Dental treatment involves the use of a wide range of materials. Many of the dental materials or their components pose a potential risk to the patient and member of the dental team. Pre-market ...biocompatibility testing cannot guarantee absolute safety, making monitoring of materials likely to cause an adverse reaction essential. The prevalence of adverse reactions to dental materials amongst dental patients and staff has not been systematically monitored in the UK. This project aims to develop a systematic approach to the evaluation and monitoring of the extent and severity of adverse reactions to dental materials in the UK.
Through the distribution of reporting forms to dental surgeries and laboratories in the UK, the ARRP has received 1,075 complete reports relating to adverse reactions seen or experienced by dental staff and patients.
The main findings were that different materials cause adverse reactions to different groups of people. The largest proportion of patient related adverse reactions were reported to be due to metals (n = 175). These were mainly amalgam associated oral lichenoid reactions (n = 124). Dental technicians reported acrylic resin as the causal factor of hand dermatitis in 61% (44 out of a total 72) of cases reported. Finally, dental surgery staff reported gloves as causing hand dermatitis in 75% of cases (398 out of a total 531).
Different dental materials affect different person groups depending on their exposure to the material. Dental staff are most at risk from an adverse reaction to latex gloves, whereas most reported reactions for patients were due to metals. For dental technicians the biggest danger of an adverse reaction was from acrylic resins. There is a need to continue to raise the awareness among dental professionals of the existence of the Adverse Reactions Reporting Project so as to overcome problems of under-reporting.
As a consequence of the significantly larger inoculum of lymphoid cells present in peripheral blood stem cell (PBSC) harvests compared to bone marrow (BM), it is possible that autoPBSCT recipients ...may have an earlier and*or enhanced response to vaccines. Until data to confirm this become available, the European Blood and Marrow Transplantation Association (EBMT) recommend that all transplant recipients be immunized in the same way regardless of stem cell source. We performed a prospective study comparing serological responses to influenza, pneumococcal polysaccharide and tetanus toxoid vaccines between autoPBSCT with autoBMT recipients. Antibody responses in sibling HLA-matched allogeneic BMT (alloBMT) survivors were also evaluated. All vaccines were administered within the first 2 years after stem cell transplantation. Fifty patients were enrolled. The time of vaccination after transplant was similar between autoPBSCT (mean 11 months for each vaccine) and autoBMT recipients (mean 12 months except 13 months for tetanus toxoid) (P = NS). Serological responses were poor and no significant difference in response to any of the vaccines used was seen between the three transplant cohorts. We provide no evidence that current EBMT guidelines be modified. Large prospective vaccine studies are needed to address the issue more fully.
The paper presents the boundary perturbation method applied to optimal plastic shape design. Perfect plasticity is assumed. The procedure consists of two steps: the class of fully plastic solutions ...in the limit stale is first determined, and then the optimal shape is chosen from among these solutions. Heads of tension members with skew bearing surfaces are considered. Optimal angle of inclination of such surfaces is also evaluated. The final results are verified by means of the AD1NA program.
The paper applies the boundary perturbation method (BPM) to optimal plastic design under bending with considerable shear effects. This method uses expansions of stress components and of the unknown ...boundary into power series of a small parameter. In the present paper the small parameter α represents the effects of shear. General solutions of the hyperbolic equations derived are given and the shape is described by a power series resulting from boundary conditions. The convergence is improved by extrapolation and local corrections. Verification of the results by the ADINA program is provided. An optimal beam with a doubly-connected lateral profile is also determined. Its weight is considerably smaller than that of a solid beam.
