Hypersensitivity Health Dictionary

A term generally used to describe an adverse reaction by the body to any substance ingested by the affected individual. Strictly, allergy refers to any reactions incited by an abnormal immunological response to an ALLERGEN, and susceptibility has a strong genetic component. Most allergic disorders are linked to ATOPY, the predisposition to generate the allergic antibody immunoglobulin E (IgE) to common environmental agents (see ANTIBODIES; IMMUNOGLOBULINS). Because IgE is able to sensitise MAST CELLS (which play a part in in?ammatory and allergic reactions) anywhere in the body, atopic individuals often have disease in more than one organ. Since the allergic disorder HAY FEVER was ?rst described in 1819, allergy has moved from being a rare condition to one a?icting almost one in two people in the developed world, with substances such as grass and tree pollen, house-dust mite, bee and wasp venom, egg and milk proteins, peanuts, antibiotics, and other airborne environmental pollutants among the triggering factors. Increasing prevalence of allergic reactions has been noticeable during the past two decades, especially in young people with western lifestyles.

A severe or life-threatening reaction is often termed ANAPHYLAXIS. Many immune mechanisms also contribute to allergic disorders; however, adverse reactions to drugs, diagnostic materials and other substances often do not involve recognised immunological mechanisms and the term ‘hypersensitivity’ is preferable. (See also IMMUNITY.)

Adverse reactions may manifest themselves as URTICARIA, wheezing or di?culty in breathing owing to spasm of the BRONCHIOLES, swollen joints, nausea, vomiting and headaches. Severe allergic reactions may cause a person to go into SHOCK. Although symptoms of an allergic reaction can usually be controlled, treatment of the underlying conditon is more problematic: hence, the best current approach is for susceptible individuals to ?nd out what it is they are allergic to and avoid those agents. For some people, such as those sensitive to insect venom, IMMUNOTHERAPY or desensitisation is often e?ective. If avoidance measures are unsuccessful and desensitisation ine?ective, the in?ammatory reactions can be controlled with CORTICOSTEROIDS, while the troublesome symptoms can be treated with ANTIHISTAMINE DRUGS and SYMPATHOMIMETICS. All three types of drugs may be needed to treat severe allergic reactions.

One interesting hypothesis is that reduced exposure to infective agents, such as bacteria, in infancy may provoke the development of allergy in later life.

Predicted developments in tackling allergic disorders, according to Professor Stephen Holgate writing in the British Medical Journal (22 January 2000) include:

Identi?cation of the principal environmental factors underlying the increase in incidence, to enable preventive measures to be planned.

Safe and e?ective immunotherapy to prevent and reverse allergic disease.

Treatments that target the protein reactions activated by antigens.

Identi?cation of how IgE is produced in the body, and thus of possible ways to inhibit this process.

Identi?cation of genes affecting people’s susceptibility to allergic disease.... allergy

Atopy, meaning out of place, is a form of hypersensitivity characterised – amongst other features – by a familial tendency. It is due to the propensity of the affected individual to produce large amounts of reagin ANTIBODIES which stick to MAST CELLS in the mucosa, so that when the ANTIGEN is inhaled, HISTAMINE is released from the mast cell. Atopy is the condition responsible for ASTHMA and HAY FEVER (see also ALLERGY). It is estimated that 10 per cent of the human race is subject to atopy. (See also DERMATITIS.)... atopy

A hypersensitivity reaction due to circulating antigen-antibody complexes (see ANTIGEN; ANTIBODIES), so-called because it was a not uncommon reaction to the administration of foreign SERUM which used to be given as a form of passive IMMUNITY before the days of antibiotics. By de?nition, it is a manifestation of sensitivity to serum – but the same clinical and pathological picture can occur 1–3 weeks after the administration of drugs such as PENICILLIN and STREPTOMYCIN. It is characterised by fever, ARTHRALGIA and LYMPHADENOPATHY and is usually self-limiting as it resolves when the supply of antigen is used up.... serum sickness

The initial exposure of a person to an allergen or other substance recognized as foreign by the immune system, which leads to an immune response. On subsequent exposures to the same substance, there is a much stronger and faster immune reaction. This forms the basis of allergy and other types of hypersensitivity reaction.... sensitization

The Crown-of-thorns starfish, known for the considerable damage that it may cause to coral reefs. It seems to occur in epidemics. The spines are venom-tipped, but usually the envenomation leads only to a painful spike wound which may sometimes get infected. Multiple spikes, either in one episode, or many individual stings rarely lead to systemic symptoms, but may lead to hypersensitivity.... acanthaster planci

A common skin condition starting after puberty, and which may persist for many years. It involves plugged pores (blackheads and whiteheads), pimples and deeper nodules on the face, neck, trunk and even the upper arms. It arises from pilosebaceous glands (relating to hair follicles and associated SEBACEOUS GLANDS). SEBUM production is increased and bacterial proliferation causes in?ammation with PAPULE and PUSTULE formation. Plugs of sebum and epidermal cells form blackheads (comedones); the colour is not due to dirt but to dried oil and shed skin cells in the hair-follicle openings.

Treatment Twice-daily washing with a salicylic-acid cleanser can help remove the pore-blocking debris, as can daily shampooing. Use only oil-free cosmetics and hide blackheads with a ?esh-tinted acne lotion containing benzoyl peroxide, acid or sulphur. Never squeeze blackheads, however tempting; ask a skin specialist how to do this properly. Other treatments include microdermabrasion, and the antibiotic lotions erythromycin and clindamycin may be e?ective. Tretinoin and adapilene can be used on the skin but are not permitted in pregnancy and may cause problems such as hypersensitivity to sunlight, so medical advice is essential. In resistant cases, long-term suppressive oral therapy with one of the TETRACYCLINES or with ERYTHROMYCIN may be necessary. In females a combined oestrogenantiandrogen ‘pill’ is an alternative. Severe resistant acne can be cleared by a 16- to 24week course of oral isotretinoin, but this drug is teratogenic (see TERATOGENESIS) and can cause many side-effects including depression, so its use requires specialist supervision.

See www.skincarephysicians.com/acnenet/... acne

Weak local anaesthetic found in some throat lozenges, creams and gels. It may cause allergic hypersensitivity.... benzocaine

Cilantro, coriander (Coriandrum sativum).

Plant Part Used: Leaf, seed.

Dominican Medicinal Uses: Leaf: infusion/decoction, orally, for gastro-intestinal disorders: flatulence, gastritis, acid-reflux, heartburn, indigestion and stomach pain.

Safety: Widely consumed as a condiment; generally considered safe; potential for hypersensitivity.

Laboratory & Preclinical Data: In vivo: hypolipidemic (seeds), inflammatory bowel disease treatment (multi-herbal extract).

In vitro: antioxidant (seed aqueous extract).

* See entry for Cilantro in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cilantro

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: High Saturated fat: Moderate Cholesterol: High Carbohydrates: Low Fiber: None Sodium: Moderate to high Major vitamin contribution: Vitamin A, riboflavin, vitamin D Major mineral contribution: Iron, calcium

About the Nutrients in This Food An egg is really three separate foods, the whole egg, the white, and the yolk, each with its own distinct nutritional profile. A whole egg is a high-fat, high-cholesterol, high-quality protein food packaged in a high-calcium shell that can be ground and added to any recipe. The proteins in eggs, with sufficient amounts of all the essential amino acids, are 99 percent digestible, the standard by which all other proteins are judged. The egg white is a high-protein, low-fat food with virtually no cholesterol. Its only important vitamin is riboflavin (vitamin B2), a vis- ible vitamin that gives egg white a slightly greenish cast. Raw egg whites contain avidin, an antinutrient that binds biotin a B complex vitamin for- merly known as vitamin H, into an insoluble compound. Cooking the egg inactivates avidin. An egg yolk is a high-fat, high-cholesterol, high-protein food, a good source of vitamin A derived from carotenes eaten by the laying hen, plus vitamin D, B vitamins, and heme iron, the form of iron most easily absorbed by your body. One large whole egg (50 g/1.8 ounce) has five grams fat (1.5 g satu- rated fat, 1.9 g monounsaturated fat, 0.7 g polyunsaturated fat), 212 mg cholesterol, 244 IU vitamin A (11 percent of the R DA for a woman, 9 percent * Values are for a whole egg. of the R DA for a man), 0.9 mg iron (5 percent of the R DA for a woman, 11 percent of the R DA for a man) and seven grams protein. The fat in the egg is all in the yolk. The protein is divided: four grams in the white, three grams in the yolk.

The Most Nutritious Way to Serve This Food With extra whites and fewer yolks to lower the fat and cholesterol per serving.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet

Buying This Food Look for: Eggs stored in the refrigerated dair y case. Check the date for freshness. NOTE : In 1998, the FDA and USDA Food Safety and Inspection Service (FSIS) proposed new rules that would require distributors to keep eggs refrigerated on the way to the store and require stores to keep eggs in a refrigerated case. The egg package must have a “refrigera- tion required” label plus safe-handling instructions on eggs that have not been treated to kill Salmonella. Look for: Eggs that fit your needs. Eggs are graded by the size of the yolk and the thick- ness of the white, qualities that affect appearance but not nutritional values. The higher the grade, the thicker the yolk and the thicker the white will be when you cook the egg. A Grade A A egg fried sunny side up will look much more attractive than a Grade B egg prepared the same way, but both will be equally nutritions. Egg sizes ( Jumbo, Extra large, Large, Medium, Small) are determined by how much the eggs weigh per dozen. The color of the egg’s shell depends on the breed of the hen that laid the egg and has nothing to do with the egg’s food value.

