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Also known as Queensland Itch, Seasonal Recurrent Dermatitis (SSRD) , Summer Itch or more technically, "Culicoides" Hypersensitivity.
Sweet Itch is a medical condition in equines caused by an allergic response to the bites of "Culicoides" midges. It may be found in any horses and ponies, especially in the warmer regions. It may also occur, too, in other equines. It is also found in Canada, Australia, the US and many other parts of the world.
A hypersensitivity reaction to specific allergens (protein molecules causing an extreme immune response in sensitised individuals) in the saliva of "Culicoides" midges. There are multiple allergens involved, although some workers claim that the larger proteins (of molecular weight 65kDa) are the most important. These allergens appear to be cross-reactive across many species of "Culicoides" - i.e. many different varieties of midges produce similar allergens, giving the same effects upon horses.
The hypersensitivity response is mediated by IgE, an antibody produced by the horse's immune system which binds the allergens, causing a cascade production of histamine and cytokines which make the horse's skin inflamed and itchy. Of these, histamine appears the most important in the initial phase of reaction.
Mud fever is caused by an infection of the skin by bacteria, including "Dermatophilus congolensis", and often "Staphylococcus spp." Dermatophytes (fungal organisms such as "Malassezia" or "Trichophyton") can also contribute, as can chorioptic mange mites. Photosensitivity or irritant contact may contribute in certain cases. Rarely, vasculitis can cause continued inflammation.
Under normal circumstances the skin acts as a protective barrier, preventing microorganisms from entering the horse's system and doing any damage. However, the integrity of the epidermis can become compromised through the abrasion of soil grit, sand or stable bedding on cold, wet skin. The continual wetting of the skin causes a breakdown of the protective barrier of the epidermis, allowing the bacterium to enter and cause infection.
Shared boots, wraps, grooming supplies, and horse-handler's hands can all serve as fomites, carrying the causative organism(s) from one individual to another. For this reason, mud fever should be considered a contagious disease, and general hygiene steps should be taken to limit cross-contamination.
Horses and ponies standing for hours in muddy, wet paddocks and at gates are a common sight during the winter months and early spring. It is in these conditions that mud fever thrives. Generally, those horses and ponies with white socks are more prone to the condition, although Mud Fever will affect horses of all breeds, ages and colours.
As with any bacterial infection, mud fever can become a very serious condition very quickly. The legs can become swollen and sore and open sores can become quickly infected. Often, such is the level of damage to the skin that these open sores can become very difficult to heal and can result in proud flesh, permanent hair loss and in severe cases the need for skin grafts.
In draft horses, particularly Clydesdales, Shires, and Belgians, a similar-appearing, but more serious condition occurs called chronic progressive lymphedema. This condition appears to be genetically-linked, starting early in life and progressing, causing thickening, fibrosis, and predisposing to secondary infections. This disease can progress enough to require euthanasia.
Preventative action should be taken as soon as the paddocks start to become wet and muddy. Rotation of paddocks keeps horses from having to stand in wet, muddy ground. Electric fencing may also prevent horses from standing for long periods in the deep mud that collects in high traffic areas.
In medicine, animal allergy is hypersensitivity to certain substances produced by animals, such as the proteins in animal hair and saliva. It is a common type of allergy.
Symptoms of an allergic reaction to animals may include itchy skin, nasal congestion, itchy nose, sneezing, chronic sore throat or itchy throat, swollen, red, itchy, and watery eyes, coughing, asthma, or rash on the face or chest.
In adults, the prevalence of IgE sensitization to allergens from house dust mite and cat, but not grass, seem to decrease over time as people age. However, the biological reasons for these changes are not fully understood.
It is estimated that 2—3 percent of hospitalised patients are affected by a drug eruption, and that serious drug eruptions occur in around 1 in 1000 patients.
Fungi are ubiquitous organisms that play a vital role in decomposing organic matter. Many species of fungi live on the human body and some will infect nails causing a condition called onychomycosis. There are oral and topical antifungal therapies for this condition, however, in some instances cutting, filing, or abrading the nail may be necessary to improve cure rates. Thickened nails caused by injury, infection, diabetes, psoriasis, or vascular disease may require the use of a mechanical therapy, which can expose the healthcare worker to microbial dust.
Exposure to nail dust was first discussed and described in the literature as an occupational hazard in the early 70’s. In 1975, two female chiropodists were diagnosed with allergic hypersensitivity to nail dust Since that time, there have been a number of occupational-related complaints pertaining to airborne nail dust exposure and efforts have been made to study the podiatric professionals to determine related symptoms. Biological dust from the hand and foot care procedures may deposit in the conjunctiva, nose, and throughout the respiratory tract. The local irritation of these areas can lead to conjunctivitis, itching, tearing, rhinitis, sneezing, asthmatic attacks, bronchitis, and coughing.
