In vivo diagnostic tests in adverse reactions to quinolones.

BACKGROUND AND OBJECTIVE: Contradictory reports of the sensitivity of skin tests in quinolone allergy have been reported. Our objectives were to describe the outcome of quinolone skin and challenge tests in patients consulting because of a history of adverse reaction to quinolone and to compare the outcome of quinolone skin tests and challenge tests in the subsample of patients who had undergone both tests. METHODS: We reviewed skin and challenge test results of all patients who consulted at our allergy service over the last 5 years because of a history of quinolone adverse reaction in the form of urticaria or anaphylaxis within 1 hour of drug intake (group 1), urticaria or maculopapular eruption between 1 and 24 hours after intake (group 2) or after 24 hours had passed (group 3), or atypical symptoms (group 4). RESULTS: A total of 71 cases were identified: 27, 8, 24 and 12 in groups 1 through 4, respectively. Skin tests were performed in all patients, with positive results in 31 patients. In group 1, 62.9 % of these patients showed positive skin tests and 22.2% showed positive challenge tests, whereas in the other 3 groups, about 30% of patients had positive skin tests and a variable percentage (from 0% to 4.1% depending on the group) had positive challenge tests. Quinolone challenge tests were performed in 10 patients with positive skin tests (5 of them with positive results) and in 34 patients with negative skin tests (2 of them with positive results). CONCLUSIONS: A highly suggestive history of quinolone allergy is more frequently associated with positive skin tests and positive challenge tests. Therefore, skin tests help to predict the result of the challenge test.

Intestinal anisakiasis mimicking intestinal obstruction.

We report one case of acute abdomen after the ingestion of raw or undercooked fish containing nematode larvae of the genus Anisakis. Early diagnosis is very important as it could prevent unnecessary surgical procedures since the symptoms of intestinal anisakiasis may mimic other illnesses such as appendicitis, ileitis or peritonitis. We suggest that anisakiasis should be considered in the differential diagnosis of patients with acute abdomen.

[Prevalence of tobacco dependency and its prevention in patients with persistent asthma]. / Prevalencia del tabaquismo y prevención en pacientes con asma persistente.

OBJECTIVES: To analyse in patients with persistent bronchial asthma the prevalence of tobacco dependency and its degree; and to assess measures of prevention. DESIGN: Cross-sectional, descriptive study. SETTING: Allergy Service of the Lozano Blesa University Hospital, Zaragoza, Spain. PARTICIPANTS: A total of 121 patients, from systematic selection of asthmatics attending for consultation. MAIN MEASUREMENTS: Questionnaire filled out in the consulting room, recording social, demographic and clinical variables. RESULTS: A sample of 121 patients was obtained, 62.7% women and 37.3% men. They had 5.87 +/- 4.99 years mean evolution of asthma. 21.5% were daily smokers, 4.1% occasional smokers, 27.3% ex-smokers, and 47.1% non-smokers. The ages of starting to smoke were < 10 years old, 1.7%; 10-15, 30%; 15-20, 56.7%; 20-25, 6.7%, and > 25, 5% (P > .05). There were significant differences between gender and tobacco dependency and between age and tobacco dependency (P < .01 and P < .014, respectively). 96.8% of smokers thought that tobacco was harmful to their health. This figure was 100% in daily smokers and 80% in occasional smokers (P < .02). 83.9% of smokers had the intention of giving up. Counselling to give up was received from the specialist (41.9%), the primary care doctor (12.9%), and both (9.7% of cases). 35.5% received no counselling. CONCLUSIONS: The prevalence of tobacco dependency in patients with persistent asthma is lower than in the population as a whole; over a third receive no counselling about giving up. Interventions must be conducted in still healthy smokers and chronically ill patients in both primary and specialist care.