Clinical Allergy Diagnosis and Management – G. Volcheck
Clinical Allergy Diagnosis and Management - G. Volcheck
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1 Overview of the Human Immune Response
1.1 Introduction .
1.2 Innate Immune System
1.3 Acquired Immune System
1.3.1 Immunogens and Allergens
1.3.2 Antigen-Presenting Cells
1.3.3 Major Histocompatibility Complex
1.4 T- and B-Cells in the Acquired Immune Response
1.4.1 T-Lymphocytes
1.4.2 B-Lymphocytes and Immunoglobulins
1.5 Lymphoid Tissues
1.6 Tolerance: Distinguishing Self from Nonself
1.7 Cytokines
1.7.1 Cytokines Produced by Antigen-Presenting Cells
1.7.2 Cytokines in the Humoral Immune Response
1.7.3 Cytokines in the Cellular and Cytotoxic
Immune Response
1.7.4 Cytokines in the Allergic Immune Response
1.7.5 Anti-Inflammatory Cytokines
1.8 Chemokines
1.9 Complement
1.10 Inflammatory Cells
1.10.1 Eosinophils
1.10.2 Mast Cells
1.10.3 Basophils
1.11 Primary Mediators of Inflammation
1.11.1 Histamine
1.11.2 Arachidonic Acid Metabolism
1.11.3 Cyclooxygenase Products: Prostaglandins
1.11.4 Lipooxygenase Products: Leukotrienes
1.12 Allergic Response to an Allergen: Summary
1.13 Immune-Modulating Medications in Allergic Disease
1.13.1 CpG-DNA
1.13.2 Omalizumab
1.13.3 Anti-TNF
1.13.4 Immunotherapy
1.13.5 Corticosteroids
1.13.6 Immunophilins
1.14 Summary
Suggested Reading
2 Environmental Allergens
2.1 Overview of Allergens
2.2 Pollens
2.2.1 Pollen Counts
2.2.2 Tree Pollens
2.2.3 Grass Pollens
2.2.4 Weed Pollens
2.2.5 Environmental Control: Outdoor Pollens
2.3 Fungal Allergens
2.3.1 Classification
2.3.2 Alternaria alternata
2.3.3 Aspergillus
2.3.4 Cladosporium herbarum
2.3.5 Penicillium
2.3.6 Basidiomycetes
2.3.7 Other Fungi
2.3.8 Avoidance of Fungal Allergens
2.4 Indoor Allergens
2.4.1 Mite Allergens
2.4.2 Mite Allergen Avoidance
2.5 Animal Allergens
2.5.1 Cat Allergen
2.5.2 Dog Allergen
2.5.3 Horse Allergen
2.5.4 Cow Allergen
2.5.5 Mouse Allergen
2.5.6 Rat Allergen
2.5.7 Guinea Pig Allergen
2.5.8 Rabbit Allergen
2.5.9 Animal Allergen Environmental Control
2.6 Cockroach Allergen
2.6.1 Cockroach Environmental Control
2.7 Clinical Vignettes
2.7.1 Vignette 1
2.7.2 Vignette 2
2.7.3 Vignette 3
Suggested Reading
3 Allergen Testing and Allergen Immunotherapy
3.1 Allergen Testing
3.1.1 Skin Prick Testing
3.1.2 Skin Intradermal Testing
3.1.3 In Vitro Testing
3.2 Allergen Immunotherapy
3.2.1 Clinical Effectiveness of Allergen Immunotherapy
3.2.2 Immunologic Changes in Immunotherapy
3.2.3 Practical Considerations in Allergen Immunotherapy
3.2.4 Duration of Immunotherapy
3.2.5 Safety of Allergen Immunotherapy
3.2.6 Allergen Immunotherapy in Children