The literature suggests that nail dust can be a respiratory sensitizer, which is defined as a substance that when breathed in can trigger an irreversible allergic reaction in the respiratory system. Sensitization does not usually take place immediately, but rather after months or years of exposure to the agent. Once sensitized, even the smallest amount of the substance can trigger asthma, rhinitis, or conjunctivitis that may exhibit the following symptoms: coughing, wheezing, chest tightness, runny or stuffy nose, and watery or prickly eyes. Millar found that within the podiatry profession there is four times the national prevalence of asthma. Hypersensitivity reactions are the most probable disposition for healthcare workers inhaling nail dust, although more serious lung pathology can not be ruled out
It is widely known and accepted that fungi will induce asthma, but it is estimated that only 10% of the population has allergic antibodies to fungal antigens, and half of them, that is 5% of the population, would be asymptomatic, further complicating the link between the fungal dust and troubling symptoms. "Trichophyton rubrum" is the most common fungal cause of nail dystrophy. Studies conducted in England found that the prevalence of "trichophyton rubrum" antibodies in podiatrists ranged from 14%-31%. This is evidence that the podiatrist is heavily exposed to "trichophyton rubrum" as observed in increased precipitating antibodies compared to the general population. It has been suggested that absorption of "trichophyton" fungal antigens can give rise to immunoglobulin E (IgE) antibody production, sensitization of the airways, and symptomatic asthma and rhinitis.
Nail work requiring clipping and drilling is also a potential cause for ocular injury and infection to the podiatrists, podiatric staff, and patients that are exposed to nail fragments and high-speed drills used for grinding. Possible ocular hazards result from exposure to foreign bodies, allergens, bacteria, viruses, fungi and protozoa that can be introduced at the time of eye trauma, or enter as a consequence of damage to the ocular structures; permitting the entry of opportunistic infection. The high-speed rotation of podiatry drill burrs potentially expose the healthcare worker to aerosols containing bloodborne pathogens such as Hepatitis B, Hepatitis C, or HIV. Davies et al. surveyed podiatrists and found that 41% of them complained of eye problems, particularly soreness, burning, itching and excess lacrimation.
A 1990 case illustrates the potential for ocular trauma to the healthcare provider: A podiatrist suffered a lacerated cornea when hit by a metallic shard from the grinding bit or by a fragment from the patient’s toenail. The podiatrist reported fleeting periods of blurriness for several months following the incident. The healthcare worker’s exposure to foreign bodies is not well documented in the literature like they are with dental staff using similar equipment; however, many of these incidents are certain to go unreported. The healthcare provider’s risk of injury during nail care, however slight, warrants the use of simple and inexpensive preventative measures.
There is a strong genetic predisposition toward atopic allergies, especially on the maternal side. Because of the strong familial evidence, investigators have tried to map susceptibility genes for atopy. Genes for atopy (C11orf30, STAT6, SLC25A46, HLA-DQB1, IL1RL1/IL18R1, TLR1/TLR6/TLR10, LPP, MYC/PVT1, IL2/ADAD1, HLA-B/MICA) tend to be involved in allergic responses or other components of the immune system. C11orf30 seems to be the most relevant for atopy as it may increase susceptibility to poly-sensitization.
Healthcare providers may use podiatry drills on onychauxic (thickened) nails of patients to alleviate or eliminate pain, prevent or treat subungual ulcerations, allow better penetration of topical antifungal agents, or improve cosmesis, all in effort to improve the patient’s “quality of life.” In a study conducted by Miller, 65% of respondents reported routinely drilling thickened toenails. However, the improved effectiveness of antifungal drugs such as itraconazole and terbinafine reduces the need to drill these infected nails.
Podiatry drills have a mechanical rotating burr that can be set at a range of speeds usually up to 12,000 rpm and may or may not have an integrated local ventilation extraction system. Even with the most effective dust extractors, the electric nail debridement process is not totally risk free because the extractors range from 25% - 92% effective in reducing airborne particles. While the large particles settle out to the floor, varying amounts of smaller particles remain suspended and are inhaled by or adhere to the practitioner and clinical environment. The particle sizes range from 0.1 to 100 um and 86% of these particles are less than 5 um in diameter and therefore capable of entry into the alveoli.
Zirconium granulomas are a skin condition characterized by a papular eruption involving the axillae, and are sometimes considered an allergic reaction to deodorant containing zirconium lactate. They are the result of a delayed granulomatous hypersensitivity reaction, and can also occur from exposure to aluminum zirconium complexes. Commonly, zirconium containing products are used to relieve toxicodendron irritation. The lesions are similar to those from sarcoidosis, and commonly manifest four to six weeks after contact. They appear as erythrematous, firm, raised, shiny papules. Corticosteroids are used to ease the inflammation, but curative treatment is currently unavailable.
