Foods To Avoid With Hives

Natural Urticaria Treatment

Developed by Gary M. Levin, who is a retired M.D and Surgeon in the U.S, this Natural Urticaria & Angioedema Treatment System is a brand new program that offers users a new revolutionary solution for urticaria and angioedema diseases. Dr. Gary claims that the program has been time-tested and is the result of long-term scientific studies. It can help treat all Urticaria, Angioedema and many other skin problems you might be suffering from. After learning fundamental information about this type of disease, you are about to know the list of food you should avoid and what the best quality diet for you is. In order to avoid making your condition worse, you had better avoid consuming tinned foods, sugar, processed foods, salt, and sweeteners. Continue reading...

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Beekeeping with A cerana in Movable Frame Hives

Bees of most races of A. cerana are smaller than A. mellifera they also build smaller colonies and are less productive for the beekeeper. Unlike A. mellifera, A. cerana does not collect or use propolis. A. cerana was the only hive bee in Asia until A. mellifera was introduced in the late 1800s it had been kept in traditional hives (logs, boxes, barrels, baskets, pottery) since the first or second century A.D. in China and probably from the 300s B.C. in the upper Indus basin, now in Pakistan. The movable-frame hives used for A. cerana are like a scaled-down version of those for A. mellifera. Colony management is similar, except that the beekeeper needs to take steps to minimize absconding by the colonies. In India 30 to 75 of colonies may abscond each year. To prevent this, a colony must always have sufficient stores of both pollen and honey or syrup, and preferably a young queen. Special care is needed to prevent robbing when syrup is fed. Colonies must also be protected against ants...

Urticaria and angioedema

In some patients, chronic recurrent urticaria and angioedema can be due to intolerance to food additives.17 Other causes include drugs, physical factors (cold, pressure, heat, etc.) and foods. However, it should be remembered that no cause can be found in the majority of patients (idiopathic chronic recurrent urticaria). An attempt should be made to identify a cause. If a drug or a food is found to be causative, this should be excluded. In cases where no cause is obvious, the best approach is to treat the condition with the regular use of antihistamine for a period of 6-12 weeks. If the response to antihistamine is not adequate or if symptoms return once antihistamines are discontinued, a trial diet excluding benzoate preservatives, azodyes and salicylate may be helpful. If the condition improves, an open or double-blind challenge may be warranted to confirm the causative relationship. If positive, the diet should be continued for a longer period until spontaneous remission occurs. If...

Mast Cell Disease Urticaria Pigmentosa

Urticaria pigmentosa, telangiectasia macularis eruptive Cutaneous mast cell disease has several different manifestations. It can present during the neonatal period or throughout life. Different age populations generally develop different clinical manifestations and different associated conditions. It is the systemic form of mastocy-tosis in adults that has the most potentially severe complications. It has been estimated that from 15 to 50 of patients with adult-onset mast cell disease will have systemic involvement (1,2). However, for the sake of completeness, the other variants of this disease spectrum will also be considered. Urticaria pigmentosa is the global term for all conditions that are characterized by increased numbers of mast cells within the dermis. There is no gender predilection. Adults with mast cell disease are more likely to present with a widely scattered macular eruption. Individual lesions are often red-brown or hyperpigmented. The lesions are randomly distributed...

Angioedema and Urticaria

INTRODUCTION Angioedema and urticaria are common transient phenomena that result from mast cell degranulation with the release of mediators that promote vascular permeability, causing proteins and fluids to extravasate into the extracellular space. In urticaria fluid collects within the dermal tissue, whereas in angioedema fluid collects in the deeper subcutaneous space. The causes of mast cell degranulation are varied and include both immunologic and nonimmunologic mechanisms. Systemic involvement may include rhinitis, bronchospasm, or anaphylaxis. Severe reactions may lead to syncope, bronchial asthma, and hypotension. In rare cases both urticaria and angioedema may be triggered by exercise. Acute cases reach a peak in one to three days and usually fade in 7-21 days. In chronic cases the condition waxes and wanes for months or may even persist for years. There may be recurrent attacks separated by months to years. Inciting allergens are numerous and include foods, cosmetics,...

Open patch test and the diagnosis of contact urticaria

Some food substances can induce an immediate urticarial-type reaction at the point of contact. No standardised test exists for investigating such contact urticaria, but one can demonstrate such a reaction by an open test. The substance is placed on the skin of the flexor surface of the forearm for 30-45 minutes in an attempt to replicate the urticaria. It may be necessary to use non-intact, eczematous skin. This contact urticaria may be secondary to an allergic or non-allergic reaction. In the non-allergic type no previous sensitisation has taken place the individual does not have specific IgE to the substance. The urticaria occurs because of non-immunological release of vasoactive substances in the skin. Substances that may affect the skin by this mechanism include acetic acid, benzoic acid, cinnamic acid, sorbic acid and balsam of Peru. Contact urticaria can also be mediated by allergic mechanisms, chiefly specific IgE mediated. Foods capable of causing a reaction in such sensitised...

Gender Ethnicracial And Life Span Considerations

Approximately one to two out of four patients with allergic purpura have GU symptoms such as dysuria and hematuria. Other symptoms include headaches fever peripheral edema and skin lesions accompanied by pruritus, paresthesia, and angioedema (swelling of the skin, mucous membranes, or organs). Other patients describe severe GI symptoms (spasm, colic, constipation, bloody vomitus, bloody stools) and joint pain. PHYSICAL EXAMINATION. Inspect the patient's skin for the typical skin lesions patches of purple macular lesions of various sizes that result from vascular leakage into the skin and mucous membranes. These lesions most commonly occur on the hands and arms. Note that, in children, the lesions more commonly start as urticarial areas that then expand into hemorrhagic lesions. Determine if the patient has any peripheral swelling, particularly in the hands and face. Perform gentle range of motion of the extremities to determine the presence and location ofjoint pain. Assess...

