RESUMEN
Breast cancer incidence suggests a lifestyle cause. A lifestyle factor used near the breast is the application of antiperspirants/deodorants accompanied by axillary shaving. A previous study did not support a link with breast cancer. If these habits have a role in breast cancer development, women using antiperspirants/deodorants and shaving their underarms frequently would be expected to have an earlier age of diagnosis than those doing so less often. An earlier age of diagnosis would also be expected in those starting to use deodorants and shaving at an earlier age. This is the first study to investigate the intensity of underarm exposure in a cohort of breast cancer survivors. Four hundred and thirty-seven females diagnosed with breast cancer were surveyed. Once grouped by their frequency of underarm hygiene habits, the mean age of diagnosis was the primary end point. Secondary end points included the overall frequency of these habits, and potential usage group confounding variables were evaluated. All statistical tests were two-sided. Frequency and earlier onset of antiperspirant/deodorant usage with underarm shaving were associated with an earlier age of breast cancer diagnosis. Combined habits are likely for this earlier age of diagnosis. In conclusion, underarm shaving with antiperspirant/deodorant use may play a role in breast cancer. It is not clear which of these components are involved. Reviewed literature insinuates absorption of aluminium salts facilitated by dermal barrier disruption. Case-controlled investigations are needed before alternative underarm hygiene habits are suggested.
Asunto(s)
Neoplasias de la Mama/etiología , Desodorantes/efectos adversos , Exposición a Riesgos Ambientales , Higiene , Adulto , Edad de Inicio , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Estudios de Cohortes , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The complexity of care of some patients in an allergy-immunology practice may be increased by behavioral abnormalities of the patients. Facilitating adherence through the use of social support may be the most effective treatment strategy for some of the most difficult of these patients. We report three patients whose medical management problems were alleviated largely because of the participation of their support system. All three patients were stabilized because of the acceptance of responsibility and support of the physician by the designated member of the patient's support system. The range of social support used to manage nonadherent patients ranged from directly providing instructions to a family member to the consistent presence of a spouse or companion at multiple clinical visits. In all cases, the success in management was attributed largely to the presence of a support system.
Asunto(s)
Hipersensibilidad/psicología , Conducta Social , Apoyo Social , Corticoesteroides/administración & dosificación , Adulto , Anciano , Alérgenos/inmunología , Anafilaxia/tratamiento farmacológico , Anafilaxia/psicología , Asma/tratamiento farmacológico , Asma/psicología , Epinefrina/administración & dosificación , Humanos , Hipersensibilidad/inmunología , Hipersensibilidad/terapia , MasculinoRESUMEN
Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that can be a life-threatening emergency. Previously, we have reported our favorable experience in treating 54 patients with SJS with systemic corticosteroids. We continued our prospective analysis of consecutive patients with SJS treated with corticosteroids. Possible etiologic factors and clinical outcomes of the patients are described. All 13 patients improved with initiation of systemic corticosteroid therapy. There was no mortality or permanent sequelae attributable to SJS. Drugs were the offending agents in all 13 cases. There was one death unrelated to SJS. In conclusion, prompt treatment with systemic corticosteroids reduces morbidity and improves outcome of SJS patients. This analysis extends our series to 67 consecutive patients with SJS who were treated with corticosteroids and had a favorable outcome.
Asunto(s)
Glucocorticoides/administración & dosificación , Metilprednisolona/administración & dosificación , Prednisona/administración & dosificación , Síndrome de Stevens-Johnson/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Síndrome de Stevens-Johnson/diagnóstico , Resultado del TratamientoRESUMEN
BACKGROUND: Cough equivalent asthma is a cause for chronic cough and usually responds to corticosteroid therapy. Oral corticosteroids are employed in a diagnostic-therapeutic trial and inhaled corticosteroids are employed in maintenance therapy. In certain cases the cough may be especially severe and require escalated doses of oral corticosteroids for initial control. This is labeled malignant cough equivalent asthma. OBJECTIVE: To define malignant cough equivalent asthma, provide two case reports, and identify features that should alert physicians to consider the possibility of malignant cough equivalent asthma. CASE REPORTS: We report two patients who presented complaining of chronic cough that was disruptive of sleep and normal activities, and in one patient prompted an emergency room visit and later hospitalization. The patients underwent evaluation with history, physical examination, and laboratory testing as indicated. Other causes for chronic cough were ruled out by appropriate testing, or were treated, and patients did not respond to usual corticosteroid treatment for cough equivalent asthma. These patients were considered to have a more severe form of cough equivalent asthma and did respond to treatment with higher doses of oral corticosteroids. CONCLUSION: Malignant cough equivalent asthma is a cause of chronic cough that is disruptive to sleep or normal activities, may lead to emergency room visits or hospitalization, and requires escalated doses of oral corticosteroids for initial control.
