RESUMEN
OBJECTIVE: Immunotherapies targeting immune checkpoints have achieved encouraging survival benefits in patients with various solid cancers. Corticosteroids are frequently administrated for cancer/non-cancer related indications and immune-related adverse events (irAEs). This study aimed to clarify the prognostic significance of corticosteroid administration in solid cancer patients receiving immune checkpoint inhibitor (ICI) treatment. METHOD: First, a meta-analysis was performed using the literatures searched from PubMed, Cochrane Library, Web of Science, Embase, and Clinicaltrials.gov before January 2021. The Hazard ratios (HRs) coupled with 95% confidence intervals (CIs) were used to evaluate the correlation of corticosteroid administration with overall survival (OS) and progression-free survival (PFS). Then, a retrospective analysis enrolling 118 ICI-treated cancer patients was performed for validation, among which 26 patients received corticosteroids for cancer-related indications. RESULT: In the meta-analysis, corticosteroid administration for cancer-related indications was significantly correlated with worse PFS (HR = 1.735(1.381-2.180)) and OS (HR = 1.936(1.587-2.361)) of the ICI-treated patients. However, corticosteroid administration for non-cancer-related indications and irAEs was unrelated with PFS (non-cancer-related indications: HR = 0.830(0.645-1.067); irAEs: HR = 1.302(0.628-2.696)) and OS (non-cancer-related indications: HR = 0.786(0.512-1.206); irAEs: HR = 1.107(0.832-1.474)) of the ICI-treated patients. The following retrospective analysis identified corticosteroid administration for cancer-related indications was an independent unfavorable predictor for PFS (P = 0.006) and OS (P = 0.044) of the ICI-treated patients. The subgroup analysis based on non-small cell lung cancer (NSCLC) demonstrated the similar results (P = 0.002 for PFS and P = 0.047 for OS). CONCLUSION: Our study demonstrated corticosteroid administration for cancer-related indications is an unfavorable prognostic factor in solid cancer patients receiving ICI treatment. Therefore, careful selection of corticosteroid-treated patients for ICI therapy is quite necessary in individualized clinical management.
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Glucocorticoides/uso terapéutico , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Neoplasias/mortalidad , Anciano , Fatiga/tratamiento farmacológico , Fatiga/inmunología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/tratamiento farmacológico , Náusea/inmunología , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Neoplasias/inmunología , Selección de Paciente , Pronóstico , Supervivencia sin Progresión , Estudios Retrospectivos , Vómitos/tratamiento farmacológico , Vómitos/inmunologíaRESUMEN
OBJECTIVES: Current grading systems for platinum hypersensitivities (pHSR) rely on subjective features rather than objective clinical signs leading to inconsistencies in grading. To standardize classification of pHSR, a clinical grading system was developed at our institution. We report the clinical outcomes our classification system and evaluate its correlation with the classification systems currently published and used in practice. METHODS: This was a retrospective review of patients with pHSR from 2011 to 2017. Demographics, chemotherapeutic histories (CT), and details of their initial HSR were collected. Mild reactions were defined as local skin manifestations only. Moderate-low reactions included widespread skin, respiratory or GI findings. Moderate-standard reactions were defined as transient cardiovascular compromise (CVC), hypoxia or neurologic changes whereas sustained changes (>10 min) were used to define severe reaction. Fischer Exact Tests (p < .05) and binary logistic regression analyses were performed. Spearman correlation were used to assess relationships between our grading system and the NCCN and CTCAEv4.0 criteria. RESULTS: 87 patients were identified with most having ovarian cancer (n = 55, 63.2%), receiving carboplatin (n = 62, 71.3%), and on second-line CT (n = 34, 42.5%). Chest pain was associated with transient CVC (OR 10.0, 95% CI 1.148-87.133) while nausea/vomiting (OR 8.420, 95% CI 1.263-55.275) was associated with transient hypoxia albeit less closely than transient hypotension (OR 17.010, 95% CI 2.026-142.825). Only presyncope/syncope remained associated with sustained CVC (OR 38.0, 95% CI 2.815-512.912) on logistic regression. The classification system was most strongly correlated with the NCCN grading system (ρ 0.761, p < .001). CONCLUSIONS: This classification system offers an objective means of grading pHSR severity and correlates with currently-used grading systems.