The Genus Apis Known Species

The genus Apis contains 11 known species. A. mellifera (Fig. 1) is the source of most of the world's honey. It is native throughout Africa, the Middle East, and Europe except for the far north regions. All other Apis species are native to Asia. A. cerana, which is kept in hives in the temperate zone as well as the tropics, is smaller than A. mellifera, and it makes smaller colonies. Other Asian species that build a multiple-comb nest in a cavity are A. koschevnikovi and A. nuluensis reported in Borneo, and A. nigrocincta in Sulawesi.

Immediate and Nonimmediate Reactions to Contrast Media

Mild immediate reactions occur in 0.7 -3.1 of patients receiving lower-osmolar nonionic CM (Brok-kow et al. 2005a). Pruritus and mild urticaria are the most common immediate manifestations. More severe reactions involve the respiratory and cardiovascular systems. The frequency of nonimmediate hypersensitivity reactions appears to range from 1 to 3 , and skin reactions of the maculopapular exanthematous and urti-carial angioedematous types account for the majority of them. At present, the exact pathogenesis of these delayed reactions is still unclear. There is, however, increasing evidence that a significant proportion of the reactions is T cell-mediated (Christiansen et al. 2000). Skin reactions of the maculopapular exanthematous and urticarial angioedematous types account for the majority of nonimmediate hypersensitivity reactions to CM. There is increasing evidence that a significant proportion of the reactions are T cell-mediated (Christiansen et al. 2000). Skin tests have been...

Primary Nursing Diagnosis

Typing, screening, and matching of blood units before administration eliminates most incompatibilities, but not all of them. If a transfusion reaction does occur, stop the transfusion immediately. The severity of the reaction is usually related to the amount of blood received. Begin an assessment to determine the severity and type of reaction. In minor reactions (urticaria or fever), the transfusion may be restarted after discussion with the physician and after giving the patient an antipyretic, antihistamine, or anti-inflammatory agent. Ongoing monitoring during the rest of the transfusion is essential. If the patient develops anaphylaxis, the patient's airway and breathing are maintained with oxygen supplement, intubation, and mechanical ventilation if needed.

Adverse Reactions and Warnings

The most serious adverse event reported subsequent to Activase administration is bleeding. If serious intracranial, gastrointestinal, retroperitoneal, or pericardial bleeding occurs, treatment must be immediately discontinued. Allergic reactions, including anaphylactoid reactions, laryngeal edema, and urticaria have also been reported. The product should be used with extreme caution in pregnant women, for whom there are no well-controlled studies. Activase has an embryocidal effect in rabbits when administered in doses of twice the level used to treat AMI in humans. Caution should also be exercised with nursing mothers as it is not known if Activase is excreted into human milk. Negative results were recorded when the product was subjected to a mutagenicity test (the Ames test), chromosomal aberration assays in human lymphocytes, and short-term tumorigenicity studies. Long-term studies in animals to evaluate carcinogenic potential or effect on fertility have not been undertaken.

Occupation and smoking

Respiratory diseases have known associations with those working in the food and food-related industries. These include occupational asthma, occupational rhinitis and hypersensitivity pneumonitis. Skin diseases such as contact dermatitis and contact urticaria are also associated with work in these industries.

Techniques Of Modern Movableframe Hive Beekeeping With Apis Mellifera

A colony of honey-storing bees collects nectar from which it makes honey. Nectar is not available continuously, and to store much honey a colony of bees needs many foraging bees (over, say, 10 days old) whenever a nectar flow is available within their flight range. Bees may fly 2 km if necessary, but the greater the distance, the more energy they expend in flight, and the more nectar or honey they consume. Thus, it is often cost-effective for the beekeeper to move hives to several nectar flows in turn during the active season. It is essential that hives and frames have standard dimensions and that an accessory (spacer) be used to ensure that frames are always exactly the correct distance apart. 5. Finally each queen is placed in a mating hive containing a few hundred or more workers but no other queen. These hives are taken to a mating apiary, which contains a few strong colonies that include many drones (i.e., males) of a selected strain of honey bees. The apiary is located as far as...

Package Bee Production

Package bees are prepared as follows. First, all the bees are shaken off the combs of three or four colonies into a specially designed box, taking care that the queens are left behind. The bees are then poured through the spout of the box into package boxes, each standing on a weighing machine, until their weight is either 1 or 1.5 kg, as required. Each box is given a young mated queen in a cage, and a can of syrup with feeding holes. (Enough bees are flying around to return to their hives and keep the colonies functional.) For transport, the package boxes are fixed by battens in groups of three or four, slightly separated they may travel 2400 km, and the truck needs special ventilation. Air transport, though possible, presents various difficulties.

Other Aspects Of Modern Hive Beekeeping World Spread of A mellifera

In the early 1600s the bees were taken by sailing ship across the Atlantic from England to North America. They would have been in skeps (inverted baskets made of coiled straw), which were then used as hives. The first hives were probably landed in Virginia. The bees flourished and spread by swarming, and other colonies were taken later. By 1800 there were colonies in some 25 of the areas that are now U.S. states, and by 1850 in a further 7. The bees were kept in fixed-comb hives (skeps, logs, boxes). In Asian countries where A. cerana was used for beekeeping, A. mellifera was introduced at the same time as movable-frame hives. Some probable dates of introduction were 1875-1876 in Japan, 1880s in India, 1896 in China, and 1908 in Vietnam.

Origination and World Spread of Movable Frame Beekeeping

The production of a movable-frame hive divided the history of hive beekeeping into two distinct phases. This new hive type was invented in 1851 by Reverend Lorenzo Lorraine Langstroth in Philadelphia. He was familiar with the Greek movable-comb hive (discussed later under Traditional Movable-Comb Hive Beekeeping) and with some rectangular hives devised in Europe that contained wooden frames for the bees to build their combs in. These hives, however, had only a very small gap between the frames and the hive walls, and the bees built wax to close it. In 1853 Langstroth described how he had often pondered ways in which he could get rid of the disagreeable necessity of cutting the attachments of the combs from the walls of the hives. He continued, The almost self-evident idea of using the same bee-space as between the centerlines of combs in the frames in the shallow honey chambers came into my mind, and in a moment the suspended movable frames, kept at a suitable distance from each other...

