Severe Allergic Reaction Following Administration of Antivenom Serum for Snakebite: A Case Report from Togo

Background: Ophidian envenomation is common in Sub-Saharan Africa, and its management is hampered by the lack of access to healthcare services in rural areas, in particular the availability and appropriate use of antivenom. Rare cases of serious side effects following the administration of antivenom have been reported. This is the case for a young farmer from the central region of Togo, who experienced a second snake bite within four years, and in whom antivenom serotherapy led to severe allergic manifestations. Case presentation: This 24-year-old patient, with a history of antivenom and tetanus serotherapy, was admitted to the Centre Hospitalier Régional (CHR) of Sokodé for a snakebite that occurred 45 minutes earlier while working in the field. Clinical assessment on admission revealed grade 1 envenomation, characterized by local pain in the right upper limb, with no sign of complication. He received an intravenous infusion of antivenom serotherapy, which rapidly relieved the pain, allowing him to be discharged after 24 hours of hospital monitoring. However, he was readmitted five days later for a skin rash associated with generalized pruritus and edema of the face and the neck, which prompted his evacuation to the Sylvanus Olympio University Hospital. He was diagnosed with a hypersensitivity-type allergic reaction to antivenom serum. Symptomatic treatment with antihistamines resulted in a favourable outcome after five days in the hospital. Conclusion: This young farmer developed a severe allergic reaction following a second course of antivenom serotherapy for low-grade ophidian envenomation. Although the efficacy of antivenom serum is undeniable in the management of snakebites, its use should be guided by a sound clinical assessment and framed by rigorous monitoring, especially in people sensitized to antivenom or antitoxin serotherapy. This highlights the importance of training healthcare staff alongside the availability of anti-venomous sera at peripheral healthcare centres.

Effects of Oleanolic Acid on the Immune Complex Allergic Reaction and Inflammation

When oleanolic acid (OA) was administered ig before and after sensitization on d 1 to d 5 and d 11 to d 17,it had no apparent effect on Arthus reaction.When it was administered at 48,24 and 1 h before challenge,however,Arthus reaction was significantly inhibited.OA showed markedly suppressive effects on reversible passive Arthus reaction and leukocyte migratory response.It could significantly stabilize erythrocyte membrane,inhibit the swelling of the rat's hind paw induced by in- jecting mycostatin,reduce the acid phosphatase content in the inflammatory exudate,suppress the syn- thesis or release of PGE,histamine,LTB4 and kinin,and the phlogistic action of PGE_2,histamine,5- HT and kinin.In addition,it could decrease the content of malonyldialdehyde (MDA) in hepatic tissue of alcohol-intoxicated mice,and increase the activity of catalase (CAT) in hepatic tissue of mice.OA had no apparent effect on the activity of super-oxide dismutase (SOD) in rat serum,on the content of immune complex in serum of rat with Arthus reaction,on the phagocytosis of monocytc-macrophage system,on the clearance of enzyme-containing immune complex by macrophage,or on the activity of total complement.

Early stent thrombosis secondary to food allergic reaction:Kounis syndrome following rice pudding ingestion

Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manifesting as stent thrombosis with left ventricular thrombus formation was triggered by a food-induced allergic reaction. The allergic reaction to food was confirmed by oral rice pudding ingredients challenge test while skin tests were inconclusive. To our knowledge, this is first report of early stent thrombosis secondary to food allergic reaction in a 70-year-old man patient who was found to have left ventricular thrombus and undiagnosed hypertrophic cardiomyopathy.

Report on the 10 cases of allergic reactions to oxaliplatin

Objective： The aim of this study was to investigate the mechanism, clinical manifestations, prevention and treatment measures of allergic reactions caused by oxaliplatin. Methods： Made detailed data about allergic reactions to oxaliplatin from 10 patients in our department, and made analysis and discussions about it while referring to related reference. Results： All the 10 patients had no history of allergies, 4 cases of allergies occurred during the course of multi-cycle chemotherapy, and 6 cases occurred on the first time of drug administration, whose allergic symptoms were present in the process of using oxaliplatin, with the infusion time from 10 to 25 rain. When relevant treatments such as drug withdrawal, hormone, intravenous calcium gluconate and magnesium sulfate were done to the patients, related symptoms could be soon relieved. Conclusion： Mechanisms of oxaliplatin allergic are still unclear. Applying calcium and magnesium may reduce the risk of neurotoxicity and reduce the degree of allergic reactions before administration of oxaliplatin.

