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BALTIMORE -- From saxophone lung to the strange affair of the gummy bear allergy, case reports take center stage at the annual meeting of the American College of Allergy, Asthma, and Immunology here.
That's partly because case reports help illuminate the variety of things that can affect the immune system, according to , of Children's Mercy Hospital in Kansas City, Mo.
"Immunology is replete with very unusual presentations," Portnoy, who was chair of the meeting's , told 鶹ý.
Action Points
- Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"It's not uncommon that a single case report can spark interest and perhaps lead to more reports and better medicine," he said.
The meeting attracts many younger physicians who might not yet have had time to take part in major studies, but who have had unusual clinical experiences as new allergy fellows, Portnoy added.
Presenting those cases "gets them into the scientific swing," he said. "It helps them get their feet wet."
Among the unusual cases this year:
Saxophone Lung
A musician -- a clarinet player, in fact -- had not cleaned his instrument in more than 30 years, according to Marissa Shams, MD, and colleagues at in Atlanta. He presented with a 1-year history of coughing and wheezing that didn't respond to inhaled corticosteroids, bronchodilators, or oral antibiotics.
Both the patient -- originally diagnosed with (ABPA) -- and the instrument turned out to be positive for black molds. The combination of oral steroids and improved the man's condition. Take-home message: Not everything that looks like ABPA is.
Cat Saliva Attack
An HIV-positive man tried to flick some of his pet cat's saliva off a couch, according to Kathleen Dass, MD, and colleagues at in Royal Oak, Mich. In the process, he developed a in his finger, which became "pale, swollen, and numb," the investigators reported.
The man went on to develop pruritus on his hands that spread to his arms, urticaria on his chest and trunk, and generalized swelling. After initial improvement with antihistamines and corticosteroids, he began wheezing, with hypotension and increasing tachycardia, and was rescued with epinephrine and famotidine.
Take-home message: Anaphylaxis to animal secretions is rare and has not been reported with a splinter hemorrhage as the trigger.
Blame the Lobster
A 35-year-old woman on a south Pacific vacation had shrimp salad in the morning, lobster bisque in the afternoon, and traces of lobster later -- followed by anaphylaxis. She had not previously been sensitive to shellfish, according to Anil Patel, MD, and colleagues at in Morgantown.
Six months later, after accidentally eating some crab, she was rushed to emergency with shortness of breath and a closed-throat feeling and spent 4 days in intensive care getting epinephrine every 4 hours. After release and while on oral corticosteroids, she had several other bouts of anaphylaxis.
Take-home message: It took only a day for sensitization, but the anaphylaxis was protracted.
Don't Breathe Easy
A 71-year-old man with interstitial pulmonary fibrosis received new lungs, from a 15-year-old who had died of anaphylaxis after eating peanuts, according to Priyanka Lall, MD, and colleagues at . But no one told the recipient and he had two bouts of anaphylaxis after transplant -- both times after eating a dessert with nuts in it.
The man's post-transplant serum specific IgE levels were elevated to walnut, hazelnut, pistachio and cashews, although he had no history of nut allergy.
Take-home message: The allergic profile of the donor should be on the donor card and the recipient should be cautioned, if necessary, about food allergies.
Gummy Bear Threat
Gelatin allergy is rare, but if gummy bears make you itch, you might want to be careful about getting a flu shot, according to , and a colleague at Icahn School of Medicine at Mount Sinai in New York City. They reported the case of a 4-year-old boy who was found to have gelatin sensitivity after he developed diffuse hives, watery eyes, sneezing, and vomiting within 15 minutes of receiving his flu shot.
He had previously been immunized without a problem, and his parents worried he had an egg allergy. But they also reported he had displayed watery mouth, abdominal pain, and weakness after eating gummy candies, gummy vitamins, and marshmallows.
Take-home message: People with gelatin allergies need to be careful when getting vaccines, and might consider having an allergist perform the immunization.
But all physicians involved in vaccinations should be aware of the possibility of gelatin allergies, Portnoy told 鶹ý. While a great deal of attention has been paid to egg allergies, he said, gelatin is actually more of a problem with certain vaccines.