Asunto(s)
Asma/complicaciones , Asma/diagnóstico , Tos/etiología , Corticoesteroides/administración & dosificación , Anciano , Asma/terapia , Femenino , Hospitalización , Humanos , Persona de Mediana EdadRESUMEN
Chronic cutaneous bacterial hypersensitivity (CCBH) is a syndrome of recurrent indolent inflammatory lesions that are caused by a hypersensitivity reaction to skin flora. It can cause significant physical and social distress to those affected, who often endure years of nondiagnostic evaluations and ineffective treatments. We report two additional cases of this syndrome. Skin testing demonstrated IgE to bacterial antigens in both patients, and ELISA demonstrated both IgE and IgG to bacterial antigens in one patient. Both patients improved rapidly and dramatically with oral corticosteroid therapy, although they failed to achieve a lasting remission, as had been seen in previous cases. These represent the fourth and fifth reported cases of CCBH. Despite failure to achieve remission, these patients demonstrate the effectiveness of an inexpensive and safe prednisone regimen in controlling this physically and socially destructive disease.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Bacterias/inmunología , Dermatitis Alérgica por Contacto/microbiología , Piel/microbiología , Adulto , Antiinflamatorios/uso terapéutico , Dermatitis Alérgica por Contacto/tratamiento farmacológico , Ensayo de Inmunoadsorción Enzimática , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Prednisona/uso terapéuticoRESUMEN
BACKGROUND: Northwestern University's Division of Allergy and Immunology has had experience with the diagnosis and treatment of more than 350 patients with idiopathic anaphylaxis (IA). In 1992 we reported a group of patients with IA whose presentations mimicked IA, but IA and other organic causes were later excluded. Psychologic factors were suspected as the underlying problem. These patients were classified as IA-variant. Management of these cases was extremely difficult. There was significant morbidity and high and unnecessary costs. OBJECTIVE: We aim to distinguish the nature of this disease and to highlight the evaluation and treatment of this group of patients. METHODS: Their cases are reviewed and reported. RESULTS: Common features included (1) presenting symptoms mimicking IA, (2) no objective findings that correlated with 1, (3) no response to the therapeutic regimen for IA, (4) meeting the Diagnostic and Statistical Manual of Mental Disorders criteria for undifferentiated somatoform disorder, and (5) significant wasted health care expenditure. CONCLUSIONS: This group of patients were better defined as having undifferentiated somatoform-IA. An algorithm was proposed to expedite the diagnosis of the disease so that with early recognition of the disease, unwarranted repetitive consultations, tests, and inappropriate therapy can be avoided.
Asunto(s)
Anafilaxia/diagnóstico , Trastornos Somatomorfos/diagnóstico , Adulto , Albuterol/uso terapéutico , Anafilaxia/tratamiento farmacológico , Anafilaxia/psicología , Diagnóstico Diferencial , Femenino , Humanos , Hidroxizina/uso terapéutico , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/tratamiento farmacológico , Hipersensibilidad Inmediata/psicología , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Trastornos Somatomorfos/tratamiento farmacológico , Trastornos Somatomorfos/psicología , SíndromeRESUMEN
A case we described and reported 6 years ago as chronic cutaneous granulomatous dermopathy was believed due to bacterial hypersensitivity. We now report a second case with similar features of chronic recurrent indolent inflammatory skin lesions, nondiagnostic skin biopsies, and failure to respond to antibiotics. In the absence of another diagnosis and because of the remarkably similar appearance to the first case, we initiated a therapeutic trial with corticosteroids, which induced a remission. The initial case has now been observed for 6 years, and the patient remains in remission on 5 mg of prednisone on alternate days. The second case was considered consistent with bacterial allergy because of IgG and IgE antibodies against common cutaneous bacteria. As there were no granulomas in the current patient's skin lesions, a new designation, chronic cutaneous bacterial hypersensitivity, has been assigned. The differential diagnosis and criteria for this clinical entity are discussed. Either a remission from prednisone or control with low-dose prednisone may be achieved in this dermopathy, which is both disfiguring and frightening to patients.