Honey Bee Diseases Parasites Predators and Poisoning

Disease or parasitization debilitates the colonies, and diagnosis and treatment require time, skill, and extra expense. Most of the diseases and infestations just listed can be treated if colonies are in movable-frame hives, and in many countries bee disease inspectors provide help and advice. Colonies in fixed-comb hives and wild colonies cannot be inspected in the same way, and they can be a long-term focus of diseases. But by far the most common source of contagion is the transport into an area of bees from elsewhere. The development of large-scale agriculture has involved the use of insecticides, many of which are toxic to bees and can kill those taken to pollinate crops. In California alone, insecticides killed 82,000 colonies in 1962 in 1973 the number was reduced to 36,000, but in 1981 it had risen again, to 56,000. More attention is now paid to the use of practices that protect the bees, including selecting pesticides less toxic to beneficial insects, using pesticides in the...

Harvesting And Processing

When a beekeeper harvests combs of honey from the hives, the honey is first extracted from the combs. Then the wax is melted and the liquid wax separated from any contaminants. On a small scale, clean wax from hives may be melted and strained through cloth, or a solar wax extractor may be used, in which the wax pieces are spread out on a sloping metal base in a shallow container with a double glass top, to be melted by radiation from the sun. The liquid wax flows into a container any contaminants settle at the bottom, and clear wax flows out through an outlet near the top.

World Production And Trade

Beekeeping with modern movable-frame hives aims to maximize honey production, and wax production is suppressed by providing the bees with sheets of ready-built wax comb foundation in frames. In experiments in Egypt, wax production in modern hives was only 0.4 to 0.6 of honey production, whereas in traditional hives it was 9 to 11 . Bees secrete beeswax more readily in hot than in cold climates, and most surplus beeswax is produced in those tropical regions where traditional hives are still used. According to export figures published in 1990, relating to the preceding decade, the three regions producing most beeswax annually were Asia, Central America, and Africa (15.9, 10.5, and 8.7 X 103 tonnes, respectively). Major importing countries (in 1984) were France, German Federal Republic, United States, and Japan.

Treatment of overt hyperthyroidism

Patients with overt hyperthyroidism from Graves' disease or from toxic mul-tinodular goiter should clearly be treated. One therapeutic option for patients with Graves' disease is medical management with methimazole (MMI) or pro-pylthiouracil (PTU), both of which decrease thyroid hormone synthesis. Therapy with one of these drugs will induce long-term remission of Graves' disease in about half of all patients, although those patients with large goiters are less likely to remain euthyroid (70). Since remission of the hyperthyroidism caused by toxic multinodular goiter almost never occurs, therapy with MMI or PTU is only given prior to definitive therapy, as described below. Side effects of both of these medications include rash or urticaria. More seriously, agranulocytosis occurs in approximately 0.3 of patients (71). Patients starting on these medications should be cautioned to discontinue them and call their physician if they develop fever, rash, jaundice, arthralgia, or sore throat.

Clinical Application Questions

A 48-year-old woman is seen for intensely pruritic raised lesions on her trunk and extremities of 3 weeks' duration. Clinically her lesions look to you like hives. 2. Would this most likely be classified as acute urticaria, chronic urticaria, or chronic intermittent urticaria, and why 3. Assuming this is acute urticaria, what history should be sought to establish a possible cause 4. Assuming this is acute urticaria, what laboratory studies are indicated 6. What is the prognosis for acute urticaria

Dermatologic Physical Exam

Edematous plaques wheals or hives (see Photos 20-22). These raised plaques have sharp margins and the central color can vary from pink to yellow to white. A peau d'orange effect may be present in the center and there is often a peripheral dusky blotchy red border, which is the axon reflex. Individual hives may vary from a few millimeters to greater than palm-sized. Hives may remain discrete or may become confluent, forming geometric and polycyclic shapes. Pruritus is usually severe, especially at onset, and the lesions usually evolve rapidly, then resolve within a few hours. Although they are usually primary lesions, rarely bullae may develop as secondary lesions on the hive surface when edema is rapid and severe. Also very rarely purpura may occur in hives with marked vasodilation.

Indicated Supporting Diagnostic Data

Case history is critical to the discovery of a specific cause in acute, intermittent, or chronic urticaria. Testing should be guided by historical data, and extensive blind testing is seldom productive. History should be repeated periodically, as the victim may recall forgotten information or, over time, may make new associations. Biopsy is seldom indicated for urticaria when a question arises regarding common hives versus urticarial vasculitis (see Differential Diagnosis section), biopsy will help to distinguish them. This should be done in a staged fashion, eliminating first any suspect allergens and any substances known to cause pseudoallergic hives or nonspecific histamine or mediator release. With severe symptoms or with chronic disease, an avoidance diet with staged reintroduction of different food groups may be useful. In chronic urticaria, sinus films and apical dental films have the highest yield. They may be positive even when symptoms are absent. Other X-rays should be...

Characteristics of patients with food intolerance

Briefly, intolerance reactions are more common in adults and a wide range of responsible foods and symptoms induced are demonstrated.11,12 It must be remembered that not all IgE-mediated disease occurs immediately. There is a well-described phenomenon of late-phase IgE reactions with late urticaria (itchy hives) and oedema (swelling) within the first 24 hours of exposure to the foods. It can be difficult to distinguish clinically this 24-48 hour reaction from that which is caused by non-IgE-mediated immunological reactions such as those that cause an exacerbation of eczema. Often the temporal association with a dietary exposure to allergen is the only clue.

Approach to food avoidance

Unconfirmed food intolerance (food known or suspected) If the food is known or suspected either from the history or from skin test or RAST, a trial exclusion diet is recommended. The period of exclusion depends, to some extent, on the type and frequency of reaction. If the subject is having frequent symptoms, for example urticarial episodes several times a week or diarrhoea, exclusion for a couple of weeks might be sufficient to gauge the response. For atopic eczema or chronic recurrent urticaria, a longer period, i.e. 2-3 months, may be required to assess improvement, allowing for spontaneous fluctuation in the disease severity. If significant improvement is observed on a trial exclusion diet, then open or DBPCFC should be performed.6 An open challenge or reintroduction of the food in the diet may be sufficient if an objective improvement has been observed, for example if the frequency and severity of urticaria or severity of eczema assessed objectively with a standardised score has...

