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SUMMARY: The efficacy and safety of subcutaneous immunotherapy with modified, high-dose, major allergen house dust mite extract is widely supported by double-blind, placebo-controlled studies. However, little is known regarding patient-perceived efficacy and satisfaction. An observational, retrospective, multicentre study in patients treated with Acaroid® was conducted to assess the efficacy and degree of satisfaction of the patients after the first six months of treatment with it. All the clinical study procedures were performed according to the routine clinical practice. This study demonstrates that Acaroid® is effective and well tolerated. The patients' condition demonstrated a clear and marked improvement in the first 6 months after treatment initiation. Patients treated with Acaroid® were very satisfied, with a correlation to improvement in patient-perceived symptoms and the administration of treatment by a healthcare professional.
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Satisfacción del Paciente , Pyroglyphidae/inmunología , Adolescente , Adulto , Anciano , Animales , Niño , Preescolar , Desensibilización Inmunológica/métodos , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Although the efficacy and safety of high dose hypoallergenic mite subcutaneous immunotherapy (SCIT) using a conventional administration schedule has already been demonstrated, there is no reported experience on the safety of these extracts with cluster schedules. We wanted to determine whether the use of a cluster schedule of a hypoallergenic allergen with a high concentration of house dust mite allergens commonly used in normal practice was safe and well-tolerated in patients with dust mite allergy. MATERIAL AND METHODS: Multicentre, observational, retrospective study of dust mite allergic patients treated with a cluster schedule of SCIT (Acaroid; Day 1: 300/300 therapeutic units, TU--Day 8: 1000/1000 TU--Day 15: 3000/3000 TU) in 23 Spanish sites. RESULTS: Cluster schedule was used on 434 patients (40.1% children), with a total of 3256 doses (38.2% in children). There were 88 clinically relevant adverse reactions, 79 out of them local and 9 systemic (but mild-moderate) that amounted to 2.7% of all the administered doses. All the patients fulfilled the cluster schedule. CONCLUSIONS: Cluster schedule with high dose hypoallergenic mite-SCIT was safe and well-tolerated in routine clinical practice. Therefore, its use could reduce the costs and time needed to achieve the desired maintenance dose and increase compliance.
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Antígenos Dermatofagoides/inmunología , Desensibilización Inmunológica/efectos adversos , Hipersensibilidad/terapia , Pyroglyphidae/inmunología , Adolescente , Adulto , Anciano , Animales , Niño , Preescolar , Desensibilización Inmunológica/métodos , Humanos , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Alérgenos/análisis , Ropa de Cama y Ropa Blanca , Cabello , Ácaros , Cuero Cabelludo , Adolescente , Animales , Antígenos Dermatofagoides/análisis , Proteínas de Artrópodos/análisis , Lechos , Niño , Cisteína Endopeptidasas/análisis , Polvo/análisis , Humanos , Hipersensibilidad , Masculino , Ácaros/clasificación , Ácaros/inmunología , EspañaAsunto(s)
Asma/prevención & control , Desensibilización Inmunológica/métodos , Calidad de Vida , Rinitis Alérgica/prevención & control , Adulto , Antígenos Dermatofagoides/administración & dosificación , Antígenos Dermatofagoides/inmunología , Proteínas de Artrópodos/administración & dosificación , Proteínas de Artrópodos/inmunología , Cisteína Endopeptidasas/administración & dosificación , Cisteína Endopeptidasas/inmunología , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
BACKGROUND AND OBJECTIVE: Severe alpha1 antitrypsin deficiency has been clearly associated with pulmonary emphysema, but its relationship with bronchial asthma remains controversial. Some deficient alpha 1 antitrypsin (AAT) genotypes seem to be associated with asthma development. The objective of this study was to analyze the distribution of AAT genotypes in asthmatic patients allergic to house dust mites (HDM), and to asses a possible association between these genotypes and severe asthma. METHODS: A cross-sectional cohort study of 648 patients with HDM allergic asthma was carried out. Demographic, clinical and analytical variables were collected. PI*S and PI*Z AAT deficient alleles of the SERPINA1 gene were assayed by real-time PCR. RESULTS: Asthma was intermittent in 253 patients and persistent in 395 patients (246 mild, 101 moderate and 48 severe). One hundred and forty-five asthmatic patients (22.4%) with at least one mutated allele (S or Z) were identified. No association between the different genotypes and asthma severity was found. No significant differences in all clinical and functional tests, as well as nasal eosinophils, IgA and IgE serum levels were observed. Peripheral eosinophils were significantly lower in patients with the PI*MS genotype (p = 0.0228). Neither association between deficient AAT genotypes or serum ATT deficiency (AATD) and development of severe asthma, or correlation between ATT levels and FEV1 was observed. CONCLUSION: In conclusion, the distribution of AAT genotypes in HDM allergic asthmatic patients did not differ from those found in Spanish population. Neither severe ATTD or deficient AAT genotypes appear to confer different clinical expression of asthma.
