Relevance of Allergenic Sensitization to Cynodon dactylon and Phragmites communis: Cross-reactivity With Pooideae Grasses.

BACKGROUND AND OBJECTIVES: The homologous group of sweet grasses belongs to the Pooideae subfamily, but grass pollen species from other subfamilies can also cause allergy, such as Cynodon dactylon (Chloridoideae) and Phragmites communis (Arundinoideae). C dactylon and P communis have not been included in the sweet grasses homologous group because of their low cross-reactivity with other grasses. The aims of this study were to investigate the profile of sensitization to C dactylon and P communis in patients sensitized to grasses and to analyze cross-reactivity between these 2 species and temperate grasses. METHODS: Patients were skin prick tested with a grass mixture (GM). Specific IgE to GM, C dactylon, P communis, Cyn d 1, and Phl p 1 was measured by ImmunoCAP. A pool of sera was used for the immunoblot assays. Cross-reactivity was studied by ELISA and immunoblot inhibition. RESULTS: Thirty patients had sIgE to GM. Twenty-four (80%) had positive results for C dactylon, 27 (90%) for P communis, 22 (73.3%) for nCyn d 1, and 92.9% for rPhl p 1. Bands were detected in the 3 extracts by immunoblot. Inhibition of GM was not observed with C dactylon or P communis by immunoblot or ELISA inhibition. When C dactylon or P communis were used in the solid phase, GM produced almost complete inhibition. CONCLUSIONS: Eighty percent of patients sensitized to grasses were also sensitized to C dactylon and 90% were sensitized to P communis. Sensitization to these species seems to be induced by allergens different to those in sweet grasses.

Kounis syndrome: report of 5 cases.

Kounis syndrome has been defined as an acute coronary syndrome that manifests as unstable vasospastic or nonvasospastic angina, and even as acute myocardial infarction. It is triggered by the release of inflammatory mediators following an allergic insult. We report 5 patients attended at our hospital between January 2005 and May 2008 who were diagnosed with unstable angina or acute myocardial infarction-according to analytical parameters, electrocardiographic abnormalities, and/or coronary angiography--in the context of an anaphylactic episode. Age at the time of the episode, age ranged between 50 and 68 years. The results of an allergology study revealed the causal agents to be drugs in 4 cases (nonsteroidal anti-inflammatory drugs and omeprazole) and food in 1 case (kiwi). Coronary disease of a blood vessel was observed in 2 patients. Serious allergic reactions may be the cause of acute coronary syndrome in patients with healthy or altered coronary arteries and no cardiovascular risk factors.

Edema of the uvula: etiology, risk factors, diagnosis, and treatment.

Edema of the uvula (EU) is a rare occurrence sometimes associated with angioedema, urticaria, and anaphylaxis. We analyze the causes, predisposing factors, and characteristics of EU in a group of 58 patients with a mean (SD) age of 48.2 (15.2) years over the course of a year. Of the 58 patients studied, 49 (84.5%) were male and 44 (75.9%) presented isolated EU. Thirty-two patients (55.1%) with no clear etiology were classed as idiopathic. Snoring and a high body mass index were more prevalent in these patients. A variety of probable causes were identified in 26 patients (44.9%). In this group, EU was usually accompanied by urticaria, angioedema, and anaphylaxis and there was also a greater prevalence of atopy. We found that EU was idiopathic in just over half of the patients studied and that the predisposing factors were being overweight and having a tendency to snore. Patients with EU should be tested for allergies to drugs, airborne allergens, and food.

Oestrogen-dependent hereditary angio-oedema with normal C1 inhibitor: description of six new cases and review of pathogenic mechanisms and treatment.

BACKGROUND: Hereditary angio-oedema (HAE) is a rare condition in which there is a deficiency in the quantity or activity of C1 inhibitor (C1INH). Recently, an additional type of HAE with no alterations in the levels or the function of C1INH has been reported. It is defined as HAE with normal C1INH, and named type III HAE or oestrogen-dependent HAE. The aim of this study is to describe the clinical and laboratory findings of six new cases of type III HAE and to review the literature about this disease. METHODS: A short description of six women with recurrent angio-oedema is provided. The characteristics of the patients are compared with the previously reported case series in a literature-based review. RESULTS: The mean age of the patients at onset was 22 years (range 16-30). All of them had angio-oedema attacks during oestrogen-based contraceptive treatment and four reported episodes during pregnancy. Four patients reported a positive past family history. Two of them had experienced episodes of laryngeal oedema. None of the patients responded to corticoids or antihistamines during the attacks. Levels and functional activity of C1INH were within the normal range in all cases. CONCLUSIONS: Clinical and laboratory findings mirror the observations of previous reports of oestrogen-dependent angio-oedema with normal C1INH. This is the first published series of type III HAE in Spain.

Drug neosensitization during anticonvulsant hypersensitivity syndrome.

