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Superior vena cava (SVC) syndrome: A differential diagnosis not to be forgotten by an allergist
Abstracts S247
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
983
Pericarpium Zanthoxyli—a New Food Allergen
H. Li, H. Zhang; Allergy department, Peking Union Medical College Hospital, Beijing, CHINA. RATIONALE: Pericarpium Zanthoxyli is the fruit of zanthoxylum bungeanum Maxim., which is belong to zanthoxylum Linn.(Genus), Rutaceae (family). It is an ingredient of the famous Chinese “five spices” mixture. It has other common names: Pricklyash peel, Hua chiao, Szechuan pepper, etc. It’s widely used as a condiment in Chinese dishes, but to date there have been no report on allergy to Pericarpium Zanthoxyli. METHODS: One subject with allergy to Pericarpium Zanthoxyli was confirmed by a clear history of systemic allergic reaction, skin prick test, specific IgE (CAP System, Pharmacia). SDS-PAGE for the peel and seed of Pericarpium Zanthoxyli was performed. RESULTS: One fifty-year-old female subject had experienced four times allergic anaphylaxis after ingestion foods containing Pericarpium Zanthoxyli and recovered by emergency treatment . IgE specific for the seed of Pericarpium Zanthoxyli was 23.7kUa/L, and 0.35 kUa/L for the peel of Pericarpium Zanthoxyli. In the seed SDS-PAGE, five protein-abundant bands were found, while only one protein-less band was found in the peel SDS-PAGE. CONCLUSIONS: Pericarpium Zanthoxyli should be considered as a possible source for causing allergic anaphylaxis. The main allergenic components comes from the seed of Pericarpium Zanthoxyli.
Superior Vena Cava (SVC) Syndrome: A Differential Diagnosis Not to Be Forgotten by an Allergist R. Dworski, S. Marney, Jr.; Vanderbilt University, Nashville, TN. RATIONALE: Patients with facial edema are frequently consulted by allergists. Differential diagnosis of this condition should include not only diverse allergic, immunologic and inflammatory conditions, but also infections, malignancies, neuropathies, vascular disorders, trauma, and other pathologies. METHODS: A patient with facial and neck edema referred to allergy clinic. RESULTS: A 48 year old female with allergic rhinitis, asthma, chronic sinusitis and common variable immunodeficiency developed edema of her face and neck associated with mild dysphagia, dyspnea, and chest pain. She also had Bartter’s syndrome and had had a longstanding history of multiple central venous catheters used for supplementation of potassium. Her physical examination revealed mild facial and neck edema without erythema or tenderness, slightly prominent neck and upper chest veins, clear lungs and heart, and intact left Porta-A-Cath. She underwent venogram and CT of the chest that showed stenosis of the SVC and both subclavian veins, and neck collaterals. A thrombolysis and balloon angioplasty of her SVC was performed followed by another dilatation attempt few moths later. Her condition significantly improved over the next several months probably due to both therapeutic interventions and spontaneous enlargement of venous collaterals. CONCLUSIONS: The SVC syndrome usually develops gradually. Acute disease may cause dramatic dyspnea, edema, flushing, and cyanosis. A primary lung carcinoma is the underlying cause in approximately 85% of cases. Other etiologies include lymphomas, tumors, fibrosing mediastinitis, stenosis after multiple central venous catheterization, aneurysm of the ascending aorta, and infections. A prompt diagnosis of SVC syndrome is essential to avoid life threatening complications.
984
985
Role of Penicillium Molds in Three Cases of Food Allergy
M. Lombardero1, C. Díaz-Donado2, B. Añibarro3, M. Á. Núñez4, D. Barber1; 1ALK-Abelló, S.A., Madrid, SPAIN, 2Hospital Comarcal del Bierzo, Ponferrada, SPAIN, 3Hospital Severo Ochoa, Leganés, SPAIN, 4Hospital Central de la Defensa, Madrid, SPAIN. RATIONALE: Molds are present, as additives or even pollutants, in several foods. We described 3 cases of food allergy probably caused by Penicillium molds. METHODS: Patients referred allergic symptoms after ingestion of dry sausage (fuet) or ham (patient 1), after eating fuet or a specific rice (patient 2), or after ingestion of fuet, sheep cheese or pork (patient 3). A microbiological study of samples of white dust from the sausage casings and the rice that caused the allergic reaction was carried out. Skin prick tests (SPT) were performed with a standard battery of allergens, and also with sausage casings, the specific rice (patient 2), and Penicillium nalgiovense mycelium extract. IgE-immunoblotting was performed with the patients’ serum after SDS-PAGE. RESULTS: All patients had a positive SPT response to sausage casings and P. nalgiovense extract. Patient 2 also had a positive response to the rice that caused the symptoms, but not to other rice. The microbiological study disclosed the presence of the mold P. nalgiovense in the samples of the sausage casings, and several Aspergillus and mainly Penicillium species in the rice that caused the symptoms to patient 2. IgEimmunoblotting of P. nalgiovense extract revealed the presence of serum IgE against several protein bands (range 15-100 kDa) in patients 1 and 3, and against a band of about 55 kDa in patient 2. CONCLUSIONS: Penicillium molds used as additives in highly consumed products (i.e. processed cold meat) or present as pollutants in some foods could act as hidden allergens and explain some cases of food allergy. Funding: ALK-Abelló, S.A.
