An allergy can refer to several kinds of immune reactions including Type I hypersensitivity in which a person's body is hypersensitised and develops IgE type antibodies to typical proteins. When a person is hypersensitised, these substances are known as allergens. The word allergy derives from the Greek words allos meaning "other" and ergon meaning "work". Type I hypersensitivity is characterised by excessive activation of mast cells and basophils by immunoglobulin E resulting in a systemic inflammatory response that can result in symptoms as benign as a runny nose, to life-threatening anaphylactic shock and death.

Allergy is a very common disorder and more than 50 million Americans suffer from allergic diseases. Allergies are the 6th leading cause of chronic disease in the United States, costing the health care system $18 billion annually (Allergy statistics).

History

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The term and concept of "allergy" was coined by a Viennese pediatrician named Clemens von Pirquet in 1906 ^*. He observed that the symptoms of some of his patients might have been a response to outside allergens such as dust, pollen, or certain foods. For a long time all hypersensitivities were thought to stem from the improper action of inflammatory immunoglobulin class IgE, however it soon became clear that several different mechanisms utilizing different effector molecules were responsible for the myriad of disorders previously classified as "allergies". A new four-class (now five) classification scheme was designed by P. G. H. Gell and R. R. A. Coombs. Allergy has since been kept as the name for Type I Hypersensitivity, characterised by classical IgE mediation of effects.

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International Archives of Allergy and Immunology : Last 20 articles

Erratum
Thu, 29 Oct 2009 00:00:00 +0100
Int Arch Allergy Immunol 2009;150:342 (DOI:10.1159/000255392)
The Longest Wheal Diameter Is the Optimal Measurement for the Evaluation of Skin Prick Tests
Thu, 22 Oct 2009 00:00:00 +0100
Int Arch Allergy Immunol 2010;151:343-345 (DOI:10.1159/000250443)
Prevalence of Food Allergy among Children in Al-Ain City, United Arab Emirates
Thu, 22 Oct 2009 00:00:00 +0100
Int Arch Allergy Immunol 2010;151:336-342 (DOI:10.1159/000250442)

Latest Issue of Annals of Allergy, Asthma and Immunology

On the Cover
Weber, Richard W.
Smoking cessation toolbox for allergists
Johnson, Kimberly S.Tankersley, Michael S.
The atopic march: what's the evidence?
Ker, JenniferHartert, Tina V.

