The journal of allergy and clinical immunology. In practice
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J Allergy Clin Immunol Pract · May 2015
Review Case ReportsAnaphylaxis after hymenoptera sting: is it venom allergy, a clonal disorder, or both?
A 47-year-old man presented with loss of consciousness 5 minutes after being stung by a yellow jacket in his backyard. Epinephrine and fluids were required for resuscitation. Allergy evaluation revealed specific IgE to yellow jacket and honeybee, and the patient was started on venom immunotherapy. ⋯ A diagnosis of systemic mastocytosis was made. The patient was treated with omalizumab and was able to tolerate immunotherapy and is currently maintained on lifelong immunotherapy. He was restung in the field and has not had anaphylaxis.
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J Allergy Clin Immunol Pract · May 2015
Improving the Effectiveness of Penicillin Allergy De-labeling.
Approximately 10-20% of hospitalized patients are labeled as penicillin allergic, and this is associated with significant health and economic costs. ⋯ Penicillin SPT/IDT/OC safely de-labels penicillin-allergic patients and identifies selective beta-lactam allergies; however, incomplete adherence to ALM recommendations impairs effectiveness. Infrequent SPT/IDT+ and absent OC reactions in patients with NIM reactions suggest OC alone to be a safe and cost-effective de-labeling strategy that could improve the coverage of penicillin allergy de-labeling in lower risk populations.
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J Allergy Clin Immunol Pract · May 2015
IgE to Poppy Seed and Morphine Are Not Useful Tools to Diagnose Opiate Allergy.
Correct diagnosis of genuine IgE-mediated opiate allergy poses a significant challenge, mainly because of uncertainties associated with opiate skin testing and the unavailability of drug-specific IgE (sIgE) assays. Recently, it has been suggested that sIgE to poppy seed extract and morphine would be reliable in the diagnosis of opiate allergy. However, given the high prevalence of sIgE antibodies to these compounds in an allergic population, the predictive value of these tests leaves significant doubts. ⋯ Positive sIgE results to poppy seed and morphine are not per se predictive for genuine opiate allergy and should not be used in isolation to diagnose morphine or codeine allergy. To avoid overdiagnosis, for the time being, we propose to supplement serological diagnosis with an oral provocation test. Whether BAT might help to discriminate between clinical reactivity and sensitization remains to be confirmed in larger collaborative studies.
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J Allergy Clin Immunol Pract · May 2015
Practice GuidelineContact dermatitis: a practice parameter-update 2015.
This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. ⋯ These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www. JCAAI.org or http://www.allergyparameters.org.