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Antineoplásicos/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Carboplatino/efectos adversos , Dolor en el Pecho/epidemiología , Dolor en el Pecho/inmunología , Cisplatino/efectos adversos , Hipersensibilidad a las Drogas/complicaciones , Hipersensibilidad a las Drogas/epidemiología , Hipersensibilidad a las Drogas/inmunología , Femenino , Humanos , Hipotensión/epidemiología , Hipotensión/inmunología , Hipoxia/epidemiología , Hipoxia/inmunología , Persona de Mediana Edad , Náusea/epidemiología , Náusea/inmunología , Estudios Retrospectivos , Factores de Riesgo , Síncope/epidemiología , Síncope/inmunología , Vómitos/epidemiología , Vómitos/inmunologíaRESUMEN
The month of December 2019 became a critical part of the time of humanity when the first case of coronavirus disease 2019 (COVID-19) was reported in the Wuhan, Hubei Province in China. As of April 13th, 2020, there have been approximately 1.9 million cases and 199,000 deaths across the world, which were associated with COVID-19. The COVID-19 is the seventh coronavirus to be identified to infect humans. In the past, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome were the two coronaviruses that infected humans with a high fatality, particularly among the elderly. Fatalities due to COVID-19 are higher in patients older than 50 years of age or those with multimorbid conditions. The COVID-19 is mainly transmitted through respiratory droplets, with the most common symptoms being high fever, cough, myalgia, atypical symptoms included sputum production, headache, hemoptysis and diarrhea. However, the incubation period can range from 2 to 14 days without any symptoms. It is particularly true with gastrointestinal (GI) symptoms in which patients can still shed the virus even after pulmonary symptoms have resolved. Given the high percentage of COVID-19 patients that present with GI symptoms (e.g., nausea and diarrhea), screening patients for GI symptoms remain essential. Recently, cases of fecal-oral transmission of COVID-19 have been confirmed in the USA and China, indicating that the virus can replicate in both the respiratory and digestive tract. Moreover, the epidemiology, clinical characteristics, diagnostic procedures, treatments and prevention of the gastrointestinal manifestations of COVID-19 remain to be elucidated.
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Infecciones por Coronavirus/fisiopatología , Diarrea/fisiopatología , Náusea/fisiopatología , Neumonía Viral/fisiopatología , Vómitos/fisiopatología , Betacoronavirus/fisiología , COVID-19 , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Síndrome de Liberación de Citoquinas/inmunología , Citocinas/inmunología , Diarrea/inmunología , Endoscopía del Sistema Digestivo , Heces/virología , Humanos , Náusea/inmunología , Pandemias/prevención & control , Neumonía Viral/inmunología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , SARS-CoV-2 , Tropismo Viral , Esparcimiento de Virus , Vómitos/inmunologíaRESUMEN
Acute pancreatitis is a heterogeneous illness. Most patients experience a mild course of disease, but one third will develop local complications and/or organ failure associated with increased morbidity and risk of mortality. Diagnosis of acute pancreatitis is based on typical epigastric pain, elevation of serum lipase or amylase levels, and/or characteristic findings on imaging. Personalised management is needed in patients with acute pancreatitis. Currently, analgesia, Ringer's lactate solution-based goal-directed fluid resuscitation and early oral refeeding providing enteral nutrition if not tolerated are the cornerstones for early management. Prophylactic antibiotics or endoscopic retrograde cholangiopancreatography in the absence of cholangitis are considered to be futile. Future clinical trials should address optimal fluid resuscitation, the early administration of anti-inflammatory drugs and the exact role of nutritional support in severe acute pancreatitis. Here, we present a patient case and review the diagnosis, treatment and prognosis of acute pancreatitis.
