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

The Diabetic Antigen Glutamic Acid Decarboxylase (GAD 65) in the Human Peripheral Blood
Wed, 16 Dec 2009 00:00:00 +0100
Int Arch Allergy Immunol 2010;152:184-194 (DOI:10.1159/000265540)
Anaphylaxis to Wheat Flour-Derived Foodstuffs and the Lipid Transfer Protein Syndrome: A Potential Role of Wheat Lipid Transfer Protein Tri a 14
Wed, 16 Dec 2009 00:00:00 +0100
Int Arch Allergy Immunol 2010;152:178-183 (DOI:10.1159/000265539)
Human Leukocyte Antigen (DR1)-DQB1*0501 and (DR15)-DQB1*0602 Haplotypes Are Associated with Humoral Responses to Early Food Allergens in Children
Wed, 16 Dec 2009 00:00:00 +0100
Int Arch Allergy Immunol 2010;152:169-177 (DOI:10.1159/000265538)

Latest Issue of Annals of Allergy, Asthma and Immunology

On the Cover
Weber, Richard W.
Comparison of allergen immunotherapy practice patterns in the United States and Europe
Cox, LindaJacobsen, Lars
The effect of statin therapy on allergic patients with asthma
Ostroukhova, MarinaKouides, Ruth W.Friedman, Elizabeth

