Funtabulously Frivolous Friday Five 270

The atopic march describes the general progression of allergic disorders with age. 

Generally starting with eczema in infants and toddlers, to allergic rhinitis and finally asthma in young children and adolescents

Reference: Ker J and Hartert TV. The atopic march: what’s the evidence? Ann Allergy Asthma Immunol. 2009;103(4):282-289.

Ticks (specifically Ixodes holocyclus).

Humans can be specifically allergic to tick bites on their own, however the mechanism whereby meat allergy is induced is unique. The allergen associated with this allergic reaction is a sugar molecule, alpha-galactose. Alpha-galactose is present in the gut (and likely saliva) of ticks and all mammalian meats except for the meat of humans, great apes and Old World monkeys. Some people can become so allergic they are unable to ingest any mammalian milk or animal derived gelatin.  IV products such as Haemaccel and Gelofusine contain gelatin colloid and should be avoided. 

See ASCIA Tick allergy for further details on how to remove a tick and allergy testing.

Drug Reaction with Eosinophilia and Systemic Symptoms, also known as Drug Induced Hypersensitivity Syndrome.

Incidence ranges from 1/1000 to 1/10,000 drug exposures.  Frequently DRESS is a delayed onset from drug exposure, usually 2-6 weeks.  

Patients will present with:

• Fever >38 Celsius
• Skin rash
• Hepatic involvement noted with abnormal LFTs
• Eosinophilia
• Organ involvement may include hepatitis, pneumonitis, myocarditis, pericarditis, nephritis or colitis

The major cause of the morbidity and mortality associated with DRESS which can be as high as 10% (mortality). Unsurprisingly given the fever, rash, systemic features, DRESS can frequently be confused with infection and sepsis.

The two major drug culprits are carbamazepine and allopurinol. Treatment involves stopping to offending drug and steroids.

Reference: Cacoub P et al. The DRESS Syndrome: A Literature Review. Am J Med 2011;124(7):588-597

Amoxicillin.

Seemingly pathognomonic, this exaggerated eosinophil rich maculopapular exanthem frequently occurs a few days after commencing amoxicillin in a patient with EBV.  A good reason to cease the antibiotic but to explain to the patient this does not mean they are allergic to beta-lactams!

Reference: Ónodi-Nagy K et al. Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitisation. Allergy Asthma Clin Immunol. 2015;11(1):1

Hawaii

Dr Richard Creagan, a Hawaiian Democratic Representative proposed the bill that calls for raising the cigarette-buying age to 30 by next year, 40 in 2021, 50 in 2022 and 60 in 2023. By 2024, the minimum age would be 100.

Reference: SBS news