Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
-
Anaphylaxis, the maximal manifestation of an immediate allergic reaction, is a life-threatening systemic reaction. The immediate therapy is chosen according to the clinical manifestations and new German guidelines are in preparation. Required measures include immediate removal of allergen, adequate positioning, assessment of severity and organ involvement and activation of emergency medical services. ⋯ In patients with anaphylaxis, the elicitor of the reaction has to be diagnosed by allergy testing. Patients with sustained risk for anaphylaxis should receive a self-medication kit and should be educated about behavioral patterns needed for prophylaxis and therapy of anaphylactic reactions. Patient educational intervention increases knowledge about anaphylaxis, and practical competence and thus, is a basis of a successful management of anaphylaxis.
-
This review summarizes the epidemiology, clinical aspects, diagnosis and new therapeutic options of the superficial venous thrombosis. An important new finding is, that the thrombophlebitis is actually a thrombosis, which occurs in an intra- or epifascial vein. ⋯ New placebo-controlled studies show a clear benefit for low molecular weight heparin or the pentasaccharide fondaparinux. In addition to the medical treatment, compression is recommended for superficial venous thrombosis in varicose veins, but not in normal veins.
-
Chronic pruritus and chronic pain are frequent symptoms of a variety of underlying diseases. Painful sensations usually suppress acute itching. ⋯ The early detection of (neuropathic) pain in patients with chronic pruritus can be done using the PainDetect questionnaire. In general, patients suffering from both itch and pain have a highly impaired quality of life, high degree of objective health burden, need a more intensive health care and a complex analgetic and antipruritic therapy.
-
The association between the carbohydrate galactose-[alpha]-1,3-galactose (α-Gal) and anaphylaxis was first documented after severe hypersensitivity reactions to cetuximab, a chimeric mouse-human IgG1 monoclonal antibody approved for targeted therapy of carcinomas of colon, as well as of the head and neck region. α-Gal is a ubiquitous glycan moiety expressed on cells and tissue of non-primate mammals. Since this epitope is not expressed in humans, it is very immunogenic for them. α-Gal is located on the Fab portion of cetuximab and thus on the murine part of the chimera. The anaphylactic reactions to the antibody were mediated by IgE specific for α-Gal. ⋯ Anti-α-Gal-IgE seems to be of clinical relevance for allergy to red meat and for the pork-cat syndrome. It is also associated with a novel form of delayed anaphylaxis, which appears more than 3 hours following the ingestion of red meat (beef, pork and lamb), a phenomenon which is still to be elucidated. For most of these patients conventional skin prick tests with commercial reagents proved insufficient for diagnosis.