vital signs. Any signs of an allergic (hyper-sensitivity) reaction, such as difficulty breathing, wheezing, hives, skin rash, and hypotension, are reported immediately to the primary health care provider.

Promoting an Optimal Response to Therapy

This drug may be given by the intravenous (IV), SC, or IM route. During parenteral administration of ACTH, the nurse observes the patient for hypersensi-tivity reactions. Symptoms of hypersensitivity include a rash, urticaria, hypotension, tachycardia, or difficulty breathing. If the drug is given IM or SC, the nurse observes the patient for hypersensitivity reactions immediately and for about 2 hours after the drug is given. If a hypersensitivity reaction occurs, the nurse notifies the primary health care provider immediately. Long-term use increases the risk of hypersensitivity.

The dosage is 100 mgd Sulfasalazine Azulfidine

The most common side effects, occurring in up to one-third of patients, include anorexia, headache, nausea, vomiting, gastric distress, and apparently reversible oligospermia. Rash, pruritus, urticaria, fever, and hemolytic anemia are less frequent. Rare reactions such as blood dyscrasia (especially leukopenia), hypersensitivity reaction, and central nervous system reaction have been reported.

Traditional Beekeeping

As the African honey-bee, unlike its Asian counterpart, is a cavity-nesting bee, bee keeping using fixed hives developed in Africa from a very early period. Indeed, so-called 'traditional' bee-keeping was evident in Egypt from around 2400 bc. Bees and honey are mentioned several times in the Bible, and though the phrase may be simply metaphorical Canaan is described as 'a land flowing with milk and honey' (Exodus 3 17). Both wax and honey were important as items of trade, and wax had invaluable uses for writing tablets, for candles, and for embalming (Cansdale 1970 245). Several factors may have been conducive to the development of bee-keeping - an abundance of bee forage but a lack of suitable nesting sites, a growing human population that practised agriculture and had an increasing need for honey and wax, and the availability of pots and baskets to make suitable hives (Crane 1999 161). Thus the earliest records that we have of African peoples south of the Sahara, including those in...

Immediate Hypersensitivity

Wheel And Flare Allergy Skin Test

Immediate hypersensitivity can produce allergic rhinitis (chronic runny or stuffy nose) conjunctivitis (red eyes) allergic asthma atopic dermatitis (urticaria, or hives) and other symptoms. These symptoms result from the immune response to the allergen. In people who are not allergic, the allergen stimulates one type of helper T lymphocyte, the TH1 cells, to secrete interferon-y and inter-leukin-2. In people who are allergic, dendritic cells stimulate the other type of helper T lymphocytes, the TH2 cells, to secrete other lymphokines, including interleukin-4 and interleukin-13. These, in

Clinical Aspects Immunity

Hypersensitivity is a harmful overreaction of the immune system, commonly known as allergy. In cases of allergy, a person is more sensitive to a particular antigen than the average individual. Common allergens are pollen, animal dander, dust, and foods, but there are many more. A seasonal allergy to inhaled pollens is commonly called hay fever. Responses may include itching, redness or tearing of the eyes (conjunctivitis), skin rash, asthma, runny nose (rhinitis), sneezing, urticaria (hives), and angioedema, a reaction similar to hives but involving deeper layers of tissue. angioedema A localized edema with large hives (wheals) similar to urticaria but urticaria_ A skin reaction consisting of round, raised eruptions (wheals) with itching hives

Clinical Symptoms And Occurrence Of Complement Activationrelated Pseudoallergy

Common allergic symptoms Anaphylactic shock, angioedema, asthma attack, bronchospasm, chest pain, chill, choking, confusion, conjunctivitis, coughing, cyanosis, death, dermatitis, diaphoresis, dyspnoea, edema, erythema, feeling of imminent death, fever, flush, headache, hypertension, hypotension, hypoxemia, low back pain, lumbar pain, metabolic acidosis, nausea, pruritus, rash, rhinitis, skin eruptions, sneezing, tachypnea, tingling sensations, urticaria, and wheezing Unique symptoms

Localized Anaphylaxis Atopy

FOOD ALLERGIES Various foods also can induce localized anaphylaxis in allergic individuals. Allergen crosslinking of IgE on mast cells along the upper or lower gastrointestinal tract can induce localized smooth-muscle contraction and vasodilation and thus such symptoms as vomiting or diarrhea. Mast-cell degranulation along the gut can increase the permeability of mucous membranes, so that the allergen enters the bloodstream. Various symptoms can ensue, depending on where the allergen is deposited. For example, some individuals develop asthmatic attacks after ingesting certain foods. Others develop atopic urticaria, commonly known as hives, when a food allergen is carried to sensitized mast cells in the skin, causing swollen (edematous) red (ery-thematous) eruptions this is the wheal and flare response, or P-K reaction, mentioned earlier.