3.2.7 Allergen Immunotherapy in Pregnancy
3.2.8 Future Allergen Immunotherapy
3.3 Summary
3.4 Clinical Vignettes
3.4.1 Vignette 1
3.4.2 Vignette 2
3.4.3 Vignette 3
3.4.4 Vignette 4
Suggested Reading
4 Allergic Rhinitis and Rhinosinusitis
4.1 Overview
4.2 Nasal Anatomy and Function
4.3 Clinical Overview
4.4 Allergic Rhinitis
4.4.1 Pathophysiology
4.4.2 History
4.4.3 Physical Examination
4.4.4 Testing
4.4.5 Treatment
4.5 Nonallergic Rhinitis and Rhinosinusitis
4.6 Infectious-Acute Rhinosinusitis
4.6.1 Physical Examination
4.6.2 Microbiology
4.6.3 Testing
4.6.4 Treatment
4.7 Chronic Rhinosinusitis
4.8 Infectious Chronic Rhinosinusitis
4.8.1 Testing
4.8.2 Treatment
4.9 Allergic Fungal Rhinosinusitis
4.10 Chronic Eosinophilic (Fungal or Hyperplastic) Rhinosinusitis
4.11 Systemic Disease
4.12 Noninfectious Structural Rhinosinusitis
4.12.1 Nasal and Sinus Polyposis
4.12.2 Tumors
4.12.3 Foreign Body
4.12.4 Adenoidal Hypertrophy
4.12.5 Cerebrospinal Fluid Rhinorrhea
4.12.6 Septal Deviation
4.13 Noninfectious Nonstructural Rhinitis and Rhinosinusitis
4.13.1 Vasomotor Rhinitis
4.13.2 Nonallergic Rhinitis with Eosinophilia Syndrome
4.13.3 Atrophic Rhinitis
4.13.4 Hormonal Rhinitis
4.13.5 Medication-Induced Rhinitis
4.13.6 Rhinitis from Food Ingestion
4.14 Clinical Vignettes
4.14.1 Vignette 1
4.14.2 Vignette 2
4.14.3 Vignette 3
4.14.4 Vignette 4
4.14.5 Vignette 5
Suggested Reading
5 Allergic Eye Disease
5.1 Overview
5.2 Basic Eye Anatomy
5.3 Approach to the Patient
5.4 Allergic and Allergic-Like Eye Disease
5.4.1 Seasonal Allergic Conjunctivitis
5.4.2 Perennial Allergic Conjunctivitis
5.4.3 Atopic Keratoconjunctivitis
5.4.4 Vernal Conjunctivitis
5.4.5 Giant Papillary Conjunctivitis
5.4.6 Infectious Conjunctivitis
5.4.7 Contact Dermatoconjunctivitis
5.4.8 Blepharoconjunctivitis
5.4.9 Dry Eye Syndrome
5.5 Clinical Vignettes
5.5.1 Vignette 1
5.5.2 Vignette 2
5.5.3 Vignette 3
5.5.4 Vignette 4
Suggested Reading
6 Asthma
6.1 Overview
6.2 Epidemiology
6.3 Pathophysiology
6.3.1 Genetics
6.3.2 Airway Obstruction
6.3.3 Airway Hyperresponsiveness
6.3.4 Fatal Asthma
6.4 Clinical Presentation and Differential Diagnosis
6.4.1 Differential Diagnosis in Children
6.4.2 Differential Diagnosis in Adults
6.4.3 Testing
6.5 Classification of Asthma
6.5.1 Types
6.5.2 Initial Evaluation of Chronic Asthma Severity
6.6 Evaluation of Factors Contributing to Asthma Severity
6.6.1 Allergens
6.6.2 Infections
6.6.3 Exercise
6.6.4 Vocal Cord Dysfunction
6.6.5 Irritants and Pollutants
6.6.6 Rhinosinusitis (United Airway Hypothesis)
6.6.7 Smoking
6.6.8 Medications
6.6.9 Occupational
6.6.10 Obstructive Sleep Apnea