Surgical Endoscopy

Laparoscopic splenectomy in portal hypertension: a single-surgeon 13-year experience
Wed, 23 Dec 2009 22:27:54 -0000
Abstract Background  Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude LS are not clearly defined. Portal hypertension from liver cirrhosis still is a contraindication to LS in the clinical practice guidelines of the European Association for Endoscopic Surgery published in 2008. This study aimed to evaluate the feasibility of LS for hypersplenism secondary to liver cirrhosis and portal hypertension. Methods  The study retrospectively analyzed 206 laparoscopic splenectomies performed for a variety of indications over 13 years. According to diagnosis, the patients were divided into group A (hypersplenism secondary to liver cirrhosis and portal hypertension, n = 96) and group B (hematologic and other disorders, n = 110). A detailed review of medical records was conducted. The perioperative data for the two groups were compared including patient characteristics, diagnosis, operative details, complication rates, and postoperative hospital stay. Results  Laparoscopic splenectomy was completed for 201 patients. Conversion from laparoscopic to open surgery was necessary for 5 patients (2.4%) because of hemorrhage, and 26 patients (12.6%) had complications. There were significant differences between groups A and B in terms of mean operation time (2.8 vs. 2.1 h), complication rates (17.7% vs. 8.2%), and postoperative stay (7.1 vs. 4.7 days). However, the two groups showed no significant differences with respect to intraoperative blood loss, blood transfusion, and conversion rate. Conclusion  Laparoscopic splenectomy is a feasible, effective, and safe surgical procedure for patients who require splenectomy. Hypersplenism secondary to cirrhosis and portal hypertension should not be considered contraindications for LS. Content Type Journal ArticleDOI 10.1007/s00464-009-0744-4Authors Yuedong Wang, Zhejiang Provincial People’s Hospital Department of General Surgery Hangzhou 310014 ChinaXiaoli Zhan, Zhejiang Provincial People’s Hospital Department of General Surgery Hangzhou 310014 ChinaYangwen Zhu, Zhejiang Provincial People’s Hospital Department of General Surgery Hangzhou 310014 ChinaZhijie Xie, Zhejiang Provincial People’s Hospital Department of General Surgery Hangzhou 310014 ChinaJinhui Zhu, Zhejiang Provincial People’s Hospital Department of General Surgery Hangzhou 310014 ChinaZaiyuan Ye, Zhejiang Provincial People’s Hospital Department of General Surgery Hangzhou 310014 China Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
News and Notices
Thu, 10 Dec 2009 15:17:29 -0000
News and Notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0821-8 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 Journal Volume Volume 24 Journal Issue Volume 24, Number 1 / January, 2010
Laparoscopic splenectomy for severe blunt trauma: initial experience of ten consecutive cases with a fast hemostatic technique
Thu, 10 Dec 2009 00:12:28 -0000
Abstract Background  Minor splenic injuries from blunt trauma can be treated conservatively, whereas high-grade injuries commonly associated with multiple trauma require surgical treatment and usually removal of the organ. Although splenectomy is nowadays routinely performed laparoscopically for the treatment of hematological pathologies, in an emergency the operational procedure is performed through conventional laparotomy worldwide, advocating the need for hemostasis. Progress in surgical skill and new developments in equipment allow us to treat also patients affected by severe splenic blunt trauma minimally invasively. Methods  In this study we analyzed 12 patients who consecutively came under our observation during a 2-year period and, being affected by severe spleen injury from blunt trauma requiring surgery, underwent emergency laparoscopy. All of them had Injury Severity Score (ISS) ≥ 20 with Glasgow Coma Score (GCS) ≥ 10. Laparoscopic splenectomy was performed in ten of the cases utilizing a quick hemostatic technique. In one case bleeding was controlled without removal of the organ and in another case laparoscopy revealed that the supposed hemoperitoneum and splenic rupture were in fact the rupture of a giant splenic cyst. Results  The median operative time to reach hemostasis was 17 min (13–125 min) and the median overall operative time was 120 min (55–210 min). All operations were performed fully laparoscopically. Neither mortality nor morbidity related to abdominal problems was observed. Median postoperative stay was 4 days (3–11 days). Conclusion  Laparoscopic approach to splenic blunt trauma requiring surgery is a safe and effective procedure. The described technique allows laparoscopic splenectomy to be performed in an emergency, with much the same hemostatic efficacy as the open technique, but with much better outcome for the patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0768-9Authors Andrea Carobbi, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 ItalyFrancesco Romagnani, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 ItalyGiacomo Antonelli, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 ItalyManlio Bianchini, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy
Thu, 10 Dec 2009 00:12:28 -0000