Asunto(s)
Dermatitis por Contacto/microbiología , Enfermedades Cutáneas Infecciosas/complicaciones , Infecciones Cutáneas Estafilocócicas/complicaciones , Adulto , Enfermedad Crónica , Dermatitis por Contacto/diagnóstico , Dermatitis por Contacto/inmunología , Diagnóstico Diferencial , Ensayo de Inmunoadsorción Enzimática , Estudios de Evaluación como Asunto , Femenino , Humanos , Inmunoglobulina E/análisis , Inmunoglobulina G/análisis , Masculino , Persona de Mediana Edad , Recurrencia , Enfermedades Cutáneas Infecciosas/inmunología , Infecciones Cutáneas Estafilocócicas/diagnóstico , Infecciones Cutáneas Estafilocócicas/inmunologíaRESUMEN
Diagnosis and particularly the management of erythema multiforme and Stevens-Johnson syndrome are controversial in medical textbooks and thus in individual cases. In these diseases, fatalities may result from various causes, including secondary infection or visceral organ damage to lung, liver, or kidneys. We present a series of 13 cases managed by one group of physicians which demonstrates the controversy in certain cases, and we review the controversy in the medical literature. Corticosteroid therapy used in this series was considered beneficial in every case by the managing physician and lifesaving in some cases. There were no fatalities in this series. Although the summation may be considered as our opinion only, the frequently suggested "controlled trial of corticosteroid therapy" can probably never be done for ethical reasons, and series such as this will have to establish the standard of therapy.
Asunto(s)
Eritema Multiforme , Síndrome de Stevens-Johnson , Terminología como Asunto , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamiento farmacológico , Femenino , Humanos , Hidrocortisona/uso terapéutico , Persona de Mediana Edad , Prednisona/uso terapéutico , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/tratamiento farmacológicoRESUMEN
A series of three patients were evaluated and treated by the Northwestern University Section of Allergy. These patients had allergic disease that threatened their professional careers as performing artists. Although the clinical manifestations of allergic rhinitis were not unusually severe, these were sufficient to interfere with the performance of these professional singers. Because previous allergic diagnostic and therapeutic regimens had not controlled the voice related symptoms, career changes were reluctantly being considered. Unusually aggressive therapy including systemic corticosteroids was initiated as a diagnostic and therapeutic trial. The resultant improvement was then maintained with more standard allergic management and the three singers were able to perform satisfactorily. This report demonstrates how allergic disease affecting three performing artists justified intense therapy to prevent job loss and the potential financial, emotional and social consequences.
Asunto(s)
Corticoesteroides/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Música , Rinitis Alérgica Perenne/tratamiento farmacológico , Administración por Inhalación , Administración Oral , Corticoesteroides/administración & dosificación , Adulto , Selección de Profesión , Terapia Combinada , Desensibilización Inmunológica , Quimioterapia Combinada , Femenino , Humanos , Masculino , Embarazo , Rinitis Alérgica Perenne/complicaciones , Rinitis Alérgica Perenne/terapiaRESUMEN
To identify patients at risk for immediate-type allergic reactions to streptokinase, we performed streptokinase skin tests on patients immediately before planned administration of intravenous streptokinase for treatment of acute myocardial infarction. Forty-five patients had negative skin tests and received streptokinase without allergic reaction. One patient had a positive skin test and was given urokinase instead, without incident. Positive skin tests were also present in a patient who had recently had an anaphylactic reaction to streptokinase, and in two physician volunteers who had been sensitized to streptokinase during initial determination of the optimal skin testing dose. Immunoassays for IgE to streptokinase were performed on serum samples from skin-tested patients and volunteers, and on 16 other patients who had not been skin tested but had previously received streptokinase without allergic reactions. The skin test was a sensitive and specific indicator of elevated levels of IgE to streptokinase. We propose that skin testing immediately before streptokinase administration is a practical approach for identifying patients at risk for immediate-type allergic reactions to streptokinase, and its use may possibly prevent anaphylaxis and death.