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Medicina Basada en la Evidencia/métodos , Gastroenterología/métodos , Pancreatitis/terapia , Dolor Abdominal/diagnóstico , Dolor Abdominal/inmunología , Dolor Abdominal/terapia , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Colangiopancreatografia Retrógrada Endoscópica , Nutrición Enteral/métodos , Medicina Basada en la Evidencia/tendencias , Fluidoterapia/métodos , Gastroenterología/tendencias , Humanos , Masculino , Persona de Mediana Edad , Náusea/diagnóstico , Náusea/inmunología , Náusea/terapia , Páncreas/diagnóstico por imagen , Páncreas/inmunología , Páncreas/cirugía , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Pancreatitis/inmunología , Pronóstico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Vómitos/diagnóstico , Vómitos/inmunología , Vómitos/terapiaRESUMEN
PURPOSE OF REVIEW: An increase in incidence of unique phenotypic non-IgE-mediated gastrointestinal food allergies (non-IgE GIFAs) has occurred in Japan ahead of Western countries. There are differences in clinical features of non-IgE GIFAs in Western and Japanese patients. As this phenotype has now come to be recognized internationally, we describe it in this review. RECENT FINDINGS: A large number of Japanese patients with non-IgE GIFAs present with vomiting accompanied by bloody stool, putting them between food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis. Some neonates and early infants with non-IgE GIFAs who present with fever and elevated C-reactive protein have symptoms consistent with severe systemic bacterial infections (e.g., sepsis). Some of these cases have now been defined in international guidelines as chronic FPIES. Eosinophils might be involved in the inflammatory process observed. The incidence of FPIES and food protein-induced allergic proctocolitis is increasing in Western countries and likely worldwide, after it has increased in Japan. SUMMARY: The phenotype observed in Japan shows distinct clinical features compared with the classical phenotype, that is, increased levels of eosinophils, suggestive of 'eosinophilic shift' alongside symptomatic differences, making it difficult to categorize.
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Enterocolitis/epidemiología , Hipersensibilidad a los Alimentos/epidemiología , Hemorragia Gastrointestinal/epidemiología , Proctocolitis/epidemiología , Vómitos/epidemiología , Proteínas en la Dieta/inmunología , Enterocolitis/diagnóstico , Enterocolitis/inmunología , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/inmunología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/inmunología , Humanos , Incidencia , Lactante , Recién Nacido , Japón/epidemiología , Proctocolitis/diagnóstico , Proctocolitis/inmunología , Vómitos/diagnóstico , Vómitos/inmunologíaRESUMEN
Anti-Glial fibrillary acidic protein (GFAP) encephalomyelitis is a recently described entity and while the spectrum of this disease has been explored, further research is needed to fully describe its phenotype. Area postrema syndrome (APS) is usually associated with neuromyelitis optica spectrum disorders (NMOSDs), whereas no case of APS has been previously reported with anti-GFAP encephalomyelitis. In this article, we report a case of APS in a 41-year-old woman in the context of anti-GFAP encephalomyelitis. This case was not associated with additional anti-AQP4 IgG and therefore extends the clinico-radiological spectrum of anti-GFAP encephalomyelitis.
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Área Postrema , Autoanticuerpos/inmunología , Encefalomielitis/inmunología , Proteína Ácida Fibrilar de la Glía/inmunología , Adulto , Autoantígenos/inmunología , Encefalomielitis/complicaciones , Encefalomielitis/patología , Femenino , Humanos , Náusea/inmunología , Síndrome , Vómitos/inmunologíaAsunto(s)
Dolor Abdominal/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Hepatitis/diagnóstico , Enfermedad Inflamatoria Pélvica/diagnóstico , Peritonitis/diagnóstico , Dolor Abdominal/inmunología , Dolor Abdominal/microbiología , Femenino , Hepatitis/complicaciones , Hepatitis/inmunología , Hepatitis/microbiología , Humanos , Hígado/diagnóstico por imagen , Hígado/inmunología , Hígado/microbiología , Náusea/inmunología , Náusea/microbiología , Enfermedad Inflamatoria Pélvica/complicaciones , Enfermedad Inflamatoria Pélvica/inmunología , Enfermedad Inflamatoria Pélvica/microbiología , Peritonitis/complicaciones , Peritonitis/inmunología , Peritonitis/microbiología , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Ultrasonografía , Vómitos/inmunología , Vómitos/microbiología , Adulto JovenRESUMEN
OBJECTIVE: Increase in the evidence of global occurrence of Zika viral infection suggests that in Africa the circulation of the virus which causes 80% of asymptomatic infection could be undetected and/or overlooked. We sought to serologically detect Zika virus infection in febrile patients at Greater Accra Regional Hospital, Ghana. RESULTS: Of the 160 patient serum samples analyzed, 33 were found to have antibodies against Zika virus infection. Among the sero-positives 30 (91%) of the cases were anti-Zika virus IgM with the 21-30-year age group recording the highest number of 8 (26%) and 2 (7%) cases being the least for the 61 years and above age group. All sero-positive febrile patients developed at least one symptom consistent with Zika virus infection: 33 (100%) fever, 25 (76%) muscle pain, 24 (73%) joint pain, and conjunctivitis 2 (6%). Digestive symptoms recorded include 16 (49%) nausea, 12 (36%) vomiting and diarrhea 18 (55%). In addition, 28 (85%) loss of appetite, 14 (75%) rapid respiration and chest pain 15 (42%) were reported by seropositive febrile patients. Our data indicates exposure to Zika virus which suggests the possible circulation of the virus among febrile patients in Ghana with a sero-prevalence rate of 20.6%.