Hepatitis C virus (HCV) infection has been implicated in the pathogenesis of mixed cryoglobulinaemia. Several studies have shown the presence of anti‐HCV antibodies and HCV‐RNA in both sera and ...cryoglobulins of such patients. However, the prevalence and clinical significance of cryoglobulins remain uncertain in patients with chronic HCV infection. We have studied 113 consecutive patients referred for assessment because of the presence of anti‐HCV antibody in serum for the presence of cryoglobulinaemia and ascertained their clinical relevance and immunochemical properties. Twenty‐one of 113 (19%) had detectable cryoglobulins with a mean protein concentration of 0.38 g/l (range 0.15–3.34 g/l). Most of these patients were asymptomatic. The cryoglobulins were of type III in 19 (91%) and of type II in two patients (9%). The latter two patients had the highest concentration of cryoglobulins, subnormal C4 and C1q levels suggesting classical pathway activation and vasculitis with renal impairment. The cryoglobulin IgG subclasses were mainly IgG1 and IgG3. HCV‐RNA was detected more frequently in the sera of cryoglobulin‐positive patients than in cryoglobulin‐negative patients. This study showed that mixed cryoglobulinaemia is common in chronic HCV infection, and is predominantly type III. Evidence of systemic or renal disease was rare except in those with type II cryoglobulinaemia, and this may reflect either the concentration of the cryoprecipitate or the presence of a monoclonal complement‐activating IgM paraprotein. The detection of HCV‐RNA in the majority of the cryoprecipitates further supports the important role of HCV in the etiopathogenesis of essential mixed cryoglobulinaemia, although the mechanism is at present unclear.
Patients with autoimmune polyendocrine syndrome type 1 (APS-1) suffer from multiple organ-specific autoimmunity with autoantibodies against target tissue-specific autoantigens. Endocrine and ...nonendocrine organs such as skin, hair follicles, and liver are targeted by the immune system. Despite sporadic observations of pulmonary symptoms among APS-1 patients, an autoimmune mechanism for pulmonary involvement has not been elucidated. We report here on a subset of APS-1 patients with respiratory symptoms. Eight patients with pulmonary involvement were identified. Severe airway obstruction was found in 4 patients, leading to death in 2. Immunoscreening of a cDNA library using serum samples from a patient with APS-1 and obstructive respiratory symptoms identified a putative potassium channel regulator (KCNRG) as a pulmonary autoantigen. Reactivity to recombinant KCNRG was assessed in 110 APS-1 patients by using immunoprecipitation. Autoantibodies to KCNRG were present in 7 of the 8 patients with respiratory symptoms, but in only 1 of 102 APS-1 patients without respiratory symptoms. Expression of KCNRG messenger RNA and protein was found to be predominantly restricted to the epithelial cells of terminal bronchioles. Autoantibodies to KCNRG, a protein mainly expressed in bronchial epithelium, are strongly associated with pulmonary involvement in APS-1. These findings may facilitate the recognition, diagnosis, characterization, and understanding of the pulmonary manifestations of APS-1.
Background
Changeover from Phadebas RAST to Pharmacia AutoCAP increased double‐positivity to both honey‐bee and common wasp (vespula) venom in our patients.
Objective
We examined the frequency of IgE ...double‐positivity, its clinical relevance and utility in investigating potentially allergic patients.
Methods
One hundred and eighty‐two patients with hymenoptera allergy were tested using RAST (n = 51) and AutoCAP (n = 131) assays over 4 years. Patients had a history of reactions to vespulae (22), honey‐bee (10) and unidentified hymenoptera (vespinae) (7).
Results
After changing from RAST to AutoCAP double‐positivity increased from 10 (5/ 51) to 30% (39/131) (P < 0.01). RAST and CAP assays gave similar median class results (vespula = 3, honey‐bee = 2). Thirty‐six CAP patients had systemic reactions of Mueller grade II and above. In vespula‐allergic double‐positive subjects, high CAP classes ( class 3) to honey‐bee were common (30%). In 25% the CAP classes were equal. In honey‐bee‐allergic subjects, all vespula venom CAP IgE was low titre (class 1 or 2) and 20% were equal for both venoms. In 43% of vespinae‐allergic patients the CAP class was equal to both (class 2 and 3). In contrast, intradermal skin test double‐positivity was uncommon. Double‐negative skin test results were common in the CAP double‐positive population (22% of honey‐bee‐allergic, 13% of vespula‐allergic and 43% of vespinae‐allergic patients). Vespula allergic patients have higher bee‐venom IgE than vice versa. Twenty‐seven per cent of CAP double‐positive patients (representing 8% of all venom allergic patients tested over this period) had equal class IgE to both venoms which was not helpful in diagnosis. Combination of skin testing and CAP is unhelpful in only 5/37 (14%) of patients with double‐positive serology.