Anticonvulsant hypersensitivity syndrome (AHS) is a rare, severe drug hypersensitivity reaction included in the drug-related rash with eosinophilia and systemic symptoms syndrome (DRESS), in which a transient state of immune suppression and reactivation of latent virus infections have been observed. We describe 5 patients who developed neosensitization to different drugs taken during a previous episode of anticonvulsant-related DRESS, in whom skin prick, intradermal and/or patch tests were performed to confirm the diagnosis of drug hypersensitivity. In 1 patient, transient hypogammaglobulinemia was observed during the AHS. Four of the 5 patients developed a delayed skin eruption or a delayed systemic hypersensitivity reaction after intake of a drug that they had also taken during a previous anticonvulsant DRESS which had occurred months or years earlier; in the fifth, a possible reaction was prevented thanks to the allergy workup. The diagnosis of drug allergy was demonstrated by positive delayed reaction to intradermal test with amoxicillin in 2 cases, positive patch tests to paracetamol and amitriptyline in 2 cases, and by clinical evidence of ceftriaxone erythroderma in one. The possibility of neosensitization to drugs administered during anticonvulsant-related DRESS should be considered. A transient state of immunosuppression induced during the anticonvulsant-related DRESS may trigger latent virus reactivation and massive nonspecific immune system response, which may lead to breakdown of tolerance to other drugs present at that time in the organism.

[Hoigne's syndrome]. / Síndrome de Hoigne.

BACKGROUND: Hoigne's syndrome is a pseudoanaphylactic or pseudoallergic reaction that occurs after intramuscular administration of penicillin G procaine or benzathine. These are usually embolic toxic reactions possibly due to vascular occlusion by large crystals of the penicillin salts. We report a case of Hoigne's syndrome. CASE REPORT: A 44-year-old woman received 1,200,000 U.I. of intramuscular procaine penicillin once daily for treatment of acute amygdalitis. Immediately after the second dose the patient developed mental confusion, visual and auditory hallucinations, perceived changes of body shape, swelling of the tongue and a fear of impending death. Penicillin allergy study (serum-specific IgE levels, skin tests and provocation test) was performed. The diagnosis of Hoigne's syndrome was confirmed by negative oral challenge test with penicillin. CONCLUSIONS: Hoigne's syndrome is a pseudoanaphylactic reaction that must be differentiated from authentic anaphylactic shock due to penicillin. This distinction allows treatment to be continued in Hoigne's syndrome, whereas it is contraindicated in anaphylactic shock.

Epidemiology of urticaria in Spain.

BACKGROUND: In spite of the frequency of chronic urticaria there are very few epidemiological studies of its prevalence and distribution. OBJECTIVE: We wanted to approach the real prevalence of chronic urticaria in a population-based study and to depict demographic distribution and personal perception of the disease. We also wanted to describe the frequency of acute urticaria episodes in the population studied. METHODS: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a sample size for a maximum variability (conservative approach p=q=0.5). RESULTS: We found a 0.6% (95% CI: 0.4-0.8) prevalence of chronic urticaria. The prevalence is significantly higher in women than in men with a OR=3.82 (95%CI 1.56-9.37). Chronic urticaria is a self-limited disease, yet in 8.7% of cases chronic urticaria lasts from one to 5 years and in 11.3%, for more than 5 years. The average age of onset is 40 years. CONCLUSIONS: We offer large epidemiology study data on the prevalence of chronic urticaria. The prevalence of chronic urticaria has not yet been defined in an adult population-based study. With this work we offer such data to describe the prevalence and features of this disease.

Topical dexketoprofen as a cause of photocontact dermatitis.

We reported on the case of a patient who developed a cutaneous eruption in a photoexposed area 1 week after a continous topical treatment with dexketoprofen (Enangel). Photopatch tests were positive for dexketoprofen, ketoprofen and piketoprofen and patch test was positive for piketoprofen. Control photopatch testing with dexketoprofen in 15 healthy volunteers was negative. Dexketoprofen, ketoprofen and piketoprofen are non-steroidal anti-inflamatory drugs (arylpropionic acid derivatives) often used as topical anti-inflammatory agents. It appears that the benzophenone moiety of their chemical structure is the cause of their photosensitivity and cross-photoreaction.

[Application of immunotherapy in Catalonia (Spain)]. / Aplicación de la inmunoterapia en Cataluña.

BACKGROUND: The aim of this study was to determine the use of specific immunotherapy (SIT) in public and private hospitals in Catalonia (Spain) in the management of respiratory allergic diseases and opinions about this treatment through a questionnaire. SIT dosage schedules and the creation of immunotherapy units were also investigated. METHODS AND RESULTS: A questionnaire containing eight items was sent by post and/or electronic mail to the heads of allergy units in 24 public and private hospitals in Catalonia.A total of 18 hospitals responded. The most commonly used route of administration was subcutaneous (89.4 %, SD 9.05) and the most widely used dosage schedule was the classical schedule (77.2 %, SD 24.9). Most of the hospitals (83.3 %) believed that immunotherapy units were an advantage but only 44 % of them believed that their creation was feasible. CONCLUSIONS: The results of this survey identify the application of SIT in Catalonia and reveal certain features of this treatment that remain to be established such as the optimal dosage schedule and the precautions that should be followed when administering SIT.