Asunto(s)
Anticuerpos Antivirales/sangre , Artralgia/inmunología , Fiebre/inmunología , Mialgia/inmunología , Infección por el Virus Zika/inmunología , Virus Zika/inmunología , Adolescente , Adulto , Anciano , Artralgia/diagnóstico , Artralgia/epidemiología , Artralgia/fisiopatología , Niño , Preescolar , Conjuntivitis Viral/diagnóstico , Conjuntivitis Viral/epidemiología , Conjuntivitis Viral/inmunología , Conjuntivitis Viral/fisiopatología , Estudios Transversales , Diarrea/diagnóstico , Diarrea/epidemiología , Diarrea/inmunología , Diarrea/fisiopatología , Femenino , Fiebre/diagnóstico , Fiebre/epidemiología , Fiebre/fisiopatología , Ghana/epidemiología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Mialgia/diagnóstico , Mialgia/epidemiología , Mialgia/fisiopatología , Náusea/diagnóstico , Náusea/epidemiología , Náusea/inmunología , Náusea/fisiopatología , Estudios Seroepidemiológicos , Vómitos/diagnóstico , Vómitos/epidemiología , Vómitos/inmunología , Vómitos/fisiopatología , Virus Zika/crecimiento & desarrollo , Virus Zika/patogenicidad , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/fisiopatologíaRESUMEN
Autoantibodies targeting aquaporin 4 (AQP4) water channels are a sensitive and specific biomarker for neuromyelitis optica spectrum disorder (NMOSD). Presence of AQP4 antibodies distinguishes NMOSD from multiple sclerosis. We present our experience with an anti-AQP4 antibody-positive patient diagnosed with NMOSD who complained of intractable nausea and vomiting, not restricted to optic neuritis or acute myelitis during the first attack. Her symptoms partially resolved after appropriate therapy with intravenous methylprednisolone and oral prednisolone. Through this case, we hope to draw attention to an unusual neurological presentation of NMOSD which should be included in the differential diagnosis of intractable nausea and vomiting.
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Acuaporina 4/inmunología , Autoanticuerpos/inmunología , Náusea/etiología , Neuromielitis Óptica/diagnóstico , Vómitos/etiología , Administración Intravenosa , Administración Oral , Adulto , Autoanticuerpos/sangre , Femenino , Glucocorticoides/administración & dosificación , Humanos , Metilprednisolona/administración & dosificación , Mielitis Transversa/diagnóstico , Mielitis Transversa/tratamiento farmacológico , Náusea/tratamiento farmacológico , Náusea/inmunología , Neuromielitis Óptica/diagnóstico por imagen , Neuromielitis Óptica/tratamiento farmacológico , Neuromielitis Óptica/inmunología , Prednisolona/administración & dosificación , Vómitos/tratamiento farmacológico , Vómitos/inmunologíaRESUMEN
BACKGROUND: Mycoprotein, which is produced by a mold and is the basis of Quorn-brand meat substitutes, is a novel cause of allergic and gastrointestinal reactions, but little information has been available on its associated symptomatology. OBJECTIVE: To describe the nature and frequency of adverse reactions to mycoprotein. METHODS: Self-reports of adverse reactions to mycoprotein were collected via a Web-based questionnaire (www.quorncomplaints.org) and then analyzed. RESULTS: Analysis of 1,752 adverse reactions found that Quorn products caused allergic and gastrointestinal symptoms, with some people experiencing both. Allergic reactions, including urticaria and anaphylaxis, occurred within 4 hours of consumption in 312 people. Of those reactions, 45.8%, 1 fatal, began within 1 hour of exposure. Of those 312 individuals, 188 (60.3%) reported repeated reactions after repeated consumption of Quorn, and 2 people experienced 8 reactions (13 people did not say whether they experienced more than 1 reaction). Quorn foods caused gastrointestinal symptoms, including emesis and diarrhea, within 8 hours of consumption in 1,692 people. Of the gastrointestinal symptoms, 66.6% occurred 46 to 180 minutes after consumption of the products. Symptoms ranged from mild nausea to emesis severe enough to warrant medical attention. CONCLUSION: Mycoprotein may be causing numerous and sometimes life-threatening allergic and gastrointestinal reactions. The acceptance in the food supply of this nonessential ingredient deserves reconsideration.