TUESDAY
French Allergovigilance Network Report About Severe Anaphylactic Reactions to Foods From 2001 To 2004 D. Moneret-Vautrin1, M. Morisset1, L. Parisot1, G. Kanny1, +. other members of the Allergovigilance Network2; 1Department of Internal Medecine, Clinical Immunology and Allergology, University Hospital, Nancy, FRANCE, 2the Allergovigilance Network, (including allergol. from Benelux, maghreb...), FRANCE. RATIONALE: The increased prevalence of food allergies points to the need of an Allergovigilance Network, created since January 2001. The main objectives are to index the cases of lethal or prelethal anaphylaxis and to evaluate the risk of new foods. METHODS: The network is composed of 330 trained allergologists. Around 80 declared severe anaphylaxis cases: anaphylactic shocks (AS), laryngeal angioedema, severe acute asthma. RESULTS: From January 2001 to June 2004, the register encloses 254 cases (78 children and 176 adults): 3 cases of lethal anaphylaxis have been recorded. The most important allergens were peanut (11, 5%), tree nuts (15,5%), other Legumes (12% including lupine 6%), latex cross-reacting foods (9,5%), wheat (6%) and celery (4%). Anaphylaxis to crustaceans (10% including shrimps 8%) and mollusks (7,5% including snails 6%) are especially observed in patients allergic to dust mites. The major associated risk factors were exercise (13%) and alcohol (7%). Wheat is the main allergen in exercise-induced anaphylaxis. If peanuts and tree nuts are the first cause of food anaphylaxis in France, they are not as important as in USA, concerning only 27.5 %. The incriminated foods are extraordinarily various, reflecting the French gastronomic habits. 5 AS (including 1 death) were attributed to masked peanut in macaroons. Declaration of lupine is not required according to the new European Community food labelling legislation, even though the main cause of masked food anaphylaxis. CONCLUSIONS: This Allergovigilance Network provides helpful data, especially for the National Agency for Safety of Foods and the French Customs and Frauds Authorities.
982
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
983
Pericarpium Zanthoxyli—a New Food Allergen
H. Li, H. Zhang; Allergy department, Peking Union Medical College Hospital, Beijing, CHINA. RATIONALE: Pericarpium Zanthoxyli is the fruit of zanthoxylum bungeanum Maxim., which is belong to zanthoxylum Linn.(Genus), Rutaceae (family). It is an ingredient of the famous Chinese “five spices” mixture. It has other common names: Pricklyash peel, Hua chiao, Szechuan pepper, etc. It’s widely used as a condiment in Chinese dishes, but to date there have been no report on allergy to Pericarpium Zanthoxyli. METHODS: One subject with allergy to Pericarpium Zanthoxyli was confirmed by a clear history of systemic allergic reaction, skin prick test, specific IgE (CAP System, Pharmacia). SDS-PAGE for the peel and seed of Pericarpium Zanthoxyli was performed. RESULTS: One fifty-year-old female subject had experienced four times allergic anaphylaxis after ingestion foods containing Pericarpium Zanthoxyli and recovered by emergency treatment . IgE specific for the seed of Pericarpium Zanthoxyli was 23.7kUa/L, and 0.35 kUa/L for the peel of Pericarpium Zanthoxyli. In the seed SDS-PAGE, five protein-abundant bands were found, while only one protein-less band was found in the peel SDS-PAGE. CONCLUSIONS: Pericarpium Zanthoxyli should be considered as a possible source for causing allergic anaphylaxis. The main allergenic components comes from the seed of Pericarpium Zanthoxyli.