6.6.11 Gastroesophageal Reflux Disease
6.7 Treatment
6.7.1 Patient Education
6.7.2 Pharmacologic Therapy
6.7.3 Treatment of an Acute Asthmatic Attack
6.7.4 Status Asthmaticus Treatment
6.7.5 General Approach
6.7.6 Treatment of Persistent Severe or Intractable Asthma
6.7.7 Special Groups
6.8 Clinical Vignettes
6.8.1 Vignette 1
6.8.2 Vignette 2
6.8.3 Vignette 3
6.8.4 Vignette 4
6.8.5 Vignette 5
Suggested Reading
7 Urticaria and Angioedema
7.1 Description and Epidemiology
7.2 Pathophysiology
7.3 Acute Urticaria: Etiologies
7.3.1 Medications
7.3.2 Foods
7.3.3 Insect Stings and Bites
7.3.4 Infection
7.4 Chronic Urticaria
7.4.1 Autoimmune and Idiopathic Urticaria
7.4.2 Physical Urticaria
7.4.3 Underlying Causes of Chronic Urticaria
7.5 Urticaria-Angioedema-Associated Disorders
7.5.1 Urticarial Vasculitis
7.5.2 C1 Esterase Inhibitor Deficiency
7.5.3 Mastocytosis
7.5.4 Pruritic Urticarial Papules and Plaques of Pregnancy.
7.6 Patient Evaluation
7.6.1 Acute Urticaria
7.6.2 Chronic Urticaria
7.7 Medications Used in the Treatment of Acute
and Chronic Urticaria
7.7.1 Antihistamines (H1 Blockers)
7.7.2 H2 Blockers
7.7.3 Leukotriene Modifiers
7.7.4 Tricyclic Antidepressants (Doxepin)
7.7.5 Corticosteroids
7.7.6 Thyroxine
7.7.7 Immunomodulatory Agents
7.8 Therapy Recommendations
7.9 Clinical Vignettes
7.9.1 Vignette 1
7.9.2 Vignette 2
7.9.3 Vignette 3
Suggested Reading
8 Atopic and Contact Dermatitis
8.1 Atopic Dermatitis
8.1.1 Epidemiology
8.1.2 Pathogenesis
8.1.3 Clinical Manifestations and Diagnosis
8.1.4 Triggers of Atopic Dermatitis
8.1.5 Evaluation
8.1.6 Management
8.1.7 Guidelines for Management
8.2 Contact Dermatitis
8.2.1 Overview
8.2.2 Pathogenesis
8.2.3 Clinical Manifestations and Diagnosis
8.2.4 Evaluation
8.2.5 Special Exposures Associated with Contact Dermatitis
8.2.6 Treatment
8.3 Clinical Vignettes
8.3.1 Vignette 1
8.3.2 Vignette 2
8.3.3 Vignette 3
Suggested Reading
9 Drug Allergy
9.1 Epidemiology
9.2 Definitions
9.3 Pathophysiology and Clinical Manifestations
9.3.1 Type 1 Immediate Hypersensitivity (IgE Mediated)
9.3.2 Type 2 Hypersensitivity
9.3.3 Type 3 Hypersensitivity
9.3.4 Type 4 Hypersensitivity
9.3.5 Exanthematous (Morbilliform) Drug Eruptions
9.3.6 Erythema Multiforme
9.3.7 Fixed Drug Eruptions
9.3.8 Photosensitive Drug Eruptions
9.3.9 Erythema Multiforme Major, Stevens–Johnson
Syndrome, and Toxic Epidermal Necrolysis
9.3.10 Anaphylactoid Drug Reactions
9.3.11 Hypersensitivity Syndrome/Drug Rash with
Eosinophilia and Systemic Symptoms
9.4 Clinical Evaluation of Suspected Drug Sensitivity
9.4.1 History
9.4.2 Physical Examination
9.4.3 Laboratory Testing of Suspected Drug Sensitivity