Allergic Drug Reactions

Allergic reactions are manifested by a variety of signs and symptoms observed by the nurse or reported by the patient. Examples of some allergic symptoms include itching, various types of skin rashes, and hives (urticaria). Other symptoms include difficulty breathing, wheezing, cyanosis, a sudden loss of consciousness, and swelling of the eyes, lips, or tongue. Tachycardia (heart rate 100 bpm) Palpations Syncope (fainting) Cardiac arrest Integumentary Urticaria Angioedema Pruritus (itching) Sweating Gastrointestinal Nausea Angioedema (angioneurotic edema) is another type of allergic drug reaction. It is manifested by the collection of fluid in subcutaneous tissues. Areas that are most commonly affected are the eyelids, lips, mouth, and throat, although other areas also may be affected. Angioedema can be dangerous when the mouth is affected because the swelling may block the airway and asphyxia may occur. Difficulty in breathing or swelling to any area of the body is reported...

Poisonous Lizards Arachnids and Insects

This is unfortunate for them, as their barbed stingers stay in the skin of victims, and in pulling away after stinging, essential bee body tissue is ripped away. This causes the bee to die quickly. Workers also defend hives in this way, committing suicide to protect the hive. Bee stings often disable or kill predators who seek to eat the bees or their honey.

Immune Globulins and Antivenins

Adverse reactions to immune globulins are rare. However, local tenderness and pain at the injection site may occur. The most common adverse reactions include urticaria, angioedema, erythema, malaise, nausea, diarrhea, headache, chills, and fever. Adverse reactions, if they occur, usually last for several hours. Systemic reactions are extremely rare. The antivenins may cause various reactions, with hypersensitivity being the most severe. Some antivenins are prepared from horse serum, and if a patient is sensitive to horse serum, serious reactions and death may result. The immediate reactions usually occur within 30 minutes after administration of the antivenin. Symptoms include apprehension flushing itching urticaria edema of the face, tongue, and throat cough dyspnea vomiting cyanosis and collapse. Other adverse reactions are included in the Summary Drug Table Agents for Passive Immunity.

Anaphylactoid Purpura

Henoch-Schonlein purpura is nonthrombocytopenic vascular purpura. The pur-puric eruption differs considerably from that due to thrombocytopenia in that lesions are maculopapular, initially resembling urticaria because of edema and perivascular infiltration and later becoming erythematous, with central areas of hemorrhage that finally fade to brown because of denaturation of the extravasated hemoglobin. The rash appears on the buttocks and on the extensor surfaces of the arms and lower legs. Accompanying the rash are joint or gastrointestinal symptoms, localized areas of edema, and renal damage. Initial hematuria occurs in about one third of patients. The platelet count, bleeding time, and tests for hemostasis are normal. A positive tourniquet test is found in 25 of patients. Treatment is symptomatic. When severe abdominal pain is present, steroid therapy is beneficial.

Opportunistic Honey Hunting among Hunter Gatherers

In a seminal paper on the ecological and sociological aspects of honey-collecting among the Mbuti, Mitsuo Ichikawa notes that during the months of May to July it is their main subsistence activity. The Mbuti, like other forest hunter-gatherers, are skilful tree climbers, and collect honey usually in the early morning. Within a few hours a person may find 2-3 hives. When the bee colony is opened, they blow in smoke through a tube, and do not seem unduly worried by the bees, in spite of the 'aggressive' reputation of African honey-bees. During a twelve-day period at one camp, Ichikawa recorded that they collected honey from the hives of forty-five honey-bees and four stingless bees. This amounted to 229 kg of honey, and as the camp consisted of twenty-three persons, it was estimated that 0.83 kg of honey was consumed by each person per day. Thus during the honey season honey was not only deemed to be their favourite food, but constituted around 70 per cent of their diet - and 80 per...

The Introduction of Modern Beekeeping

Although bee-keeping with frame hives had first been introduced by early missionaries at the end of the nineteenth century, throughout much of the colonial period the collecting of honey was either through traditional beekeeping methods, or by sporadic and rather opportunistic 'raiding' of the hives in order to obtain the honey. Soon after independence the Malawi government, principally through the Ministry of Agriculture, began to implement various feasibility studies and surveys in order to ascertain the viability of bee-keeping and to encourage the development of beekeeping projects. The aim was both to increase the production of honey and beeswax - for there was little honey available in the shops, and it was at a very high price by local standards, and also to provide a viable source of alternative income for rural people. Between 1968 and 1973 a beekeeping survey was established in the northern region, at Mzimba, Karonga and Rumphi, by the Agricultural Planning Unit. Some...