Superior Vena Cava (SVC) Syndrome: A Differential Diagnosis Not to Be Forgotten by an Allergist R. Dworski, S. Marney, Jr.; Vanderbilt University, Nashville, TN. RATIONALE: Patients with facial edema are frequently consulted by allergists. Differential diagnosis of this condition should include not only diverse allergic, immunologic and inflammatory conditions, but also infections, malignancies, neuropathies, vascular disorders, trauma, and other pathologies. METHODS: A patient with facial and neck edema referred to allergy clinic. RESULTS: A 48 year old female with allergic rhinitis, asthma, chronic sinusitis and common variable immunodeficiency developed edema of her face and neck associated with mild dysphagia, dyspnea, and chest pain. She also had Bartter’s syndrome and had had a longstanding history of multiple central venous catheters used for supplementation of potassium. Her physical examination revealed mild facial and neck edema without erythema or tenderness, slightly prominent neck and upper chest veins, clear lungs and heart, and intact left Porta-A-Cath. She underwent venogram and CT of the chest that showed stenosis of the SVC and both subclavian veins, and neck collaterals. A thrombolysis and balloon angioplasty of her SVC was performed followed by another dilatation attempt few moths later. Her condition significantly improved over the next several months probably due to both therapeutic interventions and spontaneous enlargement of venous collaterals. CONCLUSIONS: The SVC syndrome usually develops gradually. Acute disease may cause dramatic dyspnea, edema, flushing, and cyanosis. A primary lung carcinoma is the underlying cause in approximately 85% of cases. Other etiologies include lymphomas, tumors, fibrosing mediastinitis, stenosis after multiple central venous catheterization, aneurysm of the ascending aorta, and infections. A prompt diagnosis of SVC syndrome is essential to avoid life threatening complications.
984
985
Role of Penicillium Molds in Three Cases of Food Allergy
M. Lombardero1, C. Díaz-Donado2, B. Añibarro3, M. Á. Núñez4, D. Barber1; 1ALK-Abelló, S.A., Madrid, SPAIN, 2Hospital Comarcal del Bierzo, Ponferrada, SPAIN, 3Hospital Severo Ochoa, Leganés, SPAIN, 4Hospital Central de la Defensa, Madrid, SPAIN. RATIONALE: Molds are present, as additives or even pollutants, in several foods. We described 3 cases of food allergy probably caused by Penicillium molds. METHODS: Patients referred allergic symptoms after ingestion of dry sausage (fuet) or ham (patient 1), after eating fuet or a specific rice (patient 2), or after ingestion of fuet, sheep cheese or pork (patient 3). A microbiological study of samples of white dust from the sausage casings and the rice that caused the allergic reaction was carried out. Skin prick tests (SPT) were performed with a standard battery of allergens, and also with sausage casings, the specific rice (patient 2), and Penicillium nalgiovense mycelium extract. IgE-immunoblotting was performed with the patients’ serum after SDS-PAGE. RESULTS: All patients had a positive SPT response to sausage casings and P. nalgiovense extract. Patient 2 also had a positive response to the rice that caused the symptoms, but not to other rice. The microbiological study disclosed the presence of the mold P. nalgiovense in the samples of the sausage casings, and several Aspergillus and mainly Penicillium species in the rice that caused the symptoms to patient 2. IgEimmunoblotting of P. nalgiovense extract revealed the presence of serum IgE against several protein bands (range 15-100 kDa) in patients 1 and 3, and against a band of about 55 kDa in patient 2. CONCLUSIONS: Penicillium molds used as additives in highly consumed products (i.e. processed cold meat) or present as pollutants in some foods could act as hidden allergens and explain some cases of food allergy. Funding: ALK-Abelló, S.A.
TUESDAY
French Allergovigilance Network Report About Severe Anaphylactic Reactions to Foods From 2001 To 2004 D. Moneret-Vautrin1, M. Morisset1, L. Parisot1, G. Kanny1, +. other members of the Allergovigilance Network2; 1Department of Internal Medecine, Clinical Immunology and Allergology, University Hospital, Nancy, FRANCE, 2the Allergovigilance Network, (including allergol. from Benelux, maghreb...), FRANCE. RATIONALE: The increased prevalence of food allergies points to the need of an Allergovigilance Network, created since January 2001. The main objectives are to index the cases of lethal or prelethal anaphylaxis and to evaluate the risk of new foods. METHODS: The network is composed of 330 trained allergologists. Around 80 declared severe anaphylaxis cases: anaphylactic shocks (AS), laryngeal angioedema, severe acute asthma. RESULTS: From January 2001 to June 2004, the register encloses 254 cases (78 children and 176 adults): 3 cases of lethal anaphylaxis have been recorded. The most important allergens were peanut (11, 5%), tree nuts (15,5%), other Legumes (12% including lupine 6%), latex cross-reacting foods (9,5%), wheat (6%) and celery (4%). Anaphylaxis to crustaceans (10% including shrimps 8%) and mollusks (7,5% including snails 6%) are especially observed in patients allergic to dust mites. The major associated risk factors were exercise (13%) and alcohol (7%). Wheat is the main allergen in exercise-induced anaphylaxis. If peanuts and tree nuts are the first cause of food anaphylaxis in France, they are not as important as in USA, concerning only 27.5 %. The incriminated foods are extraordinarily various, reflecting the French gastronomic habits. 5 AS (including 1 death) were attributed to masked peanut in macaroons. Declaration of lupine is not required according to the new European Community food labelling legislation, even though the main cause of masked food anaphylaxis. CONCLUSIONS: This Allergovigilance Network provides helpful data, especially for the National Agency for Safety of Foods and the French Customs and Frauds Authorities.
982