Other symptomatic treatment

Ketotifen with antihistaminic and anti-inflammatory properties has been used in food allergic reactions such as urticaria and bronchospasm. It may be useful as an additional therapy in some patients. Beta-2 agonists such as salbutamol or terbutalin may be used when bronchospasm is a prominent feature in an allergic reaction. These drugs can be delivered by inhalation through a metered dose inhaler, in an aerosol form through a nebuliser, or by intravenous route. Food-related eczema and rhinitis should be treated along the standard line with topical steroids and antihistamine in addition to allergen avoidance.

Treating the immediate symptoms 551 Acute allergic reactions to foods

The severity of reaction depends on sensitivity of the patients to food allergen and the amount ingested. Patients with life-threatening symptoms such as respiratory difficulty due to laryngeal oedema or severe bronchospasm and or hypotension should be regarded as having a severe reaction or anaphylaxis.13 Troublesome, but not immediately life-threatening, reactions such as generalised urticaria angioedema and bronchospasm of moderate severity may be termed severe allergic reactions. Sometimes the reaction is mild and confined to an organ or system, for instance oral or gastrointestinal symptoms or localised urticaria.

Allergy to food additives20

An additive is a substance added to foods for preservation, coloration and some other purposes. Additives are numerous and include benzoates, metabisulphites and azodyes. The prevalence of adverse reaction to additives is 0.03-0.5 . Adverse reactions to additives occur in 20-25 of patients with aspirin intolerance and in 10-20 with chronic recurrent urticaria. IgE-mediated hypersensitivity, resulting in acute allergic reaction, has been described for azodyes, ethylene oxide and penicillin, and delayed-type hypersensitivity for nickel salt. A list should be provided of foods containing the additive that the patient does not tolerate. Clear labelling of packaged food helps to avoid accidental exposure.

The Cryopyrinopathies Familial Cold Autoinflammatory Syndrome Muckle Wells Syndrome and Neonatal Onset Multisystem

Similar to pyrin and PSTPIP1, many other proteins involved in the regulation of innate immunity consist of multiple protein interaction domains. A second disease-associated molecule containing an N-terminal PYD is denoted cryopyrin (Hoffman et al. 2001b), so named for its N-terminal PYD and to reflect its association with cold-induced urticaria. This protein is also known as NALP3 (Aganna et al. 2002 Tschopp et al. 2003), PYPAF1 (Manji et al. 2002), or caterpiller 1.1 (Harton et al. 2002 O'Connor et al. 2003 Ting and Davis 2004). Mutations in this protein cause three separate disease entities that vary in severity. Familial cold autoinflammatory syndrome (FCAS, also known as familial cold urticaria, familial polymorphous cold eruption, and cold hypersensitivity) is a relatively mild febrile syndrome characterized by episodic fever, rash, and arthralgia, precipitated by exposure to cold temperature. The rash resembles urticaria, but biopsies show a neutrophilic infiltrate and the...

Clinical manifestation

Most common in children, who have 25100 red-brown macules or barely elevated papules, usually over the trunk lesion becomes a wheal when rubbed (Darier's sign) solitary mastocytoma usually appears within first month of life rubbery, yellow to brown, plaques, urticate with or without vesiculation after rubbing (bullous urticaria pigmentosa) telangiectasia macu-laris eruptiva perstans brown macules and telangiectasias with erythema, often over upper trunk associated with peptic ulcer disease diffuse mastocytosis bullae in infancy, replaced by doughy skin, with generalized pruritus dermatographism, bullae after minor skin trauma mast cell infiltration of liver, spleen, skeleton, and gastrointestinal tract flushing syndrome, most common in early life

DihydroxyN3Hydroxypropyl33Dimethylbutanamide Pantothenylol NPantoyl3Propanolamine Panthenol Pantothenyl Alcohol

Pan(to)thenol is the alcohol corresponding to pantothenic acid,of the vitamin B5 group. It is used as a food additive, and in skin and hair products as a conditioning agent. Contact dermatitis and urticaria have been reported. Schalock PC, Storrs FJ, Morrison L (2000) Contact urticaria from panthe-

Henoch Schonlein Purpura

Henoch-Schonlein purpura (HSP) is a disease that manifests symptoms of purple spots on the skin, joint pain, gastrointestinal symptoms, and glomerulone-phritis. HSP is a type of hypersensitivity vasculitis and inflammatory response within the blood vessel. It is caused by an abnormal response of the immune system. The exact cause for this disorder is unknown. The syndrome is usually seen in children, but people of any age maybe affected. It is more common in boys than in girls. Many people with HSP had an upper respiratory illness in the previous weeks. Purpuric lesions are usually over the buttocks, lower legs, and elbows. Besides purpuric lesions, nephritis, angioedema, joint pains, abdominal pain, nausea, vomiting, diarrhea, and he-matochezia can be seen. The scrotum can also be affected in 13 -35 of cases (Ioannides and Turnock 2001). While the testis and or scrotum can rarelybe involved, usually the scrotum is diffusely tender with erythema distributed all over the scrotum....

Picornalike Viruses of Hymenopterans Wasps and Bees

Kashmir bee virus (KBV) was initially isolated from A. cerana in Kashmir and India. Several strains of KBV were subsequently isolated from the European honeybee in Australia and New Zealand as well as from the wasp V. germanica and has since been shown to be pandemic in A. mellifera populations. Initially it was thought to cause extensive mortality in hives. Later studies showed that KBV normally exists in a latent state but that infections with other bee pathogens such as the microsporidian Nosema apis and the foul brood bacterium Melisococcus pluton can trigger virus replication leading to death. Some data suggest that KBV has a serological relationship to ABPV. However, this may be a nonspecific reaction similar to the serological crossreactivity detected between CrPV and the mammalian picornavirus EMCV or an example of convergent evolution since they can both be transmitted through the salivary glands. Molecular studies on the genome of KBV and ABPV will likely resolve these...

