Pertussis Vaccine Information

Most combined vaccine formulations for pertussis contain neomycin. However, the only reason an individual cannot receive the vaccine is if they have an anaphylactic reaction. Boostrix-IPV is an inactivated vaccine that will not be affected by anti-D treatment. Even if a pregnant woman has a feverish illness or suspected whooping cough, the pertussis vaccine should still be offered to provide optimal antibody levels for the baby. Evidence shows that immunization during pregnancy can increase pertussis antibodies in breast milk, potentially protecting the baby from the illness. However, this doesn’t replace the need for the infant to complete the recommended primary immunization schedule.

Hyposensitisation: Gradual Exposure to Allergens for Allergy Treatment

Hyposensitisation, also known as immunotherapy, is a treatment that involves gradually exposing a patient to increasing amounts of an allergen to reduce or eliminate their allergic response. The British National Formulary recommends this treatment for seasonal allergic hay fever and hypersensitivity to wasp and bee venoms that have not responded to anti-allergic drugs. However, it should be used with caution in patients with asthma.

The treatment typically lasts four weeks and can be administered through different dosing schedules, including conventional, modified rush, and rush. In a conventional schedule, injections are given weekly for 12 weeks, with the interval increasing stepwise to two, three, then four weeks. Maintenance treatment is then continued four weekly for at least three years.

Immunotherapy is recommended for patients with a history of severe systemic reactions or moderate systemic reactions with additional risk factors, such as a high serum tryptase or a high risk of stings, or whose quality of life is reduced by fear of venom allergy. Skin testing can be done, and measuring allergen-specific immunoglobulin E (IgE) antibodies is less sensitive.

Patients need referral to an immunotherapy specialist, and injections can be self-administered at home. However, a healthcare professional who can recognize and treat anaphylaxis should be present at the time of injection, and cardiopulmonary resuscitation facilities should be available. The patient should be observed for one hour after injection, and any symptoms, even if mild, need to be monitored until they resolve.

While local or systemic reactions may occur, including anaphylaxis, major side-effects are not a significant risk. However, risks are higher in people with asthma. Overall, hyposensitisation can be an effective treatment for allergies that have not responded to other therapies.

Oral allergy syndrome is closely associated with pollen allergies and exhibits seasonal fluctuations. It occurs when allergens in certain foods cross-react with pollens, causing the body to react to the food proteins as if they were pollen. This results in a localized reaction around the mouth, such as an itchy mouth or throat, and sometimes hives. As the patient experiences symptoms with various fruits, it is not a pure kiwi allergy. Urticaria is characterized by an itchy rash triggered by an allergen, but there is no mention of a rash in this case. Anaphylaxis is a severe allergic reaction that causes swelling of the throat and tongue, as well as breathing difficulties. However, since there is only mild lip swelling and no breathing difficulties, anaphylaxis is unlikely.

Understanding Oral Allergy Syndrome

Oral allergy syndrome, also known as pollen-food allergy, is a type of hypersensitivity reaction that occurs when a person with a pollen allergy eats certain raw, plant-based foods. This reaction is caused by cross-reaction with a non-food allergen, most commonly birch pollen, where the protein in the food is similar but not identical in structure to the original allergen. As a result, OAS is strongly linked with pollen allergies and presents with seasonal variation. Symptoms of OAS typically include mild tingling or itching of the lips, tongue, and mouth.

It is important to note that OAS is different from food allergies, which are caused by direct sensitivity to a protein present in food. Non-plant foods do not cause OAS because there are no cross-reactive allergens in pollen that would be structurally similar to meat. Food allergies may be caused by plant or non-plant foods and can lead to systemic symptoms such as vomiting and diarrhea, and even anaphylaxis.

OAS is a clinical diagnosis, but further tests can be used to rule out other diagnoses and confirm the diagnosis when the history is unclear. Treatment for OAS involves avoiding the culprit foods and taking oral antihistamines if symptoms develop. In severe cases, an ambulance should be called, and intramuscular adrenaline may be required.