Boeravinone B ameliorates allergic nasal inflammation by modulating the GATA-3/T-bet signaling pathway in a mouse model of allergic rhinitis

Objective:To evaluate the anti-allergic effect of boeravinone B against ovalbumin-induced allergic rhinitis in mice and explore its possible mechanism.Methods:For the induction of allergic rhinitis,mice were intraperitoneally sensitized and intranasally challenged with ovalbumin,as well as orally received various concentrations of boeravinone B.Nasal mucosal inflammation,and the levels of nitric oxide,β-hexosaminidase,IFN-γ,LTC-4,myeloperoxidase,Nrf2,HO-1,GATA-3,ROR-γ,T-bet,antioxidant parameters,and allergen-specific cytokines were assessed.Results:Boeravinone B markedly reduced ovalbumin-induced increase in the number of episodes of nasal sneezing,rubbing,and discharge,as well as the levels of IgE,IgG1,andβ-hexosaminidase(P<0.05).It also significantly reduced differential cell count,myeloperoxidase,oxide-nitrosative stress,and the levels of IL-1β,IL-4,IL-5,IL-6,IL-13,IL-17,tumor necrosis factor-α,GATA-3,and ROR-γwhile enhancing the level of T-bet.Conclusions:Boeravinone B is a potential therapeutic agent for allergic rhinitis by modulating various inflammatory mediators and immune responses.

Ineffectiveness of Skin Tests in Predicting Allergic Reactions Induced by Chinese Herbal Injections

Objective:To evaluate whether skin tests are suitable to predict the allergy reactions induced by Chinese herbal injections(CHIs).Methods:The skin tests including skin prick tests(SPT),intradermal tests(IDT)and provocation tests including subcutaneous tests and intravenous tests were administered to 249 healthy subjects and 180 allergic patients for 3 CHIs,including ginkgolide injection,diterpene ginkgolide meglumine injection and Salvianolate lyophilized injection.The results of the provocation tests were used as the"gold standard"to determine the sensitivity and specificity of the skin tests.Results:The results did not show any significant differences between the healthy and allergy groups in both skin tests and provocation tests(P>0.05).The specificities of SPT and IDT were 0.976 and 0.797,respectively,and the sensitivities of both SPT and IDT were 0.Conclusion:Skin tests are insufficient to predict the likelihood of allergic reactions resulting from CHIs.(ChiCTR-CPC-15006921)

Nail Cosmetics Can Cause Infection,Allergic Reaction

在美国田纳西州首府纳什维尔召开的美国皮肤病学会年会上,有一篇论文指出:修指甲或给指甲化妆是引起感染和过敏反应的两大因素。其最严重的后果可能是:the entire nail can be lost.本文出现的salons,不能理解为“沙龙”。它是beauty salon(美容院)的简称。

Induced Immunity of Response to Some Allergens Towards Response of Other Skin Test Allergens and Its Correlation with Immediate Hypersensitivity Reactions

Allergens are innocuous environmental antigens that cause lgE mediated hypersensitivity reactions. These antigens can be divided into several groups according to their nature like plant allergens, grasses, fungal allergens, pollen grains and house dust mite. Skin response to such allergens is associated with each other either by positive relation （positive correlation） or negative （inverse） relation. No previous papers found to discuss such correlations. In order to investigate these correlations, skin prick test of standard allergens solutions was carried out in 500 patients suffering allergic reactions of the age 12-60 years of both sexes. The results showed that there is a high significance of positive and negative correlations in skin response to allergens in the same group and with allergens of different groups suggesting that there is an induction or suppression of immune response. In conclusion the similarity or dissimilarity in the primary structure of some allergens in addition to gene-environment interaction may reflect positive/negative correlations between certain allergens that can influence the related allergic reactions.

