Anaphylaxis after a horse bite

EAACI Molecular Allergology User's Guide 2.0

Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.

Autopsy Features of Fatal Donkey Attack

Lethal donkey attacks have very rarely been described. The case of a 65-year-old man who was found deceased on a country road with 2 domestic donkeys nearby is, therefore, reported. Examination of the body revealed contusions and lacerations of the face and scalp, a comminuted fracture of the left maxilla, comminuted fracturing of the right radius and ulna and of the left anterior superior iliac spine, a flail chest, and pulmonary contusions. In addition, there were bite marks on the left thigh, right buttock, right axilla/upper arm, and left cheek which corresponded to the dental arcades of the donkeys. Death had resulted from blunt chest trauma due to an attack by 1 or 2 donkeys. Deaths and serious injuries are much more commonly caused by horses; however, this case shows that even domesticated donkeys may also rarely be capable of inflicting significant trauma and so should be approached with circumspection.

Direct and indirect exposure to horse: risk for sensitization and asthma

Most studies on the sensitization to horse allergens in populations without professional exposure have been carried out in geographical areas where the rate of horse ownership is high and horse riding is popular. Very few studies have been carried out in populations living in large urban areas. This gap in the literature probably reflects the widespread view that prevalence of horse-related allergy is low in urban populations because the latter are not regularly exposed to horses. On the contrary, we suggest that urban areas constitute a model useful to study potential modalities of exposure and sensitization to horse allergen by other routes of exposure than horse-riding. In this article, we describe the risks related to various modalities of exposure to horse allergen, clinical aspects of airway sensitization to horse allergens in patients living in urban areas, and non-occupational exposure to horse allergen. In addition, we illuminate some aspects related to dispersion of horse allergens from sources such as stables to indoor environments.

Anaphylaxis as a manifestation of horse allergy

Allergic disease induced by animal exposure is a common phenomenon worldwide. Whereas cat and dog dander exposure are well recognized as causative of allergic rhinitis, allergic asthma, and contact urticaria, horse allergy can present with anaphylaxis. Horse allergy is induced by exposure to the major horse allergens Equ 1 through 5. The severity of the symptoms may be related to the level of exposure. Greatest risk of anaphylaxis occurs in those sensitized patients who have large amounts of animal allergen exposure, such as when in a barn, or when an animal bite occurs exposing sensitized persons to large quantities of the animal allergen that resides in the saliva. Horse allergy may be successfully treated with allergen specific immunotherapy.

That horse bit me: zoonotic infections of equines to consider after exposure through the bite or the oral/nasal secretions

Millions of individuals are in contact with horses through occupational or recreational activities. Injuries from horses are responsible for over 100,000 emergency room visits each year in the United States. Although various types of traumatic injuries related to direct contact with horses are well described, roughly 3% to 4.5% of all reported injuries are due to bites by equines. The immediate injuries are commonly either blunt or penetrating trauma to local tissue; however, the bite exposure may also transmit a microbial agent of equine origin that can lead to a zoonotic infection. In almost all jurisdictions in the United States, animal bites are considered public health events and should be reported to the local health departments. Many animals can harbor many unusual zoonotic pathogens that both the individual health provider and public health officials much consider as they can adversely impact both the patient and the community health. This review focuses on those zoonoses that have been reported in the literature, including those that may in theory be transmitted from equine to human by direct inoculation or exposure to oral/nasal secretions from horses and other equine species.