scholarly journals Cold Agglutinins and Cryoglobulins Associate With Clinical and Laboratory Parameters of Cold Urticaria

2021 ◽  
Vol 12 ◽  
Author(s):  
Mojca Bizjak ◽  
Mitja Košnik ◽  
Dorothea Terhorst-Molawi ◽  
Dejan Dinevski ◽  
Marcus Maurer
Keyword(s):  
Cold Water ◽  
Immunoglobulin E ◽  
Complete Blood Count ◽  
Ambient Air ◽  
Cold Agglutinin ◽  
Test Results ◽  
Serum Tryptase ◽  
Cold Urticaria ◽  
Cold Agglutinins ◽  
Basal Serum

Mast cell-activating signals in cold urticaria are not yet well defined and are likely to be heterogeneous. Cold agglutinins and cryoglobulins have been described as factors possibly associated with cold urticaria, but their relevance has not been explained. We performed a single-center prospective cohort study of 35 cold urticaria patients. Cold agglutinin and cryoglobulin test results, demographics, detailed history data, cold stimulation test results, complete blood count values, C-reactive protein, total immunoglobulin E levels, and basal serum tryptase levels were analyzed. Forty six percent (n = 16) of 35 tested patients had a positive cold agglutinin test and 27% (n = 9) of 33 tested patients had a positive cryoglobulin test. Cold agglutinin positive patients, when compared to cold agglutinin negative ones, were mainly female (P = 0.030). No gender-association was found for cryoglobulins. A positive cold agglutinin test, but not a positive cryoglobulin test, was associated with a higher rate of reactions triggered by cold ambient air (P = 0.009) or immersion in cold water (P = 0.041), and aggravated by increased summer humidity (P = 0.007). Additionally, patients with a positive cold agglutinin test had a higher frequency of angioedema triggered by ingestion of cold foods or drinks (P = 0.043), and lower disease control based on Urticaria Control Test (P = 0.023). Cold agglutinin levels correlated with erythrocyte counts (r = −0.372, P = 0.028) and monocyte counts (r = −0.425, P = 0.011). Cryoglobulin concentrations correlated with basal serum tryptase levels (r = 0.733, P = 0.025) and cold urticaria duration (r = 0.683, P = 0.042). Results of our study suggest that cold agglutinins and cryoglobulins, in a subpopulation of cold urticaria patients, are linked to the course and possibly the pathogenesis of their disease.

Characteristics and Laboratory Findings of Food-Induced Anaphylaxis in Children: Study in an Asian Developing Country

2021 ◽  
pp. 1-9
Author(s):  
Rapisa Nantanee ◽  
Narissara Suratannon ◽  
Pantipa Chatchatee
Keyword(s):  
Developing Country ◽  
Immunoglobulin E ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Cow’S Milk ◽  
Care Hospital ◽  
Serum Tryptase ◽  
Cutaneous Manifestations ◽  
Cow's Milk ◽  
Geographical Regions

<b><i>Introduction:</i></b> Food allergy is the major cause of pediatric anaphylaxis. Characteristics and triggers may be different in different geographical regions. Studies focusing on food-induced anaphylaxis (FIA) in Asian developing countries are limited. Our study aimed to study characteristics of FIA in a tertiary care center in an Asian developing country. <b><i>Methods:</i></b> Retrospective review of pediatric anaphylaxis admission and outpatient visit at a tertiary care hospital in Bangkok, Thailand during 2008–2018 was performed. Data regarding clinical presentation, place reaction occurred, time of onset, investigations (serum tryptase, specific immunoglobulin E, and skin test), treatment, and follow-up periods were collected. <b><i>Results:</i></b> One hundred seventy-four anaphylaxis admission records of which 61 episodes of FIA were retrieved. Data from outpatients visit consisted of 17 patients. Most patients were male (76.7%). The median age was 7.1 years (interquartile range 1.9–12.4). The major causes of FIA were shrimp/shellfish (37%), wheat (15.1%), and cow’s milk (11%). Food causing anaphylaxis varied according to age-group: infants had anaphylactic reactions to egg, wheat, and cow’s milk, preschools to wheat and peanut, and older children to shrimp/shellfish. Cutaneous manifestations occurred in all patients, followed by lower respiratory tract symptoms (83.6%) and gastrointestinal symptoms (50.8%). There was no biphasic anaphylaxis reported. Elevated serum tryptase was found in only 4 patients (7%). <b><i>Conclusion:</i></b> Recognizing characteristics of pediatric FIA is crucial. The common causes of FIA in our study in Asian children were egg in infants, wheat and peanut in preschool children, and shrimp/shellfish in school-age children and adolescents. Skin manifestation presented in all patients with FIA.

