Processionary caterpillar reactions in Southern Italy forestry workers: description of three cases

Abstract Background Processionary caterpillar (PC), also named Thaumatopea pityocampa, has been reported to cause hypersensitivity reactions after contact with a toxin contained in hair-like bristles which cover this insect. Occupational exposure to PC is underestimated in outdoor workers and especially in forestry workers (FW) and is globally diffusing because of rising temperatures. Cases presentation We present the first three cases of FW from Sicily, a Southern Italy (SI) region, which reported hypersensitivity reactions due to exposure to PC infested trees. These cases were identified by the occupational health physician during the annual screening of FW working in the Mountains of north-eastern Sicily. Interviewing a population of 630 FW, 1 male and 2 females reported direct contact skin reactions together with airborne contact reactions to PC hairs causing mild respiratory symptoms in two cases and ocular symptoms in one case, which needed treatment with systemic corticosteroids and antihistamines. Conclusions This is the first report of hypersensitivity reactions in SI FW due to occupational exposure to PC. Further screenings not only in FW but also in other populations of outdoor workers are needed in order to assess the real incidence of contact and airborne reactions due to occupational exposure to PC. Though so far no correlation has been found with atopy, it seems apparent that the reactions occur in susceptible subjects; further research is needed for a correct diagnosis and to identify possible desensitization procedures.

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Delayed allergic skin reactions to vaccines

Allergy and Asthma Proceedings ◽

10.2500/aap.2022.43.210105 ◽

2022 ◽

Vol 43 (1) ◽

pp. 20-29 ◽

Cited By ~ 1

Author(s):

Marcella R. Aquino ◽

Theresa A. Bingemann ◽

Anil Nanda ◽

Kelly M. Maples

Keyword(s):

Patch Testing ◽

Case Reports ◽

Delayed Hypersensitivity ◽

Delayed Type Hypersensitivity ◽

Hypersensitivity Reactions ◽

Skin Reactions ◽

Cutaneous Manifestations ◽

Systemic Corticosteroids ◽

Causative Agents ◽

Delayed Reactions

Background: Recent advances in vaccination against the severe acute respiratory syndrome coronavirus 2 pandemic have brought allergists and dermatologists to the forefront because both immediate and delayed hypersensitivity reactions have been reported. Objective: This literature review focused on delayed reactions to vaccines, including possible causative agents and practical information on how to diagnose, evaluate with patch testing, and manage subsequent dose administration. Methods: Currently published reviews and case reports in PubMed, along with data on vaccines from the Centers for Disease Control and Prevention web site. Relevant case reports and reviews that focused on delayed reactions to vaccines were selected. Results: Most delayed hypersensitivity reactions to vaccines include cutaneous manifestations, which vary from local persistent pruritic nodules to systemic rashes. The onset is usually within a few days but can be delayed by weeks. Multiple excipients have been identified that have been implicated in delayed vaccine reactions, including thimerosal, formaldehyde, aluminum, antibiotics, and gelatin. Treatment with antihistamines, topical corticosteroids, or systemic corticosteroids alleviates symptoms in most patients. Such reactions are generally not contraindications to future vaccination. However, for more-severe reactions, patch testing for causative agents can be used to aid in diagnosis and approach further vaccination. Conclusion: Delayed-type hypersensitivity reactions to vaccines are not uncommon. If needed, patch testing can be used to confirm agents, including antibiotics, formaldehyde, thimerosal, and aluminum. In most cases, delayed cutaneous reactions are not contraindications to further vaccine administration.

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Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835921992989 ◽

2021 ◽

Vol 13 ◽

pp. 175883592199298

Author(s):

Orthi Shahzad ◽

Nicola Thompson ◽

Gerry Clare ◽

Sarah Welsh ◽

Erika Damato ◽

...

Keyword(s):

Adverse Events ◽

Checkpoint Inhibitors ◽

Case Reports ◽

Case Series ◽

Simple Algorithm ◽

Cancer Therapeutics ◽

Management Algorithm ◽

Ocular Symptoms ◽

Systemic Corticosteroids ◽

Permanent Loss

Ocular immune-related adverse events (IrAEs) associated with use of checkpoint inhibitors (CPIs) in cancer therapeutics are relatively rare, occurring in approximately 1% of treated patients. Recognition and early intervention are essential because the degree of tissue damage may be disproportionate to the symptoms, and lack of appropriate treatment risks permanent loss of vision. International guidelines on managing ocular IrAEs provide limited advice only. Importantly, local interventions can be effective and may avoid the need for systemic corticosteroids, thereby permitting the continuation of CPIs. We present a single institution case series of eight affected patients managed by our multidisciplinary team. Consistent with previously published series and case reports, we identified anterior uveitis as the most common ocular IrAE associated with CPIs requiring intervention. Based on our experience, as well as published guidance, we generated a simple algorithm to assist clinicians efficiently manage patients developing ocular symptoms during treatment with CPIs. In addition, we make recommendations for optimising treatment of uveitis and address implications for ongoing CPI therapy.

