We are reporting a rare case of a delayed hypersensitivity reaction caused by hyaluronidase allergy following a lumbar transforaminal epidural block. Using an intradermal skin test, we have provided evidence that the systemic allergic reaction resulted from hypersensitivity to hyaluronidase. To our knowledge, this is a rare case of a delayed hypersensitivity reaction to epidural hyaluronidase, comprised of an initial exposure to hyaluronidase with no subsequent allergic response in prior block followed by a subsequent delayed reaction to hyaluronidase during a second epidural block.
Hyaluronoglucosaminidase* ; Hypersensitivity* ; Hypersensitivity, Delayed ; Skin Tests

No abstract available.
Hypersensitivity, Delayed* ; Ranitidine* ; T-Lymphocytes*

Hyaluronic acid fillers have been proposed as an alternative to other temporary skin fillers for treating facial skin lines and providing soft tissue augmentation. There is no antigenic specificity for species or tissue; thus, these agents have a low potential for allergic or immunogenic reaction. However, there are a few reports about allergic hypersensitivity reactions to hyaluronic acid. We report here on the case of a woman who developed a delayed hypersensitivity reaction to the non-animal stabilized hyaluronic acid filler, Restylane(R).
Epitopes ; Female ; Humans ; Hyaluronic Acid ; Hypersensitivity ; Hypersensitivity, Delayed ; Skin

Hypersensitivity to cholecalciferol (vitamin D3) or its active metabolite, calcitriol, is an exceedingly rare clinical phenomenon, with only 2 previously reported cases of suspected immediate hypersensitivity. Diagnosis of delayed drug hypersensitivity reactions is inherently difficult due to the lack of any robust in vitro diagnostic assay, particularly in those patients for whom provocation testing confers an unacceptable risk. In these situations, diagnosis relies on reproducible clinical manifestations following administration of the culprit agent, resolution upon its withdrawal and exclusion of other potential differential diagnoses. Based on these criteria, we propose the first reported case of delayed hypersensitivity to cholecalciferol successfully managed with a desensitisation protocol to pure cholecalciferol.
Calcitriol ; Cholecalciferol ; Diagnosis ; Diagnosis, Differential ; Drug Hypersensitivity ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; In Vitro Techniques

The objectives of this study are 1) To review the published data and document the current knowledge on allergic manifestations to the fruit mango 2) To highlight the two distinct clinical presentations of hypersensitivity reactions caused by mango 3) To discuss the role of cross-reactivity 4) To increase awareness of potentially life threatening complications that can be caused by allergy to mango. An extensive search of the literature was performed in Medline/PubMed with the key terms "mango", "anaphylaxis", "contact dermatitis", "cross-reactivity", "food hypersensitivity", "oral allergy syndrome" and "urticaria". The bibliographies of all papers thus located were searched for further relevant articles. A total of 17 reports describing 22 patients were documented, including ten patients with immediate hypersensitivity reaction and twelve patients with delayed hypersensitivity reaction to mango. Ten of these patients (four with immediate reaction; six with delayed reaction) were from geographical areas cultivating mango, whereas twelve patients (six with immediate reaction; six with delayed reaction) were from the countries where large scale mango cultivation does not occur. The clinical features, pathogenesis and diagnostic modalities of both these presentations are highlighted. The fruit mango can cause immediate and delayed hypersensitivity reactions, as also "oral allergy syndrome". Although rare, it can even result in a life threatening event. Reactions may even occur in individuals without prior exposure to mango, owing to cross reactivity. It is imperative to recognize such a phenomenon early so as to avoid potentially severe clinical reactions in susceptible patients.
Anaphylaxis ; Dermatitis, Contact ; Fruit ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; Mangifera ; Urticaria

Rituximab is a monoclonal antibody used for the treatment of B-cell malignancies, including diffuse large B-cell lymphoma. Infusion-related hypersensitivity reactions to rituximab is well known, and delayed hypersensitivity reactions to rituximab are also reported. Desensitization is commonly used to prevent immediate hypersensitivity reactions, but recently there have been cases of successful desensitization therapy for delayed hypersensitivity reactions. A 66-year-old patient who underwent rituximab treatment for diffuse large B-cell lymphoma showed repeated rituximab-induced delayed hypersensitivity reactions with whole body rashes. Intravenous rapid desensitization was performed by using a 1-bottle, 11-step protocol for 6 cycles and thereafter hypersensitivity reaction did not recur. We herein reported a case of delayed hypersensitivity reaction caused by rituximab, which was successfully desensitized using our 11-step protocol.
Aged ; B-Lymphocytes ; Desensitization, Immunologic ; Exanthema ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; Lymphoma, B-Cell ; Rituximab

We present a patient who developed granuloma in a previous herpes zoster scar (post-zoster granuloma). The development of granuloma in healed herpes zoster lesions may represent an atypical delayed hypersensitivity reaction to viral antigens or tissue antigens altered by the virus. To our knowledge, this is the first case reported in Korean literature.
Antigens, Viral ; Cicatrix ; Granuloma* ; Herpes Zoster ; Humans ; Hypersensitivity, Delayed

Sympathetic ophthalmia is rare, bilateral, diffuse, and granulomatous inflammation of the uvea, which occurs days, months, or years after penetrating ocular injury or intraocular surgery. The cause of the disease is still unknown but seems to be an autoimmune disease by reaction of delayed hypersensitivity mediated by T-Iymphocyte. There have been 4 cases reports on sympathetic ophthalmia domestically untill now, which occurred after ocular penetrating injury. The authors experienced two cases of sympathetic ophthalmia; one occurred after implantation of intraocular lens and the other occurred after cyclocryotherapy. A brief review of the related literatures is presented.
Autoimmune Diseases ; Hypersensitivity, Delayed ; Inflammation ; Lenses, Intraocular ; Ophthalmia, Sympathetic* ; Uvea

Sympathetic ophthalmia is rare, bilateral, diffuse, and granulomatous inflammation of the uvea, which occurs days, months, or years after penetrating ocular injury or intraocular surgery. The cause of the disease is still unknown but seems to be an autoimmune disease by reaction of delayed hypersensitivity mediated by T-Iymphocyte. There have been 4 cases reports on sympathetic ophthalmia domestically untill now, which occurred after ocular penetrating injury. The authors experienced two cases of sympathetic ophthalmia; one occurred after implantation of intraocular lens and the other occurred after cyclocryotherapy. A brief review of the related literatures is presented.
Autoimmune Diseases ; Hypersensitivity, Delayed ; Inflammation ; Lenses, Intraocular ; Ophthalmia, Sympathetic* ; Uvea

Non-cardiogenic pulmonary edema (NCPE) is a rare adverse reaction to iodinated radiocontrast media (RCM), in which all previous cases were immediate reactions. A 56-year-old male was given iopamidol, a non-ionic, low osmolar RCM, during coronary artery angiography. He developed pulmonary edema and fever a day after the procedure. Despite diuretic therapy, the patient's pulmonary edema worsened and his high fever persisted. The patient's pulmonary edema was eventually resolved with intravenous steroid treatment. We interpreted the patient's condition as NCPE manifesting as a delayed reaction to RCM. To our knowledge, our case is the first to show NCPE as a delayed hypersensitivity reaction.
Angiography ; Contrast Media ; Coronary Angiography ; Coronary Vessels ; Fever ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Iopamidol ; Male ; Pulmonary Edema