A 31-year-old female presented with complaints of itching with previous history of 5-6 anaphylactic reactions since last one month. Her symptoms were preceded (3-6 hours) with intake of red meat. She suffered one tick bite (probably a lone star tick) one month before the allergic episodes. Laboratory tests showed elevated serum IgE levels. She was suspected to suffer from Alpha gal syndrome. It is a disease causally linked to bites from ticks. Although cases of alpha-gal allergy have already been reported in a few European countries, to our best knowledge, no cases have been reported so far in South India. She was managed with steroids and dietary restrictions.
Journal of the Egyptian National Cancer Institute •
Head and neck squamous cell carcinoma (HNSCC) accounts for a large oncologic burden in the developing countries. In patients with locally advanced head and neck cancer multimodality treatment is warranted. Radiation therapy with concurrent chemotherapy has long been considered the standard for patients with disease involving the oropharynx, larynx and hypopharynx. However, addition of chemotherapy to radiotherapy increases treatment related toxicity by many folds and compliance rates decrease. In this context a systemic therapy, which when used concurrent with radiation with favorable toxicity profile is of great importance for improving disease control in locally advanced HNSCC. Anti-epithelial growth factor receptor targeted therapy emerged as a potential treatment option. In recent years many trials were conducted to find the optimum treatment option with the combination of these targeted agents. The initial trials showed excellent results with minimal morbidity and led to great enthusiasm across the globe to incorporate these regimens as a standard of care. However, subsequently many trials failed to maintain such results and now there is little agreement to the initial results achieved with these drugs. Based on the current evidence we cannot recommend the replacement of cisplatin with targeted therapy in concurrent setting. It may be considered in patients with altered renal parameters, hypersensitivity or intolerance to cisplatin. The addition of targeted therapy in addition to chemotherapy in the concurrent setting can't also be recommended as the benefit is doubtful and is associated with a significant increase in toxicity.