9.5 Therapy and Management
9.5.1 Type 1 Reactions
9.5.2 Types 2, 3, and 4 Reactions
9.5.3 Morbilliform Reaction
9.5.4 Erythema Multiforme
9.5.5 Erythema Multiforme Major, Stevens–Johnson
Syndrome, Toxic Epidermal Necrolysis
9.5.6 Hypersensitivity Syndrome/Drug Rash with
Eosinophilia and Systemic Symptoms Syndrome
9.6 Special Medication Reactions
9.6.1 Radiocontrast Media Reactions
9.6.2 Sulfa Reactions
9.6.3 Sulfonamide and HIV
9.6.4 Aspirin and NSAIDs
9.6.5 Intraoperative Anaphylaxis
9.6.6 Vaccine Allergy
9.7 Clinical Vignettes
9.7.1 Vignette 1: Immediate Hypersensitivity
Type 1 Reaction
9.7.2 Vignette 2: Exanthematous (Morbilliform)
Reaction
9.7.3 Vignette 3: DRESS Syndrome
9.7.4 Vignette 4: Aspirin Sensitivity
Suggested Reading
10 Food Allergy
10.1 Definitions
10.2 Epidemiology
10.3 Pathophysiology
10.4 Food Allergens
10.4.1 Cow’s Milk
10.4.2 Hen’s Egg
10.4.3 Soy
10.4.4 Peanut
10.4.5 Fish
10.4.6 Shellfish
10.4.7 Wheat
10.4.8 Tree Nuts
10.5 Approach to Patients
10.6 Clinical Disorders
10.6.1 IgE-Mediated Disorders
10.6.2 IgE-Associated–Cell-Mediated Disorders
10.6.3 Immunologic-Cell-Mediated (Non-IgE)
Disorders
10.6.4 Non-IgE-Nonimmunologic Food
Intolerance
10.7 Management
10.8 Food Additive Reactions
10.9 Summary
10.10 Clinical Vignettes
10.10.1 Vignette 1
10.10.2 Vignette 2
10.10.3 Vignette 3
10.10.4 Vignette 4
10.10.5 Vignette 5
11 Anaphylaxis and Anaphylactoid Reactions
11.1 Definition and Epidemiology
11.2 Pathophysiology
11.3 History and Physical Examination
11.4 Risk Factors
11.5 Common Causes of Anaphylactic and Anaphylactoid
Reactions
11.5.1 Foods
11.5.2 Medications
11.5.3 Radiocontrast Media
11.5.4 Latex
11.5.5 General Anesthesia and Intraoperative
Anaphylaxis
11.5.6 Hymenoptera
11.5.7 Exercise Induced
11.5.8 Blood and Blood Products
11.5.9 Seminal Fluid-Induced Anaphylaxis
11.6 Idiopathic Anaphylaxis
11.7 Differential Diagnosis
11.8 Diagnosis and Diagnostic Testing
11.8.1 Identification of a Specific Allergen
11.8.2 Tests Performed in the Evaluation of Conditions
That Mimic Anaphylaxis or Idiopathic
Anaphylaxis
11.9 Management
11.9.1 Acute Management
11.9.2 Further Management
11.10 Clinical Vignettes
11.10.1 Vignette 1
11.10.2 Vignette 2
11.10.3 Vignette 3
Suggested Reading
12 Stinging Insect Allergy
12.1 Introduction
12.2 Identification of Stinging Insects
12.3 Reactions to Stinging Insects
12.3.1 Large Local Reaction
12.3.2 Systemic Reaction
12.3.3 Toxic Reaction
12.3.4 Non-IgE Reactions
12.4 Diagnostic Testing
12.5 Management
12.5.1 Acute Management
12.5.2 Avoidance Measures
12.5.3 Venom Immunotherapy for Hymenoptera
12.6 Conclusion
12.7 Clinical Vignettes