Common IgEMediated Allergic Reactions

Symptoms, occurring 10-14 days following treatment, can be distinctly different. Urticaria and angioedema characteristic of an IgE-mediated reaction have been reported. Serum sickness and immune complex vasculitis are a common occurrence. In rare instances, penicillin induces pulmonary fibrosis associated with an autoimmune response.

Example natural rubber and latex allergy

Contact urticaria, Prompt glove-related urticaria, by questionnaire urticaria, by Glove-related urticaria, by questionnaire Glove-related urticaria, by questionnaire A better measure of the burden of latex allergy on healthcare workers is the incidence (rate of new onset) of latex sensitization onset. Data from the Finnish Register of Occupational Diseases showed that the reported incidence rates of latex contact urticaria were 0.2 10 000 per year for the overall working population, 2.2 10 000 per year for working nurses, 3.9 10 000 per year for working physicians, 6.0 10 000 per year for working dentists, and 11.8 10 000 per year for working dental assistants 70 . A study of 122 apprentices in dental hygiene technology throughout their training showed much higher incidence rates of self-reported measures 249 10 000 per year for skin

Ci Inhibitor C1inh

This prevents the function of activated C1s and C1r by binding to their active sites. It also inhibits activated Hageman factor (one of the components of the clotting cascade) and all the systems activated by Hageman factor fragments. Thus, C1INH regulates enzymes of the kinin-generating system (chemicals which stimulate the sensation of pain), the clotting system and the fibrinolytic system (molecules involved in the regulation of blood clotting and wound repair). The importance of this regulatory protein in prevention of pathological damage is evidenced by the immunodeficiency disease hereditary angioedema (HAE) where sufferers are unable to produce normal levels of functional C1INH. This is discussed further in Section 5.3.

Immunoglobulin E IgE

Componente Secretor Iga

The potent biological activity of IgE allowed it to be identified in serum despite its extremely low average serum concentration (0.3 g ml). IgE antibodies mediate the immediate hypersensitivity reactions that are responsible for the symptoms of hay fever, asthma, hives, and anaphylactic shock. The presence of a serum component responsible for allergic reactions was first demonstrated in 1921 by K. Prausnitz and H. Kustner, who injected serum from an allergic person intra-dermally into a nonallergic individual. When the appropriate antigen was later injected at the same site, a wheal and flare reaction (analogous to hives) developed there. This reaction, called the P-K reaction (named for its originators, Prausnitz and Kustner), was the basis for the first biological assay for IgE activity.

Home Building

Land animals often live in more complex homes. For example, social insects such as bees, termites, and wasps inhabit nests or hives. Birds also build nests. They nest in trees, on the ground, or on rocky mountain terrain. In contrast, grazing animals such as deer and antelope live on the ground, wherever their search for food takes them

Radiocontrast Media

During the radiologic evaluation of patients, various types of low-molecular-mass, water-soluble, radiocontrast media are administered to patients via the intravenous route. Rashes, urticaria, angioneurotic edema, and smooth muscle spasms occur with some frequency. Occasionally, patients develop hypotension, pulmonary edema, and cardiac arrest as a result of an anaphylaxis-type reaction. Mortality from radiocontrast media administration is 1-5 100,000 (Moreau et al., 1988).

Fungal arthritis

Rubella is accompanied by a polyarthritis after appearance of the exanthem and usually resolves within 2 weeks. Polyarthritis also may develop following rubella vaccination. Prodromal hepatitis B is associated with polyarthritis and skin eruptions such as urticaria, maculopapular rashes, petechiae, purpura, and angioneurotic edema. Joint symptoms usually resolve after 1 to 3 weeks coincident with the onset of jaundice. Recurrent arthritis can be seen with chronic active hepatitis or persistent antigenemia.

Sideeffect profile

Prophylactic folic acid supplementation can reduce the rate of gastrointestinal and oral side effects. The optimal dosage of folic acid is uncertain, although 5mg weekly appears adequate and has no more than a modest impact on efficacy. Alopecia is fairly frequent and causes particular concern to female patients. Other skin reactions include urticaria, and cutaneous vasculitis. Occasionally, methotrexate causes accelerated nodulosis, usually involving small nodules on the fingers or elbows. These nodules are indistinguishable from rheumatoid nodules except for their rapid onset and the fact that they can develop in patients negative for rheumatoid factor. Controversy surrounds their management ie, whether to stop methotrexate treatment or add an antirheumatic drug such as hydroxychloroquine which has been shown to reduce nodules in this circumstance. Other adverse events related to methotrexate therapy include fever, fatigue or myalgia. Infections sometimes occur, including...