Asunto(s)
Anafilaxia/inducido químicamente , Estreptoquinasa/efectos adversos , Humanos , Inmunoglobulina E/análisis , Riesgo , Pruebas CutáneasRESUMEN
Streptokinase used as a thrombolytic agent may produce immunologic drug reactions. We report a second case of IgE-mediated anaphylaxis and a late reaction to streptokinase. This late reaction was consistent with an IgG-mediated antigen-antibody disease with transient renal involvement, fever, and cutaneous lesions. The second case responded to prednisone therapy.
Asunto(s)
Anafilaxia/inducido químicamente , Complejo Antígeno-Anticuerpo/inmunología , Estreptoquinasa/efectos adversos , Anciano , Ensayo de Inmunoadsorción Enzimática , Humanos , Inmunodifusión , Activación de Linfocitos , Masculino , Pruebas CutáneasRESUMEN
A case of a unique factitious disorder resulted from self-inducement of oral lacerations, erosions, and abrasions. Previous medical investigations included evaluations by two general dentists, one oral surgeon, two periodontists, one internist, one otolaryngologist, and one infectious-disease physician. The patient had two gingival biopsies and one hospitalization. The lesions were unresponsive to several therapeutic regimens including temporary discontinuation of tooth brushing, antibiotics, and gingival dressings. The differential diagnosis included infectious, nutritional, immunologic, and factitious disorders. An apparent initial response to corticosteroids suggested the possibility of an immunologic inflammatory disease; however, no organic cause could be found. The enigma was resolved by discussion with the patient who reported that the lesions were self-induced and the manner in which this was done.
Asunto(s)
Gingivitis/diagnóstico , Enfermedades del Sistema Inmune/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Gingivitis/etiología , Humanos , Cepillado Dental/efectos adversosRESUMEN
Streptokinase is used worldwide as a thrombolytic agent. Allergic reactions to streptokinase have been reported, but the immunologic mechanisms have not been well characterized. To develop a canine model of streptokinase immune responses analogous to human responses, four dogs received intravenous streptokinase infusions. Significant rises in IgG, IgA and IgM antibody levels occurred after streptokinase administration in three of four dogs; a fourth dog developed significant increases in IgG and IgA antibody levels. Two dogs developed immediate-type cutaneous hypersensitivity to streptokinase. One dog developed subacute dermatitis with eosinophilic infiltrates which was possibly a manifestation of an allergic reaction to streptokinase.
Asunto(s)
Hipersensibilidad Inmediata/inmunología , Estreptoquinasa/administración & dosificación , Animales , Anticuerpos Antiidiotipos/inmunología , Biopsia , Dermatitis por Contacto/inmunología , Perros , Inmunoglobulina A/inmunología , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Inyecciones Intravenosas , Piel/inmunología , Piel/patologíaRESUMEN
We report on a syndrome of disfiguring lower extremity cutaneous lesions of 6 years duration. Previous medical evaluations included 5 skin biopsies and several therapeutic regimens which did not alter the course of illness. The histologic interpretations of skin biopsies included panniculitis, papulonecrosis, and granuloma. One biopsy was interpreted as a localized cutaneous vasculitis with a wedge-shaped infarct. Infectious, collagen vascular, and factitious etiologies could not be demonstrated to explain the patient's lesions. The Chicago Dermatological Society included in their differential diagnosis bacterial allergy, including the tuberculoid reaction. Mycobacterium tuberculosis as the etiology was dismissed by negative cultures, histologic staining and failure of response to antituberculous therapy. Our report includes a series of immunologic tests that might be consistent with but do not definitively establish a bacterial hypersensitivity reaction to explain this patient's skin lesions. Despite a lack of proven etiology dramatic improvement occurred with corticosteroid therapy.
Asunto(s)
Bacterias/inmunología , Hipersensibilidad/diagnóstico , Enfermedades de la Piel/diagnóstico , Corticoesteroides/uso terapéutico , Adulto , Diagnóstico Diferencial , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Activación de Linfocitos , Neutrófilos/fisiología , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/etiología , Pruebas CutáneasRESUMEN
Streptokinase is used worldwide as a thrombolytic agent. Allergic reactions have been observed to streptokinase; however, the immunologic mechanisms have not been described. In a case of an anaphylactic reaction to intravenously administered streptokinase during the evolution of a myocardial infarction, the patient had elevated specific IgE and IgG levels to this agent demonstrated by in vitro methods. In vivo testing demonstrated cutaneous immediate-type hypersensitivity with a typical wheal and flare reaction. Critically ill patients receive short-term treatment with streptokinase. Because of the potential danger of anaphylaxis in these patients, we provide an approach that may identify those at risk. The urgency of the requirement for immediate administration of streptokinase is such that an in vitro test cannot be used; thus, results of appropriate skin testing must be evaluated.