12.7.1 Vignette 1
12.7.2 Vignette 2
12.7.3 Vignette 3
Suggested Reading
Index
1.1 Introduction .
1.2 Innate Immune System
1.3 Acquired Immune System
1.3.1 Immunogens and Allergens
1.3.2 Antigen-Presenting Cells
1.3.3 Major Histocompatibility Complex
1.4 T- and B-Cells in the Acquired Immune Response
1.4.1 T-Lymphocytes
1.4.2 B-Lymphocytes and Immunoglobulins
1.5 Lymphoid Tissues
1.6 Tolerance: Distinguishing Self from Nonself
1.7 Cytokines
1.7.1 Cytokines Produced by Antigen-Presenting Cells
1.7.2 Cytokines in the Humoral Immune Response
1.7.3 Cytokines in the Cellular and Cytotoxic
Immune Response
1.7.4 Cytokines in the Allergic Immune Response
1.7.5 Anti-Inflammatory Cytokines
1.8 Chemokines
1.9 Complement
1.10 Inflammatory Cells
1.10.1 Eosinophils
1.10.2 Mast Cells
1.10.3 Basophils
1.11 Primary Mediators of Inflammation
1.11.1 Histamine
1.11.2 Arachidonic Acid Metabolism
1.11.3 Cyclooxygenase Products: Prostaglandins
1.11.4 Lipooxygenase Products: Leukotrienes
1.12 Allergic Response to an Allergen: Summary
1.13 Immune-Modulating Medications in Allergic Disease
1.13.1 CpG-DNA
1.13.2 Omalizumab
1.13.3 Anti-TNF
1.13.4 Immunotherapy
1.13.5 Corticosteroids
1.13.6 Immunophilins
1.14 Summary
Suggested Reading
2 Environmental Allergens
2.1 Overview of Allergens
2.2 Pollens
2.2.1 Pollen Counts
2.2.2 Tree Pollens
2.2.3 Grass Pollens
2.2.4 Weed Pollens
2.2.5 Environmental Control: Outdoor Pollens
2.3 Fungal Allergens
2.3.1 Classification
2.3.2 Alternaria alternata
2.3.3 Aspergillus
2.3.4 Cladosporium herbarum
2.3.5 Penicillium
2.3.6 Basidiomycetes
2.3.7 Other Fungi
2.3.8 Avoidance of Fungal Allergens
2.4 Indoor Allergens
2.4.1 Mite Allergens
2.4.2 Mite Allergen Avoidance
2.5 Animal Allergens
2.5.1 Cat Allergen
2.5.2 Dog Allergen
2.5.3 Horse Allergen
2.5.4 Cow Allergen
2.5.5 Mouse Allergen
2.5.6 Rat Allergen
2.5.7 Guinea Pig Allergen
2.5.8 Rabbit Allergen
2.5.9 Animal Allergen Environmental Control
2.6 Cockroach Allergen
2.6.1 Cockroach Environmental Control
2.7 Clinical Vignettes
2.7.1 Vignette 1
2.7.2 Vignette 2
2.7.3 Vignette 3
Suggested Reading
3 Allergen Testing and Allergen Immunotherapy
3.1 Allergen Testing
3.1.1 Skin Prick Testing
3.1.2 Skin Intradermal Testing
3.1.3 In Vitro Testing
3.2 Allergen Immunotherapy
3.2.1 Clinical Effectiveness of Allergen Immunotherapy
3.2.2 Immunologic Changes in Immunotherapy
3.2.3 Practical Considerations in Allergen Immunotherapy
3.2.4 Duration of Immunotherapy
3.2.5 Safety of Allergen Immunotherapy
3.2.6 Allergen Immunotherapy in Children
3.2.7 Allergen Immunotherapy in Pregnancy
3.2.8 Future Allergen Immunotherapy
3.3 Summary
3.4 Clinical Vignettes