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Anafilaxia/diagnóstico , Exposición Dietética/efectos adversos , Hipersensibilidad a los Alimentos/diagnóstico , Proteínas Fúngicas/efectos adversos , Urticaria/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anafilaxia/inducido químicamente , Anafilaxia/inmunología , Anafilaxia/fisiopatología , Niño , Preescolar , Diarrea/inducido químicamente , Diarrea/diagnóstico , Diarrea/inmunología , Diarrea/fisiopatología , Femenino , Alimentos/toxicidad , Hipersensibilidad a los Alimentos/etiología , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/fisiopatología , Fusarium/química , Fusarium/inmunología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/diagnóstico , Náusea/inmunología , Náusea/fisiopatología , Autoinforme , Encuestas y Cuestionarios , Urticaria/inducido químicamente , Urticaria/inmunología , Urticaria/fisiopatología , Vómitos/inducido químicamente , Vómitos/diagnóstico , Vómitos/inmunología , Vómitos/fisiopatologíaAsunto(s)
Diarrea/dietoterapia , Enterocolitis/dietoterapia , Alimentos Formulados , Hipersensibilidad a la Leche/dietoterapia , Hidrolisados de Proteína/efectos adversos , Vómitos/dietoterapia , Animales , Diarrea/etiología , Diarrea/inmunología , Diarrea/fisiopatología , Enterocolitis/etiología , Enterocolitis/inmunología , Enterocolitis/fisiopatología , Femenino , Humanos , Lactante , Fórmulas Infantiles/efectos adversos , Masculino , Leche/efectos adversos , Hipersensibilidad a la Leche/etiología , Hipersensibilidad a la Leche/inmunología , Hipersensibilidad a la Leche/fisiopatología , Alimentos de Soja/efectos adversos , Vómitos/etiología , Vómitos/inmunología , Vómitos/fisiopatologíaRESUMEN
Objectives The aim of this study was to describe the clinical manifestations in cats of contact with caterpillars of the pine processionary moth. Methods Data were retrospectively obtained from the medical records (2004-2016) of cats that had been in contact with caterpillars of the pine processionary moth. Results Eleven cats were included in the study. The prevalence of lepidopterism was 0.13%. Tongue lesions and ptyalism were both present in 10/11 (91%) cats. Systemic signs consisted exclusively of vomiting and were encountered in 4/11 (36%) cats. The survival rate was 100%. Long-term follow-up data were available for 7/11 cats, and none of the cats showed impaired quality of life or definitive sequelae. Conclusions and relevance The clinical presentation of lepidopterism in cats appears to be similar to that in other animals; however, the clinical signs are less severe than those previously reported, mainly owing to the cautious behaviour of this species. Moreover, the prognosis is excellent, the length of hospitalisation is short (maximum 48 h) and our study showed the absence of any long-term disability after hospital discharge.
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Alérgenos/envenenamiento , Enfermedades de los Gatos/etiología , Mariposas Nocturnas , Vómitos/veterinaria , Alérgenos/inmunología , Animales , Enfermedades de los Gatos/inmunología , Gatos , Larva , Estudios Retrospectivos , Vómitos/inducido químicamente , Vómitos/inmunologíaRESUMEN
This article reports the case of a 45-year-old male immunocompetent patient who presented with acute epigastric pain and vomiting. Diagnostic tests confirmed a recent cytomegalovirus (CMV) infection as a contributory cause of a florid gastric ulcer. Primary CMV infections affecting the upper gastrointestinal tract are rare in immunocompetent adults. In this case treatment with a proton pump inhibitor and eradication of concomitant Helicobacter pylori colonization led to a full recovery. Anti-CMV treatment was not necessary.
