Food allergy symptoms usually involve nausea and diarrhea, regardless of whether the allergen has been cooked or not. However, oral allergy syndrome is a specific type of reaction that causes tingling in the lips, tongue, and mouth after consuming raw plant foods like spinach or apples. This reaction doesn’t occur when the food is cooked. Patients with this syndrome often have a history of atopic diseases like asthma. Anaphylaxis, on the other hand, presents with wheezing, hives, low blood pressure, and even collapse. Angioedema, which is swelling of the upper airway’s submucosa, is usually caused by ACE inhibitors or C1-esterase inhibitor deficiency and may be accompanied by urticaria.

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.

Please find below the recommended doses of adrenaline for Adult Life Support (ALS) in different scenarios:

– Anaphylaxis: 0.5mg or 0.5ml of 1:1,000 adrenaline should be administered intramuscularly.
– Cardiac arrest: For intravenous administration, 1 mg or 10ml of 1:10,000 adrenaline or 1 ml of 1:1000 adrenaline is recommended.

Understanding Adrenaline and Its Effects on the Body

Adrenaline is a hormone that is responsible for the body’s fight or flight response. It is released by the adrenal glands and acts on both alpha and beta adrenergic receptors. Adrenaline has various effects on the body, including increasing cardiac output and total peripheral resistance, causing vasoconstriction in the skin and kidneys, and stimulating glycogenolysis and glycolysis in the liver and muscle.

Adrenaline also has different actions on alpha and beta adrenergic receptors. It inhibits insulin secretion by the pancreas and stimulates glycogenolysis in the liver and muscle through alpha receptors. On the other hand, it stimulates glucagon secretion in the pancreas, ACTH, and lipolysis by adipose tissue through beta receptors. Adrenaline also acts on beta 2 receptors in skeletal muscle vessels, causing vasodilation.

Adrenaline is used in emergency situations such as anaphylaxis and cardiac arrest. The recommended adult life support adrenaline doses for anaphylaxis are 0.5ml 1:1,000 IM, while for cardiac arrest, it is 10ml 1:10,000 IV or 1 ml of 1:1000 IV. However, accidental injection of adrenaline can occur, and in such cases, local infiltration of phentolamine is recommended.

In conclusion, adrenaline is a hormone that plays a crucial role in the body’s response to stress. It has various effects on the body, including increasing cardiac output and total peripheral resistance, causing vasoconstriction in the skin and kidneys, and stimulating glycogenolysis and glycolysis in the liver and muscle. Adrenaline is used in emergency situations such as anaphylaxis and cardiac arrest, and accidental injection can be managed through local infiltration of phentolamine.

The patient is at high risk for tuberculosis (TB) due to his unemployment, living in a deprived area, and having diabetes. His symptoms, including a persistent cough with blood, shortness of breath, weight loss, and fatigue, suggest active TB. To diagnose TB, multiple sputum samples should be sent for analysis and a chest X-ray (CXR) should be performed urgently. A Mantoux test is not necessary in a symptomatic individual like this. A blood serology test for TB is not the recommended first-line investigation. A CT scan of the chest is not the first-line test for TB. The patient doesn’t meet the criteria for an urgent referral for suspected cancer, but if he were over 40 years of age, he would meet criteria for a CXR to look for lung cancer. However, even if he were over 40 years of age, his clinical picture with risk factors would still warrant sending sputum samples and arranging a CXR. The role of primary care is to make the diagnosis and refer the patient promptly for appropriate management and contact tracing.

Understanding Common Variable Immunodeficiency: Prevalence, Diagnosis, and Delayed Treatment

Common variable immunodeficiency (CVID) is the most prevalent primary antibody deficiency, affecting approximately 1 in 25,000 individuals. However, due to its rarity, only a small fraction of healthcare professionals will encounter a patient with CVID during their career. This, coupled with a delay in diagnosis, increases the risk of irreversible lung damage and bronchiectasis.

Defects in humoral immunity account for 50% of primary immunodeficiencies, with combined humoral and cellular deficiencies making up 20-30% of cases. Inherited single-gene disorders are the most common cause of primary immune deficiencies. While many of these defects present in infancy and childhood, CVID typically presents after the age of five, with a peak in the second or third decade of life.

A diagnosis of CVID is based on defective functional antibody formation, accompanied by decreased serum immunoglobulin levels (IgG and IgA), generally decreased serum IgM, and exclusion of other known causes of antibody deficiency. Identifying defective functional antibody formation may involve measuring the response to a vaccine such as the pneumococcal vaccine.

Overall, understanding the prevalence, diagnosis, and delayed treatment of CVID is crucial in providing appropriate care for individuals with this rare but potentially debilitating condition.

Administering Adrenaline: Dosage and Site of Injection

When administering adrenaline, it is recommended to inject it intramuscularly in the anterolateral aspect of the middle third of the thigh. This site is considered safe, easy, and effective. The standard adult dose is 0.5 ml 1:1000, while children aged 6-12 years should receive 0.3 ml. For younger children, the dose varies from 0.15 ml for those aged 6 months to 6 years, and 0.1-0.15 ml for infants younger than 6 months. If there is no improvement after 5 minutes, a repeat dose of intramuscular adrenaline may be necessary. In some cases, patients may require intravenous adrenaline, which should only be administered by trained and experienced medical professionals such as anaesthetists and A&E consultants.

