Workup of insulin allergy involves a thorough history and physical exam to exclude other potential culprits. It is worth noting that contamination of the insulin needle can occur with latex when insulin is being drawn up, as latex is commonly found in the insulin vial [23]. As a result, latex allergy should be excluded, or latex-free insulin vials should be used if suspicion is high for a latex allergy. Allergy to excipients zinc, protamine and metacresol used with different formulations of insulin have been described as a potential cause of systemic reactions, and should be evaluated with skin prick testing (SPT) [9,10,11,12]. However, intradermal skin testing can also be used to diagnose insulin allergy and has been suggested to be more sensitive than SPT to detect insulin allergy [7]. As in this case, if commercial skin test kits are not available, insulin and protamine can be diluted for use for SPT and intradermal testing as per published dilution recommendations outlined in Table 2 [24]. Skin test results should be interpreted in association with the clinical symptoms as false positives do occur and have been noted in 28% of diabetic patients with low specific IgE titers [10]. In fact, it has been postulated that as high as 40% of asymptomatic diabetic patients may have a positive skin test result or specific IgE to insulin [25]. The presence of specific IgE insulin is more supportive of a type 1 hypersensitivity reaction and its absence less likely so. Circulating IgE levels can be elevated or absent in patients with insulin hypersensitivity reactions and may be low in acute reactions due to consumption [26].
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Author: Mark Peakman, Diego VerganiWithin this one volume both basic science and clinical immunology are demystified for the medical and other health sciences student. The basic immunological processes are described first, with a level of detail restricted to what is appropriate for medical (and similar) curricula. In the second part of the book, immunological mechanisms behind major diseases of the various body systems are explained. Throughout the text clinical details are highlighted and more in-depth material is differentiated from the main text.Buy NowClinical Immunology: Principles and PracticeAuthor: Robert R. Rich MD, Thomas A Fleisher MD FAAAAI FACAAI, William T. Shearer MD PhD, Harry Schroeder, Anthony J. Frew MD FRCP, Cornelia M. Weyand MD PhD
For over 40 years the Manual of Molecular and Clinical Laboratory Immunology has served as the premier guide for the clinical immunology laboratory. From basic serology testing to the present wide range of molecular analyses, the Manual has reflected the exponential growth in the field of immunology over the past decades. This eighth edition reflects the latest advances and developments in the diagnosis and treatment of patients with infectious and immune-mediated disorders.The Manual features detailed descriptions of general and specific methodologies, placing special focus on the interpretation of laboratory findings, and covers the immunology of infectious diseases, including specific pathogens, as well as the full range of autoimmune and immunodeficiency diseases, cancer, and transplantation.Written to guide the laboratory director, the Manual will also appeal to other laboratory scientists, especially those working in clinical immunology laboratories, and pathologists. It is also a useful reference for physicians, mid-level providers, medical students, and allied health students with an interest in the role that immunology plays in the clinical laboratory.Buy NowImmunology Made Ridiculously SimpleAuthor: Massoud Mahmoudi
Edited and written by experts in the field, this book introduces the up-to-date knowledge of the role of the immune system during pregnancy and provides the necessary background to understand pregnancy complications associated with alterations in the functioning of the immune system. The book provides a complete discussion on the immunological aspects of pregnancy and serves as a great tool for research scientists, students, reproductive immunologists and OBGYNs.Buy NowReview of Medical Microbiology and ImmunologyAuthor: Warren LevinsonCovering everything you need to know for academic and career success, Review of Medical Microbiology and Immunology delivers a high-yield review of the most important aspects of the topic in a concise yet comprehensive style. It explores both the basic and clinical aspects of bacteriology, virology, mycology, parasitology, and immunology and discusses important infectious diseases using an organ system approach. With an effective mix of engaging text, color images, tables, figures, Q&As, and clinical vignettes, this is the proven, one-stop guide to mastering the application of microbiology and immunology to infectious diseases.
Author: Richard Coico, Geoffrey SunshineImmunology: A Short Course, 7th Edition introduces all the critical topics of modern immunology in a clear and succinct yet comprehensive fashion. The authors offer uniquely-balanced coverage of classical and contemporary approaches and basic and clinical aspects. The strength of Immunology: A Short Course is in providing a complete review of modern immunology without the burden of excessive data or theoretical discussions. Each chapter is divided into short, self-contained units that address key topics, illustrated by uniformly drawn, full-color illustrations and photographs.This new edition of Immunology: A Short Course:
In general, clinical evolution is characterized by regular and even seasonal recurrences. Each outbreak can be different from the previous one, and periods between each recurrence are rarely completely asymptomatic [1]. CFS's symptomatology worsens with physical or emotional stress, interfering or limiting previous activities (including family, work, and social activities); in some cases, patients may need help for their basic daily activities.
Currently, there are no specific biological or morphological markers to establish per se the diagnosis of the CFS, and therefore none of the alterations that can be found are useful for diagnosis. Diagnostic criteria basically arise as a research requirement, but their limitations for actual clinical practice must be accepted.
Following demonstration of biological activity in animals, drug development - also when starting from a recombinant bacterium - follows set rules. As for any pharmaceutical, establishing a medicinal product requires the set-up of adequate CMC. The process of genetic engineering, strain selection and maintenance of a research cell bank is straightforward and well known to most researchers in the field. These activities are - almost by definition -non-GMP processes. Documentation must nevertheless be of the highest quality because at this stage, identity of the active component is fixed and stability of the transgenic trait and containment system must be demonstrated. Every activity beyond the final strain selection - the establishment of a master cell bank, the development of the processes for fermentation and biomass concentration as well as lyophilization to produce a drug substance in bulk and stability studies - need to comply with GMP standards and documentation should be recorded accordingly. All segments of the production process must be robust - i.e. should not overly depend on any variable - and scalable. All raw materials have to be of clinical grade and by high preference, if not exclusively, free of all animal-derived products. The product must be safe and therefore the very initial development phase will encompass toxicology studies in relevant animal species and small, phase I safety and tolerability studies in humans. The drug must be sufficiently stable to allow treatment of thousands of patients. At any of the relevant stages during processing, thorough and reliable, validated documentation is required. 2ff7e9595c
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