Commonly reported food allergies 1031 Cows milk

Cows' milk is an important weaning food in many countries. In recent years it has become practically ubiquitous, being found in an increasing range of commercially produced foods (Sampson 1998). There is extensive cross-reactivity between milks of different species (Businco et al. 1995, Carroccio et al. 1999). Cows' milk is one of the first foods to enter an infant's diet and therefore is often the first to cause problems. Adverse reactions to cows' milk can be divided into two main groups, immunological (IgE or non-IgE mediated) or non-immunolo-gical (Host et al. 1997, Host and Halken 1998). This latter group is mainly due to lactase deficiency and may be difficult to differentiate clinically from non-IgE mediated cows' milk allergy (Host et al. 1997, Bruinjzeel-Koomen et al. 1995). Cows' milk allergy gives rise to a spectrum of disease from immediate symptoms ranging from urticaria to anaphylaxis (Goldman et al. 1963, Sampson et al. 1992) and late symptoms which may not develop for...

Appendix A Table of Primary Lesions and Related Disorders

Tinea (large, multiloculated) Part III Urticaria (bullae as secondary lesions) Part III Macules Malignant melanoma Part V Molluscum (tightly-grouped papules) Part II Pityriasis rosea (rosy red) Part II Psoriasis Part II SCLE (sharply defined) Part IV Seborrheic keratosis Part V SLE (edematous) Part IV Squamous cell carcinoma (indurated) Part V Tinea (indurated) Part III Toxicodendron dermatitis (linear) Part IV Urticaria (edematous) Part III Pustules

Eyelid Lesions and Tissues of Origin

Excretory Glands

The dermis is composed largely of collagen with a small amount of elastin. Few lesions arise directly from these materials, but the dermis is frequently involved with infiltrative and other processes (Fig. 2). In angioedema the dermis is edematous with an inflammatory cell infiltrate. White blood cell infiltration also predominates in blepharitis, cellulitis, insect bites, and in cicatricial phemphigoid. Leukemic infiltrates also accumulate within the dermal stroma.

Evaluation of Eyelid Lesions

Eyelid Blood Vessels

Configuration represents the shape of the lesion as it is seen from above. Common types of configurations include nummular (coin sized and shaped), gyrate, annular (ring-like border with some degree of clearing in the center), and linear lesions. Most lesions have a circular configuration. A few lesions are oval, notably those of pityriasis rosea, and many others are irregular in shape. Examples of irregular shapes include gyrate and serpigenous lesions, which generally occur due to the melding of adjacent lesions that are enlarging in a centrifugal manner until they reach the point of confluence. Such lesions are frequently found, for example in psoriasis and urticaria. On the other hand, irregular lesions with angular or linear shapes generally occur as a result of external trauma such as scratching or are due to the direct inoculation of antigen (ocular medications) or virus (linear warts). Linear lesions (the shape, not the arrangement of a group of lesions) are special types that...

Natural History of the Disease

Natural History Disease Diagram

The incubation period following exposure is 3-6 months. In the week before icterus appears, some patients develop a serum sickness-like syndrome including arthralgia, fever, and urticaria. The clinical picture varies from asymptomatic anicteric infection to protracted icterus and, in some patients (< 1 ), liver failure (fulminant hepatitis). The acute infection is self-limiting and most patients recover within 1-2 months after the onset of icterus.

Traditional Movablecomb Hive Beekeeping

In a book published in 1682 in England, Sir George Wheler recounted his journeys in Greece and provided details of the hives he saw there (Fig. 3). He described the wooden bars shown lying across the top of the hive as broad, flat sticks and said that the bees built a comb down from each top-bar, which may be taken out whole, without the least bruising, and with the greatest ease imaginable. So it was a movable-comb hive. The Greek beekeepers must have placed the bars at the bees' natural spacing of their combs. They made a new colony by putting half the bars and combs from a hive into an empty one the queen would be in one of the hives, and the bees in the other would rear a new queen. TRADITIONAL BEEKEEPING WITHOUT HIVES A. dorsata In tropical Asia, a nest of the giant honey bee, A. dorsata, which is migratory, can yield much more honey than a hive of A. cerana. In a form of beekeeping with A. dorsata practiced in a few areas, people use horizontal supports called rafters instead of...

Symbolism And Reverence

Because of the perceived similarities between human and insect societies, social insects figure prominently in the symbolic representation of insects. Social insects such as ants, termites, and some bees represent desirable qualities such as unity, cooperation, and industriousness. For example, ants represent the benefits of teamwork and cooperation for the good of all. Many symbolic depictions feature the ancient activities of honey hunting and beekeeping. In Europe, bees and hives also are widely used in various signage and as heraldic emblems, perhaps extolling various qualities of bees upon their bearer. A fine example of the latter is found on the coat of arms of Pope Urban VIII, Maffeo Barberini, who consecrated the present church in St. Peter's Basilica in 1626. The three Barberini bees adorn various ornamentations at the church and many papal objects located in the Vatican museum, including the building itself. In the United States, honey bees are used to symbolize virtuous...

Food Intolerance and Allergy

Many people eat a variety of foods and show no ill effects however, a few people exhibit adverse reactions to certain foods. Food sensitivities refer to the broad concept of individual adverse reactions to foods. Food sensitivities are reproducible, unpleasant reactions to specific food or food ingredients. There are many types of adverse reactions to foods, e.g., hives, headaches, asthma, and gastrointestinal complaints. Food sensitivities can be divided into primary and secondary sensitivities (Table 10.1). in the blood stream are called basophils. Basophils and mast cells contain granules filled with active chemicals (mediators) thatcanbereleasedduringanallergicor inflammatory response. The mechanism hypersensitivity (Type I Figure 10.1), is composed of two major events. The first event or sensitization is when an allergen(antigen)isconsumed.Otherroutes of exposure can be portals for Serum concentration of IgE is low comparedwiththatofotherimmunoglobulins, and its serum half-life...