Cutaneous disorders in musicians include frictional injury ("fiddler's neck"), hyperhidrosis, acne mechanica and vascular compromise. Other agents of irritant and allergic contact dermatitis may be rosewood, Makassar ebony, cocobolo wood, African blackwood, nickel, reed, propolis (bee glue), chromium and paraphenylenediamine. Patch testing can be performed for identification of the cause.
Treatment may include corticoids, astringents, and keratolytics. Dermatoses tend to be recurrent unless the use or contact can be avoided. Discontinuation of the instrument is curative in almost all cases, but usually impractical.
Risk factors for drug allergies can be attributed to the drug itself or the characteristics of the patient. Drug-specific risk factors include the dose, route of administration, duration of treatment, repetitive exposure to the drug, and concurrent illnesses. Host risk factors include age, sex, atopy, specific genetic polymorphisms, and inherent predisposition to react to multiple unrelated drugs (multiple drug allergy syndrome).
A drug allergy is more likely to develop with large doses and extended exposure.
In medicine, a drug eruption is an adverse drug reaction of the skin. Most drug-induced cutaneous reactions are mild and disappear when the offending drug is withdrawn. These are called "simple" drug eruptions. However, more serious drug eruptions may be associated with organ injury such as liver or kidney damage and are categorized as "complex". Drugs can also cause hair and nail changes, affect the mucous membranes, or cause itching without outward skin changes.
The use of synthetic pharmaceuticals and biopharmaceuticals in medicine has revolutionized human health, allowing us to live longer lives. As a consequence, the average human adult is exposed to a large number of drugs over longer treatment periods throughout a lifetime. This unprecedented rise in pharmaceutical use has led to an increasing number of observed adverse drug reactions.
There are two broad categories of adverse drug reactions. Type A reactions are known side effects of a drug that are largely predictable and are called, pharmatoxicologic. Whereas Type B or hypersensitivity reactions, are often immune-mediated and reproducible with repeated exposure to normal dosages of a given drug. Unlike type A reactions, the mechanism of type B or hypersensitivity drug reactions is not fully elucidated. However, there is a complex interplay between a patient's inherited genetics, the pharmacotoxicology of the drug and the immune response that ultimately give rise to the manifestation of a drug eruption.
Because the manifestation of a drug eruption is complex and highly individual, there are many subfields in medicine that are studying this phenomenon. For example, the field of pharmacogenomics aims to prevent the occurrence of severe adverse drug reactions by analyzing a person's inherited genetic risk. As such, there are clinical examples of inherited genetic alleles that are known to predict drug hypersensitivities and for which diagnostic testing is available.
When a medication causes an allergic reaction, it is called an allergen. The following is a short list of the most common drug allergens:
- Antibiotics
- Penicillin
- Sulfa drugs
- Tetracycline
- Analgesics
- Codeine
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Antiseizure
- Phenytoin
- Carbamazepine
Some examples:
- Allergic asthma
- Allergic conjunctivitis
- Allergic rhinitis ("hay fever")
- Anaphylaxis
- Angioedema
- Urticaria (hives)
- Eosinophilia
- Penicillin allergy
- Cephalosporin allergy
- Food allergy
- Sweet itch
Pityriasis lichenoides chronica (PLC) is probably caused by a hypersensitivity reaction to infectious agents such as the Epstein–Barr virus. Other infectious agents include the adenovirus and Parvovirus B19.
Cork is often harvested from the cork oak ("Quercus suber") and stored in slabs in a hot and humid environment until covered in mold. Cork workers may be exposed to organic dusts in this process, leading to this disease.
Pityriasis lichenoides chronica is an uncommon, idiopathic, acquired dermatosis, characterized by evolving groups of erythematous, scaly papules that may persist for months.
Some of the drugs associated with serum sickness are:
- allopurinol
- barbiturates
- captopril
- cephalosporins
- griseofulvin
- penicillins
- phenytoin
- procainamide
- quinidine
- streptokinase
- sulfonamides
- rituximab
- ibuprofen
- infliximab
Farmer's lung (not to be confused with silo-filler's disease) is a hypersensitivity pneumonitis induced by the inhalation of biologic dusts coming from hay dust or mold spores or any other agricultural products. It results in a type III hypersensitivity inflammatory response and can progress to become a chronic condition which is considered potentially dangerous.
Allergenic extracts, hormones and vaccines can also cause serum sickness.
Treatment usually involves adrenaline (epinephrine), antihistamines, and corticosteroids.
If the entire body is involved, then anaphylaxis can take place, which is an acute, systemic reaction that can prove fatal.