3.4.1 Vignette 1
3.4.2 Vignette 2
3.4.3 Vignette 3
3.4.4 Vignette 4
Suggested Reading
4 Allergic Rhinitis and Rhinosinusitis
4.1 Overview
4.2 Nasal Anatomy and Function
4.3 Clinical Overview
4.4 Allergic Rhinitis
4.4.1 Pathophysiology
4.4.2 History
4.4.3 Physical Examination
4.4.4 Testing
4.4.5 Treatment
4.5 Nonallergic Rhinitis and Rhinosinusitis
4.6 Infectious-Acute Rhinosinusitis
4.6.1 Physical Examination
4.6.2 Microbiology
4.6.3 Testing
4.6.4 Treatment
4.7 Chronic Rhinosinusitis
4.8 Infectious Chronic Rhinosinusitis
4.8.1 Testing
4.8.2 Treatment
4.9 Allergic Fungal Rhinosinusitis
4.10 Chronic Eosinophilic (Fungal or Hyperplastic) Rhinosinusitis
4.11 Systemic Disease
4.12 Noninfectious Structural Rhinosinusitis
4.12.1 Nasal and Sinus Polyposis
4.12.2 Tumors
4.12.3 Foreign Body
4.12.4 Adenoidal Hypertrophy
4.12.5 Cerebrospinal Fluid Rhinorrhea
4.12.6 Septal Deviation
4.13 Noninfectious Nonstructural Rhinitis and Rhinosinusitis
4.13.1 Vasomotor Rhinitis
4.13.2 Nonallergic Rhinitis with Eosinophilia Syndrome
4.13.3 Atrophic Rhinitis
4.13.4 Hormonal Rhinitis
4.13.5 Medication-Induced Rhinitis
4.13.6 Rhinitis from Food Ingestion
4.14 Clinical Vignettes
4.14.1 Vignette 1
4.14.2 Vignette 2
4.14.3 Vignette 3
4.14.4 Vignette 4
4.14.5 Vignette 5
Suggested Reading
5 Allergic Eye Disease
5.1 Overview
5.2 Basic Eye Anatomy
5.3 Approach to the Patient
5.4 Allergic and Allergic-Like Eye Disease
5.4.1 Seasonal Allergic Conjunctivitis
5.4.2 Perennial Allergic Conjunctivitis
5.4.3 Atopic Keratoconjunctivitis
5.4.4 Vernal Conjunctivitis
5.4.5 Giant Papillary Conjunctivitis
5.4.6 Infectious Conjunctivitis
5.4.7 Contact Dermatoconjunctivitis
5.4.8 Blepharoconjunctivitis
5.4.9 Dry Eye Syndrome
5.5 Clinical Vignettes
5.5.1 Vignette 1
5.5.2 Vignette 2
5.5.3 Vignette 3
5.5.4 Vignette 4
Suggested Reading
6 Asthma
6.1 Overview
6.2 Epidemiology
6.3 Pathophysiology
6.3.1 Genetics
6.3.2 Airway Obstruction
6.3.3 Airway Hyperresponsiveness
6.3.4 Fatal Asthma
6.4 Clinical Presentation and Differential Diagnosis
6.4.1 Differential Diagnosis in Children
6.4.2 Differential Diagnosis in Adults
6.4.3 Testing
6.5 Classification of Asthma
6.5.1 Types
6.5.2 Initial Evaluation of Chronic Asthma Severity
6.6 Evaluation of Factors Contributing to Asthma Severity
6.6.1 Allergens
6.6.2 Infections
6.6.3 Exercise
6.6.4 Vocal Cord Dysfunction
6.6.5 Irritants and Pollutants
6.6.6 Rhinosinusitis (United Airway Hypothesis)
6.6.7 Smoking
6.6.8 Medications
6.6.9 Occupational
6.6.10 Obstructive Sleep Apnea
6.6.11 Gastroesophageal Reflux Disease
6.7 Treatment
6.7.1 Patient Education
6.7.2 Pharmacologic Therapy
6.7.3 Treatment of an Acute Asthmatic Attack
