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Rhinitis is a common problem encountered daily by most health professionals. Although allergy is the most common cause of rhinitis, the clinician should be aware of the complex differential diagnosis and the variety of allergens that may be responsible for the symptoms. The clinical challenge is magnified by the lack of specific symptoms in the various forms of rhinitis and by the number of potential...
Rhinosinusitis describes a group of inflammatory conditions of the nasal mucosa and paranasal sinuses that affect 31 million people in the USA each year. When the term chronic rhinosinusitis (CRS) is used, it implies that the condition has persisted for more than 12 weeks despite medical therapy. The diagnosis of CRS requires the presence of at least two of the following over a 12-week period: anterior...
The eye is a common target of inflammatory responses induced by local and systemic immunological hypersensitivity reactions. Inflammatory ocular conditions resulting from immune responses are highly prominent because of the eyes’ considerable vascularization and the sensitivity of the vessels in the conjunctiva embedded in a transparent medium. Cases related to the presentation and management of the...
The different urticaria subtypes represent a common diagnostic and treatment challenge. In acute urticaria that is often induced by an acute infection and/or intake of NSAID such as acetylsalicylic acid, no further diagnostic procedures are recommended. In contrast, a targeted work-up and therapeutic management should be performed in spontaneous chronic urticaria, physical urticaria, and special urticaria...
Allergic contact dermatitis, an inflammatory skin disease characterized by erythema, edema, vesiculation, and scaling, is a delayed type hypersensitivity reaction following cutaneous exposure to allergenic chemicals.
Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, encompasses a group of pulmonary disorders characterized by immune response to a variety of antigens derived from medications, chemicals, microorganisms, and plant and animal proteins. The first cases of HP were described in occupational or hobbyist settings, but HP secondary to home exposures is becoming more common....
Atopy can be defined as a familial hypersensitivity of skin and mucous membranes against environmental substances, associated with increased immunogloblin E (IgE) production and/or altered unspecific reactivity in different organ systems, for example, skin in the case of atopic dermatitis (AD) and lung in the case of asthma. It is a chronic, highly pruritic, inflammatory skin disease frequently seen...
IgE-mediated food allergies are part of a spectrum of adverse reactions to foods including immune and nonimmune mechanisms. Anaphylaxis is the most serious and life-threatening manifestation of food allergy. Asthma, rhinitis, atopic dermatitis, and urticaria/angioedema also result from IgE-mediated reactions to foods. Not only ingestion of an allergenic food, but inhalation of food allergens may cause...
Drug allergy and sensitivity is one of the most challenging presentations that the practicing allergist encounters. Because of the extensively complex nature of these cases and the multiply mediated forms of drug allergy, we will present two illustrative and challenging cases with two very different mechanisms.
Anaphylaxis is the most severe presentation of immediate-type hypersensitivity. It occurs rapidly and is often dramatic and unanticipated. Most episodes are not fatal; however, death may occur suddenly through airway obstruction or irreversible vascular collapse. There are at least 40 different signs and symptoms that may occur during the course of anaphylaxis. Cases related to the presentation and...
Eosinophilic disorders are a spectrum of diseases characterized by peripheral eosinophilia and eosinophilic infiltration in various organs. The manifestation of each disease varies by the affected organ. Here, we present two challenging cases in eosinophilic pneumonia and eosinophilic esophagitis.
Occupational asthma is believed to be responsible for up to 15% of all new cases of asthma in the United States. Evaluation of patients with asthma, therefore, requires a careful and complete work history to identify or exclude potential causes or triggers for asthma. It is important for the clinician to have a strong understanding of how to evaluate and manage work-related asthma induced by both...
Difficult-to-control asthma in adult patients is a conundrum encountered frequently in clinical practice. Recognizing the range of asthma case presentations and conundrums can improve asthma treatment plans and better patient outcomes.
Mastocytosis is a neoplastic disease involving mast cells (MC) and their CD34+ progenitors and consists of a heterogeneous group of diseases with a clinical spectrum ranging from localized mastocytoma to generalized forms such as mast cell leukemia. In 80% of mastocytosis, the skin is involved. Cutaneous mastocytosis (CM) has to be distinguished from systemic mastocytosis. CM is divided into maculopapular...
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity response to Aspergillus antigens in the lung, which is an uncommon but serious respiratory condition characterized by chronic airway inflammation and airway damage resulting from persistent colonization by and sensitization to the fungus Aspergillus fumigatus (A. fumigatus). The first case of ABPA in the United States was identified...
In the setting of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), two well-characterized syndromes can present with fevers, rash, headache, and other nonspecific complaints that may mimic an allergic or immune system-mediated reaction. Both the HIV specialist and non-HIV health care provider need to recognize these syndromes to initiate effective treatment and prevent...
Immune system homeostasis is tightly maintained by regulatory mechanisms that allow for the destruction of pathologic microorganisms while preventing pathologic inflammation. Disruption of these regulatory mechanisms can lead to immunodeficiency and uncontrolled inflammation as seen in hyper-IgE syndrome and in immunodysregulation, polyendocrinopathy, enteropathy, X-linked syndrome. The discovery...
Autoimmune diseases are characterized by autoantibody formation and visceral involvement that is often of an inflammatory nature. Rheumatoid arthritis (RA) is a classic immune complex disease characterized by antibody formation and inflammatory arthritis. Extra-articular manifestations of RA may also occur. Systemic sclerosis (scleroderma, SSc) is another autoimmune disease and includes autoantibody...
Systemic lupus erythematosus (SLE) is the prototypical human, autoimmune disease and is characterized by immune dysregulation, production of autoantibodies, generation of circulating immune complexes, and activation of the complement system. SLE is notable for unpredictable exacerbations and remissions with a predilection for clinical involvement of joint, skin, kidney, brain, serosa, lung, heart,...
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