Beekeeping Clubs

In the harvesting and processing of honey and beeswax. It seems that extension workers and the potential bee-keepers underwent this training at almost the same time. The bee-keepers were also offered support by the project in the formation and registration of bee-keeping clubs, and offered loans in order to purchase bee-keeping equipment - protective clothing being especially emphasized, although in the past men tended to collect honey clothed only in the briefest shorts By 1997 some 104 bee-keeping clubs had been formed, with an overall membership of 872 bee-keepers -interested people were organized in groups of around ten - the majority (612) being men. However, some nineteen bee-keeping clubs consisted of women only. They utilized both top bar hives and the traditional log and bark hives. The top bar hives numbered 1,746, around 75 per cent of the hives containing bee colonies while traditional hives numbered 852 hives, with 70 per cent holding bees. This only amounts to three...

Collecting Honey

Or the top bar hive, is that bee populations are extremely unstable. Within any apiary, many of the hives at any one time do not hold a colony of bees - as the above records indicate. People like Biton therefore spend an inordinate amount of time and care encouraging bees to colonize particular hives - making sure that the entrance is downwind, and not troubled by adverse local climatic conditions rubbing the hives with beeswax and propolis, or using aromatic herbs such as lemon grass (Cymbopogon citratus) or beer residues to encourage a bee swarm to take up residence in a hive and selecting a site for the hive where there is adequate forage and a perennial water supply. All the hives at Zoa were thus placed by Biton close to riparian forest or near dams. He also took great care to ensure that no ants (nyerere) could gain access to the hives, cutting down branches and creepers near the hive, and smearing the wires that hold the top bar hives with a liberal amount of engine oil or...

Alendronate Fosamax

Nausea and vomiting occur in 10 of patients with either the intranasal or SC route. Flushing of face and hands, peripheral paresthesias, urticaria, altered taste, and local skin reactions may be more common with SC calcitonin. Low-dose skin testing is recommended by some before full-dose SC treatment is administered. Irritation of the nasal mucosa, epistaxis, and rarely perforation can be seen with nasal inhalation, so that periodic nasal examinations are indicated.

Adverse Drug Effects

Most drugs have potential adverse effects or side effects that must be evaluated before being prescribed. In addition, there may be contraindications, or reasons not to use a particular drug for a specific individual based on that person's medical conditions, current medications, sensitivity, or family history. Also, while a patient is under treatment, it is important to be alert for signs of adverse effects such as digestive upset, changes in the blood, or signs of allergy, such as hives or skin rashes. Anaphylaxis is an immediate and severe allergic reaction that may be caused by a drug. It can lead to life-threatening respiratory distress and circulatory collapse.

Bees and Beeswax

Yet I have seen Malawians taking honey from nests in hollow trees or houses, wearing no protective clothing and seemingly untroubled by the bees, as well as bee-keeping handbooks that carry photographs of young African boys opening, and helping themselves to the honey from, top-bar hives, dressed in ordinary clothes and without any protection at all (Clauss 1982). Not understanding and puzzled by this seeming contradiction, I asked an experienced bee-keeper at Zoa Biton Gulumba, to explain to me the real nature of African bees. His response was quite simple. Bees are not usually angry or hostile they are normally gentle creatures, and only become aggressive when under stress. If he receives reports, he told me, that his bees are attacking women working in the gardens that are close to his hives he simply ascertains what is troubling the bees. Are they being attacked by ants (nyerere), or being unduly disturbed, or is the hive short of food or water He then, he suggested to me, did...


Localized allergic reactions can occur with almost any treated tattoo color. It can result in an immediate hypersensitivity reaction such as urticaria (Ashinoff 1993). In the alternative, a delayed hypersensitivity reaction such as granuloma formation may occur. The most serious complication reported after Q-switched laser tattoo removal was a systemic allergic reaction. The Q-switched laser targets intracellular tattoo pigment, causing rapid thermal expansion that fragments pigment-containing cells and causes the pigment to become extracellular. This extracellular pigment may then be recognized by the immune system as foreign, potentially triggering an allergic reaction. Therefore, if a patient exhibits a local immediate hypersensitivity reaction, prophylaxis before subsequent laser treatments with systemic antihistamines and steroids should be considered. Pulsed CO2 and erbium lasers do not seem to trigger this reaction, since the particle size does not change. These lasers may be...


Patients who have cellulitis typically present with erythematous, edema-tous tender skin lesions that are warm to palpation. Regional lymphadenop-athy and lymphangitis may be present. Systemic signs usually are more prominent in patients who have associated bacteremia. The differential diagnosis for cellulitis is broad and includes deep and superficial venous thromboses gout herpes zoster angioedema contact dermatitis relapsing polychondritis local reactions to chemicals, foreign bodies, and insect venom and lymphedema, among others 29 .

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