Storing This Food Store fresh eggs with the small end down so that the yolk is completely submerged in the egg white (which contains antibacterial properties, nature’s protection for the yolk—or a developing chick embryo in a fertilized egg). Never wash eggs before storing them: The water will make the egg shell more porous, allowing harmful microorganisms to enter. Store separated leftover yolks and whites in small, tightly covered containers in the refrigerator, where they may stay fresh for up to a week. Raw eggs are very susceptible to Salmonella and other bacterial contamination; discard any egg that looks or smells the least bit unusual. Refrigerate hard-cooked eggs, including decorated Easter eggs. They, too, are suscep- tible to Salmonella contamination and should never be left at room temperature.

Preparing This Food First, find out how fresh the eggs really are. The freshest ones are the eggs that sink and lie flat on their sides when submerged in cool water. These eggs can be used for any dish. By the time the egg is a week old, the air pocket inside, near the broad end, has expanded so that the broad end tilts up as the egg is submerged in cool water. The yolk and the white inside have begun to separate; these eggs are easier to peel when hard-cooked. A week or two later, the egg’s air pocket has expanded enough to cause the broad end of the egg to point straight up when you put the egg in water. By now the egg is runny and should be used in sauces where it doesn’t matter if it isn’t picture-perfect. After four weeks, the egg will float. Throw it away. Eggs are easily contaminated with Salmonella microorganisms that can slip through an intact shell. never eat or serve a dish or bever age containing r aw fr esh eggs. sa lmonella is destroyed by cooking eggs to an inter nal temper atur e of 145°f ; egg-milk dishes such as custar ds must be cooked to an inter nal temper atur e of 160°f. If you separate fresh eggs by hand, wash your hands thoroughly before touching other food, dishes, or cooking tools. When you have finished preparing raw eggs, wash your hands and all utensils thoroughly with soap and hot water. never stir cooked eggs with a utensil used on r aw eggs. When you whip an egg white, you change the structure of its protein molecules which unfold, breaking bonds between atoms on the same molecule and forming new bonds to atoms on adjacent molecules. The result is a network of protein molecules that hardens around air trapped in bubbles in the net. If you beat the whites too long, the foam will turn stiff enough to hold its shape even if you don’t cook it, but it will be too stiff to expand natu- rally if you heat it, as in a soufflé. When you do cook properly whipped egg white foam, the hot air inside the bubbles will expand. Ovalbumin, an elastic protein in the white, allows the bubble walls to bulge outward until they are cooked firm and the network is stabilized as a puff y soufflé. The bowl in which you whip the whites should be absolutely free of fat or grease, since the fat molecules will surround the protein molecules in the egg white and keep them from linking up together to form a puff y white foam. Eggs whites will react with metal ions from the surface of an aluminum bowl to form dark particles that discolor the egg-white foam. You can whip eggs successfully in an enamel or glass bowl, but they will do best in a copper bowl because copper ions bind to the egg and stabilize the foam.

What Happens When You Cook This Food When you heat a whole egg, its protein molecules behave exactly as they do when you whip an egg white. They unfold, form new bonds, and create a protein network, this time with molecules of water caught in the net. As the egg cooks, the protein network tightens, squeez- ing out moisture, and the egg becomes opaque. The longer you cook the egg, the tighter the network will be. If you cook the egg too long, the protein network will contract strongly enough to force out all the moisture. That is why overcooked egg custards run and why overcooked eggs are rubbery. If you mix eggs with milk or water before you cook them, the molecules of liquid will surround and separate the egg’s protein molecules so that it takes more energy (higher heat) to make the protein molecules coagulate. Scrambled eggs made with milk are softer than plain scrambled eggs cooked at the same temperature. When you boil an egg in its shell, the air inside expands and begins to escape through the shell as tiny bubbles. Sometimes, however, the force of the air is enough to crack the shell. Since there’s no way for you to tell in advance whether any particular egg is strong enough to resist the pressure of the bubbling air, the best solution is to create a safety vent by sticking a pin through the broad end of the egg before you start to boil it. Or you can slow the rate at which the air inside the shell expands by starting the egg in cold water and letting it warm up naturally as the water warms rather than plunging it cold into boiling water—which makes the air expand so quickly that the shell is virtually certain to crack. As the egg heats, a little bit of the protein in its white will decompose, releasing sulfur that links up with hydrogen in the egg, forming hydrogen sulfide, the gas that gives rot- ten eggs their distinctive smell. The hydrogen sulfide collects near the coolest part of the egg—the yolk. The yolk contains iron, which now displaces the hydrogen in the hydrogen sulfide to form a green iron-sulfide ring around the hard-cooked yolk.

How Other Kinds of Processing Affect This Food Egg substitutes. Fat-free, cholesterol-free egg substitutes are made of pasteurized egg whites, plus artificial or natural colors, flavors, and texturizers (food gums) to make the product look and taste like eggs, plus vitamins and minerals to produce the nutritional equivalent of a full egg. Pasteurized egg substitutes may be used without additional cooking, that is, in salad dressings and eggnog. Drying. Dried eggs have virtually the same nutritive value as fresh eggs. Always refrigerate dried eggs in an air- and moistureproof container. At room temperature, they will lose about a third of their vitamin A in six months.

Medical Uses and/or Benefits Protein source. The protein in eggs, like protein from all animal foods, is complete. That is, protein from animal foods provides all the essential amino acids required by human beings. In fact, the protein from eggs is so well absorbed and utilized by the human body that it is considered the standard by which all other dietary protein is measured. On a scale known as biological value, eggs rank 100 ; milk, 93; beef and fish, 75; and poultry, 72. Vision protection. The egg yolk is a rich source of the yellow-orange carotenoid pigments lutein and zeaxanthin. Both appear to play a role in protecting the eyes from damaging ultraviolet light, thus reducing the risk of cataracts and age-related macular degeneration, a leading cause of vision of loss in one-third of all Americans older than 75. Just 1.3 egg yolks a day appear to increase blood levels of lutein and zeaxanthin by up to 128 percent. Perhaps as a result, data released by the National Eye Institute’s 6,000-person Beaver Dam ( Wisconsin) Eye Study in 2003 indicated that egg consumption was inversely associated with cataract risk in study participants who were younger than 65 years of age when the study started. The relative risk of cataracts was 0.4 for people in the highest category of egg consumption, compared to a risk of 1.0 for those in the lowest category. External cosmetic effects. Beaten egg whites can be used as a facial mask to make your skin look smoother temporarily. The mask works because the egg proteins constrict as they dry on your face, pulling at the dried layer of cells on top of your skin. When you wash off the egg white, you also wash off some of these loose cells. Used in a rinse or shampoo, the pro- tein in a beaten raw egg can make your hair look smoother and shinier temporarily by filling in chinks and notches on the hair shaft.

Adverse Effects Associated with This Food Increased risk of cardiovascular disease. Although egg yolks are high in cholesterol, data from several recent studies suggest that eating eggs may not increase the risk of heart disease. In 2003, a report from a 14-year, 177,000-plus person study at the Harvard School of Public Health showed that people who eat one egg a day have exactly the same risk of heart disease as those who eat one egg or fewer per week. A similar report from the Multiple R isk Factor Intervention Trial showed an inverse relationship between egg consumption and cholesterol levels—that is, people who ate more eggs had lower cholesterol levels. Nonetheless, in 2006 the National Heart, Lung, and Blood Institute still recommends no more than four egg yolks a week (including the yolk in baked goods) for a heart-healthy diet. The American Heart Association says consumers can have one whole egg a day if they limit cholesterol from other sources to the amount suggested by the National Cholesterol Education Project following the Step I and Step II diets. (Both groups permit an unlimited number of egg whites.) The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Food poisoning. Raw eggs (see above) and egg-rich foods such as custards and cream pies are excellent media for microorganisms, including the ones that cause food poisoning. To protect yourself against egg-related poisoning, always cook eggs thoroughly: poach them five minutes over boiling water or boil at least seven minutes or fry two to three minutes on each side (no runny center) or scramble until firm. Bread with egg coating, such as French toast, should be cooked crisp. Custards should be firm and, once cooked, served very hot or refrigerated and served very cold. Allergic reaction. According to the Merck Manual, eggs are one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach. The others are berries (blackberries, blueberries, raspberries, strawberries), choco- late, corn, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).

Food/Drug Interactions Sensitivity to vaccines. Live-virus measles vaccine, live-virus mumps vaccine, and the vac- cines for influenza are grown in either chick embryo or egg culture. They may all contain minute residual amounts of egg proteins that may provoke a hypersensitivity reaction in people with a history of anaphylactic reactions to eggs (hives, swelling of the mouth and throat, difficulty breathing, a drop in blood pressure, or shock).... eggs

Prickly pear cactus (Opuntia ficus-indica).