Study of Effectiveness of Combined Antiallergic Drug Dualler-G

The secretory granules of mast cells contain several mediators, some of which, such as histamine and serotonine, are known to participate in many immune reactions and allergic diseases. Allergic reactions play the leading role in pathogenesis of dermatitis and mechanism of such reactions is based on release of histamine and serotonin. Due to this, the development of drug with both antihistamine and antiseritinine activity was the goal of this study. Drugs with close chemical structure and pharmacological activity were selected from derivates of quinuclidin carbinols. This difference in pharmacological activity of different compounds makes Dualler-G, a new antiallergic drug with antihistamine and antiserotonine activity. The goal of the study was clinical trial of Dualler-G in patients with allergic dermatosis. Obtained data shows that Dualler-G shows high effectiveness in treatment of different types of dermatosis. The effect of Dualler-G, an original antiallergic drug, was evaluated in patients displaying different kinds of dermatosis （urticarea, eczema）. A total of 22 patients diagnosed with dermatosisis were randomized to receive in an open fashion 40 mg of Dualler-G per day, for 2 weeks. Efficacy was assessed according to the common improvement of pathological elements on skin or itching as symptom. Clinical course of patients treated with Dualler-G tended to be significantly better than the patients treated with other antiallergic preparations and the symptoms were significantly correlated in the Dualler-G treated group. These data suggest that Dualler-G provides direct efficacy on the symptoms （skin elements and itching） in patients with different kinds of dermatosis.

Evaluating the management of anaphylaxis in US emergency departments:Guidelines vs.practice

BACKGROUND:Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting.Current guidelines recommend:1) quick diagnosis using standard criteria;2) first-line treatment with epinephrine;and 3) discharge with a prescription for an epinephrine auto-injector,written instructions regarding long-term management,and a referral(preferably,allergy) for follow-up.However,studies suggest low concordance with guideline recommendations by emergency medicine(EM) providers.The study aimed to evaluate how emergency departments(EDs) in the United States(US) manage anaphylaxis in relation to guideline recommendations.METHODS:This was an online anonymous survey of a random sample of EM health providers in US EDs.RESULTS:Data analysis included 207 EM providers.For respondent EDs,approximately 9%reported using agreed-upon clinical criteria to diagnose anaphylaxis;42%reported administering epinephrine in the ED for most anaphylaxis episodes;and <50%provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge.Most provided some written materials,and follow-up with a primary care clinician was recommended.CONCLUSIONS:This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis,treatment,and follow-up of patients with anaphylaxis.The primary gaps are low(or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine.Prospective research is recommended.

Deposition of nanoparticles on school eyeglasses in urban and rural areas:A methodology for a more real assessment of the possible impacts

Because incomplete confirmation is available concerning the influential role of atmosphere contamination on conjunctivitis,myopia,asthma,and allergic rhinitis in Brazil,the focus of the present work is to explore the possible relations among atmosphere contamination and eye problems.Rather that a case study on eye diseases,by way of questionnaires supplemented by the investigation of nanoparticles(NPs)on eyeglasses,the study examines the mechanisms in which NPs and ultra-fine particles are deposited on the glasses of children up to 10 years of age in urban and rural area.The important connection between atmosphere contaminants and individual protection equipment justifies improving indoor school properties in order could protect children’s eyes,particularly in high-pollution/high-particulate areas.

BACTERIAL SWOLLEN STEM CANKER ON POPLAR:THE DISEASE AND ITS CAUSES

The bacterial swollen stem canker of poplar is prevalent in planted poplars of northeast China. Serious damage occurs in the form of necrosis, putridity, cankers, swollen stems and discolored wood of trunks and branches of young and mature trees. Tests of allergic reaction, pathogenicity, culture characteristic, Gram stain and anaerobic culture revealed that the pathogen is Erwinia sp. Its occurrence depends mainly on the predisposing factors of the disease among which the susceptibility of poplars is the most important one. The disease becomes widespread in association with low-lying and high-humidity terrain, frost injury, node wounds, insect damage, and pruning and other mechanical wounds. Harmful factors promote the disease.

