Angioedema can be triggered by drug-induced reactions or, in rare cases, other factors.

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.

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.

Skin prick testing is the preferred initial approach as it is cost-effective and can assess a wide range of allergens. Although IgE testing is useful in food allergy, it is specific IgE antibodies that are measured rather than total IgE levels.

Types of Allergy Tests

Allergy tests are used to determine the specific allergens that trigger an individual’s allergic reactions. There are several types of allergy tests available, each with its own advantages and limitations. The most commonly used test is the skin prick test, which is easy to perform and inexpensive. Drops of diluted allergen are placed on the skin, and a needle is used to pierce the skin. If a patient has an allergy, a wheal will typically develop. This test is useful for food allergies and pollen allergies.

Another type of allergy test is the radioallergosorbent test (RAST), which determines the amount of IgE that reacts specifically with suspected or known allergens. Results are given in grades from 0 (negative) to 6 (strongly positive). This test is useful for food allergies, inhaled allergens (such as pollen), and wasp/bee venom.

Skin patch testing is another type of allergy test that is useful for contact dermatitis. Around 30-40 allergens are placed on the back, and irritants may also be tested for. The patches are removed 48 hours later, and the results are read by a dermatologist after a further 48 hours.

Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines. Overall, the choice of allergy test depends on the individual’s specific needs and circumstances.

Understanding Primary Antibody Deficiencies: Causes, Symptoms, and Diagnosis

Primary antibody deficiencies refer to a group of rare disorders that affect the body’s ability to produce effective antibodies against pathogens. These disorders may be caused by a mutation in a single gene or by multiple genetic factors, similar to diabetes. While primary antibody deficiencies are the most common forms of primary immune deficiency, other primary immune deficiencies involve defects in cellular immunity, phagocyte defects, and complement defects. It is important to distinguish primary antibody deficiencies from secondary immune deficiencies caused by factors such as malignancy, malnutrition, or immunosuppressive therapy.

Clinical history is crucial in identifying primary antibody deficiencies. Patients of any age who experience recurrent infections, particularly in the respiratory tract, should be investigated if the frequency or severity of infection is unusual or out of context. While most patients are under 20 years old, common variable immunodeficiency typically peaks in the second or third decade of life. A systematic review has found that respiratory and sinus infections are the most common presenting symptoms, followed by gastrointestinal and cutaneous infections. Meningitis, septic arthritis/osteomyelitis, and ophthalmic infections are much less common.

In summary, understanding primary antibody deficiencies is essential in diagnosing and managing patients with recurrent infections. Clinical history plays a crucial role in identifying these disorders, which can be caused by genetic factors and affect the body’s ability to produce effective antibodies against pathogens.

Diagnosing Food Allergies and Intolerances: Importance of Symptom History and Testing

When dealing with a potential case of food allergy or intolerance, it is crucial to gather a detailed symptom history to identify possible allergens and determine if the reaction is IgE-mediated, which could lead to anaphylaxis. Symptoms such as acute urticaria, nausea, vomiting, abdominal colic, rhinorrhea, itchy eyes, or bronchospasm with a temporal relationship to the offending item may suggest an IgE-mediated reaction. However, it is important to note that many people attribute symptoms to food that are not actually caused by it.

To support or refute the mother’s suspicions, a skin-prick test and/or blood tests for specific IgE antibodies to the suspected foods can be performed in conjunction with the symptom history. However, it is essential to remember that there have been cases of systemic reactions and anaphylaxis in food allergen skin testing, so referral is necessary in most cases.

Hay fever is typically diagnosed clinically, so a skin-prick test is unnecessary. Acute urticaria usually resolves within six weeks, so testing is also unnecessary unless the patient can identify a possible trigger. Skin-prick testing is not typically performed on asthmatics unless there is a likely precipitant that could be eliminated. For hairdressers, who are prone to both irritant and allergic contact dermatitis, patch testing would be appropriate for diagnosing delayed hypersensitivity.