6.7.4 Status Asthmaticus Treatment
6.7.5 General Approach
6.7.6 Treatment of Persistent Severe or Intractable Asthma
6.7.7 Special Groups
6.8 Clinical Vignettes
6.8.1 Vignette 1
6.8.2 Vignette 2
6.8.3 Vignette 3
6.8.4 Vignette 4
6.8.5 Vignette 5
Suggested Reading
7 Urticaria and Angioedema
7.1 Description and Epidemiology
7.2 Pathophysiology
7.3 Acute Urticaria: Etiologies
7.3.1 Medications
7.3.2 Foods
7.3.3 Insect Stings and Bites
7.3.4 Infection
7.4 Chronic Urticaria
7.4.1 Autoimmune and Idiopathic Urticaria
7.4.2 Physical Urticaria
7.4.3 Underlying Causes of Chronic Urticaria
7.5 Urticaria-Angioedema-Associated Disorders
7.5.1 Urticarial Vasculitis
7.5.2 C1 Esterase Inhibitor Deficiency
7.5.3 Mastocytosis
7.5.4 Pruritic Urticarial Papules and Plaques of Pregnancy.
7.6 Patient Evaluation
7.6.1 Acute Urticaria
7.6.2 Chronic Urticaria
7.7 Medications Used in the Treatment of Acute
and Chronic Urticaria
7.7.1 Antihistamines (H1 Blockers)
7.7.2 H2 Blockers
7.7.3 Leukotriene Modifiers
7.7.4 Tricyclic Antidepressants (Doxepin)
7.7.5 Corticosteroids
7.7.6 Thyroxine
7.7.7 Immunomodulatory Agents
7.8 Therapy Recommendations
7.9 Clinical Vignettes
7.9.1 Vignette 1
7.9.2 Vignette 2
7.9.3 Vignette 3
Suggested Reading
8 Atopic and Contact Dermatitis
8.1 Atopic Dermatitis
8.1.1 Epidemiology
8.1.2 Pathogenesis
8.1.3 Clinical Manifestations and Diagnosis
8.1.4 Triggers of Atopic Dermatitis
8.1.5 Evaluation
8.1.6 Management
8.1.7 Guidelines for Management
8.2 Contact Dermatitis
8.2.1 Overview
8.2.2 Pathogenesis
8.2.3 Clinical Manifestations and Diagnosis
8.2.4 Evaluation
8.2.5 Special Exposures Associated with Contact Dermatitis
8.2.6 Treatment
8.3 Clinical Vignettes
8.3.1 Vignette 1
8.3.2 Vignette 2
8.3.3 Vignette 3
Suggested Reading
9 Drug Allergy
9.1 Epidemiology
9.2 Definitions
9.3 Pathophysiology and Clinical Manifestations
9.3.1 Type 1 Immediate Hypersensitivity (IgE Mediated)
9.3.2 Type 2 Hypersensitivity
9.3.3 Type 3 Hypersensitivity
9.3.4 Type 4 Hypersensitivity
9.3.5 Exanthematous (Morbilliform) Drug Eruptions
9.3.6 Erythema Multiforme
9.3.7 Fixed Drug Eruptions
9.3.8 Photosensitive Drug Eruptions
9.3.9 Erythema Multiforme Major, Stevens–Johnson
Syndrome, and Toxic Epidermal Necrolysis
9.3.10 Anaphylactoid Drug Reactions
9.3.11 Hypersensitivity Syndrome/Drug Rash with
Eosinophilia and Systemic Symptoms
9.4 Clinical Evaluation of Suspected Drug Sensitivity
9.4.1 History
9.4.2 Physical Examination
9.4.3 Laboratory Testing of Suspected Drug Sensitivity
9.5 Therapy and Management
9.5.1 Type 1 Reactions
9.5.2 Types 2, 3, and 4 Reactions
9.5.3 Morbilliform Reaction
