To confirm that corticosteroids are beneficial in the treatment of Stevens-Johnson syndrome (SJS), 15 patients with the syndrome were evaluated by the same group of physicians over 2 years. All pat ients had cutaneous and most had mucosal lesions. Patients were treated with corticosteroids rangingfrom prednisone 40 mg daily to methylprednisolone 750 mg daily. The same group of physicians participated in the management of these patients until recovery. No deaths occurred among the 15 patients. Recovery was complete in all cases, and there was no residual skin, mucosal, or visceral damage except for minimal scarring in one patient. In some cases, reversal of disease after onset of corticosteroid therapy was sufficiently dramatic to demonstrate a benefit. The use of corticosteroids in the treatment of SJS remains controversial. We conclude that corticosteroids are beneficial in treatment of the syndrome. They may be lifesaving in some patients and should be the standard of therapy. SJS should be considered to be erythema multiforme with either bullous lesions or visceral involvement or both. (AllergyProc. 13, 2:89-95, 1992)
R Re es sp pi ir ra at to or ry y a an nd d s sy ys st te em mi ic c r re ea ac ct ti io on n f fo ol ll lo ow wi in ng g e ex xp po os su ur re e t to o h he ea at te ed d e el le ec ct tr ro os st ta at ti ic c p po ol ly ye es st te er r p pa ai in nt t A. Cartier*, O. Vandenplas*, L.C. Grammer**, M.A. Shaughnessy**, J-L. Malo* Respiratory and systemic reaction following exposure to heated electrostatic polyester paint. A, Cartier, O. Vandenplas, L.C. Grammer, M.A. Shaughnessy, J-L. Malo. ERS Journals Ltd 1994. ABSTRACT: A 39 year old nonatopic man developed episodes of cough, dyspnoea, sweating and shivers within 2-3 weeks of starting a new job in a factory where metallic boards were treated with an electrostatic powder paint, made of an epoxy resin and a carboxylated polyester containing polyethylene terephthalate and polybutylene terephthalate. The subject sprayed the metallic boards which were then heated in 200°C ovens.The subject was first seen in an emergency room after being at work for 4 h. The physical examination revealed bilateral wheezing with fever (39°C), hypoxaemia (arterial oxygen tension (PaO 2 ) 58 torr (7.7 kPa), leucocytosis (white blood count cells·mm -3 17,000 (17×10 9 cells·l -1 ) and severe airway obstruction (forced expiratory volume in one second (FEV 1 )/forced vital capacity, (FVC) 1.3/2.4 l, improving to 2.2/3.8 l after bronchodilator; predicted values = 3.4/4.1 l). The subjects condition improved after being treated with oral steroids. His spirometry was normal two weeks later, although he showed mild bronchial hyperresponsiveness to methacholine with the (provocative concentration producing a 20% fall in FEV 1 (PC 20 ) being 1.7 mg·ml -1 ).The subject underwent specific inhalation challenges at the workplace 4 months later. After being exposed at work for 4 h, he developed a significant fall in FEV 1 (-40%), fever, leucocytosis, and a fall in diffusing capacity. Lung function tests were back to normal two weeks later. Exposing the subject to heated granulated polyester for one hour in a hospital laboratory produced a fall in FEV 1 of 41%, fever, leucocytosis and a fall in diffusing capacity. Nine months later, the subject still had symptoms of mild asthma and his PC 20 was 0.2 mg·ml -1 .To the best of our knowledge, this is the first account of occupational asthma and an alveolitis-type reaction after exposure to polyester. Eur Respir J., 1994, 7, 608-611 Asthma is now the most common occupational respiratory ailment [1,2]. More than 200 agents have been described as causing occupational asthma, including many low molecular weight agents [3].Occupational asthma is occasionally accompanied by systemic symptoms compatible with "alveolar" involvement. This has been shown in the case of isocyanates [4], as was reviewed recently [5].We describe the case of a subject who developed asthma with systemic symptoms, leucocytosis and functional evidence of lung parenchymal involvement after being exposed to a carboxylated linear polyester containing polyethylene terephthalate and polybut...
Acid anhydrides such as trimellitic anhydride (TMA) are of interest due to their important industrial uses and to their adverse health effects in exposed populations. Important industrial uses of TMA include the production of epoxy and alkyd resins used to manufacture a variety of coating materials. The adverse health effects are a result of its direct irritant effects on mucosal surfaces in all exposed humans as well as its ability to cause immunologic sensitization in a small proportion of humans. In those individuals who are immunologically sensitized, reexposure to TMA can result in well described immunologic syndromes: asthma-rhinitis, late respiratory systemic syndrome (LRSS), and very rarely pulmonary disease anemia syndrome (PDA). In summary, adverse health effects of TMA are due to its effects as an irritant, an immunologic sensitizer, or a combination of both.
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