Plant Part Used: Cactus pad (leaf-stem).

Dominican Medicinal Uses: The fresh cactus pad is traditionally prepared as a juice taken orally for diabetes, high blood pressure, heart disease, stomach ailments and indigestion. The gel from inside the leaf-stem is typically applied topically for wound-healing.

Safety: The cactus pad and fruit are widely consumed and generally considered safe. Caution is advised during handling due to sharp spines and glochids which cover the surface; these spiny projections should be removed before use. Cases of contact dermatitis have been reported.

Contraindications: Contraindicated in individuals with a history of allergy or hypersensitivity to Opuntia and other cactus species. Due to lack of available data, avoid use during pregnancy or breastfeeding and in small children.

Drug Interactions: Besides potential synergistic effects with drugs that share similar biological activities to this plant (see “Laboratory and Preclinical Data”), particularly diabetes and blood-sugar modulating medications, insufficient information has been identified on herb-drug interactions in the available literature.

Clinical Data: The following effects of this plant have been investigated in human clinical trials: anti-hangover, anti-inflammatory, antioxidant and anti-lipid peroxidation.

Laboratory & Preclinical Data: The following activities of this plant have been shown in laboratory and preclinical studies: anti-inflammatory, antioxidant, chondroprotective, gastro-protective, hypoglycemic, immunomodulatory, neuroprotective, radical scavenging and wound-healing.

* See entry for Alquitira in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... alquitira

An immediate (and potentially health- or life-threatening) hypersensitivity reaction produced by the body’s immunoglobulin E (IgE) antibodies to a foreign substance (antigen); the affected tissues release histamine which causes local or systemic attack. An example is the pain, swelling, eruption, fever and sometimes collapse that may occur after a wasp sting or ingestion of peanut in a particularly sensitive person. Some people may suffer from anaphylaxis as a result of allergy to other foods or substances such as animal hair or plant leaves. On rare occasions a person may be so sensitive that anaphylaxis may lead to profound SHOCK and collapse which, unless the affected person receives urgent medical attention, including injection of ADRENALINE, may cause death. (See also ALLERGY; IMMUNITY.)... anaphylaxis

(Thunb.) Cogn.

Synonym: B. cerifera Savi. Cucurbita hispada Thunb.

Family: Cucurbitaceae.

Habitat: Cultivated largely in Uttar Pradesh, Punjab, Rajasthan and Bihar.

English: Ash Gourd, White Gourd, Wax Gourd, White Pumpkin.

Ayurvedic: Kuushmaanda, Kuush- maandaka, Kuushmaandanaadi.

Unani: Pethaa, Mahdabaa, Kaddu- e-Roomi.

Siddha/Tamil: Ven-poosani, Saambalpushani.

Action: Leaves—cooling, juice rubbed on bruises. Fruit decoction—laxative, diuretic, nutritious, styptic (given for internal haemorrhages and diseases of the respiratory tract.) Juice of fruit— used for treating epilepsy, insanity and other nervous diseases. The ash of fruit rind—applied on painful swellings. Seeds—anthelmintic.

The fruits contain lupeol, beta-sitos- terol, their acetates and several amino acids. The fruit juice produces tran- quilizing activity and mild CNS depressant effect in mice.

The roots of mature plant contain a pentacyclic triterpene, which exhibits antiallergic activity against both homologous passive cutaneous ana- phylaxis and delayed hypersensitivity in mice. The fruit beverage contains pyrazine compounds.

Isomultiflorenol acetate, a penta- cyclic triterpene, has been isolated as the major constituent of wax coating of fruits.

Dosage: Dried pieces of the fruit— 5-10 g (API Vol. IV.) Fruit juice— 10-20 m (CCRAS.)... benincasa hispida

Annatto (Bixa orellana).

Plant Part Used: Seed coats, leaves.

Dominican Medicinal Uses: The powdered seed coats are traditionally combined with other plants to make a tea or vegetable juice drink for treating anemia, cysts, dysmenorrhea, tumors, uterine fibroids and to support post-partum recovery. The seeds coats and/or leaves are also used externally for topical burns, injury and musculoskeletal trauma.

Safety: The seeds and seed coats are generally regarded as safe and commonly used as a culinary flavoring and coloring agent. Animal studies have shown this plant to be relatively nontoxic, although allergic reactions reported.

Contraindications: Hypersensitivity; history of allergic reaction.

Laboratory & Preclinical Data: The seed extract has shown the following activities in animal studies: anti-inflammatory, chemopreventive, hyperglycemic. In vitro the plant extract has demonstrated antibacterial, antifungal, antimicrobial and antiplatelet effects, and the seed extract has shown anti-inflammatory, anti-tumor and immunomodulatory activity.

* See entry for Bija in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... bija

Along with DEXTRAN and GELATIN, this is a substance with a large molecular structure used to treat shocked patients with burns (see BURNS AND SCALDS) or SEPTICAEMIA in order to expand and maintain their blood volume. Like other plasma substitutes, this form of starch can be used as an emergency, short-term treatment for severe bleeding until blood for transfusion is available. Plasma substitutes must be used with caution in patients who have heart disease or impairment of their kidney function. Patients should be monitored for hypersensitivity reactions and for changes in their BLOOD PRESSURE (see SHOCK).... etherified starch

A non-opioid analgesic (see ANALGESICS) used in the short-term management of moderate to severe acute post-operative pain. It may be given orally or by intramuscular or intravenous injection. Gastrointestinal side-effects are common in elderly people, and there are a range of side-effects from ANAPHYLAXIS to HYPERTENSION, prolonged bleeding time and liver function changes. Contraindications include hypersensitivity to ASPIRIN, ASTHMA, renal impairment and pregnancy (including during labour and delivery).... ketorolac

Chocolate (Theobroma cacao).

Plant Part Used: Leaf, seeds.

Dominican Medicinal Uses: The seeds are traditionally prepared as a tea by decoction (i.e. hot chocolate) taken orally for fatigue and weakness. The leaf decoction is used for kidney and urinary tract disorders.

Safety: Chocolate is widely consumed and generally regarded as safe. No data on the safety of the leaf has been identified in the available literature.

Contraindications: Avoid use in individuals with a history of heart disorders (due to cardiac stimulant effects) or hypersensitivity (due to potential skin reactions or migraines).

Drug Interactions: Avoid concomitant use with phenelzine due to potential for high blood pressure. The following medications may inhibit caffeine metabolism or clearance: oral contraceptives, cimetidine, furafylline, verapamil, disulfiram, fluconoazole, mexiletine, phenylpropanolamine, numerous quinolone antibiotics (i.e. enoxacin, pipemidic acid, ciprofloxacin, norfloxacin), idrocilamide and methoxsalen.

Clinical Data: The following effects of the seed extract have been investigated in human clinical trials: anti-ulcer, antioxidant and decreased platelet function.

Laboratory & Preclinical Data: In animal studies the seed extract has shown anti-ulcer effects. In vitro the seed extracts and/or constituents have shown antibacterial, antioxidant, anti-tumor, cardio-protective, dopaminergic, immunomodulatory and red blood cell production stimulant effects.

* See entry for Cacao in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cacao

Allspice, bay rum tree (Pimenta dioica).

Plant Part Used: Leaf, berry, essential oil.

Dominican Medicinal Uses: Leaves: tea for common cold, flu; externally: mashed and applied topically for arthritis, joint pain; multi-herb tincture: taken internally for impotence, infertility, sexually transmitted infections. Berries, essential oil: externally for joint pain.

Safety: Potential hypersensitivity to essential oil. Leaf extract: low to moderate toxicity when taken orally.

Contraindications: Lack of information on use in pregnancy, lactation or young children.

Laboratory & Preclinical Data: In vitro: antibacterial, antifungal (essential oil). In vivo: anti-inflammatory, anti-nociceptive (leaf extract).

* See entry for Canelilla in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... canelilla

A rare in?ammation of the skin which causes universal itching. The skin is red, thickened and scaly. It is also called generalised exfoliative dermatitis (see SKIN, DISEASES OF). It may complicate chronic eczema (see DERMATITIS) or PSORIASIS, particularly in men, in the second half of life. It may also result from HYPERSENSITIVITY to a drug, such as gold injections used in RHEUMATOID ARTHRITIS. Rarely, it may be a manifestation of T-cell LYMPHOMA.

Universal in?ammation of the skin may cause heart failure, particularly in elderly people with pre-existing heart disease. It may lead to HYPOTHERMIA due to excessive heat loss from the skin and protein de?ciency caused by the shedding of large quantities of skin scales containing keratin. Rarely, these complications can be fatal.

Treatment depends on the cause, but in eczematous erythroderma, oral CORTICOSTEROIDS (PREDNISOLONE) in full dosage may be needed.... erythroderma

Eucalyptus (Eucalyptus globulus).

Plant Part Used: Leaf, essential oil.

Dominican Medicinal Uses: Leaf: infusion or decoction, orally or inhaled vapor, for asthma, common cold, flu-like symptoms, congestion, cough and pulmonary infection.

