May 28th, 2011 by ChristopherChangMD in Health Tips, Research
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It is a prevalent belief out in the medical (and lay public) community that patients with iodine or seafood allergy can not receive contrast when undergoing certain radiological tests like CT or MRI scans. The concern is that contrast contains minute amounts of free iodide and as such, IV administration of this material puts the patient at risk of a life-threatening anaphylactic reaction.
Contrast is often given in these tests as it traces out bloodflow enabling the physician to see organ and mass architecture much more clearly allowing for improved accuracy in seeing anything abnormal.
Well… rest assured that patients with iodine and seafood allergy CAN receive contrast without any significant increased risk of an allergic reaction as compared to other allergies.
In a large study encompassing 112,003 patients, Read more »
*This blog post was originally published at Fauquier ENT Blog*
May 11th, 2011 by ChristopherChangMD in News
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Up until now, there have been three anti-histamine nasal sprays in the United States market available only by prescription… Astelin, Astepro, and Patanase.
However, in May 2011, Meda Pharma announced a new anti-histamine nasal spray Rhinolast Allergy that is available over-the-counter.
The active ingredient is azelastine, the same one as found in the prescription nasal spray Astelin and Astepro.
Azelastine has a triple mode of action: anti-histamine effect, mast-cell stabilizing effect, and anti-inflammatory effect. Azelastine has a rapid onset of action of 15 minutes.
It can be used from the age of 5 years.
This nasal spray can be used in combination with other over-the-counter anti-histamines medications taken orally like zyrtec, claritin, allegra, and benadryl.
Read more about this new nasal spray here.
Read more about allergy medications in general here.
*This blog post was originally published at Fauquier ENT Blog*
April 10th, 2011 by ChristopherChangMD in Health Tips, Research
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Researchers in Turkey found that there is an association between nasal hair density and risk of asthma developing in patients with seasonal rhinitis patients. No joke… They published their findings in the International Archives of Allergy and Immunology in March 2011.
The rate of asthma found in patients with little or no nasal hair was 44.7% whereas only 16.7% of patients with a dense forest of nasal hair had asthma.
They hypothesize that increased nasal hair improves allergen filtration thereby preventing the allergens from irritating the airway. The assumption here being that allergen irritation of the airway can potentially cause asthma.
IF this is true (and that’s a big if)… patients with allergies should be encouraged to grow nice thick nasal hair to prevent future asthma!
Read the research abstract here!
Reference:
Does Nasal Hair (Vibrissae) Density Affect the Risk of Developing Asthma in Patients with Seasonal Rhinitis? Int Arch Allergy Immunol. 2011 Mar 30;156(1):75-80
*This blog post was originally published at Fauquier ENT Blog*
March 28th, 2011 by ChristopherChangMD in Health Tips
1 Comment »
DISCLAIMER: This post is not meant to condone or promote allergy shots to be given at home. It is meant to promote discussion and make patients aware of the issues involved.
Allergy shots, unlike medications like claritin and flonase, offer patients with significant allergies a way to potentially be cured of their misery without the need for daily medication use. However, there is a small, but substantial risk for anaphylaxis and even death with allergy shot administration. After all, a patient is being injected with the very substances that cause their allergies. As such, many allergists will allow allergy shots to be administered ONLY within a medical setting. Also, the American Academy of Allergy Asthma and Immunology (AAAAI) specifically forbids allergy shots to be administered at home.
Furthermore, the allergen extracts used to make the allergy vial serum used for allergy shots carry a black box warning on the medication package insert: Read more »
*This blog post was originally published at Fauquier ENT Blog*
September 10th, 2009 by RamonaBatesMD in Better Health Network, Health Tips
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This past week I was once again asked about suture allergy. It has prompted me to revisit the issue which I have posted about twice now. (photo credit).
Sutures by their very nature of being foreign material will cause a reaction in the tissue. This tissue reactivity is NOT necessarily a suture allergy.
Many factors may contribute to suture reactivity.
- The length of time the sutures remain. The longer the sutures are in, the more reactivity occurs.
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The size of the sutures used. The larger the caliber of the suture, the more reactivity. The increase of one suture size results in a 2- to 3-fold increase in tissue reactivity.
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The type of suture material used. Synthetic or wire sutures are much less reactive than natural sutures (eg, silk, cotton, catgut). Monofilament suture is less reactive than a braided suture.