Surgical Endoscopy

News and notices
Thu, 05 Nov 2009 07:55:26 -0000
News and notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0731-9 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Upper gastrointestinal investigations before gastric banding
Thu, 29 Oct 2009 07:03:06 -0000
Abstract Background  Long-term complications after laparoscopic gastric banding (LAGB) are frequent, leading to reoperations for a substantial number of patients. It is not known whether esophageal motility or the lower esophageal sphincter (LES) play a role in the development of complications. The results of preoperative upper gastrointestinal (GI) testing were compared with outcome after LAGB. Methods  Before LAGB, 68 bariatric patients had esophageal manometry, endoscopy, and pH monitoring. For 61 of these patients (90% follow-up rate), the differences in weight loss, complications, and reoperation rate were retrospectively compared. Results  Of these patients, 8.2% had a nonspecific motility disorder of the esophagus, 44.3% had an incompetent sphincter shown by manometry, and 17.5% had acid reflux shown by pH monitoring. Endoscopic evaluation showed esophagitis in 10.3% and hiatal hernia in 33.8% of the patients. Abnormal pH monitoring and endoscopic findings were not predictive for the long-term outcome or complications. The presence of an incompetent LES led to reoperation for a greater number of patients (44.4 vs. 14.7%; p = 0.01), especially if the band was placed using the pars flaccida technique. Conclusions  Endoscopy and pH monitoring do not predict outcome for gastric banding and therefore have no relevance in the selection of patients for gastric banding. Patients with an incompetent LES shown by manometry had a higher reoperation rate. If this finding can be confirmed, patients with LES incompetence may need another intervention. Content Type Journal ArticleDOI 10.1007/s00464-009-0720-zAuthors Marco Bueter, University of Würzburg Department of Surgery Würzburg GermanyAndreas Thalheimer, University of Würzburg Department of Surgery Würzburg GermanyCarel W. le Roux, Hammersmith Hospital, Imperial College London Department of Metabolic Medicine Du Cane Road London W12 0NN UKAlexander Wierlemann, University of Würzburg Department of Surgery Würzburg GermanyFlorian Seyfried, University of Würzburg Department of Surgery Würzburg GermanyMartin Fein, University of Würzburg Department of Surgery Würzburg Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Ergonomics of disposable handles for minimally invasive surgery
Wed, 28 Oct 2009 20:13:25 -0000
Abstract Background  The ergonomic deficiencies of currently available minimally invasive surgery (MIS) instrument handles have been addressed in many studies. In this study, a new ergonomic pistol handle concept, realized as a prototype, and two disposable ring handles were investigated according to ergonomic properties set by new European standards. Methods  In this study, 25 volunteers performed four practical tasks to evaluate the ergonomics of the handles used in standard operating procedures (e.g., measuring a suture and cutting to length, precise maneuvering and targeting, and dissection of a gallbladder). Moreover, 20 participants underwent electromyography (EMG) tests to measure the muscle strain they experienced while carrying out the basic functions (grasp, rotate, and maneuver) in the x, y, and z axes. The data measured included the number of errors, the time required for task completion, perception of pressure areas, and EMG data. The values for usability in the test were effectiveness, efficiency, and user satisfaction. Surveys relating to the subjective rating were completed after each task for each of the three handles tested. Results  Each handle except the new prototype caused pressure areas and pain. Extreme differences in muscle strain could not be observed for any of the three handles. Experienced surgeons worked more quickly with the prototype when measuring and cutting a suture (~20%) and during precise maneuvering and targeting (~20%). On the other hand, they completed the dissection task faster with the handle manufactured by Ethicon. Fewer errors were made with the prototype in dissection of the gallbladder. In contrast to the handles available on the market, the prototype was always rated as positive by the volunteers in the subjective surveys. Conclusions  None of the handles could fulfil all of the requirements with top scores. Each handle had its advantages and disadvantages. In contrast to the ring handles, the volunteers could fulfil most of the tasks more efficiently using the prototype handle without any remarkable pressure areas, cramps, or pain. Content Type Journal ArticleDOI 10.1007/s00464-009-0714-xAuthors D. Büchel, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyR. Mårvik, St. Olavs Hospital, Trondheim, Norwegian University of Science and Technology (NTNU) National Center for Advanced Laparoscopic Surgery Trondheim NorwayB. Hallabrin, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyU. Matern, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes
Wed, 28 Oct 2009 20:13:23 -0000
Abstract Background  This study aimed to compare the efficacy of laparoscopic sleeve gastrectomy (SG) with that of laparoscopic gastric bypass (GBP) and laparoscopic adjustable gastric banding (AGB) for glucose homeostasis in morbidly obese subjects with type 2 diabetes mellitus (T2DM) at a 3-year follow-up assessment and to elucidate the role of weight loss in the T2DM resolution after SG. Methods  For this study, 60 morbidly obese T2DM patients (44 females and 16 males) who underwent AGB (24 patients), GBP (16 patients), or SG (20 patients) between 1996 and 2008 were retrospectively analyzed. Age, sex, body mass index (BMI), estimated weight loss (EWL), fasting glycemia, HbA1c, euglycemic hyperinsulinemic clamp, discontinuation of diabetes treatment, and time until interruption of therapy were evaluated. Results  In the study, 54 patients received oral hypoglycemic agents for at least 12 months before surgery, and 6 patients received insulin. The mean follow-up period was 36 months. The resolution rate was 60.8% for the AGB patients, 81.2% for the GBP patients, and 80.9% for the SG patients. The postoperative time until interruption of therapy was 12.6 months for the AGB patients, 3.2 months for the GBP patients, and 3.3 months for the SG patients. The hyperinsulinemic euglycemic clamp test was performed 12 months after surgery for the cured patients. Insulin resistance was restored to normal values in all the patients. The greatest improvement from preoperative values occurred in the SG group. For the not-cured GBP and SG patients, an improvement of 120 mg/dl in fasting plasma