Safety: Leaves considered safe for internal and external use if administered appropriately; essential oil is highly toxic if taken internally and may cause allergic reaction when administered topically; vapor inhalation may transmit fungal spores.

Contraindications: Young children and infants (inhalation or topical administration my lead to respiratory disorders); gastro-intestinal inflammatory conditions (internal use may irritate mucosa), history of allergy or hypersensitivity to eugenol (essential oil constituent).

Drug Interactions: Antidiabetic drugs (may potentiate effect), barbiturates (may decrease effect), pyrrolizidine-containing herbs (may exacerbate hepatotoxic effects).

Laboratory & Preclinical Data: In vivo: anti-inflammatory, bronchitis treatment (essential oil).

In vitro: antibacterial, antioxidant (essential oil)

* See entry for Eucalipto in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... eucalipto

Round or oval cells found predominantly in the loose CONNECTIVE TISSUE. They contain HISTAMINE and HEPARIN, and carry immunoglobulin E, the antibody which plays a predominant part in allergic reactions (see ANTIBODIES; ALLERGY). Although known to play a part in in?ammatory reactions, allergy, and hypersensitivity, their precise function in health and disease is still not quite clear.... mast cells

A HYPERSENSITIVITY reaction of the conjunctiva (see EYE). At the turn of the century the most common cause was TUBERCULOSIS; nowadays it is most commonly due to hypersensitivity to staphylococci (see STAPHYLOCOCCUS).... phlyctenule

A group of CYTOTOXIC drugs administered intravenously for the treatment of advanced ovarian cancer (see OVARIES, DISEASES OF) and secondary spread of breast cancer (see BREASTS, DISEASES OF). Given under specialist supervision in hospital, taxanes are not e?ective for all patients but results are encouraging when they do respond. Side-effects include HYPERSENSITIVITY, MYELOSUPPRESSION, cardiac ARRHYTHMIA, and peripheral NEUROPATHY. Examples of the taxanes are PACLITAXEL and DOCETAXEL.... taxanes

Stomach hypersensitivity, with absence of acidity or organic disturbance. Calamus, Cinnamon, Burnett Saxifrage, Lovage, Fumitory, Rosemary, Wormwood, Oats, Skullcap.

German Chamomile tea. ... nervous stomach

Many factors in?uence the activity with which drugs operate. Among the factors which affect the necessary quantity are age, weight, sex, idiosyncrasy, genetic disorders, habitual use, disease, fasting, combination with other drugs, the form in which the drug is given, and the route by which it is given.

Normally, a young child requires a smaller dose than an adult. There are, however, other factors than age to be taken into consideration. Thus, children are more susceptible than adults to some drugs such as MORPHINE, whilst they are less sensitive to others such as ATROPINE. The only correct way to calculate a child’s dose is by reference to texts supplying a recommended dose in milligrams per kilogram. However, many reference texts simply quote doses for certain age-ranges.

Old people, too, often show an increased susceptibility to drugs. This is probably due to a variety of factors, such as decreased weight; diminished activity of the tissues and therefore diminished rate at which a drug is utilised; and diminished activity of the KIDNEYS resulting in decreased rate of excretion of the drug.

Weight and sex have both to be taken into consideration. Women require slightly smaller doses than men, probably because they tend to be lighter in weight. The e?ect of weight on dosage is partly dependent on the fact that much of the extra weight of a heavy individual is made up of fatty tissue which is not as active as other tissues of the body. In practice, the question of weight seldom makes much di?erence unless the individual is grossly over- or underweight.

Idiosyncrasy occasionally causes drugs administered in the ordinary dose to produce unexpected effects. Thus, some people are but little affected by some drugs, whilst in others, certain drugs – for example, psychoactive preparations such as sedatives – produce excessive symptoms in normal or even small doses. In some cases this may be due to hypersensitivity, or an allergic reaction, to the drug, which is a possibility that must always be borne in mind

(e.g. with PENICILLIN). An individual who is known to be allergic to a certain medication is strongly advised to carry a card to this e?ect, and always to inform medical and dental practitioners and/or a pharmacist before accepting a new prescription or buying an over-the-counter preparation.

Habitual use of a drug is perhaps the in?uence that causes the greatest increase in the dose necessary to produce the requisite e?ect. The classical example of this is with OPIUM and its derivatives.

Disease may modify the dose of medicines. This can occur in several ways. Thus, in serious illnesses the patient may be more susceptible to drugs, such as narcotics, that depress tissue activity, and therefore smaller doses must be given. Again, absorption of the drug from the gut may be slowed up by disease of the gut, or its e?ect may be enhanced if there is disease of the kidneys, interfering with the excretion of the drug.

Fasting aids the rapidity of absorption of drugs, and also makes the body more susceptible to their action. Partly for this reason, as well as to avoid irritation of the stomach, it is usual to prescribe drugs to be taken after meals, and diluted with water.

Combination of drugs is to be avoided if possible as it is often di?cult to assess what their combined e?ect may be. In some cases they may have a mutually antagonistic e?ect, which means that the patient will not obtain full bene?t. Sometimes a combination may have a deleterious e?ect.

Form, route and frequency of administration Drugs are now produced in many forms, though tablets are the most common and, usually, convenient. In Britain, medicines are given by mouth whenever possible, unless there is some degree of urgency, or because the drug is either destroyed in, or is not absorbed from, the gut. In these circumstances, it is given intravenously, intra-muscularly or subcutaneously. In some cases, as in cases of ASTHMA or BRONCHITIS, the drug may be given in the form of an inhalant (see INHALANTS), in order to get the maximum concentration at the point where it is wanted: that is, in the lungs. If a local e?ect is wanted, as in cases of diseases of the skin, the drug is applied topically to the skin. In some countries there is a tendency to give medicines in the form of a suppository which is inserted in the rectum.

Recent years have seen developments whereby the assimilation of drugs into the body can be more carefully controlled. These include, for example, what are known as transdermals, in which drugs are built into a plaster that is stuck on the skin, and the drug is then absorbed into the body at a controlled rate. This method is now being used for the administration of GLYCERYL TRINITRATE in the treatment of ANGINA PECTORIS, and of hyoscine hydrobromide in the treatment of MOTION (TRAVEL) SICKNESS. Another is a new class of implantable devices. These are tiny polymers infused with a drug and implanted just under the skin by injection. They can be tailored so as to deliver drugs at virtually any rate – from minutes to years. A modi?cation of these polymers now being investigated is the incorporation of magnetic particles which allow an extra burst of the incorporated drug to be released in response to an oscillating magnetic ?eld which is induced by a magnetic ‘watch’ worn by the patient. In this way the patient can switch on an extra dose of drug when this is needed: insulin, for instance, in the case of diabetics. In yet another new development, a core of drug is enclosed in a semi-permeable membrane and is released in the stomach at a given rate. (See also LIPOSOMES.)... dosage

Lung disorders caused by dust particles inhaled and absorbed into the lung tissues. There they may cause fibrosis (formation of scar tissue) and progressive lung damage. The main symptoms are a cough and breathing difficulty. It may take at least 10 years of exposure to dusts containing coal, silica, talc, or asbestos before serious lung damage develops (see pneumoconiosis). Hypersensitivity to moulds on hay or grain may lead to allergic alveolitis. Preventive measures, such as the installation of dust extraction machinery, have reduced the incidence of dust diseases.... dust diseases

A group of antiallergy drugs, such as montelukast and zafirlukast, used to prevent symptoms of mild to moderate asthma. The drugs work by blocking the effects of leukotrienes – naturally occurring substances released in the lungs during an allergic reaction.

Because they are not bronchodilator drugs, and will not relieve an existing attack, they are usually used with bronchodilators and inhaled corticosteroids to reduce the frequency of attacks.

Side effects include gastrointestinal disturbances and headache.

Skin and hypersensitivity reactions may also occur.... leukotriene receptor antagonists

Immunoglobulin E is a type of antibody produced by IgE plasma cells. These are specialized B-cell lymphocytes that make free-floating antibodies for what is termed humoral resistance. IgE is peculiar for several reasons. It is not made to be specific against only one antigen like other gamma globulins, but instead can bind with a number of dangerous proteins. Further, IgE travels to mast cells, sticks to their surfaces, and when antigens get stuck to the IgE, the mast cells secrete inflammatory compounds like histamine. Since IgE is a generalist, coded for a number of potential toxins, not just a single substance, it can decide that Juniper pollen and cat dander are antigens...and you have an allergy. Elevated production of IgE is often inherited, which is why allergies run in a family-and why, once you have an allergy, the mast cells and IgE can decide that, for the duration, a whole bunch of other stuff causes hypersensitivity reactions, stuff that wouldn’t normally bother you without an ongoing allergy.... ige

Papaya (Carica papaya).

Plant Part Used: Fruit (ripe and unripe), papain enzymes.

Dominican Medicinal Uses: Fruit: eaten for digestive ailments, flatulence, stomachache, intestinal pain, heartburn, heart disease, hypertension, menopausal hot flashes, urinary tract infection, skin infection.

Safety: Ripe fruit is widely consumed and generally considered safe; topical application of the unripe fruit did not show toxicity in rabbits; other plant preparations have shown mixed results in animal toxicity studies.