Effects on Particular Organs or Organ Systems

The skin suffers toxic effects itself, including cancer, primary irritation, allergic reactions, hair loss, pigment disturbances, ulceration, and chloracne. Dermatitis is an inflammation of the dermis. Irritant contact dermatitis and allergic dermatitis can both be caused by exposure to chemicals and produce similar symptoms, including hives, rashes, blistering, eczema, or skin thickening. The difference between them is that a true allergy takes time to develop, typically at least two weeks whereas irritation does not require a previous exposure. For example, no one reacts to poison ivy when first exposed. Only after a second or subsequent exposure does the itchy rash develop.


(Pterocarpus angolensis) A Central African tree, and the best of African timbers, very durable. Both the bark and roots are used medicinally, the bark by hot infusion mixed with figs, and used as a breast massage to induce lactation. The bark on its own is used as a cure for nettle rash, and the infusion for stomach upsets, headaches and mouth ulcers

Bee Balm

Melissa means a bee, and has the reputation of keeping bees in their hive. Gerard said The hives of bees being rubbed with the leaves of Bawme, causeth the bees to keep together, and causeth others to come unto them, a belief still current in East Anglia, where they say that if this grows in the garden, the bees will not leave the hive (G E Evans. 1966). Wiltshire beekeepers agree they rub the inside of the skeps with it (Wiltshire) after hiving a new swarm, to encourage them to stay.


Beekeepers in the East Riding of Yorkshire used to sprinkle the hive with an elder branch dipped in sugar and water when the bees were ready to swarm (Addy). In Cornwall, too, they say that the inside of hives should be scrubbed with elder flowers to prevent a new swarm from leaving (Courtney). But bees do not seem to like the smell. When they swarm, a sprig of elder is often held about nine inches above them. The idea is that the elder will drive them out of the tree in which they are swarming. In any case, elder is a well-known insect repellant. SWEET CICELY is very attractive to bees, and was often rubbed over the inside of hives to induce swarms to enter (Northcote). So was THYME, which was always grown near the hives (Gordon. 1977). BEE BALM, too, could be used, for it had the reputation of keeping bees in their hive, as Gerard said, and this is a belief still current, at least in East Anglia, where they say that if this grows in the garden, the bees will not leave the hive (G E...


The physical examination of a patient who lists urticaria and or angioedema as their symptom is often unremarkable. There should be a particular emphasis on the search for the signs of other systemic illnesses known to be associated with urticaria. Any urticarial lesion should be noted, such as an itchy well-demarcated raised area, often with surrounding erythema.

Crop Pollination

Colonies taken to pollinate crops should be strong, with many foraging bees, and also much unsealed brood (to stimulate the bees to forage for pollen), and space for the queen to lay more eggs. Hives should not be taken to the crop before it comes into bloom, or the bees may start foraging on other plants and continue to do so when the crop flowers. If the hives are in a greenhouse, four to eight frames of bees in each may be sufficient, but the beekeeper must check regularly that the bees have enough food alternatively, each hive may be provided with two flight entrances, one into the greenhouse and one outside. Beekeepers who hire out hives of bees for crop pollination need to have a sound legal contract with the crop grower they should also be aware of the risks of their bees being poisoned by insecticides.

Most common foods

The oral allergy syndrome discussed in Chapter 1 solely involves the oropharynx (mouth, tongue and throat). Patients describe the rapid onset of itching of the mouth and angioedema (swelling of the lips, tongue, palate and throat). This is generally followed by a rapid resolution of symptoms. They are most commonly associated with the ingestion of various fresh fruit and vegetables. Patients with allergic rhinoconjunctivitis ('hayfever') associated with airborne allergens are most commonly afflicted with this problem. Care must be exercised when taking the history that these symptoms were not in fact the herald of more generalised systemic symptoms.

Specific History

Commonplace urticaria is a monomorphous eruption of intensely pruritic wheals and is usually of sudden, sometimes explosive onset. Occasionally, victims will note gradual onset with increasing intensity, but this is not the typical presentation. A small number of patients during the acute phase will develop laryngeal or glottic edema, bronchospasm, and circulatory collapse, which can comprise fatal anaphylactic shock. This is a true medical emergency that requires prompt action. Acute urticaria is more frequent in young persons. Chronic hives are more frequent in middle-aged women. Urticarial lesions may also occur in other skin conditions, such as the peribullous areas of pemphigus vulgaris and bullous pemphigoid, or the wheal lesions seen as part of erythema multiforme. Here, however, the welts are associated with other lesions of more distinctive morphology. They are more fixed in duration, and the resemblance to true urticaria is superficial. At one time or another, urticaria is...

Erythema multiforme

Stevens-Johnson syndrome toxic epidermal necrolysis Henoch-Schonlein purpura urticaria viral exanthem Kawasaki disease figurate erythema fixed drug eruption lupus erythematosus primary her-petic gingivostomatitis Behcet's disease aphthous stomatitis Most commonly associated with herpes simplex virus infection also associated with other infections, drug ingestion, rheumatic diseases, vasculitides, non-Hodgkin's lymphoma, leukemia, multiple myeloma, myeloid metaplasia, polycythemia Erythema multiforme minor variant occasional mild flu-like prodrome initial lesion dull red macule or urticarial plaque in the center, with small papule, vesicle, or bulla sometimes developing raised, pale ring with edematous periphery gradually

Erythema toxicum

Erythema toxicum neonatorum erythema neonatorum toxic erythema erythema neonatorum allergicum erythema papulo-sum urticaria neonatorum erythema dys-pepsicum Candidiasis miliaria pyoderma insect bite reaction varicella herpes simplex virus infection urticaria folliculitis transient neonatal pustular melanosis


The most serious complication of hepatitis is fulminant hepatitis, which occurs in approximately 1 of all patients and leads to liver failure and hepatic encephalopathy and, in some, to death within 2 weeks of onset. Other complications include a syndrome that resembles serum sickness (muscle and joint pain, rash, angioedema), as well as cirrhosis, pancreatitis, myocarditis, aplastic anemia, or peripheral neuropathy.