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OBJECTIVE: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. PATIENTS AND METHODS: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). RESULTS: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting beta2 agonists. The mean cost was 1555.70 Euros (95% confidence interval [CI], 1237.60 Euros-1907.00 Euros), of which 93.8% (1460.60 Euros; 95% CI, 1152.50 Euros-1779.40 Euros) was due to direct costs, and 6.2% (95.10 Euros; 95% CI, 35.50 Euros-177.00 Euros) to indirect costs. Cost rose with increasing severity of the exacerbation--292.60 Euros for a mild exacerbation, 1230.50 Euros for a moderate exacerbation, and 3543.10 Euros for a severe exacerbation. CONCLUSIONS: The mean cost was 1555.70 Euros. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting beta2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.
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Hospitalización/estadística & datos numéricos , Estado Asmático/economía , Corticoesteroides/economía , Corticoesteroides/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 2 , Agonistas Adrenérgicos beta/economía , Agonistas Adrenérgicos beta/uso terapéutico , Adulto , Antiasmáticos/uso terapéutico , Broncodilatadores/economía , Broncodilatadores/uso terapéutico , Costos y Análisis de Costo , Costos de los Medicamentos , Femenino , Recursos en Salud/economía , Costos de Hospital , Hospitalización/economía , Humanos , Antagonistas de Leucotrieno/economía , Antagonistas de Leucotrieno/uso terapéutico , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Prevalencia , Estudios Prospectivos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , España/epidemiología , Estado Asmático/complicaciones , Estado Asmático/tratamiento farmacológico , Estado Asmático/epidemiología , Teofilina/economía , Teofilina/uso terapéuticoRESUMEN
No disponible
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Humanos , Hipersensibilidad Respiratoria/epidemiología , Asma/epidemiología , Rinitis Alérgica/epidemiología , Material Particulado/análisis , Contaminación del Aire Interior/análisis , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the prevalence of and risk factors for asthma and related conditions in the Canaries, Spain. METHODS: From a randomised sample of 9506 adults aged 20-44 years who answered a short questionnaire, a random sample corresponding to 20% of the original was taken. Subjects classified as symptomatic in the previous survey and who were not included in the random sample were also invited to participate. The subjects completed a respiratory questionnaire, and underwent spirometry, bronchial hyperresponsiveness (BHR) test, skin tests and immunoglobulin E (IgE) measurements. RESULTS: The random sample included 593 subjects. The prevalence of skin sensitisation to mites was 30.3% (95%CI 26.7-34.2) and the prevalence of IgE to mites 30.5% (95%CI 26.2-35.2). A prevalence of 40.6% (95%CI 35.9-45.5) was found for atopy, 14.1% (95%CI 11.1-17.1) for BHR and 4.2% (95%CI, 2.5-5.9) for asthma. The risk factors most strongly associated with asthma were atopy (OR 4.89, 95%CI 3.07-7.78) and respiratory infection before the age of 5 years (OR 2.78, 95%CI 1.66-4.67). CONCLUSION: This study shows a high prevalence of sensitisation to mites, atopy, BHR and asthma in the Canaries, similar to that observed in English-speaking countries. We suggest that these findings could partially result from climatic conditions.