Conclusion
If used in isolation CAP may be misleading, especially if only one venom is tested. Identification of the causative venom must utilize both clinical history and skin testing in these double‐positive patients, and challenge testing if indicated.
The Adverse Reaction Reporting Project (ARRP) was set up to measure the extent and severity of adverse reactions to dental materials in the UK. Further analysis into the use of protective gloves has ...been carried out to establish the degree to which gloves are having a deleterious effect on the dental profession. In addition the survey aimed to establish the techniques used to manage adverse reactions and their effectiveness. In a 23-month period, 369 reports were received concerning adverse reactions to protective gloves used in dental practices. Reporters were contacted for further information, and a 92% response rate was achieved. The 330 reports analysed showed dentists to be the largest group to report adverse reactions, whilst dental technicians reported the fewest. The referral rate for staff and patients was similar with a third of adverse reactions being referred (n=110) to a specialist for diagnosis. A confirmed diagnosis was received in 65% of referred cases (n=72), but the symptoms reported suggested a larger degree of Type I reactions occurring than diagnosed. The use of non-powdered gloves appeared to be favoured over powdered gloves in 42% of glove changes, and nitrile gloves were used as an alternative to latex in 39% of changes. In conclusion, the results from this survey showed that wearing gloves in dental practices in the UK caused a range of adverse reactions. In 79% (n=330) of cases reported and analysed, these reactions were readily resolved or improved by self-medication, prescribed medication and/or changing to a different type of protective glove.
Background: The UK National Health Service is failing to meet the need for diagnosis and treatment of allergic disorders, which are common and increasing in prevalence. The House of Commons select ...committee report on allergy services highlighted the inequalities and urgent need for investment. Aim: To survey the allergy workload provided by clinical immunologists to inform service planning and resource allocation. Methods: The allergy services performed by clinical immunologists during a 12 month period from 1 April 2003 to 31 March 2004 were surveyed by means of a questionnaire via supraregional audit groups. Results: The immunology centres surveyed serve 32 million people and offer almost the complete repertoire of a specialised allergy service. There were large variations in clinic capacity, new referrals, appointment duration, and service configuration. Services were largely consultant delivered, but availability of joint clinics with paediatricians and anaesthetists was locally variable. Novel service delivery models utilising nurses and clinical assistants have been developed and merit further investigation. Conclusion: Consultant immunologists and trainees currently make a major contribution to the development and provision of specialised allergy services. Consultant immunologists will probably remain key providers of tertiary level allergy care in the UK in the long term (in line with other countries) and will be pivotal in supporting and developing the provision of equitable national access to specialist allergy services in a timely manner. Rapid progress in developing the new specialty of allergy and securing better access to services for patients in the short term will be best served by strengthening the collaborative relationship between allergists and clinical immunologists.
Primary immune deficiencies (PIDs) are a growing group of over 230 different disorders caused by ineffective, absent or an increasing number of gain of function mutations in immune components, mainly ...cells and proteins. Once recognized, these rare disorders are treatable and in some cases curable. Otherwise untreated PIDs are often chronic, serious, or even fatal. The diagnosis of PIDs can be difficult due to lack of awareness or facilities for diagnosis, and management of PIDs is complex. This document was prepared by a worldwide multi-disciplinary team of specialists; it aims to set out comprehensive principles of care for PIDs. These include the role of specialized centers, the importance of registries, the need for multinational research, the role of patient organizations, management and treatment options, the requirement for sustained access to all treatments including immunoglobulin therapies and hematopoietic stem cell transplantation, important considerations for developing countries and suggestions for implementation. A range of healthcare policies and services have to be put into place by government agencies and healthcare providers, to ensure that PID patients worldwide have access to appropriate and sustainable medical and support services.
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