Head and Neck Medicine by Alexandros G.Sfakianakis

Diagnosis of almond allergy is complicated by a high rate of false positive test results. Accurate diagnosis of almond allergy is critical as almond is a source of nutrition and milk products for children with other food allergies.

Objectives

We reviewed the outpatient almond oral food challenges (OFCs) performed at our institution to analyze the pass rate and identify variables that predict OFC outcome.

Methods

We reviewed all almond OFCs performed at our pediatric, university-based outpatient practice between October 2015 and July 2017. OFC details, including dosing, reactions, and treatments, as well as demographic, clinical, and laboratory data were compiled. Statistical analysis was performed using the Fisher's exact and student t-tests.

Results

We identified 400 patients who underwent consecutive almond OFCs. Of these, 375 passed (93.8%, median sIgE 1.41 kU_A/L, mean SPT wheal 3.23 mm), 16 failed (4.0%, sIgE 2.54 kU_A/L, SPT 5.0 mm), and 9 were indeterminate (2.3%, sIgE 3.33 kU_A/L, SPT 5.0 mm). Among children who reacted, pruritus was the most common symptom. Only two children had reactions that required epinephrine. There was no difference in demographics or allergic comorbidities between those who passed and failed.

Conclusions

Among patients in our cohort, the probability of passing an almond OFC was 94%. Although higher almond sIgE level and SPT wheal size correlated with OFC failure, the pass rate remained >95% for patients with sIgE up to 10 kU_A/L and SPT wheal size up to 5 mm. Among the patients who had a reaction to almond, anaphylaxis was uncommon. Our data support that performing outpatient OFCs to almond is safe for select patients.

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Andrologische Beratung bei neuen onkologischen Systemtherapien mit „small molecules“

Zusammenfassung

Die sog. „small molecules" erweitern das Spektrum onkologischer Systemtherapien rasant. Zielproteine dieser Medikamentengruppe sind u. a. die Tyrosinkinasen VEGF(„vascular endothelial growth factor")-R, EGF(„epidermal-growth-factor")-R, Bcr-Abl, c‑kit, JAK („just another-kinase", Januskinase), CDK („cycline dependent kinases"/cyclinabhängige Kinasen) u. a. In der Dermatologie gehören die Serin-Threonin-Kinasen BRAF und MEK beim Melanom und der Transmembranrezeptor SMO („smoothened") beim Basalzellkarzinom dazu. Die Auswirkungen dieser zielgerichteten Therapien auf die männliche Fertilität sind z. T. nur unzureichend untersucht. Klinische Daten gibt es meist nur für die älteren Präparate. Darüber hinaus handelt es sich häufig um Multikinaseinhibitoren, sodass selbst „small molecules" mit gleichem (Haupt‑)Target nicht vollständig vergleichbar sind. Bei unzureichender Datenlage sollte vor einer Therapie unter Berücksichtigung individueller Suszeptibilitätsunterschiede und andrologischer Vorerkrankungen eine Spermienkryokonservierung angeboten werden.

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Natural and modified IL-2 for the treatment of cancer and autoimmune diseases

Publication date: Available online 8 November 2018

Source: Clinical Immunology

Author(s): Masayuki Mizui

Abstract

Interleukin-2 (IL-2) is a pleiotropic cytokine required for both effector lymphocyte proliferation/differentiation and regulatory T cell expansion/survival. Ability to receive IL-2 signals is defined by the affinity to distinct IL-2-receptor-complexes on each subset of cells. While IL-2 targets anti-tumor cytotoxic lymphocytes (CTLs) for the treatment of patients with melanoma or renal cell carcinoma, IL-2 directed at regulatory T (Treg) cells has value in several immune-related diseases including chronic graft-versus-host disease (cGVHD), type 1 diabetes (T1D) and systemic lupus erythematosus (SLE). A variety of IL-2 alteration has been made to deliver IL-2 to the proper target, including mutant IL-2, IL-2-fusion proteins and anti-IL-2 antibodies. Experimental and clinical trials with IL-2 are spreading for diverse group of diseases. Although the sustainability and efficiency of IL-2-responding cells in controlling disease activity are still not fully understood, the results of clinical trials will provide a basis of the most effective regimen for each disease.

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Reversible dilative cardiomyopathy after electrical injury: a case report

Dilative cardiomyopathy is an uncommon cardiac complication of electric shock.

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