Abstract Background  Minimally invasive esophagectomy (MIO) is now established as a valid alternative to open surgery for the management of esophagogastric cancers. However, a high incidence of ischemia-related gastric conduit failure (ICF) is observed, which is detrimental to any potential benefits of this approach. Methods  Since April 2004, MIO has been the procedure of choice for esophagogastric resection in the authors’ unit. Data relating to the surgical technique were collected, with a focus on ischemic conditioning by laparoscopic ligation of the left gastric artery (LIC) 2 weeks or 5 days before resection. Results  A total of 97 patients underwent a planned MIO. Four in-patient deaths (4.1%) occurred, none of which were conduit related, and overall, 20 patients experienced ICF (20.6%). In four patients, ICF was recognized and dealt with at the initial surgery. The remaining 16 patients experienced this complication postoperatively, with 9 (9.3%) of them requiring further surgery. Of the 97 patients, 55 did not undergo ischemic conditioning, and conduit failure was observed in 11 (20%). Thirty-five patients had LIC at 2 weeks, and 2 (5.7%) experienced ICF. All seven patients (100%) who had LIC at 5 days experienced ICF. Timing of ischemic conditioning (p < 0.0001) had a definite impact on the conduit failure rate, and the benefit of ischemic conditioning at 2 weeks compared with no conditioning neared significance (p = 0.07). Conclusions  Ischemic failure of the gastric conduit significantly impairs recovery after MIO. Ischemic conditioning 2 weeks before surgery may reduce this complication and allow the benefits of this approach to be realized. Content Type Journal ArticleDOI 10.1007/s00464-009-0739-1Authors Darmarajah Veeramootoo, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKAngela C. Shore, Peninsula NIHR Clinical Research Facility and Peninsula Medical School Exeter UKBeverley Shields, Peninsula NIHR Clinical Research Facility and Peninsula Medical School Exeter UKRakesh Krishnadas, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKMartin Cooper, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKRichard G. Berrisford, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKShahjehan A. Wajed, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
When does testing for GERD become cost effective in an integrated health network?
Thu, 10 Dec 2009 00:12:27 -0000
Abstract Background  Gastroesophageal reflux (GERD) is the most common gastrointestinal disorder, affecting as many as 14% of the US population. Rising rates of esophageal adenocarcinoma are seen in this population, and chronic proton pump inhibitor (PPI) use does not normalize cancer risk. It has also been demonstrated that up to one-third of patients on PPI therapy did not actually have GERD and could be taken off the medication. These facts form the basis for a quality-assurance study of care provided to patients in an integrated health care network who were on high-dose, long-term PPI therapy. Methods  A cost–benefit analysis of patients who were on double-dose PPI therapy for more than 6 months was performed. Pharmacy, facility, physician reimbursement, and radiologic data from a cohort who were both primary-care patients and insured in our system were utilized. Results  Two hundred and twenty-four patients were prescribed a double dose of this medication for over 6 months. Utilizing a 4.5% discount rate, our break-even analysis showed that Bravo testing [with esophagogastroduodenoscopy (EGD)] needed to identify those patients who could be taken off PPI therapy paid for itself in 33 months. Bravo + EGD + manometry testing needed to screen for other possible pathologies paid for itself in 38 months. Bravo + barium swallow + EGD testing to screen patients for possible esophageal adenocarcinoma paid for itself in 42 months. Bravo + barium swallow + manometry + EGD testing paid for itself in 47 months. Conclusions  Significant savings can be realized through early use of upper endoscopy, Bravo testing, barium swallow, and manometry to identify patients that are taking double-dose PPIs unnecessarily based on presumptive diagnosis of GERD. This early testing also has the potential to diagnose a variety of other clinically important pathologic conditions more readily. Content Type Journal ArticleDOI 10.1007/s00464-009-0754-2Authors Anoop Raman, Tufts University School of Medicine Boston MA USAJoel Sternbach, Tufts University School of Medicine Boston MA USAAzeesat Babajide, Tufts University School of Medicine Boston MA USAKetan Sheth, Harvard Medical School Department of Surgery, Cambridge Health Alliance 1493 Cambridge Street Cambridge MA 02139 USASteven D. Schwaitzberg, Harvard Medical School Department of Surgery, Cambridge Health Alliance 1493 Cambridge Street Cambridge MA 02139 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Dietetic-led management of patients undergoing laparoscopic gastric banding: early results
Thu, 10 Dec 2009 00:12:27 -0000
Abstract Background  Optimal results of bariatric surgery are achieved when it is performed within a multidisciplinary team. Within this team, the dietician plays a key role before and after surgery in patient education and behaviour change. With long-term follow-up, the number of patients per surgeon increases exponentially. This study evaluated the outcomes of a dietician-only led management program for patients who underwent laparoscopic gastric banding in our unit. Methods  Between April 2003 and November 2007, 1,335 patients underwent laparoscopic gastric banding in two hospitals by the same surgical team. Weight loss outcomes were compared for patients in a dietician-led management program against a surgeon/nurse specialist follow-up program with more frequent patient visits. For the dietician-led group, a standard protocol of six postoperative visits and two to three fluoroscopic adjustments was developed from referral until 2 years after surgery. Results  There were 316 patients followed up in a dietician-led program. They were compared with the remaining patients who were followed up in a surgeon/ nurse specialist led program. The mean preoperative weight and body mass index (BMI) for the dietetic-led subset was significantly higher (weight: 147.4 ± 30.2; BMI: 52.8 ± 8.9) compared with the remaining group (weight: 113.8 ± 18.7; BMI: 41.6 ± 5.2; p < 0.001: Mann–Whitney test). Percent BMI loss was initially lower in the dietician-led group, but this difference disappeared at the end of 24 months (p = 0.056). Conclusions  A patient management program led by specialist dieticians is an effective way to manage large numbers of patients after laparoscopic gastric banding while maintaining comparable weight loss to surgeon/nurse-led series. Content Type Journal ArticleDOI 10.1007/s00464-009-0758-yAuthors Rishi Singhal, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UKMark Kitchen, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UKSue Bridgwater, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UKPaul Super, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