Allergic eosinophilic gastroenteritis in a child with Crohn's disease.

A case of a child with Crohn's disease who developed an eosinophilic gastroenteritis is reported. Although symptoms of eosinophilic gastroenteritis at age 8 could mimic those of Crohn's disease, laboratory, radiographic and histologically studies are clearly different. Peripheral blood eosinophilia (7,476 cells per mm3), high serum IgE level (1,050 kU/l) and normal C-reactive protein and erythrocyte sedimentation rate are common in eosinophilic gastroenteritis and uncommon in Crohn's disease. Eosinophilic gastroenteritis was due to bovine serum albumin (BSA) hypersensitivity, confirmed with skin tests, serum levels to specific IgE and a SDS-PAGE IgE-immunoblotting. A strict meat-free diet was started, with progressive relief of symptoms and decrease of eosinophil count twelve months later; the patient became fully symptom-free and eosinophil count was normal.

Effects of specific immunotherapy on the development of new sensitisations in monosensitised patients.

BACKGROUND: Specific immunotherapy (SIT) is the only treatment that interferes with the basic pathophysiological mechanisms of allergic disease and is widely used in the management of clinically significant respiratory IgE-mediated diseases. Nevertheless, until recently, information on the influence of SIT on the development of new allergic sensitisations has been scant. METHODS: One hundred consecutive patients (45 males and 55 females, aged 6 to 69 years) with respiratory allergic diseases and attending the allergy unit of a general hospital were selected. All had been diagnosed by clinical history and skin prick tests of allergic rhinitis and/or asthma, were monosensitised (71 to Dermatophagoides spp, 22 to Parietaria judaica pollen and 7 to grass pollen) and had been followed up as outpatients between 1990-98. Sixty-six patients had been treated with conventional SIT for at least 3 years, while thirty-four followed only environmental measures and drug treatment. Family atopy status (first-degree relatives), smoking, family pets (cat and/or dog), rhinitis and/or asthma symptom score and inhalant skin prick tests to the same aeroallergens were compared between baseline and after 3 to 5 years of treatment. RESULTS: No statistically-significant differences in the development of new sensitisations were observed between the two groups (36.4 % of SIT-treated patients versus 38.2 % in control group, RR = 0.97, CI 95 %: 0.72-1.3). Smoking, family atopy history and pets did not appear to be risk factors for the development of neosensitisations (p < 0.05). Nevertheless, SIT-treated patients presented a better clinical score than the control group, with improvements of 89.4 % and 61.8 %, respectively (p = 0.007). CONCLUSIONS: Three-year SIT did not protect against development of new sensitisations in monosensitised allergic rhinitis or asthma. Smoking, family atopy history and pets were not associated with development of new sensitisations. Clinical score improved significantly in the SIT-treated group compared with drug-treated patients.

Efficacy of the eradication of Helicobacter pylori infection in patients with chronic urticaria. A placebo-controlled double blind study.

Helicobacter pylori has been involved in the pathogenesis of chronic idiopathic urticaria (CIU) in patients suffering both CIU and H. pylori infection. We selected 49 patients with 13C urea breath test positive, long-lasting CIU and H. pylori infection; 20 remained symptomatic, had positive urease test or H. pylori histologic identification in gastric biopsy material and accepted to participate in a pacebo-controlled treatment trial. They were randomized for a 7-day, double-blind, placebo-controlled H. pylori eradication treatment with amoxicillin, clarithromycin and omeprazol or placebo. H. pylori eradication was assessed by a second 13C urea breath test six weeks after the end of treatment. We observed a significant improvement of more than 70 % of CIU; baseline clinical score was seen in 4 of the 9 (44 %) patients who eradicated H. pylori after active treatment and in 1 of the 7 (12,3 %) of those who did not (p = 0.19). No clinical differences in CIU characteristics were found between patients with and without improvement. No serious adverse effects were observed in either treatment group. We conclude that the eradication of H. pylori may be useful for patients suffering long-lasting CIU and H. pylori infection, although theses results did not reach statistical significance probably owing to the strict conditions of the recruitment.

Urticaria to cetirizine.

A patient with recurrent idiopathic urticaria reported exacerbations after treatment with cetirizine. Prick test to cetirizine was negative. Double-blind challenge tests with mizolastine, loratadine, fexofenadine, dexchlorpheniramine, ebastine, ketotifen, and placebo were negative, whereas hydroxyzine and its active metabolite, cetirizine, reproduced the urticaria. Identification of uncommon adverse reactions to H1 antihistamines is important, particularly because they may mimic the underlying disease.