Subcutaneous or intramuscular adrenaline is used as the first-line treatment for anaphylactic reaction to food and other allergens.11 The intramuscular route is preferable if there is evidence of circulatory collapse, as the absorption is better than from the subcutaneous site. Patients who are at risk of anaphylactic reactions, for example those with nut allergies, should be provided with a self-injectable adrenaline device. This delivers a set dose of adrenaline by intramuscular route. The adult dose is 300 ig and the paediatric dose is 150 g repeatable after 15 minutes. Patients and their carers should be given instructions in the use of the device in case of emergency. When absorption from the intramuscular route is not adequate, for example in severe hypotension and shock, slow intravenous injection may be used by trained personnel. Inhaled adrenaline is not useful for the treatment of anaphylaxis. However, it may be effective for angioedema or laryngeal oedema in the absence of...


In the treatment of food allergy, antihistamines are given primarily to relieve symptoms such as itching and urticaria due to inadvertent exposure. Oral symptoms, such as itching in the mouth and throat and swelling, may also respond but there is little effect on gastrointestinal symptoms such as vomiting and diarrhoea. For mild symptoms, oral antihistamine may be effective and may be continued until symptoms disappear. For moderate to severe allergic reactions, antihistamine should be given through the parentral route for rapid systemic availability. Occasionally antihistamines are used regularly for chronic food allergic symptoms where causative food(s) have not been identified.

Clinical Symptoms

Vomiting, and diarrhea, as well as epigastric distress, headache, and burning sensation of the throat. This can be followed by neurological numbness, tingling, cutaneous flushing, and urticaria. Symptoms subside in ca. 16 h and generally there are no lasting ill effects. Diagnosis of the illness is usually based on the patient's symptoms, time of onset, and the effect of treatment with antihistamine medication. The onset of intoxication symptoms is rapid, ranging from immediate to 30 min. The duration of the illness is usually 3 h, but may last several days. To confirm a diagnosis, the suspected food must be analyzed within a few hours for elevated levels of histamine.


Chlorhexidine gluconate, a cationic bisbiguanide, was developed in England in the early 1950s and was introduced into the United States in the 1970s. It is a chlorophenol biguanide with a broad antimicrobial spectrum. It is thought that chlorhexidine produces enzymatic reactions within the cell that result in protein denaturation and inactivation of nucleic acids 16 . Chlorhexidine is active against many Gram-positive and to a slightly lesser degree Gram-negative bacteria. Chlorhexidine is supplied in various concentrations of 0.5 with 70 alcohol, 2 , and a 4 detergent. It has greater residual activity than alcohol alone and is not inactivated by the presence of blood or human protein 19, 38-40 . There is minimal absorption through the skin. Anaphylactic reactions with bronchospasms and generalized urticaria are very rare and are associated with use on mucous membranes. In a prospective, randomized trial by Fuchs et al. 41 , three different methods of catheter exit site care were...


Although angioedema is clinically dissimilar to idiopathic edema in that the episodes of edema are acute and episodic, some have postulated a change in capillary permeability to protein in women with idiopathic edema 11 . In one series comparing normal subjects and patients with idiopathic edema, plasma albumin concentrations were lower in women with the disorder. A greater fractional turnover of albumin was deemed the cause in some, while a lower rate of albumin synthesis was observed in others. However, there is no convincing evidence that the disappearance rate of 125I-labeled albumin is greater in patients with idiopathic edema, although women have greater transcapillary protein flux than men when venous pressure is raised artificially. The decrease in plasma volume reported in some series may reflect obesity, which reduces calculated plasma volume when expressed as milliliters per kilogram of body weight.


Nicotine is an alkaloid found in tobacco, and is responsible for its pharmacological effects and addiction. Contact dermatitis from nicotine, considered as rare, has been more frequent since its use in transdermal systems. Irritant dermatitis is mainly encountered, as contact urticaria seems to be rare. Allergic contact dermatitis, sometimes generalized, has been reported, with positive patch testing to nicotine base (10 ethanol or petrolatum). No consequences have been reported in patients who start smoking again after skin sensitization.

Barium Enema

Hypersensitivity reactions during barium enema are extremely rare, and usually are mild, such as urticaria (7). Anaphylactic reactions have been reported during barium enema (8), but most were probably related to the use of latex balloons on enema tips (9,10). Therefore, patients with a history of reaction during a prior barium study should probably undergo some other type of examination. Intravascular contrast agents are used during most CT examinations, but not for virtual colonoscopy. Most radiologists use nonionic contrast agents that have a lower risk of adverse reactions. Steroid premedication should be considered for patients who have had a prior reaction to intravenous contrast, including urticaria, bronchospasm, laryngeal edema, vagal reaction, or anaphylactic shock.


Has been observed (Longley et al., 1993). Mast cell chymase has been reported to cleave membrane-associated SCF to a soluble and biologically active form. This mast cell-mediated process could serve to generate a feedback loop to enhance mast cell proliferation and function (Longley et al., 1997), and may be important for the etiology of mastocytosis. Transgenic mice overexpressing a form of SCF that could not be proteolytically released from keratinocytes did not develop mastocytosis, whereas similar animals expressing normal SCF in keratinocytes exhibited a phenotype resembling human cutaneous masto-cytosis (Kunisada et al., 1998). This observation suggested that formation of large amounts of soluble SCF can contribute to the pathology associated with mastocytosis in some patients. Several different mutations of the c-kit RTK that resulted in constitutive kinase activity have been found in human and rodent mast cell tumor cell lines (Furitsu et al., 1993 Tsujumura et al., 1994,...

Honey Processing

In a beekeeper's hives the bees store honey in the combs of an upper honey box that is removed when it is full. Bees may be cleared from combs in the honey box by various methods brushing and shaking bees off combs, using a bee-escape board through which bees can leave the honey box but not return, using a bee repellent, or blowing the bees out of the boxes with a stream of air.