9.5.4 Erythema Multiforme
9.5.5 Erythema Multiforme Major, Stevens–Johnson
Syndrome, Toxic Epidermal Necrolysis
9.5.6 Hypersensitivity Syndrome/Drug Rash with
Eosinophilia and Systemic Symptoms Syndrome
9.6 Special Medication Reactions
9.6.1 Radiocontrast Media Reactions
9.6.2 Sulfa Reactions
9.6.3 Sulfonamide and HIV
9.6.4 Aspirin and NSAIDs
9.6.5 Intraoperative Anaphylaxis
9.6.6 Vaccine Allergy
9.7 Clinical Vignettes
9.7.1 Vignette 1: Immediate Hypersensitivity
Type 1 Reaction
9.7.2 Vignette 2: Exanthematous (Morbilliform)
Reaction
9.7.3 Vignette 3: DRESS Syndrome
9.7.4 Vignette 4: Aspirin Sensitivity
Suggested Reading
10 Food Allergy
10.1 Definitions
10.2 Epidemiology
10.3 Pathophysiology
10.4 Food Allergens
10.4.1 Cow’s Milk
10.4.2 Hen’s Egg
10.4.3 Soy
10.4.4 Peanut
10.4.5 Fish
10.4.6 Shellfish
10.4.7 Wheat
10.4.8 Tree Nuts
10.5 Approach to Patients
10.6 Clinical Disorders
10.6.1 IgE-Mediated Disorders
10.6.2 IgE-Associated–Cell-Mediated Disorders
10.6.3 Immunologic-Cell-Mediated (Non-IgE)
Disorders
10.6.4 Non-IgE-Nonimmunologic Food
Intolerance
10.7 Management
10.8 Food Additive Reactions
10.9 Summary
10.10 Clinical Vignettes
10.10.1 Vignette 1
10.10.2 Vignette 2
10.10.3 Vignette 3
10.10.4 Vignette 4
10.10.5 Vignette 5
11 Anaphylaxis and Anaphylactoid Reactions
11.1 Definition and Epidemiology
11.2 Pathophysiology
11.3 History and Physical Examination
11.4 Risk Factors
11.5 Common Causes of Anaphylactic and Anaphylactoid
Reactions
11.5.1 Foods
11.5.2 Medications
11.5.3 Radiocontrast Media
11.5.4 Latex
11.5.5 General Anesthesia and Intraoperative
Anaphylaxis
11.5.6 Hymenoptera
11.5.7 Exercise Induced
11.5.8 Blood and Blood Products
11.5.9 Seminal Fluid-Induced Anaphylaxis
11.6 Idiopathic Anaphylaxis
11.7 Differential Diagnosis
11.8 Diagnosis and Diagnostic Testing
11.8.1 Identification of a Specific Allergen
11.8.2 Tests Performed in the Evaluation of Conditions
That Mimic Anaphylaxis or Idiopathic
Anaphylaxis
11.9 Management
11.9.1 Acute Management
11.9.2 Further Management
11.10 Clinical Vignettes
11.10.1 Vignette 1
11.10.2 Vignette 2
11.10.3 Vignette 3
Suggested Reading
12 Stinging Insect Allergy
12.1 Introduction
12.2 Identification of Stinging Insects
12.3 Reactions to Stinging Insects
12.3.1 Large Local Reaction
12.3.2 Systemic Reaction
12.3.3 Toxic Reaction
12.3.4 Non-IgE Reactions
12.4 Diagnostic Testing
12.5 Management
12.5.1 Acute Management
12.5.2 Avoidance Measures
12.5.3 Venom Immunotherapy for Hymenoptera
12.6 Conclusion
12.7 Clinical Vignettes
12.7.1 Vignette 1
12.7.2 Vignette 2
12.7.3 Vignette 3
Suggested Reading
Index
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