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Prospective study of 5-day challenge with penicillins in children

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000734 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000734

Author(s):

Birgitte Tusgaard Petersen ◽

Josefine Gradman

Keyword(s):

Prospective Study ◽

Children And Adolescents ◽

Provocation Test ◽

Specific Ige ◽

Hypersensitivity Reactions ◽

Skin Reactions ◽

Full Dose ◽

Culprit Drug ◽

Drug Provocation Test ◽

Registration Number

ObjectivesTo examine if a 5-day challenge with penicillin improves the diagnostic sensitivity compared with a single full dose in children with mild skin reactions.DesignSubjects referred with suspected allergy to penicillin were consecutively included. Irrespectively of the morphology of the index reaction and the result of specific IgE, all subjects underwent a two-step titrated drug provocation test (DPT) with the culprit drug followed by a 5-day challenge at home.ParticipantsChildren and adolescents aged 0–18 years referred to allergic workup for penicillin hypersensitivity at two paediatric Danish centres. Only subjects with non-severe skin reactions were included.ResultsA total of 305 subjects were included and 22 (7%) of the DPTs were positive. Three subjects reacted within 1 hour of the first full dose and nine reacted 1–8 hours after the first full dose. Additional 10 positive reactions were observed during the prolonged provocation. Seven subjects reacted after the second full dose and three reacted after 3–6 days. Only mild skin rashes were observed. Eighteen subjects had a specific IgE to a penicillin >0.1 kU/L. Only one of these had a positive DPT.ConclusionIn children, a DPT with penicillins should include at least two full doses. In children with mild hypersensitivity reactions it may be safe to perform DPTs despite a low specific IgE.Trial registration numberNCT04331522

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INVESTIGATION OF MEDICALLY INDUCED SKIN REACTIONS BASED ON THE ANALYSIS OF REPORTS OF ADVERSE DRUG REACTIONS IN THE REPUBLIC OF CRIMEA (FROM 2009 TO 2016)

Pharmacy & Pharmacology ◽

10.19163/2307-9266-2019-7-1-32-41 ◽

2019 ◽

Vol 7 (1) ◽

pp. 32-41 ◽

Cited By ~ 1

Author(s):

A. V. Matveev ◽

А. E. Krasheninnikov ◽

E. A. Egorova ◽

Е. I. Konyaeva

Keyword(s):

Adverse Reactions ◽

Drug Hypersensitivity ◽

Clinical Manifestations ◽

World Health ◽

Report Cards ◽

Hypersensitivity Reactions ◽

Drug Reactions ◽

Skin Reactions ◽

Drug Hypersensitivity Reactions ◽

The Republic

Drug hypersensitivity reactions are among the most important problems that arise when using drugs. The occurrence of such reactions in the population is at least 7% and tends to a constant increase. The most frequent manifestations of drug hypersensitivity reactions are medically induced skin lesions.The aimof this research was to study and analyze the cases of development of skin drug reactions on the basis of the reports on the adverse reactions (ADRs) of the drugs, registered in the Republic of Crimea in the period from 2009 to 2016.Materials and methods.The objects of the research were report cards about the adverse reactions, registered in the regional base (registry) of spontaneous messages called ARCADe (Adverse Reactions in Crimea, Autonomic Database) for the period from 2009 to 2016. During the analysis of the report cards, 2,698 cases of the development of skin drug reactions arising in response to the use of drugs in patients were selected. The study of the frequency of occurrence of skin drug reactions in the application of various groups of drugs was carried out taking into account the codes of the Anatomical Therapeutic Chemical (ATC) Сlassification System of drugs of the World Health Organization (WHO).Results.Of the study showed that the development of skin drug reactions was most often associated with the use of antimicrobial agents for internal use, nonsteroidal anti-inflammatory drugs (NSAIDs), drugs for the treatment of diseases of the gastrointestinal tract and agents that affect the nervous system. Among the clinical manifestations of skin drug reactions, generalized and localized rashes prevailed, and itching and hyperemia of the skin were much less common in patients. The analysis of age categories showed that the most frequently medically induced reactions occurred in children from birth to 3 years, as well as in the age group of patients from 46 to 60 years. The risk factors identified in the course of the analysis, were female gender, early childhood and old age, as well as the presence of aggravated drug allergy history.Conclusion.Drug hypersensitivity reactions create certain difficulties in clinical practice related to the diagnosis, treatment and prophylaxis, and may also cause danger to health or life of patients. In this connection, the study of such adverse reactions is the most important task of practical health care and requires direct participation of doctors of all specialties.