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Asma/epidemiología , Hiperreactividad Bronquial/epidemiología , Hipersensibilidad Inmediata/epidemiología , Inmunoglobulina E/inmunología , Adulto , Animales , Asma/inmunología , Clima , Humanos , Hipersensibilidad Inmediata/inmunología , Prevalencia , Pyroglyphidae/inmunología , Factores de Riesgo , Pruebas Cutáneas/métodos , España/epidemiología , Espirometría , Encuestas y Cuestionarios , Adulto JovenRESUMEN
No disponible
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Humanos , Masculino , Femenino , Niño , Pyroglyphidae/clasificación , Pyroglyphidae/fisiología , Cabello/anomalías , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/diagnóstico , Escabiosis/diagnóstico , Escabiosis/metabolismo , Rinitis Alérgica Estacional/complicaciones , Pyroglyphidae/crecimiento & desarrollo , Cabello/crecimiento & desarrollo , Enfermedades de la Piel/metabolismo , Enfermedades de la Piel/prevención & control , Escabiosis/prevención & control , Escabiosis/transmisión , Rinitis Alérgica Estacional/diagnósticoAsunto(s)
Tuberculosis/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Países en Desarrollo , Humanos , Lactante , Persona de Mediana Edad , España/epidemiologíaRESUMEN
Food allergy is a common disease in our country, especially affecting atopic children. Egg-white hypersensitivity is frequently found in these patients. However, egg-yolk hypersensitivity is not usually reported in patients with egg allergy. This article describes a young patient with egg-yolk hypersensitivity, a 12 year old female patient with a medical history of contact urticaria, angioedema and severe acute bronchospasm shortly after the intake of small amounts of egg-yolk. All these episodes required treatment in emergency care units because of the severity of the symptoms. The patient did not describe any other food hypersensitivity and remained symptom-free after the intake of boiled or fried egg-white. She had clinical symptoms of grass pollen hypersensitivity and was therefore on specific immunotherapy at the time of the study. The skin prick-tests were positive to grass pollen and egg-yolk and were negative to mites, moulds, animal dander and to the common food tested (milk, fish, peanut, almond and hazel-nut). Total serum IgE was 1.160 UL/ml. The patient had a positive RAST to egg-white (0.0 PRU/ml) as well as to egg-yolk (8.6 PRU/ml). Furthermore, an indirect enzyme immunoassay as well as a reverse enzyme immunoassay also revealed the presence of specific IgE antibodies. The reverse enzyme immunoassay uses microtiter plates as a solid surface. These plates are coated with a monospecific antihuman IgE antibody. Thereafter, the serum samples are incubated overnight in the wells. After several washings, the presence of specific antibodies is revealed by means of a peroxidase conjugated allergen.(ABSTRACT TRUNCATED AT 250 WORDS)
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Proteínas del Huevo/inmunología , Yema de Huevo/inmunología , Hipersensibilidad a los Alimentos/inmunología , Inmunoglobulina E/análisis , Espasmo Bronquial/etiología , Niño , Femenino , Humanos , Técnicas para Inmunoenzimas , Polen/inmunología , Prueba de Radioalergoadsorción , Pruebas Cutáneas , Urticaria/etiologíaRESUMEN
Acute reaction to food allergens is a fairly common problem that is often seen in the allergist's office, its incidence being specially high in childhood. Milk and eggs are the most common sensitizing foods, but usually the type of food allergens responsible for these reactions varies according to food habits in different countries. Legumes occupy an important role in the Spanish diet, being responsible for a large number of allergic reactions. It has been shown that legumes occupy the fourth place in importance among the food allergens, inducing hypersensitivity reactions in Spanish children. This article describes five patients with clinical features suggestive of being mediated by IgE antibodies specific for different legumes. In all the cases, disorders appeared immediately after the ingestion or even the inhalation of vapours from cooked legumes (lentil, bean or chick-pea). Clinical features consisted of: urticaria, angioedema, abdominal symptoms and rhinoconjunctivitis and/or asthma. The five patients required hospital emergency care on several occasions. Two patients suffered also from seasonal pollinosis with rhinoconjunctivitis and asthma. All