pubmed: 1088-5412

Egg allergy and influenza vaccination.
Settipane RA, Siri D, Bellanti JA Related Articles Egg allergy and influenza vaccination. Allergy Asthma Proc. 2009 Nov-Dec;30(6):660-5 Authors: Settipane RA, Siri D, Bellanti JA Many egg-allergic patients are unnecessarily restricted from receiving the influenza vaccine. Patients with suspected egg allergy who require seasonal or H1N1 influenza vaccination can pose a significant challenge and should be appropriately evaluated by an allergist/immunologist. In most cases, if the benefits are felt to outweigh the risks, precautionary measures are available that can enhance safe vaccine administration. A case of influenza vaccine management in a child with egg allergy is presented. Clinical characteristics, diagnostic testing, case management, and natural history are reviewed. Clinical Pearls and Pitfalls include: (1) Batch-to-batch variability of egg content in extant influenza vaccines necessitates an informed and cautious approach to vaccination of an egg-allergic individual. (2) Due to denaturation of some egg proteins through heating, tolerance of "baked egg" products may not predict tolerance of "native egg" proteins present in the influenza vaccine. (3) Intradermal skin testing with influenza vaccine diluted 1:10 may be irritating to the skin and result in false positive results. (4) If skin test to the vaccine is positive, vaccination may still be cautiously administered, if necessary, in a graded-dose protocol, as presented herein. (5) Most patients with egg allergy are likely to develop egg tolerance by late childhood. PMID: 20031013 [PubMed - in process]
A 6-year-old boy with fever and eosinophilia.
Dhanani K, Shanmugam G, Khan DA Related Articles A 6-year-old boy with fever and eosinophilia. Allergy Asthma Proc. 2009 Nov-Dec;30(6):655-9 Authors: Dhanani K, Shanmugam G, Khan DA Tissue and blood eosinophilia can be associated with a variety of infectious, allergic, and systemic diseases. Eosinophilia can range from mild and clinically inconsequential levels to high-grade eosinophilia with severe and potentially fatal consequences. Because of its ability to degranulate and produce cytotoxic mediators such as major basic protein and eosinophil peroxidase the eosinophil has the potential to cause considerable tissue damage, including potentially fatal conditions such as endomyocardial fibrosis. The most common infectious cause of eosinophilia worldwide is the parasitic helminth; fungal infection as a cause of eosinophilia is rarer, but must also be considered in the differential diagnosis. In this article we describe a unique case of reactive eosinophilia. PMID: 20031012 [PubMed - in process]
Quantitative immunoglobulins in adulthood.
Crisp HC, Quinn JM Related Articles Quantitative immunoglobulins in adulthood. Allergy Asthma Proc. 2009 Nov-Dec;30(6):649-54 Authors: Crisp HC, Quinn JM Although age-related changes in serum immunoglobulins are well described in childhood, alterations in immunoglobulins in the elderly are less well described and published. This study was designed to better define expected immunoglobulin ranges and differences in adults of differing decades of life. Sera from 404 patients, aged 20-89 years old were analyzed for quantitative immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA). The patients with diagnoses or medications known to affect immunoglobulin levels were identified while blinded to their immunoglobulin levels. A two-factor ANOVA was performed using decade of life and gender on both the entire sample population as well as the subset without any disease or medication expected to alter immunoglobulin levels. A literature review was also performed on all English language articles evaluating quantitative immunoglobulin levels in adults >60 years old. For the entire population, IgM was found to be higher in women when compared with men (p < 0.001) and lower in the oldest sample population compared with the youngest population (p < 0.001). For the population without diseases known to affect immunoglobulin levels, the differences in IgM with gender and age were maintained (p </= 0.001) and IgA levels were generally higher in the older population when compared with the younger population (p = 0.009). Elderly patients without disease known to affect immunoglobulin levels have higher serum IgA levels and lower serum IgM levels. Women have higher IgM levels than men throughout life. IgG levels are not significantly altered in an older population. PMID: 20031011 [PubMed - in process]

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