Contraindications: Pregnancy and lactation (unripe fruit and papain); children under 12 years (due to lack of clinical data); history of hypersensitivity to fruit.

Drug Interactions: Warfarin (w/papain may cause excessive bleeding).

Clinical Data: Human clinical trials: guinea worm infection (leaves), immunomodulation (papain enzymes), burn wound-healing (fruit).

Laboratory & Preclinical Data: In vivo: abortifacient (unripe fruit constituents), anthelmintic (latex), antifertility—inhibits sperm motility (seed extract), antihypertensive (unripe fruit ethanolic extract); anti-ulcer (unripe fruit latex); diuretic (root); reversible azoospermia (seed extract).

In vitro: antiamoebic (seed extract), antihypertensive (unripe fruit ethanolic extract), antimicrobial, antioxidant (unripe fruit and seed), anti-salmonella (leaf and root extracts), immunomodulatory, immunostimulatory (seed extract), uterine stimulatory (fruit latex extract).

* See entry for Lechosa in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... lechosa

Chamomile (Matricaria recutita & Chamaemelum nobile).

Plant Part Used: Flower.

Dominican Medicinal Uses: Flowers: decoction/infusion, orally, for anxiety, nervousness, stress, insomnia (adults and children), menstrual cramps, post-partum recovery, childbirth and regulating blood pressure.

Safety: Considered safe for internal use; slight potential for hypersensitivity, especially in patients with a history of allergic reaction to Aster species.

Contraindications: Pregnancy: oral administration of whole plant extract at high doses may have emmenagogue effects; however, flower extracts have not shown this effect.

Clinical Data: Clinical case report: mouthwash for oral mucositis (plant extract).

Laboratory & Preclinical Data: In vivo: antipruritic, antiulcerogenic (plant extract); anxiolytic (constituents); hypoglycemic (aerial parts of Chamaemelum nobile).

In vitro: antifungal (plant extracts).

* See entry for Manzanilla in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... manzanilla

A CYTOTOXIC drug of the taxane group (see TAXANES). Given by intravenous transfusion, it is used under specialist supervision for the treatment of ovarian cancer (usually following surgery – see OVARIES, DISEASES OF) with or without CISPLATIN. NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) guidance in 2001 also recommended that the drug could be used to treat advanced breast cancer (see BREASTS, DISEASES OF) where initial cytotoxic therapy had failed or could not be used. Its use as ?rst-line treatment is limited to clinical trials.

Side-effects of paclitaxel include hypersensitivity, MYELOSUPPRESSION, cardiac ARRHYTHMIA and peripheral NEUROPATHY. Only a minority of patients respond to the drug, but when it works the results are often long-lasting.... paclitaxel

adj. describing a *personality disorder characterized by self-consciousness, hypersensitivity to rejection and criticism from others, avoidance of normal situations because of their potential risk, high levels of tension and anxiety, and consequently a restricted life.... avoidant

n. a third-generation *cephalosporin antibiotic that has good activity against Gram-negative bacteria (including Pseudomonas). It is used for the treatment of urinary and respiratory tract infections, cellulitis, meningitis, and septicaemia. Side-effects include reaction at the site of injection, diarrhoea, and hypersensitivity reactions.... ceftazidime

(CPP) intermittent or constant pain in the lower abdomen or pelvis of at least six months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It may be caused by an underlying gynaecological condition, such as *endometriosis or adhesions, but bowel or bladder disorders (e.g. irritable bowel syndrome, interstitial cystitis), visceral hypersensitivity, and psychological conditions may all contribute.... chronic pelvic pain

n. an antibiotic used to treat serious bacterial infections, such as staphylococcal bone and joint infections. The most serious side-effect is pseudomembranous colitis, caused by overgrowth of *Clostridium difficile, which limits the use of this drug; other side-effects include nausea, vomiting, and occasional hypersensitivity reactions.... clindamycin

n. a drug that is used to relieve itching, including that associated with scabies. It is applied to the skin and sometimes causes reddening and hypersensitivity reactions.... crotamiton

The name given by Sir Alexander Fleming, in 1929, to an antibacterial substance produced by the mould Penicillium notatum. The story of penicillin is one of the most dramatic in the history of medicine, and its introduction into medicine initiated a new era in therapeutics comparable only to the introduction of ANAESTHESIA by Morton and Simpson and of ANTISEPTICS by Pasteur and Lister. The two great advantages of penicillin are that it is active against a large range of bacteria and that, even in large doses, it is non-toxic. Penicillin di?uses well into body tissues and ?uids and is excreted in the urine, but it penetrates poorly into the cerebrospinal ?uid.

Penicillin is a beta-lactam antibiotic, one of a group of drugs that also includes CEPHALOSPORINS. Drugs of this group have a four-part beta-lactam ring in their molecular structure and they act by interfering with the cell-wall growth of mutliplying bacteria.

Among the organisms to which it has been, and often still is, active are: streptococcus, pneumococcus, meningococcus, gonococcus, and the organisms responsible for syphilis and for gas gangrene (for more information on these organisms and the diseases they cause, refer to the separate dictionary entries). Most bacteria of the genus staphylococcus are now resistant because they produce an enzyme called PENICILLINASE that destroys the antibiotic. A particular problem has been the evolution of strains resistant to methicillin – a derivative originally designed to conquer the resistance problem. These bacteria, known as METHICILLINRESISTANT STAPHYLOCOCCUS AUREUS (MRSA), are an increasing problem, especially after major surgery. Some are also resistant to other antibiotics such as vancomycin.

An important side-e?ect of penicillins is hypersensitivity which causes rashes and sometimes ANAPHYLAXIS, which can be fatal.

Forms of penicillin These include the following broad groups: benzylpenicillin and phenoxymethyl-penicillin; penicillinase-resistant penicillins; broad-spectrum penicillins; antipseudomonal penicillins; and mecillinams. BENZYLPENICILLIN is given intramuscularly, and is the form that is used when a rapid action is required. PHENOXYMETHYLPENICILLIN (also called penicillin V) is given by mouth and used in treating such disorders as TONSILLITIS. AMPICILLIN, a broad-spectrum antibiotic, is another of the penicillins derived by semi-synthesis from the penicillin nucleus. It, too, is active when taken by mouth, but its special feature is that it is active against gram-negative (see GRAM’S STAIN) micro-organisms such as E. coli and the salmonellae. It has been superceded by amoxicillin to the extent that prescriptions for ampicillin written by GPs in the UK to be dispensed to children have fallen by 95 per cent in the last ten years. CARBENICILLIN, a semi-synthetic penicillin, this must be given by injection, which may be painful. Its main use is in dealing with infections due to Pseudomonas pyocanea. It is the only penicillin active against this micro-organism which can be better dealt with by certain non-penicillin antibiotics. PIPERACILLIN AND TICARCILLIN are carboxypenicillins used to treat infections caused by Pseudomonas aeruginosa and Proteus spp. FLUCLOXACILLIN, also a semi-synthetic penicillin, is active against penicillin-resistant staphylococci and has the practical advantage of being active when taken by mouth. TEMOCILLIN is another penicillinase-resistant penicillin, e?ective against most gram-negative bacteria. AMOXICILLIN is an oral semi-synthetic penicillin with the same range of action as ampicillin but less likely to cause side-effects. MECILLINAM is of value in the treatment of infections with salmonellae (see FOOD POISONING), including typhoid fever, and with E. coli (see ESCHERICHIA). It is given by injection. There is a derivative, pivmecillinam, which can be taken by mouth. TICARCILLIN is a carboxypenicillin used mainly for serious infections caused by Pseudomonas aeruginosa, though it is also active against some gram-negative bacilli. Ticarcillin is available only in combination with clarulanic acid.... penicillin

A synthetic anticoagulant (see ANTICOAGULANTS). Given by mouth, it is used to prevent the formation of clots in the blood in rheumatic heart disease and atrial ?brillation (see HEART, DISEASES OF); as prophylaxis after insertion of a prosthetic heart valve; and as prophylaxis and treatment of venous thrombosis and pulmonary embolism. It is slower in action than WARFARIN, not achieving its full anticoagulant e?ect until up to 48 hours after the initial dose. The drug should be avoided in patients with renal or hepatic impairment, and whenever severe hypersensitivity reactions have previously occurred. Adverse effects include rashes, fever, LEUCOPENIA, AGRANULOCYTOSIS, diarrhoea and pink urine; breast feeding should be avoided.... phenindione

n. a *taxane used in the treatment of breast cancer, advanced or metastatic *non-small-cell lung cancer, and metastatic prostate cancer that is resistant to hormonal treatment. Side-effects are as for all *cytotoxic drugs, but also typically include hypersensitivity reactions, neuropathy, and leg oedema.... docetaxel

drug reaction with eosinophilia and systemic symptoms: a potentially fatal reaction to medications, also called anticonvulsant and drug-induced hypersensitivity syndrome. It is characterized by a nonspecific skin rash and variable other symptoms, such as fever, lymphadenopathy, full blood count abnormalities, organ (e.g. liver) dysfunction, and malaise. Common drug culprits include anticonvulsants and antibiotics, although many others have been reported to cause it. Prompt withdrawal of the suspected drug is critical for recovery, but sometimes the reaction can be prolonged, even after drug withdrawal.... dress

n. an acute inflammatory disease affecting the brain and spinal cord. It is sometimes part of an overwhelming virus infection but acute disseminated encephalomyelitis (ADEM) is a form of delayed tissue hypersensitivity provoked by a mild infection or vaccination 7–10 days earlier. Survival through the acute phase of the illness is often followed by a remarkably complete recovery.... encephalomyelitis

nonallergic food hypersensitivity: a non-life-threatening reaction (often delayed) to a food, drink, food additive, or compound that results in symptoms in the respiratory system, gut, or skin. It can result from metabolic reactions, pharmacological reactions, or malabsorption; treatment uses *elimination and exclusion diets and the formation of tolerance over a period of time.... food intolerance

Pineapple (Ananas comosus).

