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    ABSTRACT: Many egg-allergic patients are unnecessarily restricted from receiving the influenza vaccine. Patients with suspected egg allergy who require seasonal or H1N1 influenza vaccination can pose a significant challenge and should be appropriately evaluated by an allergist/immunologist. In most cases, if the benefits are felt to outweigh the risks, precautionary measures are available that can enhance safe vaccine administration. A case of influenza vaccine management in a child with egg allergy is presented. Clinical characteristics, diagnostic testing, case management, and natural history are reviewed. Clinical Pearls and Pitfalls include: (1) Batch-to-batch variability of egg content in extant influenza vaccines necessitates an informed and cautious approach to vaccination of an egg-allergic individual. (2) Due to denaturation of some egg proteins through heating, tolerance of "baked egg" products may not predict tolerance of "native egg" proteins present in the influenza vaccine. (3) Intradermal skin testing with influenza vaccine diluted 1:10 may be irritating to the skin and result in false positive results. (4) If skin test to the vaccine is positive, vaccination may still be cautiously administered, if necessary, in a graded-dose protocol, as presented herein. (5) Most patients with egg allergy are likely to develop egg tolerance by late childhood.
    No preview · Article · Nov 2009 · Allergy and Asthma Proceedings
  • Article: Anaphylaxis
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    ABSTRACT: Anaphylaxis occurs commonly in community settings. The rate of occurrence is increasing, especially in young people. Understanding potential triggers, mechanisms, and patient-specific risk factors for severity and fatality is the key to performing appropriate risk assessment in those who have previously experienced an acute anaphylactic episode. The diagnosis of anaphylaxis is based primarily on clinical criteria and is valid even if the results of laboratory tests, such as serum total tryptase levels, are within normal limits. Positive skin test results or increased serum specific IgE levels to potential triggering allergens confirm sensitization but do not confirm the diagnosis of anaphylaxis because asymptomatic sensitization is common in the general population. Important patient-related risk factors for severity and fatality include age, concomitant diseases, and concurrent medications, as well as other less well-defined factors, such as defects in mediator degradation pathways, fever, acute infection, menses, emotional stress, and disruption of routine. Prevention of anaphylaxis depends primarily on optimal management of patient-related risk factors, strict avoidance of confirmed relevant allergen or other triggers, and, where indicated, immunomodulation (eg, subcutaneous venom immunotherapy to prevent Hymenoptera sting-triggered anaphylaxis, an underused, potentially curative treatment). The benefits and risks of immunomodulation to prevent food-triggered anaphylaxis are still being defined. Epinephrine (adrenaline) is the medication of first choice in the treatment of anaphylaxis. All patients at risk for recurrence in the community should be equipped with 1 or more epinephrine autoinjectors; a written, personalized anaphylaxis emergency action plan; and up-to-date medical identification. Improvements in the design of epinephrine autoinjectors will help to optimize ease of use and safety. Randomized controlled trials of pharmacologic agents, such as antihistamines and glucocorticoids, are needed to strengthen the evidence base for treatment of acute anaphylactic episodes.
    No preview · Article · Feb 2010 · The Journal of allergy and clinical immunology
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    ABSTRACT: Virus-like particles (VLPs) consisting of the influenza A virus proteins haemagglutinin (HA) and matrix protein (M1) represent a new alternative approach for vaccine design against influenza virus. Influenza VLPs can be fast and easily produced in sufficient amounts in insect cells using the baculovirus expression system. Up to now, influenza VLPs have been produced in the Spodoptera frugiperda cell line Sf9. We compared VLP production in terms of yield and quality in two insect cell lines, namely Sf9 and the Trichoplusia ni cell line BTI-TN5B1-4 (High Five). Additionally we compared VLP production with three different HAs and two different M1s from influenza H1 and H3 strains including one swine-origin pandemic H1N1 strain. Comparison of the two cell lines showed dramatic differences in baculovirus background as well as in yield and particle density. Taken together, we consider the establishment of the BTI-TN5B1-4 cell line advantageous as production cell line for influenza VLPs.
    Full-text · Article · Mar 2010 · Molecular Biotechnology
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