In conclusion, understanding oral allergy syndrome is important for individuals with pollen allergies who may experience symptoms after eating certain raw, plant-based foods. By avoiding the culprit foods and seeking appropriate medical care when necessary, individuals with OAS can manage their symptoms effectively.

Understanding Skin Conditions: Causes and Mechanisms

Skin conditions can have various causes and mechanisms. Urticaria, for instance, is triggered by the release of histamine and other mediators from mast cells in the skin. While IgE-mediated type I hypersensitivity reactions are a common cause of urticaria, other immunological and non-immunological factors can also play a role.

In atopic eczema, antihistamines are not recommended as a routine treatment. However, a non-sedating antihistamine may be prescribed for a month to children with severe atopic eczema or those with mild or moderate eczema who experience severe itching or urticaria. It’s worth noting that allergies to food or environmental allergens may not be responsible for the symptoms of atopic eczema.

Contact allergic dermatitis and erythema multiforme are examples of cell-mediated immunity, and their symptoms are not caused by histamine release. On the other hand, bullous pemphigoid is an autoimmune disorder that occurs when the immune system attacks a protein that forms the junction between the epidermis and the basement membrane of the dermis.

Understanding the causes and mechanisms of different skin conditions can help in their diagnosis and treatment.

Post-Liver Transplant Patient Care: Important Considerations

Liver transplant patients require specialized care to ensure optimal outcomes. Here are some important considerations:

Encourage smoking cessation: Smoking can promote fibrosis and increase the risk of hepatoma development. Nicotine replacement therapy is a safe option.

Limit alcohol intake: For non-alcohol indications, maintaining alcohol intake below 14 units/week is appropriate to prevent significant relapse and graft damage.

Encourage exercise: Exercise can provide cardiovascular benefits and reduce the risk of osteoporosis. Strenuous exercise should be avoided for the first 12 months after transplant.

Consider statins: Pravastatin and atorvastatin are safe and effective for managing hypertriglyceridaemia following a liver transplant.

Use calcium channel blockers for hypertension: These drugs have minimal side effects and do not interact with calcineurin inhibitors like tacrolimus.

Shingles Vaccination: Who Should Get It and When?

The national shingles immunisation programme aims to reduce the incidence and severity of shingles in older people. The vaccine is recommended for routine administration to those aged 70 years, but can be given up until the 80th birthday. Vaccination is most effective and cost-effective in this age group, as the burden of shingles disease is generally more severe in older ages. The vaccine is not routinely offered below 70 years of age, as the duration of protection is not known to last more than ten years and the need for a second dose is not known.

Zostavax® is the only shingles vaccine available in the UK, and is contraindicated in immunosuppressed individuals. Previous shingles is also a contraindication, as there is a natural boosting of antibody levels after an attack of shingles.

Clinical trials have shown that the vaccine reduces the incidence of shingles and post-herpetic neuralgia in those aged 60 and 70 years and older. However, it is important to note that the vaccine is only effective in reducing neuralgia.

In summary, the shingles vaccine is recommended for routine administration to those aged 70 years, but can be given up until the 80th birthday. It is contraindicated in immunosuppressed individuals and those with a history of shingles. While the vaccine is effective in reducing neuralgia, it is not a guarantee against shingles.

Understanding Oral Allergy Syndrome

Oral allergy syndrome, also known as pollen-food allergy, is a type of hypersensitivity reaction that occurs when a person with a pollen allergy eats certain raw, plant-based foods. This reaction is caused by cross-reaction with a non-food allergen, most commonly birch pollen, where the protein in the food is similar but not identical in structure to the original allergen. As a result, OAS is strongly linked with pollen allergies and presents with seasonal variation. Symptoms of OAS typically include mild tingling or itching of the lips, tongue, and mouth.

