Immune system diseases

Could protection from allergies be a collateral benefit of BCG vaccination?

Nicholas Kiraly BM BS, BSc · Katrina J Allen FRACP, PhD, FAHMS · Nigel Curtis MB BS, FRCPCH, PhD

A position statement from Coeliac Australia’s Medical Advisory Committee scrutinises the technology used in currently available kits

Evan D Newnham Jason A Tye-Din on behalf of the Coeliac Australia Medical Advisory Committee

The first reported incident and successful treatment of acute parkinsonism following melioidosis

Choon Seong Ng MB BS · Shahrul Azmin MB ChB, MMed · Zhe Kang Law MD, MRCP · Ramesh Sahathevan MD, MMed, PhD · Wan Nur Nafisah Wan Yahya MB BCh, BAO, MMed · Rabani Remli MB ChB, MIntMed · Petrick Periyasamy MD, MMed · Norlinah Mohd Ibrahim MB BCh, BAO, MRCP · Hui Jan Tan MMed, MRCP

A more flexible approach than that currently mandated by the PBS is recommended

Craig Gedye MB ChB, FRACP, PhD · Frances M Boyle MB BS, PhD, FRACP

There is growing evidence that medications with anti-TNF-alpha activity may have a role in immunocompetent individuals

James S Molton MB BS, BSc, FRACP · Paul J Huggan BSc(Hons), MB ChB · Sophia Archuleta MD

A 45-year-old previously well woman with a probable diagnosis of Takayasu arteritis

Michelle C Papandony MB BS(Hons) · Sharmayne RE Brady MB BS(Hons), BMedSc(Hons), FRACP · Tai-Juan Aw MB BS, FRACP

Meeting the challenge of increasing allergy rates through improved models of care and education

Raymond J Mullins PhD, FRACP, FRCPA · Richard K S Loh FRACP

The case of Patient R, reported to have been afflicted with a very shiny nose

Deshan F Sebaratnam MB BS(Hons), MMed · Nicholas Stewart MB BS, BSc · Supriya S Venugopal MB BS, MMed, FACD

Prompt use of replacement glucocorticoids is crucial

Sunita M C De Sousa · Georgina V Long · Katherine T Tonks

Funding needed for venom immunotherapy to protect allergic patients against the effects of jack jumper ant stings

Raymond J Mullins PhD, FRACP, FRCPA · Simon G A Brown MB BS, PhD, FACEM

Serious hypersensitivity reactions can occur with very small amounts of exposure to chlorhexidine

Usman Mushtaq MB BS · Aaron Tan MB BS, FRACP · Ju Ann Tan MB BS, MRCP, FRACP · William B Smith MB BS(Hons), FRACP, PhD

The first report of liver lesions being associated with this rare, chronic and progressive condition

Elita Santosaputri* BMedSc, BM BS · Elizabeth J Ellis* MB BS · Sureshkumar Nagiah MB BS, MD, FRACP · Anugrah Chrispal MB BS, MD, FRACP · Anthony Thomas PhD, FRCPA, FRCPath

A preservative commonly used in personal products is a leading cause of contact dermatitis

Jennifer L Cahill · Ryan W Toholka · Rosemary L Nixon

A mystery solved after 15 years of pain and swelling

Suran L Fernando · Jamma Li

To the Editor: The two contributions by Gray and colleagues1 and Loblay and colleagues2 on the topic of salicylate intolerance illustrate that absence of evidence does not equate to evidence of absence.3 Neither paper quotes the admittedly sparse European peer-reviewed literature on the topic, including an understanding of the basic biochemistry,4,5 a diagnostic test, and clinical prevalence studies of intolerance to dietary salicylate.5-7 A wealth ...

Richard F Heller · C Ann Heller · Jane Heller

To the Editor: I am concerned that the recent articles on salicylate diets in the Journal1,2 may be seen as a current position statement on the usefulness of a low-chemical elimination diet. An elderly psychiatrist colleague said in 1976, “In 20 years time many parents will not be giving their children red cordial but scientists will still be discussing the issue!” The discussion continues, not because ...