scholarly journals PENINGKATAN SIFAT MEKANIS BESI COR KELABU MELALUI PROSES TEMPERING

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
A. Noor Setyo HD ◽  
Sri Widodo
Keyword(s):  
Cold Water ◽  
Hardness Test ◽  
Heating Time ◽  
Initial Energy ◽  
Test Results ◽  
Maximum Hardness ◽  
Quenching Temperature ◽  
Independent Variables ◽  
Hardness Tester ◽  
Water Media

This study aims to determine the Hardness and Toughness of cast iron after undergoing a Tempering process with independent variables heating time and dependent Hardness, microstructure and toughness Impack. Quenching was carried out at temperatures of 7750C, 8000C and 8250C in cold water media, while Tempering was carried out at temperatures of 2000C, 3000C and 4000C with a holding time of 15 minutes. Vickers Hardness test results using "Micro Hardness Tester" after Quenching have increased by an average of 95.6% at Quenching 7750C, 99.8% at Quenching 8000C and 107.1% at Quenching temperature 8250C from Hardness value of row material of 256.6 BHN or 260.8 VHN0,040. The maximum hardness value is obtained 531.4 BHN or 553.6 VHN 0,040 at Quenching temperature 8250C and the lowest Hardness of 501.8 BHN or 541,8 VHN0,040 at Quenching 7750C temperature, has Cementite phase as a matrix with little Martensite, is due to treatment The partial tempering of Martensite is replaced by the ferrite phase between Cementites. The results of the study concluded that at Tempering temperatures of 2000C, 3000C and 4000C, the toughness of FC 30 experienced an increase of 106.5%, 121.9% and 130.5% from the initial energy of 5.21 Joule / mm2, whereas violence decreased by 88, 6%, 80.8% and 40.4% of the original Hardness of 260.8 VHN 0,040

scholarly journals April 2021 Critical Care Case of the Month: Abnormal Acid-Base Balance in a Post-Partum Woman

2021 ◽  
Vol 22 (4) ◽  
pp. 81-85
Author(s):  
Mohammad Mahmoud ◽  
Keyword(s):  
Emergency Department ◽  
Complete Blood Count ◽  
Post Partum ◽  
Healthy Woman ◽  
Blood Gases ◽  
Ambient Air ◽  
Physical Exam ◽  
Acid Base Balance ◽  
Arterial Blood ◽  
Base Balance

No abstract available. Article truncated after first page. History of Present Illness: A 29-year-old healthy woman, who is 8 weeks postpartum, presented to the emergency department with severe shortness of breath, fast shallow breathing, nausea, several episodes of nonbloody nonbilious emesis, abdominal pain and malaise for 1 week. The patient delivered a healthy boy at full-term by spontaneous vaginal delivery. Her pregnancy was uneventful. She denied smoking or use of alcohol. Physical Exam: On presentation to the emergency department her blood pressure was found to be 121/71, temperature 36.8°C, pulse 110 beats per minute, respiratory rate 20 breaths per minute and SpO2 saturation of 99% while breathing ambient air. Physical exam was remarkable except for dry mucous membranes, sinus tachycardia, and tachypnea with mild epigastric tenderness with light palpation. Which of the following should be done? 1. Complete blood count (CBC) 2. Metabolic panel 3. Chest x-ray 4. Arterial blood gases (ABGs) 5. All of the above …

scholarly journals Risk of sensitization to ecopollutants in teenagers with inherited chemical burden

2021 ◽  
pp. 123-131
Author(s):  
L.B. Masnavieva ◽  
◽  
N.V. Efimova ◽  
I.V. Kudaeva ◽  
◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Hazard Index ◽  
Allergic Diseases ◽  
Ambient Air ◽  
Inhibition Test ◽  
Immune Disorders ◽  
Migration Inhibition ◽  
Air Contamination ◽  
Relative Risks ◽  
Research Goal

At present allergic diseases are detected in 30% people and their frequency is only growing. A significant role in allergic pathology occurrence belongs to ambient air contamination and chemicals being introduced not only into children’s bodies, but their parents’ ones as well since pollutants can act as allergens and sensitizing agents. Our research goal was to examine influence exerted by parents’ pre-gestation exposure to chemicals on sensitization among teenagers living in an area where ambient air was contaminated. We examined overall immunoglobulin E contents and leukocytes migration inhibition test with formaldehyde and sodium nitrite in 115 teenagers whose parents worked under adverse working conditions at chemical and petrochemical enterprises and in 244 schoolchildren whose parents didn’t have any occupational contacts with chemicals. Each group was divided into sub-groups depending on inhalation chemical burden on schoolchildren’s bodies caused by ambient air contamination and contaminated air indoors (with hazard index (HI) for immune disorders being lower than 2 and HI≥2). The research allowed establishing that teenagers whose parents had worked at chemical and petrochemical enterprises during a pre-gestation period had elevated IgE contents more frequently as well as changes in leukocytes migration inhibition test with formaldehyde; it indicated there was sensitization to this chemical. Parents’ occupational contacts with chemicals led to an increase in relative risks of elevated igE contents and 2.5 times higher sensitization among schoolchildren with HI<2. Risk that sensitization to formaldehyde might occur was equal to 2.3 among senior schoolchildren with HI≥2 whose parents worked at chemical enterprises.