Plant Part Used: Fruit, fruit rind.

Dominican Medicinal Uses: Fruit: juice, taken orally as a diuretic for urinary tract or kidney disorders, cleansing the body internally, for treating bacterial infection, cancer, high blood pressure, high cholesterol, menopausal hot flashes; fruit rind: fermented in sugar and water for internally cleansing and refreshing the body.

Safety: Commonly consumed as food; relatively nontoxic; repeated exposure can cause hypersensitivity.

Contraindications: Caution advised during pregnancy due to possible abortifacient effects of plant steroids.

Drug Interactions: For bromelain (protease enzymes from stem): antibiotics, tetracyclines (elevated drug serum levels), anticoagulants and thrombocyte aggregation inhibitors (increased bleeding).

Laboratory & Preclinical Data: In vivo: antidiabetic, antioxidant, antidyslipidemic (ethanolic leaf extract); antifertility (unripe fruit juice); burn debridement (bromelain—stem enzymes); diuretic (root extract).

In vitro: antitumor (bromelain—stem enzymes).

* See entry for Piña in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... piña

An anticoagulant (see ANTICOAGULANTS), usually given by mouth on a daily basis. The initial dose depends upon the PROTHROMBIN or coagulation time; this should be determined before starting treatment, and then at regular intervals during treatment. It is indicated for the prophylaxis of embolisation (see EMBOLISM) in rheumatic heart disease and atrial ?brillation (see HEART, DISEASES OF); after prosthetic heart-valve insertion; prophylaxis and treatment of venous thrombosis and PULMONARY EMBOLISM; and TRANSIENT ISCHAEMIC ATTACKS OR EPISODES (TIA, TIE). When given in tablet form, its maximum e?ect generally occurs within about 36 hours, wearing o? within 48 hours. Special caution is appropriate in patients with disease of the liver or kidneys or who have had recent surgery. Warfarin is contra-indicated throughout pregnancy (especially the ?rst and third trimesters), and in cases of PEPTIC ULCER, severe HYPERTENSION and bacterial ENDOCARDITIS. The most important adverse e?ect is HAEMORRHAGE. Other reported side-effects include HYPERSENSITIVITY, rash, ALOPECIA, diarrhoea, unexplained drop in HAEMATOCRIT readings, purple toes, skin NECROSIS, JAUNDICE, liver dysfunction, nausea, vomiting and pancreatitis (see PANCREAS, DISEASES OF). (See also COAGULATION.)... warfarin

An allergic condition with hypersensitivity of eyes, nose, throat and sometimes the skin due to grass and flower pollens in May and June. These and similar allergens cause the body to produce an excess of histamine which manifests as catarrh and nasal congestion. Hay fever may simulate allergy to cow’s milk (in children), additives and colourings in foods and sweets.

Symptoms: sneezy runny itchy nose and eyes, nose-block and sensitive palate. The upset may be mild or very disabling.

Alternatives. Teas. Cudweed, Elder, Ephedra, Eyebright, Ground Ivy, Nettles, Plantain, Peppermint, Sage.

Formula. Equal parts, Eyebright, Ephedra, White Horehound. 2 teaspoons to each cup boiling water; infuse 15 minutes. Dose: half-1 cup freely.

Tablets/capsules. Iceland Moss, Garlic, Lobelia, St John’s Wort.

Powders. Formula. Equal parts: Eyebright, Ephedra, Plantain. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Tinctures. Alternatives. (1) Formula. Eyebright 3; Echinacea 2; Bayberry bark 1. (2) Formula. St John’s Wort 2; Uva Ursi 2; Bayberry bark 1. Dose: one 5ml teaspoon thrice daily. Infants: one drop each year of age.

Practitioner. Alternatives. (1) Equal parts: Ephedra (anti-allergic) and Nettles (anti-histamine). (2) Tinctures: Ephedra 2ml; Yarrow 5ml; Elder 5ml; Capsicum 0.5ml. Doses: 15-30 drops thrice daily in water.

Topical. Eyes should be treated separately. Bayberry bark powder for use as a snuff. Compresses of Chamomile for inflamed itchy eyes. Witch Hazel eye douch. Olbas oil on a handkerchief as an inhalant. Potter’s Anti-fect. Nasal douche: 1-2 drops Blood root in water. Dr Bourgeois, French Allergist, recommends Halibut liver oil nasal spray, frequently.

Diet. Avoid dairy products, caffeine drinks and alcohol entirely during the hay fever season. Low fat yoghurt contains an antihistamine. Abundant grated carrot for Vitamin A. Green tea. Raw vegetable salad once daily.

Supplementation. Vitamins A, B-complex, C (1 gram daily), E. Propolis, Pollen, Honeycomb as chewing gum, Magnesium, Zinc.

Preventative. 2 Garlic capsules, with high oil content, at night for 1-2 months before season begins. Purulent cases. 5-10 drops Tincture Myrrh in water, thrice daily. ... hay fever

a steroid antibiotic used to treat skin and eye infections caused by staphylococci. It may cause hypersensitivity reactions. See also sodium fusidate.... fusidic acid

adj. prone to respond abnormally to the presence of a particular antigen, which may cause a variety of tissue reactions ranging from *serum sickness to an allergy (such as hay fever) or, at the severest, to anaphylactic shock (see anaphylaxis). It is thought that when the normal antigen-antibody defence reaction is followed by tissue damage this may be due to an abnormality in the working of the *complement system. See also allergy; immunity. —hypersensitivity n.... hypersensitive

n. an unusual and unexpected sensitivity exhibited by an individual to a particular drug or food. Drug idiosyncrasy commonly takes the form of undue susceptibility or hypersensitivity, so that the standard dose causes an excessive effect; the normal effect is produced by a small fraction of the standard dose. —idiosyncratic adj.... idiosyncrasy

n. a *monoclonal antibody that acts against the protein CD20, located mainly on the surface of B lymphocytes; it is used in the treatment of many lymphomas and leukaemias, including non-Hodgkin’s lymphoma and chronic lymphocytic leukaemia. It is also licensed for the treatment of severe rheumatoid arthritis and *vasculitis. Side-effects include hypersensitivity reactions and immunosuppression.... rituximab

a syndrome characterized by the presence of asthma, nasal *polyps, and hypersensitivity to aspirin. [M. Samter (1908–99), German-born US physician]... samter’s triad

See: WEAKNESS.

ASTHMA. Spasmodic contraction of the bronchi following exercise, emotional tension, infection, allergens, pollens, house dust, colds.

Symptoms. Obstruction of airways with wheezing, rales or whistling sounds with a sense of constriction. Often related to eczema – ‘eczema of the epithelium’. Infantile eczema treated with suppressive ointments may drive the condition ‘inwards’ and worsen asthma. “My son’s eczema has got better, but he now has asthma” is a common observation.

Causes: hypersensitivity to domestic animals, horses and pet birds. Common salt. Red or white wine allergy. An older generation of practitioners recognised a renal-bronchial asthma encouraged by faulty kidney function. With addition of a relaxing diuretic (Dandelion, Buchu or Parsley root) to a prescription, respiratory symptoms often abate.

Broncho-dilators such as Ephedra and Wild Thyme are widely used by the practitioner. To relieve spasm: Lobelia, Pleurisy root. White Horehound, Ammoniacum, Cramp bark, Garlic, Grindelia, Hyssop.

Anti-cough agents serve to remove sticky sputum: Coltsfoot, Garden Thyme, Slippery Elm bark, Maidenhair Fern, Linseed, Bayberry bark.

For the chronic asthmatic, bacterial invasion spells distress, when Echinacea or Balm of Gilead should be added. Where an irregular pulse reveals heart involvement, add: Hawthorn or Lily of the Valley.

Lobelia is of special value for the anxious patient with spasm of the bronchi. Should be tried before resorting to powerful spray mists which frequently produce gastro-intestinal disturbance.

Alternatives. Teas. Coltsfoot, Comfrey, Horehound (White), Mullein, Skullcap, Marshmallow, Thyme, Valerian, Wild Cherry bark, Elecampane, Plantain. Formula: equal parts herbs Coltsfoot, Mullein, Valerian. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes; dose, 1 cup twice daily and when necessary.

Antispasmodic Drops. See entry.