Asunto(s)
Anafilaxia/inducido químicamente , Hipersensibilidad a las Drogas/etiología , Estreptoquinasa/efectos adversos , Anafilaxia/inmunología , Hipersensibilidad a las Drogas/inmunología , Ensayo de Inmunoadsorción Enzimática , Humanos , Inmunodifusión , Inmunoglobulina E/análisis , Inmunoglobulina G/análisis , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Radioinmunoensayo , Pruebas Cutáneas , Estreptoquinasa/inmunologíaRESUMEN
In a four-year clinical, immunologic, and environmental study of trimellitic anhydride (TMA) exposure in a single plant, 20 workers exposed to TMA powder were evaluated in 1979 and a total of 32 workers were evaluated from 1979 to 1983. Two distinct groups emerged before and after workplace control improvements were made in 1979. Seventeen of the original 20 workers were available for longitudinal study through 1983. Annual clinical evaluations and serum radioimmunoassays for total antibody binding and specific IgE binding to 125I TM-HSA (human serum albumin) were performed on all 32 workers. In 1979, six workers had antibody against TM-HSA, three had the late respiratory systemic syndrome, and two had TMA-induced allergic rhinitis or allergic rhinitis and asthma. One worker had antibody against TM-HSA without illness. Fifteen additional workers were evaluated longitudinally after institution of several workplace control measures. Four of these 15 workers had TMA exposure prior to environmental improvement and joined the study in 1982. The remaining 11 workers joined the study in 1982 and had at least two years of TMA exposure in the modified workplace. None of these 11 workers developed a TMA-induced immunologic syndrome or significant total or specific IgE antibody binding to 125I TM-HSA.
Asunto(s)
Anticuerpos/análisis , Ácidos Ftálicos/inmunología , Anhídridos Ftálicos/inmunología , Adulto , Sitios de Unión de Anticuerpos/análisis , Exposición a Riesgos Ambientales , Femenino , Humanos , Inmunoglobulina E/análisis , Estudios Longitudinales , Masculino , Enfermedades Profesionales/inducido químicamente , Enfermedades Profesionales/inmunología , Enfermedades Respiratorias/inducido químicamente , Enfermedades Respiratorias/inmunología , Rinitis/inducido químicamente , Rinitis/inmunología , Albúmina Sérica/inmunologíaRESUMEN
Eighteen workers exposed to trimellitic anhydride (TMA) powder were evaluated in 1979. Twelve of these workers were available for longitudinal study until 1982. Annual clinical evaluations and serum radioimmunoassays for total antibody binding and specific IgE binding to 125I-TM-HSA were performed. In 1979, five workers had antibody against TM-HSA. Of these, three workers were diagnosed with the late respiratory systemic syndrome (LRSS) and one worker with TMA-induced allergic rhinitis. The LRSS workers had significantly elevated total antibody binding of 125I-TM-HSA and the worker with rhinitis had significantly elevated specific IgE binding of 125I-TM-HSA per milliliter of serum. Although TMA handling was intermittent throughout the year, average airborne dust concentrations from 1974 to 1978 at job stations of the two heaviest TMA-exposed occupations, operator and assistant operator, were 2.1 and 0.82 mg/m3, respectively. After local exhaust ventilation had been improved, average airborne dust concentrations of TMA at the two latter job stations fell to levels of 0.03 and 0.01 mg/m3, respectively, in 1982. The decrease in TMA exposure coincided with a gradual fall in total antibody binding of 125I-TM-HSA per milliliter in 1982 and symptomatic improvement in the three individuals with the LRSS. The continuous low-level exposure of the worker with TMA rhinitis was sufficient to elicit a rise in specific IgE against TM-HSA from 1.1 ng of 125I-TM-HSA bound per milliliter in 1979 to 2.12 in 1982.(ABSTRACT TRUNCATED AT 250 WORDS)