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Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/inmunología , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/inmunología , Huésped Inmunocomprometido/inmunología , Úlcera Gástrica/inmunología , Úlcera Gástrica/prevención & control , Dolor Abdominal/diagnóstico , Dolor Abdominal/inmunología , Dolor Abdominal/prevención & control , Dolor Agudo/diagnóstico , Dolor Agudo/inmunología , Dolor Agudo/prevención & control , Antibacterianos/administración & dosificación , Antivirales/administración & dosificación , Infecciones por Citomegalovirus/diagnóstico , Diagnóstico Diferencial , Gastritis/diagnóstico , Gastritis/tratamiento farmacológico , Gastritis/inmunología , Infecciones por Helicobacter/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/uso terapéutico , Úlcera Gástrica/diagnóstico , Vómitos/diagnóstico , Vómitos/inmunología , Vómitos/prevención & controlRESUMEN
The latest research data emphasize the interaction between the nervous and the immune systems. It has been demonstrated that the central nervous system (CNS) can be involved secondarily due to blood brain barrier (BBB) disruption via pro-inflammatory cytokines released in allergy. More recently it was demonstrated that the parasympathetic nervous system (PNS) could also be equally involved in models of peripheral inflammation such as food allergy; although this last clinical presentation has rarely been described. Herein, the authors report the case of a five-year-old Caucasian female who was admitted to our Pediatric Acute and Emergency Operative Unit for cyclic vomiting. Her vomiting, which was preceded by objective torque vertigo, headache and weakness, had been recurring with constant frequency every two months since she was 3 years old. After a complex diagnostic flow-chart, it was found that this spectrum of neurologic symptoms was due to a food allergy syndrome, which postulates some etiopathogenic hypotheses to explain the relationship between the two mentioned diseases.
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Enfermedades del Sistema Nervioso Autónomo/inmunología , Hipersensibilidad a los Alimentos/complicaciones , Caseínas/efectos adversos , Caseínas/inmunología , Preescolar , Femenino , Cefalea/inmunología , Humanos , Solanum lycopersicum/efectos adversos , Solanum lycopersicum/inmunología , Debilidad Muscular/inmunología , Vértigo/inmunología , Vómitos/inmunologíaRESUMEN
Sublingual route, a noninjective way of allergen administration appears to be associated with a lower incidence of severe systemic reactions compared with the subcutaneous route. Local adverse reactions are reported which resolve spontaneously within a few days without need for discontinuation of treatment. Hereby, we report two pediatric cases, one with persistent asthma and the other one with persistent allergic rhinitis. Both were treated by house dust mite sublingual immunotherapy, one of whom developed severe wheezing (grade 2 systemic reaction based on World Allergy Organization subcutaneous systemic reaction grading system) and the other intractable vomiting (grade 3 local reaction based on World Allergy Organization sublingual immunotherapy local adverse events grading system) at the end of the build-up phase which repeated on re-administration of the same dose. Both of those two cases completed their 3-year immunotherapy successfully by patient-based adjustment of the highest tolerated dose of the maintenance.
Asunto(s)
Asma/terapia , Dermatophagoides farinae/inmunología , Dermatophagoides pteronyssinus/inmunología , Rinitis Alérgica/terapia , Inmunoterapia Sublingual/efectos adversos , Animales , Asma/tratamiento farmacológico , Niño , Preescolar , Relación Dosis-Respuesta Inmunológica , Fluticasona/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Masculino , Dosis Máxima Tolerada , Náusea/inmunología , Ruidos Respiratorios/inmunología , Rinitis Alérgica/tratamiento farmacológico , Vómitos/inmunologíaRESUMEN
A previously well 4-year-old boy presented to the emergency room with progressive cyanosis, pallor and vomiting over the last 5 h. Oxygen saturation on pulse oximetry was 87-89% despite 9 L/min of supplemental oxygen. He was tachypnoeic and had a systolic heart murmur, with no other findings on clinical examination. In his medical history, there was record of a restrictive atrial septal defect, with a normal echocardiogram from 3 years before. He had no relevant family history. His shoes appeared to have been recently painted, which raised the suspicion of methaemoglobinaemia, presumptively caused by aniline-containing shoe dye. The shoes were removed promptly and his feet washed profusely. After confirming the diagnosis, methylene blue was started. The level of methaemoglobin decreased rapidly and the boy made a full recovery.