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The region of the body the suture is used affects tissue reactivity. The chest, back, extremities, and sebaceous areas of the face are more reactive.
In general, accepted time intervals for superficial suture removal vary by body site, 5-7 days for the face and the neck, 7-10 days for the scalp, 7-14 days for the trunk, and 14 days for the extremities and the buttocks. The deeper placed sutures will never be removed.
Sutures meant to dissolve (ie vicryl sutures) placed too high in the dermis (which happens often when the dermis is thin) can “spit” several weeks to several months after surgery. This is a reactive process, NOT a suture allergy. It usually presents as a noninflammatory papule (looks very much like a pimple) and progresses with extrusion of the suture through the skin. The suture material may be trimmed or removed if loose, and it is not needed for maintaining wound strength. Rarely does this affect the scar outcome.
The remaining portion is a “repost” about suture allergies:
Allergic reactions to suture materials are rare and have been specifically associated with chromic gut. However, Johnson and Johnson mention known triclosan allergy as a contraindication for use of certain sutures (see below). Contact allergy to triclosan is uncommon.
Surgical gut suture (Plain and Chromic) is contraindicated in patients with known sensitivities or allergies to collagen or chromium, as gut is a collagen based material, and chromic gut is treated with chromic salt solutions.
MONOCRYL Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP(triclosan).
PDS Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).
VICRYL*suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan). [In rechecking facts, I found that only Vicryl Plus has the triclosan, so simple vicryl or coated vicryl should be okay.]
Surgical Stainless Steel Suture may elicit an allergic response in patients with known sensitivities to 316L stainless steel, or constituent metals such as chromium and nickel. Skin staples are surgical steel so should be used with the same precautions.
Dermabond — Tissue glues should not be used in patients with a known hypersensitivity to cyanoacrylate or formaldehyde.
SO WHAT IS LEFT TO USE
So what is left to use in a patient who may have or has a proven allergy to suture or closure material?
Silk, Dexon, Nylon (monofilament or braided), Prolene, INSORB (absorbable staples), and any of the above listed (in the allergy section) to which the patient in question doesn’t react negatively.
The choice of a particular suture material will have to based further on the wound, tissue characteristics, and anatomic location. Understanding the various characteristics of available suture materials will be even more important to make an educated selection.
The amount of suture placed in a wound, particularly with respect to the knot volume, affects inflammation. The suture size contributes more to knot volume than the number of throws. The volume of square knots is less than that of sliding knots, and knots of monofilament sutures are smaller than those of multifilament sutures.
REFERENCES
Allergic Suture Material Contact Dermatitis Induced by Ethylene Oxide: G. Dagregorio, G. Guillet; Allergy Net Article
Johnson and Johnson Product Information
Current Issues in the Prevention and Management of Surgical Site Infection – Part 2; MedScape Article
MECHANICS OF BIOMATERIALS: SUTURES AFTER THE SURGERY; Raúl De Persia, Alberto Guzmán, Lisandra Rivera and Jessika Vazquez
Materials for Wound Closure by Margaret Terhune, MD; eMedicine Article
Product Allergy Watch: Triclosan; MedScape Article by Lauren Campbell; Matthew J. Zirwas
New References
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Surgical Complications;
eMedicine Article, May 29, 2009; Natalie L Semchyshyn, MD, Roberta D Sengelmann, MD
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Engler RJ, Weber CB, Turnicky R. Hypersensitivity to chromated catgut sutures: a case report and review of the literature.
Ann Allergy. Apr 1986;56(4):317-20.
[Medline].
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Fisher AA. Nylon allergy: nylon suture test.
Cutis. Jan 1994;53(1):17-8.
[Medline].
Related Posts
Allergies from Suture Material (September 7, 2007)
Suture Allergies Revisited (April 30, 2008)
Suture (June 7, 2007)
Basic Suture Techniques (June 8, 2007)
*This blog post was originally published at Suture for a Living*
It is a prevalent belief out in the medical (and lay public) community that patients with iodine or seafood allergy can not receive contrast when undergoing certain radiological tests like CT or MRI scans. The concern is that contrast contains minute amounts of free iodide and as such, IV administration of this material puts the patient at risk of a life-threatening anaphylactic reaction.