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Evaluation of Occupational Exposure Limits for Heat Stress in Outdoor Workers — United States, 2011–2016

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm6726a1 ◽

2018 ◽

Vol 67 (26) ◽

pp. 733-737 ◽

Cited By ~ 17

Author(s):

Aaron W. Tustin ◽

Glenn E. Lamson ◽

Brenda L. Jacklitsch ◽

Richard J. Thomas ◽

Sheila B. Arbury ◽

...

Keyword(s):

United States ◽

Heat Stress ◽

Occupational Exposure ◽

Occupational Exposure Limits ◽

Exposure Limits ◽

Outdoor Workers

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Scabies incognito

Dermatology Reports ◽

10.4081/dr.2019.8083 ◽

2019 ◽

Author(s):

Nanny Herwanto ◽

Hasnikmah Mappamasing ◽

Septiana Widiantari ◽

Trisiswati Indranarum ◽

Afif Nurul Hidayati ◽

...

Keyword(s):

Male Patient ◽

Systemic Corticosteroid ◽

Skin Diseases ◽

Correct Diagnosis ◽

Systemic Corticosteroids ◽

Life Threatening ◽

Good Hygiene

Atypical appearance of scabies such as chronic excoriation and eczematization of the skin, is frequently found in patients with long-standing infestations. Cases of less impressive scabies are not easily diagnosed, especially when topical or systemic corticosteroids mask the typical itch and inflammation. These cases frequently occur in individuals with good hygiene and are referred as scabies incognito – a diagnosis that can be easily mistaken for other skin diseases. A fourteen-year-old male patient had been irregularly taking systemic corticosteroid for two months due to intermittent papular reaction and itching. Four weeks after treatment with anti-scabiotic therapy, the patient has no complaint of itch and no sign of new papular lesion suggesting that he had scabies all along. It is very important to make a correct diagnosis of scabies incognito because misdiagnosis is associated with serious consequences such as spreading and superinfection of the lesions; this can sometimes lead to life-threatening consequences.

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Risk of lymphoma subtypes by occupational exposure in Southern Italy

Journal of Occupational Medicine and Toxicology ◽

10.1186/s12995-017-0177-2 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 6

Author(s):

Giovanni Maria Ferri ◽

Giorgina Specchia ◽

Patrizio Mazza ◽

Giuseppe Ingravallo ◽

Graziana Intranuovo ◽

...

Keyword(s):

Occupational Exposure ◽

B Cell ◽

Southern Italy ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Agricultural Activity ◽

Retrospective Assessment ◽

Non Hodgkin Lymphoma ◽

Complete Work ◽

Increased Risk

Abstract Background Occupational exposure is known to play a role in the aetiology of lymphomas. The aim of the present work was to explore the occupational risk of the major B-cell lymphoma subtypes using a case–control study design. Methods From 2009 to 2014, we recruited 158 lymphoma cases and 76 controls in the provinces of Bari and Taranto (Apulia, Southern Italy). A retrospective assessment of occupational exposure based on complete work histories and the Carcinogen Exposure (CAREX) job-exposure matrix was performed. Results After adjusting for major confounding factors, farmers showed an increased risk of diffuse large B-cell lymphoma (DLBCL) [odds ratio (OR) = 10.9 (2.3–51.6)] and multiple myeloma (MM) [OR = 16.5 (1.4–195.7)]; exposure to the fungicide Captafol was significantly associated with risk of non-Hodgkin lymphoma (NHL) [OR = 2.6 (1.1–8.2)], particularly with the risk of DLBCL [OR = 5.3 (1.6–17.3)]. Conclusions Agricultural activity seems to be a risk factor for developing lymphoma subtypes, particularly DLBCL, in the provinces of Bari and Taranto (Apulia Region, Southern Italy). Exposure to the pesticides Captafol, Paraquat and Radon might be implicated. Trial registration Protocol number UNIBA 2207WEJLZB_004 registered 22/09/2008.