Idiopathic anaphylaxis: Diagnosis and management

2021 ◽  
Vol 42 (6) ◽  
pp. 481-488 ◽  
Author(s):  
Alyssa G. Burrows ◽  
Anne K. Ellis
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Treatment Options ◽  
Serum Tryptase ◽  
Genetic Trait ◽  
Baseline Serum ◽  
Diagnostic Technologies ◽  
Term Management ◽  
Idiopathic Anaphylaxis

Introduction: Idiopathic anaphylaxis (IA) is a diagnosis of exclusion and is based on the inability to identify a causal relationship between a trigger and an anaphylactic event, despite a detailed patient history and careful diagnostic assessment. The prevalence of IA among the subset of people who experienced anaphylaxis is challenging to estimate and varies widely, from 10 to 60%; most commonly noted is ∼20% in the adult anaphylactic population. Comorbid atopic conditions, such as food allergy, allergic rhinitis, and asthma, are present in up to 48% of patients with IA. Improved diagnostic technologies and an increased understanding of conditions that manifest with symptoms associated with anaphylaxis have improved the ability to determine a more accurate diagnosis for patients who may have been initially diagnosed with IA. Methods: Literature search was conducted on PubMed, Google Scholar and Embase. Results: Galactose-α-1,3-galactose (α-gal) allergy, mast cell disorders, and hereditary a-tryptasemia are a few differential diagnoses that should be considered in patients with IA. Unlike food allergy, when anaphylaxis occurs within minutes to 2 hours after allergen consumption, α-gal allergy is a 3‐6-hour delayed immunoglobulin E‐mediated anaphylactic reaction to a carbohydrate epitope found in red meat (e.g., beef, lamb, pork). The more recently described hereditary α-tryptasemia is an inherited autosomal dominant genetic trait caused by increased germline copies of tryptase human gene alpha-beta 1 (TPSAB1), which encodes α tryptase and is associated with elevated baseline serum tryptase. Acute management of IA consists of carrying an epinephrine autoinjector to be administered immediately at the first signs of anaphylaxis. Long-term management for IA with antihistamines and other agents aims to potentially reduce the frequency and severity of the anaphylactic reactions, although the evidence is limited. Biologics are potentially steroid-sparing for patients with IA; however, more research on IA therapies is needed. Conclusion: The lack of diagnostic criteria, finite treatment options, and intricacies of making a differential diagnosis make IA challenging for patients and clinicians to manage.

scholarly journals Immunological Factors Associated with Adult Asthma in the Aseer Region, Southwestern Saudi Arabia

2019 ◽  
Vol 16 (14) ◽  
pp. 2495 ◽  
Author(s):  
Al-Ghamdi ◽  
Koshak ◽  
Omer ◽  
Awadalla ◽  
Mahfouz ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Bronchial Asthma ◽  
Immunoglobulin E ◽  
Environmental Control ◽  
Complete Blood Count ◽  
Control Measures ◽  
House Dust Mites ◽  
Factors Associated ◽  
Immunological Factors ◽  
Age And Sex

Background: The prevalence of asthma is on the rise in Saudi Arabia. Data regarding the immunological profile of asthma in adults in the Aseer region, in southwestern Saudi Arabia, have not been well studied. Objectives: Our aim was to study the immunological factors associated with sensitization to asthma among adults in the Aseer region. Methods: A cross-sectional study with a nested case control design in a 1:1 ratio was conducted on a sample of adults attending primary health care centers in the Aseer region. The study used a validated Arabic version of the International study of asthma and allergies in childhood (ISAAC) questionnaire. The presence of wheezing in the past 12 months was used as a proxy for bronchial asthma. Matched age and sex controls were selected. Both groups were tested for complete blood count (CBC), total and differential white blood cell (WBC) count including eosinophils, total immunoglobulin E (IgE) measurement, allergen-specific immunoglobulin E (IgE), and cytokine levels. Results: The present study included 110 cases and 157 age- and sex-matched controls. Rye wheat was found to be a significant outdoor sensitizing agent ((odds ratio) OR = 5.23, 95% CI: 1.06–25.69). Indoors, house dust mites Dermatophagoides petronyssinus (OR = 2.04, 95% CI: 1.04–3.99) and Dermatophagoides farinae (OR = 2.50, 95% CI: 1.09–5.75) were significant. Higher total IgE (OR = 1.84, 95% CI: 1.10–3.06) and eosinophil levels (OR = 2.85, 95% CI: 1.14–7.15) were significantly associated with adult bronchial asthma in Aseer. On the other hand, the role of cytokines was not significant. Conclusions: In the present study, certain environmental agents were found to be important with regards to sensitization to bronchial asthma in adults. Knowledge about these sensitization agents should be disseminated to health providers and treating physicians in order to enhance preventive environmental control measures and asthma management. Asthma-treating physicians in the region should be alerted to the use of targeted biological therapies in selected asthmatics with difficult-to-control courses.