Joan C Breakey

In reply: We are pleased that our publication has generated discussion regarding the benefits of low salicylate diets. However, the correspondence and references from Heller and colleagues and Breakey do not provide any further evidence for the use of such diets and simply reaffirm the lack of good-quality data in this area. Until such data are available, the use of salicylate elimination diets remains an ...

Paul E A Gray*

A review of case notes from our Sydney-based paediatric allergy services, between 1 January 2003 and 31 December 2011, identified 74 children who had been prescribed diets that eliminated foods containing natural salicylates before attending our clinics. The most common indications for starting the diets were eczema (34/74) and behavioural disturbances (17/74) including attention deficit hyperactivity disorder (ADHD). We could find no peer-reviewed evidence to support the efficacy of salicylate elimination diets in managing these diseases. We do not prescribe these diets, and in a survey of European and North American food allergy experts, only 1/23 respondents used a similar diet for eczema, with none of the respondents using salicylate elimination to treat ADHD. A high proportion (31/66) of children suffered adverse outcomes, including nutritional deficiencies and food aversion, with four children developing eating disorders. We could find no published evidence to support the safety of these diets in children. While this uncontrolled study does not prove a causal relationship between salicylate elimination diets and harm, the frequency of adverse events appears high, and in the absence of evidence of safety or efficacy, we cannot recommend the use of these diets in children.

Paul E A Gray Mb Chb, FRACP, FRCPA · Sam Mehr MB BS, FRACP, FRCPA · Constance H Katelaris MB BS, PhD, FRACP · Brynn K Wainstein MB ChB, FRACP, PhD · Anita Star BHlthSc, PhD, APD · Dianne Campbell MB BS, FRACP, PhD · Preeti Joshi MB BS, FRACP, PhD · Melanie Wong PhD, FRACP, FRCPA · Brad Frankum BMed(Hons), FRACP · Karuna Keat MB BS, FRACP, FRCPA · Geraldine Dunne BSc(Hons), RN · Barbara Dennison DipCommNut, ANAPD · Alyson Kakakios MB BS, FRACP · John B Ziegler FRACP, MD, FAAAAI

With suitable guidance and monitoring, dietary modification is safe and can improve quality of lifeSalicylates are a diverse family of 2-OH benzoic acid derivatives produced in all plants. The parent molecule, salicylic acid (SA), is a ubiquitous phytohormone responsible for pathogen resistance, regulation of growth, and a wide variety of other biological functions.1,2 The medicinal use of salicylate-containing plant extracts was first recorded about 3500 years ...

Robert H Loblay MB BS, PhD, FRACP · Velencia L Soutter MB BS, FRACP · Anne R Swain PhD, APD

A study of the behaviour and perceptions of parents of food-allergic children finds that many parents are complacent about precautionary labelling on packaged foods, even if their children have a history of anaphylaxis.

Giovanni A Zurzolo BBioMedSc(Hon) · Jenifer J Koplin PhD · Michael L Mathai PhD · Mimi K L Tang PhD, FRACP · Katrina J Allen PhD, FRACP

Clinical record A 40-year-old, previously healthy woman presented with sudden loss of consciousness and collapse. Her work colleagues noted that she had become drowsy and light-headed moments before the collapse. She had reported a suspected spider bite about 10 hours earlier, which had caused her skin to become generally itchy. Paramedics found the woman to be in a state of pulseless electrical activity 20 minutes after the cardiovascular collapse. ...

Su Shian Lee MB BS · Gary A Unglik MB BS, FRACP, FRCPA · Adrian W Y Mar MB BS, FACD

To the Editor: A woman was assessed after an episode of goat cheese anaphylaxis. She had been using goat milk soap (various brands) to treat dry skin and mild eczema since 2009. In 2010, she experienced itchy mouth while eating goat cheese, and later in the year, she had contact urticaria after applying goat milk moisturiser (use discontinued). In early 2011, she developed tongue and ...

Raymond J Mullins