Practitioner. Ephedra, Lobelia, Gelsemium, Grindelia, Euphorbia (pill-bearing spurge), Skunk Cabbage, Senega, Pulsatilla, Lily of the Valley (cardiac asthma), Thyme. Formula. Equal parts, Tincture Lobelia simp; Tincture Belladonna; Tincture Ephedra. 5-10 drops thrice daily (maintenance), 10-20 drops for spasm.

Cockayne, Ernest, FNIMH. Hyssop tea for children throughout childhood to avoid respiratory disorders. Dr Finlay Ellingwood. Gelsemium 3.5ml; Lobelia 3.5ml. Distilled water to 120ml. One 5ml teaspoon in water every 3 hours.

Dr Alfred Vogel. Ephedra 20 per cent; Ipecac 15 per cent; Hawthorn berry 10 per cent; Blessed Thistle 5 per cent; Burnet Saxifrage 5 per cent; Garden Thyme 5 per cent; Grindelia 1 per cent. 10-15 drops in water thrice daily.

Dr Wm Thomson. 1 teaspoon Ephedra herb to cup boiling water; infuse 10-15 minutes. Half-1 cup 2-3 times daily.

Traditional. 2 teaspoons shredded Elecampane root in cup cold water; stand overnight. Next day, heat to boiling point when required. Strain. Sips, hot, with honey: 1 cup 2-3 times daily.

Potter’s Asthma & Bronchitis Compound 32. 40g medicinal teabags. Ingredients: Clove BPC 4.84 per cent; Elecampane root 17.24 per cent; Horehound 26.20 per cent; Hyssop 17.24 per cent; Irish Moss 17.24 per cent; Liquorice 17.24 per cent. Dose: 1-2 teaspoons when necessary.

Chinese Medicine. Decoction or extract from the Gingko tree widely used, as also is Ephedra, Garlic, Liquorice and Bailcalensis.

Tablets/capsules. Lobelia. Iceland Moss, (Gerard). Euphorbia (Blackmore).

Powders. Formula. Lobelia 2; Hyssop 1; Elderflowers 1; Grindelia quarter; Liquorice quarter: pinch Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) 2-3 times daily.

Aromatherapy. 6 drops Rosemary oil in 2 teaspoons Almond oil for massage upper chest to relieve congestion.

Inhalation. See: INHALATIONS, FRIAR’S BALSAM.

Nebulizer. A germicidal solution is made from 5 drops oil Eucalyptus in one cup boiling water. Use in nebulizer for droplet therapy.

Ioniser – use of.

Cider Vinegar. Sips of the vinegar in water for whoop.

Supportives. Yoga. Singing. Cures have been reported of patients on taking up singing. “During singing, up to 90 per cent of the vital capacity may be used without a conscious effort to increase tidal volume.” (Dr M. Judson, New England Journal of Medicine)

Diet. Low salt, low fat, high fibre, cod liver oil, carrots, watercress, Soya beans or flour, lecithin, sunflower seed oil, green vegetables, raw fruit, fresh fish. These foods are valuable sources of antioxidant vitamins and minerals essential for the body’s defence mechanism. A diet deficient in these reduces ability of the airways to withstand the ravages of cigarette smoke and other air pollutants.

Foods that are craved are ones often causing sensitivity. Among problem foods are: milk, corn, wheat, eggs, nuts, chocolate, all dairy products, fat of meats. Check labels for tartrazine artificial colouring.

Salt intake. Linked with chest diseases. “Those who eat a lot of salt had more sensitive airways than those with low salt intake . . . excess salt tended to cause most pronounced symptoms.” (Institute of Respiratory Diseases, Oavia, Italy)

Asthma mortality could be significantly reduced by sufferers lowering their salt consumption, an epidemiologist predicted.

Supplements. Daily. Vitamin B6 50-100mg. Vitamin C 500mg. Vitamin E 400iu. Magnesium, Zinc. Cod liver oil: 2 teaspoons.

Anti-allergic bedding. Provides a protective barrier against the house dust mite on mattresses and bedding. Droppings from the tiny pests are worse in the bedroom. ... asthenia

enlargement of the thymus gland and other parts of the lymphatic system, formerly believed to be a predisposing cause to sudden death in infancy and childhood associated with hypersensitivity to drugs or vaccines.... status lymphaticus

n. a *protein kinase inhibitor used for the treatment of advanced renal cell carcinoma. It targets a serine threonine kinase that regulates a signalling cascade controlling cell proliferation. Side-effects include hypersensitivity reactions (flushing, chest pain, breathlessness).... temsirolimus

a condition resulting from damage to the thalamus, often by a stroke, that is characterized by severe intractable pain and hypersensitivity in the area of the body served by the damaged brain region. It is extremely resistant to treatment.... thalamic syndrome

Indian tobacco. Puke weed. Lobelia inflata L. German: Indianischer tabak. French: Tabac indien. Italian: Lobelia. Part used: dried herb collected when part of capsule is inflated.

Constituents: lobeline, resin, wax, gum, lignin, fixed oil.

Action: antasthmatic, antispasmodic, mild sedative and gentle relaxant. Expectorant, diaphoretic, anti- cough. Broncho-dilator containing the alkaloid lobeline. Claimed to destroy pneumococcus. Amphoteric. Emetic. Smoking deterrent (tablets). Respiratory stimulant.

Uses: Broad spectrum therapy: chest, throat, sinuses, middle ear, urinary tract, chronic bronchitis. An effective means of controlling difficult breathing without risk of serious side-effects: croup, whooping cough, pleurisy, etc. For deteriorating asthma where there has been a declining response to routine broncho-dilator treatment. Well tolerated by those allergic to penicillin and for side-effects arising from that therapy. Tetanus (Dr H. Hart, Chi Med Journal). Irritability and hypersensitivity. Nicotine addiction. External. Use of tincture or liquid extract for gouty joints, big toe, etc.

Ear troubles in children: Inject 2 drops Oil Lobelia.

Preparations: Thrice daily.

Dried herb, 50 to 200mg in infusion (BHC Vol 1).

Liquid Extract: 0.2 to 0.6ml (3 to 10 drops).

Tincture Lobelia acid: 1 part to 10 parts cider vinegar; macerate 8 days; decant. Dose: 5 to 10ml (1-2 teaspoons).

Simple Tincture Lobelia BPC (1949), 1:8 in 60 per cent alcohol. Dose, 0.6 to 2ml.

Tablets/capsules. Lobelia compound. Powdered Lobelia BP 60mg; Powdered Gum Ammoniacum BPC 30mg; Powdered extract Squill 2:1, 30mg. Respiratory stimulant for blocked sinuses, catarrh and coughs. Contra-indicated: feeble pulse or nerve response, pregnancy, shock, paralysis. Large doses induce vomiting. ... lobelia

Cells, also called blood corpuscles, present in blood for most or part of their lifespan. They include red blood cells, which make up about 45 per cent by volume of normal blood, white blood cells, and platelets. Blood cells are made in the bone marrow by a series of divisions from stem cells.

Red blood cells (also known as RBCs, red blood corpuscles, or erythrocytes) transport oxygen from the lungs to the tissues (see respiration). Each is packed with haemoglobin, enzymes, minerals, and sugars. Abnormalities can occur in the rate at which RBCs are either produced or destroyed, in their numbers, and in their shape, size, and haemoglobin content, causing forms of

anaemia and polycythaemia (see blood, disorders of).

White blood cells (also called WBCs, white blood corpuscles, or leukocytes) protect the body against infection and fight infection when it occurs. The 3 main types of are granulocytes (also called polymorphonuclear leukocytes), monocytes, and lymphocytes. Granulocytes are further classified as neutrophils, eosinophils, or basophils, and each type of granulocyte has a role in either fighting infection or in inflammatory or allergic reactions. Monocytes and lymphocytes also play an important part in the immune system. Lymphocytes are usually formed in the lymph nodes. One type, a T-lymphocyte, is responsible for the delayed hypersensitivity reactions

White (see allergy) and Red blood blood cell is also involved in cell (neutrophil) protection against cancer. T-lymphocytes manufacture chemicals, known as lymphokines, which affect the function of other cells. In addition, the T-cells moderate the activity of B-lymphocytes, which form the antibodies that can prevent a second attack of certain infectious diseases. Platelets (also known as thrombocytes), are the smallest blood cells and are important in blood clotting.

The numbers, shapes, and appearance of the various types of blood cell are of great value in the diagnosis of disease (see blood count; blood film).... blood cells

An uncommon condition in which the lining of the small intestine is damaged due to hypersensitivity to gluten, a protein found in wheat, rye, and some other cereals. Damage to the intestinal lining causes malabsorption, weight loss, and vitamin and mineral deficiencies that can lead to anaemia and skin problems. Faeces are bulky and foul-smelling. The disease tends to run in families and varies in severity. In babies, symptoms usually develop within 6 months of the introduction of gluten into the diet. The baby may become listless and irritable, develop vomiting and acute diarrhoea, and become dehydrated and seriously ill. In adults, symptoms such as tiredness, breathlessness, diarrhoea, vomiting, abdominal pain, and swelling of the legs may develop gradually over months. A chronic, distinctive rash called dermatitis herpetiformis may develop. Some people suffer damage to the intestinal lining but never develop symptoms.