Diagnosing Food Allergies and Intolerances: Importance of Symptom History and Testing

Managing Non-IgE-Mediated Cow’s’ Milk Protein Allergy in Infants

When dealing with a breastfed infant suspected of having non-IgE-mediated cows’ milk protein allergy, it is recommended to advise the mother to exclude cows’ milk from her diet for 2-6 weeks. During this period, calcium and vitamin D supplements may be prescribed to ensure the infant’s nutritional needs are met. After the exclusion period, reintroducing cows’ milk is advised to determine if it is the cause of the infant’s symptoms. If there is no improvement or the symptoms worsen, a referral to secondary care may be necessary.

For formula-fed or mixed-fed infants, replacing cow’s milk-based formula with hypoallergenic infant formulas is recommended. Extensively hydrolysed formulas (eHF) are typically the first option, and amino acid formulas are an alternative if the infant cannot tolerate eHFs or has severe symptoms. It is important to note that parents should not switch to soy-based formulas without consulting a healthcare professional, as some infants with cow’s’ milk protein allergy may also be allergic to soy.

In cases where there is faltering growth, acute systemic reactions, severe delayed reactions, significant atopic eczema with multiple food allergies suspected, or persistent parental concern, a referral to secondary care should be considered. With proper management and guidance, infants with non-IgE-mediated cow’s’ milk protein allergy can still receive adequate nutrition and thrive.

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.

Differentiating between immunodeficiency disorders in a pediatric patient

This patient presents with symptoms of immunodeficiency, including hypocalcaemia, developmental delay, facial dysmorphism, and feeding difficulties. The differential diagnosis includes DiGeorge syndrome, selective immunoglobulin A (IgA) deficiency, Bruton’s agammaglobulinaemia, common variable immunodeficiency (CVID), and physiological hypogammaglobulinaemia of infancy.

DiGeorge syndrome, also known as 22q11.2 deletion syndrome, is a genetic syndrome that commonly presents with mild immunodeficiency due to reduced thymus function or absence of a thymus. Facial dysmorphism, such as low-set ears, hypertelorism, and hooded eyelids, is also common.

Selective IgA deficiency is the most common primary antibody deficiency and may be associated with autoimmune disease or allergies. It is not associated with characteristic facies or low calcium.

Bruton’s agammaglobulinaemia is an X-linked immunodeficiency that presents with severe respiratory tract infections in male infants. It is unlikely in this case as the patient is female with a different clinical picture.

CVID is the most common primary immunodeficiency in adults and presents with recurrent bacterial infections. It is not associated with the characteristic facies described here or developmental delay, feeding difficulties, or hypocalcaemia.

Physiological hypogammaglobulinaemia of infancy is a common phenomenon where babies gradually lose their mother’s immunoglobulin G and replace it with their own. It is not associated with any additional facial features, blood abnormalities, or developmental or feeding delay.

Therefore, a thorough evaluation and testing are necessary to differentiate between these immunodeficiency disorders in this pediatric patient.

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.

Managing Hepatitis B in Pregnancy: Vaccination and Testing for Newborns

Hepatitis B is a viral infection that can be transmitted from mother to child during childbirth. To prevent transmission, it is important to manage hepatitis B in pregnancy. Here are some important points to keep in mind:

– The baby should receive their first hepatitis B vaccination within 24 hours of birth. This is crucial to prevent transmission, as there is a 90% chance of the infant contracting hepatitis B without immunisation at birth.
– Subsequently, the baby should receive a further vaccination against hepatitis B at 4 weeks of age, followed by routine immunisations which include hepatitis B at 8, 12 and 16 weeks, and then a 6th and final hepatitis B vaccination at one year of age.
– Vaccination can occur at 8, 12 and 16 weeks of age, as per the routine immunisation schedule, but babies born to hepatitis B infected mothers require additional hepatitis B vaccinations.
– The baby should be tested for hepatitis B at 12 months old, at which point they should also have bloods taken to test for hepatitis B infection.
– The mother should not receive the hepatitis B vaccination at 28 weeks’ gestation, as this is not appropriate advice.
– The mother should not take antiviral therapy while pregnant and should not avoid breastfeeding her infant to reduce the risk of vertical transmission, as this is not necessary for hepatitis B.

In summary, managing hepatitis B in pregnancy involves vaccinating the newborn and testing for hepatitis B at 12 months old. With proper management, transmission of hepatitis B from mother to child can be prevented.