glucose was observed 3 months after the surgery, suggesting an enhancement in insulin sensitivity, which determines better medical control. The resolution rate remained constant at the 36-month follow-up evaluation in both the GBP and SG groups. Conclusions  All three bariatric procedures are effective in treating diabetes, with a 3-year follow-up evaluation showing an effect that lasts. The AGB procedure was the least effective. The antidiabetic effect was similarly precocious after GBP and SG compared with AGB. This difference may indicate that a hormonal mechanism may be involved, independent of weight loss. Content Type Journal ArticleDOI 10.1007/s00464-009-0715-9Authors F. Abbatini, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyM. Rizzello, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Casella, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Alessandri, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyD. Capoccia, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyF. Leonetti, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyN. Basso, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Ten years of Swedish experience with intraductal electrohydraulic lithotripsy and laser lithotripsy for the treatment of difficult bile duct stones: an effective and safe option for octogenarians
Fri, 23 Oct 2009 05:51:45 -0000
Abstract Background  Endoscopic procedures using electrohydraulic lithotripsy (EHL) or intraductal laser lithotripsy (ILL) are the methods of choice for managing difficult common bile duct (CBD) stones. This retrospective study examined 10 years of Swedish experience using a mother-baby endoscopic system to assist in the fragmentation of CBD stones by EHL and ILL. Methods  Between 1995 and 2006, 44 patients with a median age of 80 years underwent EHL or ILL at two Swedish centers after conventional endoscopic fragmentation of CBD stones had failed. Long-term follow-up assessment was conducted for 9 to 126 months (median, 53 months). Results   Final stone clearance after EHL or ILL treatment with or without additional conventional endoscopic retrograde cholangiopancreatography (ERCP) was achieved for 34 (77%) of 44 patients. The results for 10 patients (23%) were defined as failures. Complete or partial stone fragmentation and definitive duct clearance were achieved in one session for 23 patients (52%). A second EHL or ILL attempt made in five cases of primary failure led to definitive stone clearance in three cases. Two patients experienced perioperative complications (stone basket impaction). Mild post-ERCP pancreatitis occurred for one patient and cholangitis for two patients. During long-term follow-up evaluation, recurrent CBD stones were found in one patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0716-8Authors Fredrik Swahn, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenGunnar Edlund, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenLars Enochsson, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenConny Svensson, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenBo Lindberg, Intervention and Technology (CLINTEC), Karolinska Institutet Department of Clinical Science Stockholm SwedenUrban Arnelo, Karolinska University Hospital Huddinge Department of Surgery Stockholm Sweden Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Short-term outcomes of laparoscopic total mesorectal excision following neoadjuvant chemoradiotherapy
Thu, 22 Oct 2009 18:52:09 -0000
Abstract Objective  To investigate the feasibility of laparoscopic total mesorectal excision (TME) in mid and lower rectal cancers following neoadjuvant chemoradiation (nCRT). Background  The laparoscopic approach for colon cancer has been widely accepted. A few studies have shown that there are advantages of laparoscopic over open TME surgery for rectal cancer. However, the role of laparoscopy has not been clearly defined specifically in cases following nCRT. Methods  All patients with rectal cancer who underwent nCRT were identified; no operations for rectal carcinoma were performed laparoscopically between 1997 and 2005. The laparoscopic cases were matched to open cases based on gender, procedure, age, and body mass index (BMI). The medical records were reviewed and short-term outcome was compared between these two groups. Statistical analysis was performed using SPSS© 15 software. Results  Between 2002 and 2008, 64 patients were identified, including 32 patients who underwent laparoscopic surgery and 32 who had a laparotomy. There was no difference between the two groups based on gender, procedure, age, BMI or American Society of Anesthesiologists (ASA) classification. The procedures performed within each group included 8 abdominoperineal resections and 24 anterior resections, which included 20 colonic J-pouch-anal anastomoses and 4 straight coloanal anastomoses. In the laparoscopic group, 12 patients underwent totally laparoscopic operations, 12 were either laparoscopic-assisted or hand-assisted procedures, and 8 were converted to laparotomy. The reasons for conversion included bleeding, splenic injury, and difficult anatomy. There were no differences in comorbidities, tumor location, tumor size, tumor stage or radiation dose between the two groups. Operative time was longer in the laparoscopic group (267 ± 76 versus 205 ± 49 min, p < 0.001). Operative blood loss, complication rate, and mortality rate were all similar between the two groups. However, the laparoscopic group benefited from shorter length of stay (6.1 ± 2.4 versus 7.6 ± 2.3 days, p = 0.012), earlier first bowel movement (1.9 ± 1 versus 3.3 ± 2.4 days, p = 0.006), and shorter time to regular diet (3.9 ± 2.1 versus 5.8 ± 2.5 days, p = 0.003). There was no difference in lymph node harvest (both positive node harvest and total lymph node harvest), distal margin or radial margin. Conclusions  In our experience, laparoscopic TME for mid and lower rectal cancer is feasible and safe. Patients benefit from the short-term advantages of laparoscopy, including shorter length of hospital stay, time to tolerating a regular diet, and time to first bowel movement or stoma function. Although there were no short-term differences in oncologic parameters, the long-term oncologic outcome requires further investigation. Content Type Journal ArticleDOI 10.1007/s00464-009-0702-1Authors P. Denoya, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAH. Wang, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAD. Sands, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAJ. Nogueras, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAE. Weiss, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USASteven D. Wexner, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