Diagnosis is made by blood, urine, and faeces tests and jejunal biopsies, in which small samples of the lining of the intestine are taken for examination.

Coeliac disease is treated by a lifelong gluten-free diet, which usually relieves symptoms within weeks of introduction.... coeliac disease

An occupational disease affecting the lungs of farm workers. Farmer’s lung is a type of allergic alveolitis, in which affected people develop hypersensitivity to certain moulds that grow on hay, grain, or straw. Symptoms develop about 6 hours after exposure to dust containing fungal spores and include shortness of breath, headache, fever, and muscle aches. In acute attacks, the symptoms last for about a day. Repeated exposure to spores may lead to a chronic form of the disease, causing permanent scarring of lung tissues.

Diagnosis of farmer’s lung may involve a chest X-ray, pulmonary function tests, and blood tests for a specific antibody. Corticosteroid drugs will relieve the symptoms. Further exposure to the spores of the fungus should be avoided. (See also fibrosing alveolitis.)... farmer’s lung

An inappropriate or exaggerated reaction of the immune system to a food. Sensitivity to cow’s milk protein is a fairly common food allergy in young children. Other foods most commonly implicated in food allergy are nuts, wheat, fish, shellfish, and eggs. Food allergy is more common in people who suffer from other forms of allergy or hypersensitivity, such as asthma, allergic rhinitis, and eczema.Immediate reactions, occurring within an hour or sometimes minutes of eating the trigger food, include lip swelling, tingling in the mouth or throat, vomiting, abdominal distension, abnormally loud bowel sounds, and diarrhoea. Some serious allergies can cause anaphylactic shock, requiring immediate self-injection with adrenaline (epinephrine). The only effective treatment for food allergy is avoidance of the offending food. (See also food intolerance.)... food allergy

A collection of cells and proteins that works to protect the body from harmful microorganisms, such as bacteria, viruses, and fungi. It also plays a role in the control of cancer and is responsible for the phenomena of allergy, hypersensitivity, and rejection after transplant surgery.

The term innate immunity is given to the protection that we are born with, such as the skin and the mucous membranes that line the mouth, nose, throat, intestines, and vagina. It also includes antibodies, or immunoglobulins (protective proteins), that have been passed to the child from the mother. If microorganisms penetrate these defences, they encounter “cell-devouring” white blood cells called phagocytes, and other types of white cells, such as natural cellkilling (cytotoxic) cells. Microorganisms may also meet naturally produced substances (such as interferon) or a group of blood proteins called the complement system, which act to destroy the invading microorganisms.The 2nd part of the immune system, adaptive immunity, comes into play when the body encounters organisms that overcome the innate defences. The adaptive immune system responds specifically to each type of invading organism, and retains a memory of the invader so that defences can be rallied instantly in the future.

The adaptive immune system first must recognize part of an invading organism or tumour cell as an antigen (a protein that is foreign to the body). One of 2 types of response – humoral or cellular – is then mounted against the antigen.

Humoral immunity is important in the defence against bacteria. After a complex recognition process, certain B-lymphocytes multiply and produce vast numbers of antibodies that bind to antigens. The organisms bearing the antigens are then engulfed by phagocytes. Binding of antibody and antigen may activate the complement system, which increases the efficiency of the phagocytes.

Cellular immunity is particularly important in the defence against viruses, some types of parasites that hide within cells, and, possibly, cancer cells. It involves 2 types of T-lymphocyte: helper cells, which play a role in the recognition of antigens and activate the killer cells (the 2nd type of T-lymphocyte), which destroy the cells that have been invaded.

Disorders of the immune system include immunodeficiency disorders and allergy, in which the immune system has an inappropriate response to usually innocuous antigens such as pollen.

In certain circumstances, such as after tissue transplants, immunosuppressant drugs are used to suppress the immune system and thus prevent rejection of the donor tissue as a foreign organism.... immune system

A type of protein found in blood and tissue fluids, also known as an antibody. Such proteins are produced by B-lymphocytes (a type of white blood cell), and their function is to bind to substances in the body that are recognized as foreign antigens. This binding is crucial for the destruction of antigenbearing microorganisms. Immunoglobulins also play a key role in allergies and hypersensitivity reactions.

Immunoglobulin G (IgG) is the major class of immunoglobulin of the 5 in the blood (IgA, IgD, IgE, IgG, and IgM). Its molecule consists of 2 parts: 1 binds to an antigen; the other binds to other cells, which then engulf the microorganisms bearing the antigen.

Immunoglobulins can be extracted from the blood of people who have recovered from certain infectious diseases and used for passive immunization.... immunoglobulin

A diagnostic technique based on detection of radiation emitted by radioactive substances introduced into the body. Substances are taken up to different degrees by different tissues, allowing specific organs to be studied. For example, iodine is taken up mainly by the thyroid gland, so by “tagging” a sample of iodine with a radioactive marker (radionuclide), the uptake of iodine can be monitored to investigate the functioning of the gland. A radionuclide is swallowed or injected into the blood and accumulates in the target organ. It emits radiation in the form of gamma radiation, which is detected by a gamma camera to produce an image. Cross-sectional images (“slices”) can be obtained using a computer-controlled gamma camera that rotates around the patient. This specialized form of radionuclide scanning is known as (single photon emission computed tomography). Moving mation on blood flow, the movement of the heart walls, the flow of urine through the kidneys, and bile flow through the liver.

Radionuclide scanning is a safe procedure, requiring only minute doses of radiation that are excreted within hours. The radionuclides carry virtually no risk of toxicity or hypersensitivity.... radionuclide scanning

n. the condition of subjects with widespread narrowing of the bronchial airways, which changes in severity over short periods of time (either spontaneously or under treatment) and leads to cough, wheezing, and difficulty in breathing. Bronchial asthma may be precipitated by exposure to one or more of a wide range of stimuli, including *allergens, drugs (such as aspirin and other NSAIDs and beta blockers), exertion, emotion, infections, and air pollution. The onset of asthma is usually early in life and in atopic subjects (see atopy) may be accompanied by other manifestations of hypersensitivity, such as hay fever and dermatitis; however, the onset may be delayed into adulthood or even middle or old age. Treatment is with *bronchodilators, with or without corticosteroids, usually administered via aerosol or dry-powder inhalers, or – if the condition is more severe – via a nebulizer. Oral corticosteroids are reserved for those patients who fail to respond adequately to these measures. Severe asthmatic attacks may need large doses of oral corticosteroids (see status asthmaticus). Selection of treatment for individual cases is made using stepped guidelines issued by respiratory organizations, e.g. the British and American Thoracic Societies and the European Respiratory Society. A new group of drug treatments, using *monoclonal antibodies to target components in the allergic response, have recently become available (see omalizumab). Avoidance of known allergens, especially the house dust mite, allergens arising from domestic pets, and food additives, will help to reduce the frequency of attacks, as will the discouragement of smoking.

Cardiac asthma occurs in left ventricular heart failure and must be distinguished from bronchial asthma, as the treatment is quite different. —asthmatic adj.... asthma

n. the subjective experience of abdominal fullness, often (but not always) accompanied by abdominal distension. Its many causes include air swallowing (*aerophagia), abnormal intestinal gas handling or abdominal wall reflexes, increased gas production, and organ hypersensitivity. Bloating may be associated with increased belching, excessive flatus, or changes in bowel habit, particularly constipation. It tends to be aggravated by meals, fluctuates in severity throughout the day (with particular discomfort in the evening), and is relieved at night. Treatment includes the removal of exacerbating factors (such as specific dietary products), avoidance of carbonated drinks and fat-rich diets, reduction in dietary fibre, and reassurance. Drug therapy has limited efficacy, but antispasmodics, laxatives, peppermint oil, simeticone, prokinetics (such as domperidone), nonabsorbable antibiotics (rifaximin), and tricyclic antidepressants (to reduce hypersensitivity) may be tried.... bloating

(CJD) a rapidly progressive rare neurological disease, a form of human *spongiform encephalopathy in which dementia progresses to death after a period of 3–12 months. There is no effective treatment. The causative agent is an abnormal *prion protein that accumulates in the brain and causes widespread destruction of tissue. CJD typically affects middle-aged to elderly people. Some 15% of cases are due to a form of the disease that is inherited as an autosomal *dominant trait but most cases are sporadic, susceptibility being genetically determined. A few cases of CJD are acquired: the agent is known to have been transmitted by tissue and organ transplantation and by human growth hormone injections, but the disease may take years to manifest itself. Variant Creutzfeldt–Jakob disease (vCJD) is the human form of bovine spongiform encephalopathy (BSE), which is most likely acquired by the ingestion of infected beef products. Patients are younger than those affected with sporadic CJD and present with psychiatric symptoms (e.g. depression, anxiety) and hypersensitivity to touch, which are followed after months by myoclonic jerks (see myoclonus) and dementia. [H. G. Creutzfeldt (1885–1964) and A. M. Jakob (1884–1931), German psychiatrists]... creutzfeldt–jakob disease