Allergic Diseases: Diagnosis and Treatment by Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.),

By Randy J. Horwitz MD, PhD, Robert F. Lemanske Jr. MD (auth.), Phil Lieberman MD, John A. Anderson MD (eds.)

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Sample text

In allergic conjunctivitis, there is periorbital edema, conjunctival injection, chemosis, and excessive tearing with a white ropy discharge. "Allergic shiners," dark swelling under the eyes, are seen in many patients with allergic rhinitis (Fig. 2). A groove under the lower eyelid, "Dennie's line," is observed in many patients with allergic disorders. Examination of the tarsal conjunctiva may reveal "cobblestoning," seen in patients with vernal conjunctivitis, atopic keratoconjunctivitis, and giant cell conjunctivitis.

It is estimated that 40-80% of allergic patients have a family history of allergic disease. Pertinent family members are the parents, grandparents, and siblings. Of course, a negative family history for allergies does not rule out an allergic condition. It is important in obtaining the family history to inquire about conditions that may mimic allergic disorders, such as cystic fibrosis and immune defects. Chapter 2 / Approach to the Allergic Patient 21 PHYSICAL EXAMINATION A major component in the comprehensive evaluation of the allergic patient is the physical examination.

The patient's serum is then incubated with the solid phase. If the patient has antibodies specific for the allergen, the antibodies will become bound to the allergen, and the remaining serum proteins, including unbound antibodies, can be washed away from the solid phase (this is immunoabsorption and separation). After washing, a labeled antihuman IgE antibody is incubated with the solid phase to allow binding of the anti-IgE to any 19E bound to the solid phase. Mter washing away unbound anti-IgE, the quantity of anti-lgE bound to the solid phase is measured and converted either to units of specific IgE or to a class score.

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