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Ocular Complications in Cutaneous Lupus Erythematosus: A Systematic Review with a Meta-Analysis of Reported Cases

Journal of Ophthalmology ◽

10.1155/2015/254260 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

L. Arrico ◽

A. Abbouda ◽

I. Abicca ◽

R. Malagola

Keyword(s):

Lupus Erythematosus ◽

Meta Analysis ◽

Correct Diagnosis ◽

Cutaneous Lupus Erythematosus ◽

Discoid Lupus Erythematosus ◽

Systemic Lupus ◽

Ocular Complications ◽

Ocular Symptoms ◽

Inflammatory Syndrome ◽

Cutaneous Lupus

Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease.

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Sensitization to rodents (mouse/rat) in urban atopic populations without occupational exposure living in Campania district (Southern Italy): a multicenter study

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2013.506 ◽

2013 ◽

Vol 8 ◽

Author(s):

Gennaro Liccardi ◽

Gennaro Baldi ◽

Anna Ciccarelli ◽

Marina Cutajar ◽

Maria D’Amato ◽

...

Keyword(s):

Occupational Exposure ◽

Western Europe ◽

Southern Italy ◽

Allergic Sensitization ◽

Clinical History ◽

Specific Ige ◽

Moderate Degree ◽

Skin Prick Tests ◽

Few Data ◽

Indoor Conditions

Background: Up to now very few data on allergic sensitization to rodent allergens in Western Europe and Italy are available, and there are no information at district level. The aim of this report was to investigate clinical significance and characteristics of allergic sensitization to mouse/rat (M/ Rt) allergens in atopic subjects living in Campania district (Southern Italy). Methods: Allergists from the whole Campania district were required to report the results of skin prick tests of at least 100 consecutive subjects. In 1,477 consecutive outpatients, we selected all subjects with an immediate skin reaction to M/Rt dander. Clinical history including a careful evaluation of the modality of exposure and the results of skin-prick tests (SPTs) were recorded. Results: Fifty seven patients were sensitized to M/Rt dander (5.78%). Two patients were mono-sensitized. Fourteen patients reported indoor conditions suggesting presence of rodents allergens at home. All patients exhibited low-moderate degree of SPT positivity to M/Rt. High frequency of concomitant allergic sensitization to dust mites was found. Conclusions: Our results suggest that the role of allergic sensitization to rodents is not negligible in atopic subjects without occupational exposure living in Campania district area; these values are higher in comparison to those previously found in Naples area. Highly atopic individuals should be tested by SPTs/evaluation of serum specific IgE to rodents in the case they should begin an occupational exposure to M/Rt or keep these animals as pets.

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Ocular Vogt-Koyanagi-Harada: Is it the era of diagnosis by OCT?

10.21203/rs.3.rs-654480/v1 ◽

2021 ◽

Author(s):

Khaled Elubous ◽

Mohammed S. Farah ◽

Ahmed N. Shokry ◽

Mohammed Abu-Ameereh

Keyword(s):

Optical Coherence Tomography ◽

Subretinal Fluid ◽

Response To Treatment ◽

Laboratory Evaluation ◽

Optical Coherence ◽

Cystic Fluid ◽

Ocular Symptoms ◽

Systemic Corticosteroids ◽

Ophthalmologic Examination ◽

Fluid Collections

Abstract PURPOSE to report optical coherence tomography (OCT) changes of the retina during acute and recovery phases in a patient with atypical Vogt-Koyanagi-Harada (VKH) disease presented for the first time with ocular symptoms and role of (OCT) in the diagnosis, following and assessing response to treatment.Methods Ophthalmologic examination, laboratory evaluation, fluorescein angiography, and spectral-domain optical coherence tomography performed on a twenty-four-year-old female presented with a bilateral blurring of vision of 3 days.ResultsOCT disclosed multifocal subretinal lobulated cystic fluid collections with thickening and hyper-reflectance in outer retinal layers. Decreased retinal thickness and resolving subretinal fluid collections were seen after commencing treatment by systemic corticosteroids. Conclusion OCT is a very sensitive tool to diagnose and monitor the highly detailed retinal changes during the VKH course especially if presented primarily with ocular symptoms

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