scholarly journals Glucocorticoid-Responsive Cold Agglutinin Disease in a Patient with Rheumatoid Arthritis

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Kyoko Honne ◽  
Takao Nagashima ◽  
Masahiro Iwamoto ◽  
Toyomi Kamesaki ◽  
Seiji Minota
Keyword(s):  
Rheumatoid Arthritis ◽  
Bovine Serum Albumin ◽  
Serum Albumin ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Bovine Serum ◽  
Cold Agglutinin ◽  
Cold Agglutinin Disease ◽  
Cold Agglutinins ◽  
Thermal Amplitude

A 57-year-old man with rheumatoid arthritis developed severe anemia during treatment with adalimumab plus methotrexate. Cold agglutinin disease was diagnosed because haptoglobin was undetectable, cold agglutinin was positive (1 : 2048), and the direct Coombs test was positive (only to complement). Although the cold agglutinin titer was normalized (1 : 64) after treatment with prednisolone (0.7 mg/kg/day for two weeks), the patient’s hemoglobin did not increase above 8 g/dL. When cold agglutinins were reexamined using red blood cells suspended in bovine serum albumin, the titer was still positive at 1 : 1024. Furthermore, the cold agglutinin had a wide thermal amplitude, since the titer was 1 : 16 at 30°C and 1 : 1 at 37°C. This suggested that the cold agglutinin would show pathogenicity even at body temperature. After the dose of prednisolone was increased to 1 mg/kg/day, the patient’s hemoglobin rapidly returned to the normal range. The thermal amplitude test using red blood cells suspended in bovine serum albumin is more sensitive than the standard test for detecting pathogenic cold agglutinins.

scholarly journals The Unitary Nature of "Complete" and "Incomplete" Pathologic Cold Hemagglutinins

Blood ◽  
1962 ◽  
Vol 19 (3) ◽  
pp. 379-398 ◽  
Author(s):  
JOHN P. LEDDY ◽  
NORMA C. TRABOLD ◽  
JOHN H. VAUGHAN ◽  
SCOTT N. SWISHER
Keyword(s):  
Anion Exchange Chromatography ◽  
Exchange Chromatography ◽  
Cold Agglutinin ◽  
Complement Components ◽  
Cold Agglutinins ◽  
Zone Electrophoresis ◽  
Human Sera ◽  
Normal Human ◽  
Physicochemical Methods ◽  
Reduced Activity

Abstract Several human pathologic sera containing high titered cold agglutinins were studied to determine whether the serologic activity ascribed to an "incomplete cold antibody" could be separated from the "complete" cold agglutinin activity. Separation was not achieved by physicochemical methods, including zone electrophoresis, density gradient ultracentrifugation, and anion exchange chromatography. Both activities were susceptible to destruction by mercaptans. Neither activity could be differentially absorbed from the sera. Using "Bombay" and I-negative ("i") red cells, a difference in specificity of the two activities for the H or I antigen of human erythrocytes could not be demonstrated. The simplest interpretation of these findings is that there is only one antibody involved, the cold agglutinin, and that the serologic manifestation usually attributed to an additional "incomplete cold antibody", i.e. the production of a positive antiglobulin reaction of the "non-γ-globulin" type, results from an interaction of complement components with the cold agglutinin-erythrocyte complex. Three of these cold agglutinating sera were unreactive with I-negative erythrocytes, in keeping with the reported anti-I specificity of these antibodies. A fourth serum retained moderate, though greatly reduced, activity against these cells, and the interpretation of this finding is discussed. The anti-H specificity of the incomplete cold antibodies in normal human sera was confirmed by their failure to sensitize "Bombay" erythrocytes. This was in sharp contrast to the excellent reactivity of the pathologic sera with these cells, demonstrating that pathologic cold agglutinins are unrelated to the incomplete cold antibodies present in most normal sera.

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