Being mindful of contraindications for the influenza vaccine is crucial. The presence of ovalbumin, an egg protein, in the regular influenza vaccine may lead to anaphylaxis in individuals with a severe egg allergy. To address this concern, egg protein-free vaccines such as Optaflu are accessible for these patients.

influenza vaccination is recommended in the UK between September and early November, as the influenza season typically starts in the middle of November. There are three types of influenza virus, with types A and B accounting for the majority of clinical disease. Prior to 2013, flu vaccination was only offered to the elderly and at-risk groups. However, a new NHS influenza vaccination programme for children was announced in 2013, with the children’s vaccine given intranasally and annually after the first dose at 2-3 years. It is important to note that the type of vaccine given to children and the one given to the elderly and at-risk groups is different, which explains the different contraindications.

For adults and at-risk groups, current vaccines are trivalent and consist of two subtypes of influenza A and one subtype of influenza B. The Department of Health recommends annual influenza vaccination for all people older than 65 years and those older than 6 months with chronic respiratory, heart, kidney, liver, neurological disease, diabetes mellitus, immunosuppression, asplenia or splenic dysfunction, or a body mass index >= 40 kg/m². Other at-risk individuals include health and social care staff, those living in long-stay residential care homes, and carers of the elderly or disabled person whose welfare may be at risk if the carer becomes ill.

The influenza vaccine is an inactivated vaccine that cannot cause influenza, but a minority of patients may develop fever and malaise that lasts 1-2 days. It should be stored between +2 and +8ºC and shielded from light, and contraindications include hypersensitivity to egg protein. In adults, the vaccination is around 75% effective, although this figure decreases in the elderly. It takes around 10-14 days after immunisation before antibody levels are at protective levels.

Myth-busting Facts about Pediatric Liver Transplantation

Pediatric liver transplantation is a complex medical procedure that involves replacing a diseased liver with a healthy one from a donor. However, there are several misconceptions surrounding this life-saving surgery. Here are some myth-busting facts about pediatric liver transplantation:

– The donor must be tested for hepatitis B and C: A potential living donor with antibodies to hepatitis B and C would usually be ruled out as a donor.
– HLA matching is necessary for kidney, heart, and lung transplants, but not for liver transplants: Blood-group compatibility is necessary, and a relative is more likely to be a match.
– Immunosuppression is usually required for life, not just 12 months after transplant: While the regimen can be reduced with time, complete withdrawal is only successful in a small number of individuals.
– Prednisolone is not the only immunosuppressant needed after transplant: A combination of drugs, including prednisolone, ciclosporin, tacrolimus, mycophenolate mofetil, azathioprine, and sirolimus, are commonly used.
– Survival at one year after liver transplantation is higher than 50% in children: One-year survival is 80% for all children transplanted and may reach 90% for children with biliary atresia.

It is important to dispel these myths and provide accurate information about pediatric liver transplantation to help families make informed decisions about their child’s health.

Managing Seasonal Allergic Rhinitis: Tips for Reducing Pollen Exposure

Seasonal allergic rhinitis is a condition where the nasal mucosa becomes sensitized to allergens, such as pollen, causing inflammation and symptoms like sneezing, runny nose, and itchy eyes. To reduce pollen exposure, the National Institute for Health and Care Excellence (NICE) recommends avoiding drying laundry outdoors when pollen counts are high. Showering and washing hair after potential exposure can also help alleviate symptoms. While the tree pollen season can start as early as March, there is no need to eat locally produced honey or resort to ineffective nasal irrigation with saline. By following these simple tips, individuals with seasonal allergic rhinitis can better manage their symptoms and improve their quality of life.

Common Allergic and Non-Allergic Conditions: Causes and Differences

Seasonal rhinitis, atopic eczema, chronic urticaria, lactose intolerance, and coeliac disease are common conditions that can cause discomfort and distress. Understanding their causes and differences is important for proper diagnosis and treatment.

Seasonal rhinitis, also known as hay fever, is caused by allergens such as tree pollen, grass, mould spores, and weeds. It is an IgE-mediated reaction that occurs at certain times of the year.

Atopic eczema can be aggravated by dietary factors in some children, but less frequently in adults. Food allergy should be suspected in children who have immediate reactions to food or infants with moderate or severe eczema that is not well-controlled.

Chronic urticaria may have an immunological or autoimmune cause, but can also be idiopathic or caused by physical factors, drugs, or dietary pseudo allergens. It presents with a rash.

Lactose intolerance is due to an enzyme deficiency and is different from milk allergy, which is IgE-mediated. It can occur following gastroenteritis.

Coeliac disease is an autoimmune condition that affects the small intestine in response to gluten exposure. It is not a gluten allergy.

Detecting latent tuberculosis is crucial in controlling the disease, as up to 15% of adults with latent tuberculosis may develop active disease, and the risk may be even higher in children. In immunocompromised individuals, such as those who are HIV positive, the chance of developing active disease within 5 years of latent infection is up to 50%. The Mantoux test is a method of detecting previous exposure to the tuberculosis organism or BCG vaccination by causing a cell-mediated immune reaction. The interpretation of the test depends on factors such as BCG vaccination history, immune status, and concurrent viral infection. While a negative test in HIV-positive patients doesn’t exclude tuberculosis, a positive test at certain thresholds can indicate the need for treatment of latent tuberculosis. Indeterminate results may require further evaluation by a specialist. The use of IGT as a surrogate marker of infection can be useful in evaluating latent tuberculosis in BCG-vaccinated individuals, but it cannot distinguish between latent infection and active disease. NICE recommends different testing strategies based on age and risk factors, but the benefits of IGT over the Mantoux test in determining the need for treatment of latent tuberculosis are not certain. In children under 5 years, a positive test requires referral to a specialist to exclude active disease and consideration of treatment of latent tuberculosis.