Compound-honeysuckle-induced drug eruption with special manifestations:A case report

BACKGROUND The clinical manifestations of drug eruption are complex and diverse,which can lead to missed diagnosis or misdiagnosis.The clinical manifestations of drug eruption caused by compound honeysuckle have not been reported.CASE SUMMARY A 20-year-old man was admitted to our department of dermatology due to erythema and papules on the chest and abdomen with pruritus for 3 d.The next day after taking compound honeysuckle granules,the patient suddenly developed a rash and intense itching on his chest and abdomen.Physical examination revealed diffuse red needle-cap size macules and papules with welldefined borders on the chest and abdomen,and discoloration after finger pressure.No abnormality was observed in other areas of the skin.Back skin scratch was positive.White blood cells,eosinophil count and eosinophil ratio were higher than normal.Histopathological examination of the skin lesions on the left abdomen revealed intercellular edema,blurred focal basal cell layers,and focal lymphocyte infiltration in the superficial dermis and perivascular areas.Immunohistochemistry showed CD3+,CD4+and CD8+T lymphocytes.The diagnosis was drug eruption with special manifestations induced by compound honeysuckle.The skin lesions completely subsided without pruritus after 2 wk of antihistamine and hormone therapy.Follow-up for>1 mo showed no recurrence.CONCLUSION Chinese patent medicine compound honeysuckle granules can induce allergic reaction and rare skin damage.

Acute myocardial infarction due to Kounis syndrome:A case report

BACKGROUND Acute myocardial infarction(AMI)can be induced by several factors.However,AMI induced by Kounis syndrome(an allergic reaction)is extremely rare and is highly susceptible to misdiagnosis.CASE SUMMARY A 70-year-old man presented after suffering an allergic reaction that caused chest pain triggered upon eating ice cream.Troponin I was found to be elevated,and an electrocardiogram showed ST-segment elevation.The diagnosis was AMI.He underwent two coronary angiographies,with one intravascular ultrasound during hospitalization showing no evidence of atherosclerotic coronary artery disease.The final diagnosis was vasospastic myocardial infarction due to Kounis syndrome.The patient was then treated with hydrocortisone and intravenous antihistamines,and his chest pain symptoms resolved.CONCLUSION Allergic reactions(such as Kounis syndrome)can cause serious damage to the heart.Physicians should be alert to the consequences and avoid misdiagnosis.

Studies on Treating Eczema by Chinese Herbal Medicine with Anti-Type Ⅳ Allergic Activity

Objective: To study Chinese herbal prescription for treatment of eczema on the basis of the suppressive effect of Chinese herbal medicine with type Ⅳ allergic reaction. Methods: Various formulae composed of Chinese herbal medicines possessing suppressive effect on murine allergic contact dermatitis were formed following the therapeutic principles of traditional Chinese medicine in treating eczema, and their effect on ear swelling, ear flake weight, dermal inflammatory infiltration cell count and plasma level of calcitonin gene related peptide ( CGRP) were examined in mice with dinitrofluorobenzene induced dermatitis. The prescription, Composite Poria Decoction was formulated and made into granule form, which was used to treat 63 cases of eczema (atopic dermatitis was excluded), and compared with 59 cases treated with antihistaminic that was aimed at the type I allergic reaction. Results: Experimental study showed that all the 4 Chinese prescriptions had the effect of anti type Ⅳ allergic reaction, among them, the formula for cooling blood and removing Heat, Wind and Dampness evil possessed the most potent effect in suppressing murine dermatitis, and it was also able to up regulate the plasma CGRP concentration. The clinical cure rate of Composite Poria Granule treatment was 47.6%, and that of the control was 22.0%. The difference was significant between the two groups ( u =2.9555, P <0.01). Conclusions: Chinese herbal medicine has the effect of anti type Ⅳ allergic reaction. Composite Poria Granule has good effect in treating eczema.