pubmed: 1088-5412

Solar urticaria.
Webb LM, Mikita CP Solar urticaria. Allergy Asthma Proc. 2009 Sep-Oct;30(5):563-5 Authors: Webb LM, Mikita CP A case of solar urticaria is presented, followed by a discussion of the clinical characteristics, pathophysiology, diagnosis, and management of this disease. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. Solar urticaria is a physical urticaria that can be difficult to diagnose and distinguish from other photodermatoses. There are some characteristic features that are important to remember when evaluating a patient with suspected solar urticaria. Testing can be difficult without the assistance of an experienced dermatologist because there are several different wavelengths of light that can lead to a patient's symptoms. Solar urticaria tends to be a chronic disease with a low 5-year resolution rate but can usually be effectively managed with multiple antihistamines. PMID: 19843410 [PubMed - in process]
Twenty-one year old woman with severe eosinophilia and left bundle branch block.
Padi A, Silverman B, Schneider A Twenty-one year old woman with severe eosinophilia and left bundle branch block. Allergy Asthma Proc. 2009 Sep-Oct;30(5):558-62 Authors: Padi A, Silverman B, Schneider A Peripheral and tissue eosinophilia can occur in a wide variety of disease processes that include infectious, allergic, and primary hematologic disorders, and other more rare diseases such as hypereosinophilic syndromes (HES). We describe a case of a patient with severe eosinophilia and left bundle branch block. A 21-year-old woman with asthma and allergic rhinitis presented with neck pain and cough for >6 months with no other complaints. Physical exam was normal except for fever and minimal expiratory wheezes. Chest CT revealed diffuse airway inflammation with bronchiectasis. Admission electrocardiogram (EKG) was normal. Initial laboratory tests showed an absolute eosinophil count of 30,000 cells/mL. A thorough workup for eosinophilia was initiated, but the patient subsequently left against medical advice. The next day, in the outpatient pulmonary clinic, she was found to be tachycardic and an EKG showed sinus tachycardia with a new left bundle branch block. Laboratory tests revealed an eosinophil count of 33,200 cells/mL and elevated troponins. She was started on i.v. Solu-Medrol (Pfizer, Inc.). The next day, her EKG returned to normal. Three days later her absolute eosinophil count normalized. Identifying the cause of marked, persistent eosinophilia is a challenging problem. Excluding the more common causes of severe eosinophilia is required before making a diagnosis of HES and early therapeutic intervention can prevent morbidity from the disease. PMID: 19843409 [PubMed - in process]
Serum levels of protein oxidation products in patients with nickel allergy.
Gangemi S, Ricciardi L, Minciullo PL, Cristani M, Saitta S, Chirafisi J, Spatari G, Santoro G, Saija A Serum levels of protein oxidation products in patients with nickel allergy. Allergy Asthma Proc. 2009 Sep-Oct;30(5):552-7 Authors: Gangemi S, Ricciardi L, Minciullo PL, Cristani M, Saitta S, Chirafisi J, Spatari G, Santoro G, Saija A Nickel sensitization can not only induce allergic contact dermatitis (ACD), but also can induce an overlapping disease referred to as "systemic nickel allergy syndrome" (SNAS), characterized by urticaria/angioedema and gastrointestinal symptoms correlated to the ingestion of nickel-containing foods. This study was designed to determine if oxidative stress occurs in patients with nickel allergy. Thirty-one female patients (mean age 31.26 + 13.04 years, range 16-64 years) with confirmed nickel CD underwent oral nickel challenge because of clinically suspected SNAS; serum concentrations of protein carbonyl groups (PCGs) and nitrosylated proteins (NPs; biomarkers of oxidative stress) were measured before and after oral nickel challenge as well as in healthy female controls. Twenty-three of these 31 patients were diagnosed with SNAS because they had a positive reaction to the oral nickel challenge, and 8 patients had no reaction and therefore were classified as patients with contact nickel allergy only. Although both nickel-allergic patients and controls presented similar serum levels of PCGs, NP values in nickel-allergic patients appeared higher than in controls and tended to decrease after the challenge; furthermore, serum levels of NPs in patients affected by SNAS were higher (although not significantly) than in patients with nickel ACD only. The involvement of specific biomarkers of oxidative stress such as NPs and the lack of involvement of other biomarkers such as PCGs may help to better understand the alteration of the redox homeostasis occurring in nickel ACD and particularly in SNAS. PMID: 19843408 [PubMed - in process]

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