Hypersensitivity responses were observed in some patients during infusions but, in general, these responses declined or resolved with continued weekly therapy. One patient had several recurrences of fever and chills and four others had recurrent episodes of urticaria (hives) and, on occasion, symptoms of angioedema (swelling in the tongue or throat). No clinically significant adverse laboratory results were observed in the patients. All patients developed antibodies to the rhIDU the titers peaked by 12 to 26 weeks and declined with time over 52 and 104 weeks. Further evaluations of these patients using epitope scanning technology confirmed that the patients tolerated all iduronidase epitopes over a 104-week period 29 . Complement activation was observed in four patients when comparing pre-and postinfusion specimens, but no significant clinical symptoms were observed. Peak consumption of complement occurred at weeks 6 and 12. By weeks 26 and 52, significant complement activation did...

Sweet Cicely

The whole plant is very attractive to bees, and was often rubbed over the inside of hives to induce swarms to enter (Northcote). In popular medicine it is taken for flatulence and any digestive ailment (Clair), and is a remedy for chest troubles or bronchial colds (Gibson), and is still used to lower blood pressure (Schauenberg & Paris).

Insect Zoos Defined

Most facilities contain a series of terrariums, where species are displayed in naturalistic mini-environments. A major insectarium is a comprehensive coverage of the class Insecta, representing many different orders such as Coleoptera, Hymenoptera, Orthoptera, and Mantodea. Observation honey bee hives, ant and termite colonies, walkingsticks, katydids, lubber grasshoppers, and assassin bugs are a few examples of typical displays. These facilities can be distinguished from collections of a few species of arthropod housed in a reptile house or aquarium or included in an exhibit that focuses on the interpretation of a particular ecosystem. Many tropical rain forest exhibits today include a few displays of insects, often a leafcutter ant exhibit and a few other invertebrates as nominal representatives of the vast diversity of invertebrates. However, overall these exhibits emphasize the vertebrate fauna of rain forests and present a relatively minor treatment of the subject of...

Safety Issues

For some people, proteins in cow's milk may trigger allergic reactions. Whey proteins (beta-lactoglobulin and beta-lact-albumin) and casein are the primary proteins that trigger allergic reactions. Symptoms of a milk allergy may include nasal congestion, hives, itching, swelling, wheezing, shortness of breath, nausea, upset

Food additives

The commonest food additives thought to cause adverse reactions are tartrazine (E102), sunset yellow (E110), annatto, aspartame, benzoic acid and sulphites (Fuglsang et al. 1993). Key epidemiological studies are shown in Table 10.9. Adverse reactions to food additives can occur at any age. A UK study showed a higher reporting of adverse reactions to food additives in the first ten years of life, and more often occurring in females (Young et al. 1987). The mechanism of the reaction is often unknown, and IgE-mediated reactions are rare. Questionnaire-based studies give a high 6.6-7.4 prevalence of self-reported adverse reactions to food additives in the general population. However, when food challenges are used to make the diagnosis, the prevalence falls to about 0.23 . One study shows the risk to be greatest in the atopic population, with no reactions observed in non-atopic individuals (Fuglsang et al. 1994). Virtually all reactions are minor and limited to the skin (worsening of...

Lupus Erythematosus

Lupus Ana Levels

Common nonscarring eyelid lesions include a pruritic eruption of the lower eyelids. Scarring lesions often present as sharply demarcated purple-red, slightly raised, circumscribed plaques covered with thin adherent whitish scales and telangiectasias. Often such lesions are localized to the lateral aspect of the lower eyelids. Such lesions may enlarge to reach a size of about 5 to 10 mm. The major disfigurement of discoid lupus occurs as the lesions involute where atrophic scarring may lead to trichiasis and entropion. Often, pronounced hypopigmentation or hyper-pigmentation occurs. Other common skin manifestations include the classic butterfly rash, cutaneous vasculitic foci, urticaria, vesiculobullous lesions, and nonscarring alopecia. Ocular manifestations include retinal hemorrhages, cotton wool spots, retinal vasculitis, papillitis, diffuse retinal edema, keratoconjunctivitis sicca, and band keratopathy. Associated systemic findings in lupus erythematosus include arthralgia,...

Leukemia Cutis

Eyelid Infiltrative Disorders

CLINICAL PRESENTATION Leukemia cutis of the eyelid skin manifests most commonly as multiple 1 to 2.5 cm discrete nodules ranging from a solitary lesion to involvement of 70 of the body surface. These lesions rarely ulcerate, and may be associated with urticaria and pruritis. Lesions vary in color from blue to red, to purple to green, to brown, depending on the amount of myeloperoxidase present within the immature blast cells. Diffuse infiltration of the dermis by leukemic cells may be seen. Associated ocular involvement may include lesions of the retina, optic nerve, globe, or conjunctiva. The retina shows the most frequent clinical involvement in leukemia with hemorrhage, cotton-wool spots, venous dilatation, micro-aneurysms, and leukemic infiltrates. Associated orbital disease is not uncommon and presents with pain, lid edema, and exophthalmos. Systemic manifestations include purpura due to thrombocytopenia, urticaria, pruritis, erythema multiforme, leonine facies, alopecia,...


Periwinkle soothes nettle rash, they say in the Fen country (Porter. 1969), and an ointment made with it was used for bruises and persistent skin irritation in Scotland (Beith). The roots were a popular colic cure in the Fen country (Porter. 1969), and periwinkle used to be an Irish (County Cavan) treatment for diabetes (Maloney). The leaves laid on gatherings and boils is an Oxfordshire remedy (Oxfordshire and District Folklore Society. Annual Record. 1951). It was reckoned to be good for sore breasts in Lincolnshire, the leaves being crushed and applied to the part (Gutch & Peacock) a poultice of the roots applied to a cow's udder was said in Cambridgeshire to cure milk fever (Porter. 1969). It is said to be a good remedy for cramp, too (Grieve. 1931). People used to wear bands of green periwinkle about the calf of the leg to prevent it (Fernie), and in Lincolnshire a piece was put between the bed and mattress for the same purpose (Rudkin).

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