Asunto(s)
Cianosis/inducido químicamente , Inhibidores Enzimáticos/uso terapéutico , Metahemoglobinemia/diagnóstico , Azul de Metileno/uso terapéutico , Pintura/efectos adversos , Taquipnea/inducido químicamente , Vómitos/inducido químicamente , Preescolar , Cianosis/etiología , Cianosis/inmunología , Etanol , Humanos , Masculino , Metahemoglobinemia/tratamiento farmacológico , Metahemoglobinemia/inmunología , Oximetría , Zapatos , Taquipnea/inmunología , Resultado del Tratamiento , Vómitos/inmunologíaRESUMEN
Pathogenic bacteria and host defense system have been evolved by their offense and defense. In vivo research is crucial for elucidation of interactions between them. I have investigated their offence and defense by various standpoints using mouse models of Listeria monocytogenes and Staphylococcus aureus infections. Herein, the results of my research including the roles of endogenous cytokines in host defense, the attenuation of host defense mechanism in obesity and diabetes, the development of vaccines against S. aureus infection by staphylococcal enterotoxin (SE) family molecules, and the emesis-inducing mechanism of SEA are described.
Asunto(s)
Citocinas/inmunología , Interacciones Huésped-Patógeno/inmunología , Sistema Inmunológico/inmunología , Listeriosis/inmunología , Infecciones Estafilocócicas/inmunología , Animales , Vacunas Bacterianas , Diabetes Mellitus Tipo 2/inmunología , Modelos Animales de Enfermedad , Descubrimiento de Drogas , Enterotoxinas/inmunología , Femenino , Humanos , Masculino , Ratones , Sistemas Neurosecretores/inmunología , Obesidad/inmunología , Staphylococcus aureus/inmunología , Vómitos/inmunologíaAsunto(s)
Anafilaxia/inmunología , Anticuerpos Monoclonales Humanizados/efectos adversos , Hipersensibilidad a las Drogas/etiología , Infecciones por Virus Sincitial Respiratorio/prevención & control , Angioedema/inmunología , Anticuerpos Monoclonales Humanizados/uso terapéutico , Preescolar , Tos/inmunología , Síndrome de DiGeorge/complicaciones , Hipersensibilidad a las Drogas/diagnóstico , Disnea/inmunología , Femenino , Humanos , Enfermedades Pulmonares/complicaciones , Palivizumab , Virus Sincitial Respiratorio Humano/efectos de los fármacos , Tetralogía de Fallot/complicaciones , Urticaria/inmunología , Vómitos/inmunologíaAsunto(s)
Antibacterianos/efectos adversos , Cefixima/efectos adversos , Erupciones por Medicamentos/prevención & control , Hipersensibilidad a las Drogas/complicaciones , Enterocolitis/diagnóstico , Enterocolitis/inmunología , Amoxicilina/administración & dosificación , Amoxicilina/efectos adversos , Antibacterianos/administración & dosificación , Cefixima/administración & dosificación , Niño , Productos Lácteos/efectos adversos , Diarrea/diagnóstico , Diarrea/tratamiento farmacológico , Diarrea/inmunología , Erupciones por Medicamentos/etiología , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Enterocolitis/tratamiento farmacológico , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Hidrocortisona/administración & dosificación , Pruebas Cutáneas , Síndrome , Vómitos/diagnóstico , Vómitos/tratamiento farmacológico , Vómitos/inmunologíaRESUMEN
BACKGROUND: Neuromyelitis optica (NMO) is a severe autoimmune disease of the central nervous system characterized by spinal cord and optic nerve involvement. Brainstem manifestations have recently been described. OBJECTIVE: To evaluate the time of occurrence, the frequency and the characteristics of brainstem symptoms in a cohort of patients with NMO according to the ethnic background and the serologic status for anti-aquaporin-4 antibodies (AQP4-abs). METHODS: We performed a multicenter study of 258 patients with NMO according to the 2006 Wingerchuk criteria and we evaluated prospectively the frequency, the date of onset and the duration of various brainstem signs in this population. RESULTS: Brainstem signs were observed in 81 patients (31.4%). The most frequently observed signs were vomiting (33.1%), hiccups (22.3%), oculomotor dysfunction (19.8%), pruritus (12.4%), followed by hearing loss (2.5%), facial palsy (2.5%), vertigo or vestibular ataxia (1.7%), trigeminal neuralgia (2.5%) and other cranial nerve signs (3.3%). They were inaugural in 44 patients (54.3%). The prevalence was higher in the non-Caucasian population (36.6%) than in the Caucasian population (26%) (p<0.05) and was higher in AQP4-ab-seropositive patients (32.7%) than in seronegative patients (26%) (not significant). CONCLUSIONS: This study confirms the high frequency of brainstem symptoms in NMO with a majority of vomiting and hiccups. The prevalence of these manifestations was higher in the non Caucasian population.