It is important to note that OAS is different from food allergies, which are caused by direct sensitivity to a protein present in food. Non-plant foods do not cause OAS because there are no cross-reactive allergens in pollen that would be structurally similar to meat. Food allergies may be caused by plant or non-plant foods and can lead to systemic symptoms such as vomiting and diarrhea, and even anaphylaxis.

OAS is a clinical diagnosis, but further tests can be used to rule out other diagnoses and confirm the diagnosis when the history is unclear. Treatment for OAS involves avoiding the culprit foods and taking oral antihistamines if symptoms develop. In severe cases, an ambulance should be called, and intramuscular adrenaline may be required.

In conclusion, understanding oral allergy syndrome is important for individuals with pollen allergies who may experience symptoms after eating certain raw, plant-based foods. By avoiding the culprit foods and seeking appropriate medical care when necessary, individuals with OAS can manage their symptoms effectively.

Managing Women’s Health after Renal Transplant: Contraception, Cancer Screening, and Vaccinations

Women who have undergone renal transplant and are of childbearing age should use effective contraception to prevent unintended pregnancy. The most effective methods include intrauterine contraceptive devices, etonogestrel implants, and depot medroxyprogesterone acetate. The latter is particularly suitable as it doesn’t interact with immunosuppressive drugs commonly used in transplant patients. While pregnancy is possible after a renal transplant, it is recommended to wait for at least a year and plan it carefully. Women should also manage their cardiovascular risk factors and keep up-to-date with vaccinations and cancer screening.

Renal transplant recipients have a higher incidence of cancer than the general population, so regular cancer screening is essential. Breast screening typically starts at 50 years, while cervical screening may not require additional tests. Warfarin is unlikely to be prescribed after a renal transplant, but if necessary, careful monitoring is required. Live vaccines, including Zostavax® shingles vaccine, should be avoided due to the risk of lower efficacy and immunosuppression. Instead, Shingrix® vaccine can be used where indicated.

Understanding Hepatitis B Test Results

Hepatitis B is a viral infection that affects the liver. Testing for hepatitis B involves checking for various antibodies and antigens in the blood. Here is a breakdown of what each result means:

Anti-HBs: This antibody indicates that a person has been vaccinated against hepatitis B.

Anti-HBsAb + anti-HBc: The presence of both antibodies suggests that a person has had a past infection with hepatitis B and is now immune.

Anti-HBeAb: This antibody indicates that a person is less infectious and is recovering from an acute infection.

HBsAg + HBcAg: The presence of both antigens suggests that a person is currently infected with hepatitis B.

Immunoglobulin M to HBcAg: The presence of this antibody indicates that a person has recently been infected with hepatitis B.

Understanding these test results can help healthcare providers diagnose and manage hepatitis B infections.

Understanding Chickenpox Serology Results in Pregnancy

Chickenpox infection during pregnancy can have serious consequences for both the mother and the fetus. Therefore, it is important to determine a woman’s immunity status before she is exposed to the virus. Serology testing can help determine if a woman has been previously infected or vaccinated against Chickenpox. Here are the possible results and their implications:

– Negative IgG and negative IgM serology: This indicates that the woman has not been previously exposed to the virus and is not immune. She should avoid exposure and receive immunoglobulin if she has significant exposure. She should also be vaccinated postpartum.
– Positive IgG and negative IgM serology: This indicates that the woman has been previously infected or vaccinated and has protective immunity against re-infection. This is the desired result if the woman has no history of Chickenpox.
– Positive IgG and positive IgM serology: This suggests recent infection, but should not be used alone to diagnose infection. Clinical presentation should also be considered. If the woman develops Chickenpox, she should receive acyclovir.
– No serology testing needed: If the woman has a definite history of Chickenpox, she is considered immune and doesn’t need serology testing.

It is important to note that a history of Chickenpox may not be a reliable predictor of immunity in women from overseas, and serology testing may be necessary. The NICE guidance on Chickenpox infection in pregnancy provides further recommendations.