the patients complained of these type of disorders with any legume, but lentil was found to induce the most severe reactions and it was therefore selected for this study. The presence of specific IgE antibodies was demonstrated in vivo in all the patients by means of skin prick-test. It was performed using a lentil extract prepared in our laboratory. Negative controls were also included. A reverse enzymeimmunoassay (REIA) revealed the presence of specific IgE antibodies in the sera of the five subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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Hipersensibilidad a los Alimentos/diagnóstico , Verduras/efectos adversos , Adolescente , Antígenos/aislamiento & purificación , Arachis/inmunología , Niño , Preescolar , Reacciones Cruzadas , Fabaceae/inmunología , Hipersensibilidad a los Alimentos/inmunología , Humanos , Técnicas para Inmunoenzimas , Inmunoglobulina E/análisis , Pruebas Intradérmicas , Plantas Medicinales , Prueba de Radioalergoadsorción , Verduras/inmunologíaRESUMEN
The Reverse Enzyme Immunoassay (REIA) method for the detection of specific IgE recently described by us has been applied to the diagnosis of Vespula spp. sensitivity. To do so, 0.5 mg of Vespula venom of commercial origin was conjugated with peroxidase according to a previously described technique. The results obtained from the study of 50 nonallergic patients have demonstrated the specificity of the method in as much as no positive value was found. In addition, only one low positive value was obtained from a group of 47 atopic patients showing no evidence of sensitivity to insect stings. On the contrary, very high ELISA values from a group of 23 patients with suspected sensitivity to insect venom were obtained. With these results, we conclude that this method can constitute an aid in the diagnosis of these patients, besides being a low-cost method free from the interference of blocking antibodies. It is our opinion however, that this method is not as reliable as the RAST.
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Venenos de Abeja/inmunología , Hipersensibilidad/inmunología , Técnicas para Inmunoenzimas , Inmunoglobulina E/inmunología , Venenos de Avispas/inmunología , Humanos , Prueba de RadioalergoadsorciónRESUMEN
No disponible
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Humanos , Masculino , Femenino , Adulto , Asma/terapia , Desensibilización Inmunológica/métodos , Rinitis Alérgica Estacional/terapia , Calidad de Vida , Resultado del TratamientoRESUMEN
A case of active multicavitary tuberculosis is reported. In the 3rd month of treatment, an X-ray film of the thorax showed right pleural effusion. The properties of the pleural fluid were those of an exudate with high adenosine deaminase activity. An ELISA was performed to detect specific IgG antibody to mycobacterial antigen 60 in serum before the treatment and on a two-monthly basis following the initiation of therapy until completion of the course. Values were all above 1,750 U. Moreover, an ELISA test using the same antigen was done on pleural fluid, and a high IgG titer was obtained (950 U). A cutoff for a positive ELISA test was established at 240 U in serum and 150 U in other biologic fluids.
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Antígenos Bacterianos/análisis , Inmunoglobulina G/análisis , Mycobacterium/inmunología , Tuberculosis Pulmonar/inmunología , Adenosina Desaminasa/metabolismo , Antituberculosos/administración & dosificación , Antituberculosos/uso terapéutico , Ensayo de Inmunoadsorción Enzimática , Exudados y Transudados/inmunología , Humanos , Masculino , Persona de Mediana Edad , Derrame Pleural/inmunología , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
Objetivo: La prevalencia y el gasto sanitario originado por el asma están aumentando progresivamente en los países desarrollados. El 70% del coste total está producido por exacerbaciones. El objetivo principal del estudio fue conocer el coste hospitalario de una crisis asmática en nuestro medio. Como objetivo secundario se quiso conocer cuál era el tratamiento de mantenimiento para el control del asma que utilizaban los pacientes antes de la agudización asmática y su tratamiento. El estudio formaba parte de uno más amplio (COAX II) realizado en 8 países europeos que pretendía los mismos objetivos en cada país. Pacientes y métodos: Estudio observacional prospectivo en el que se incluyó a 126 pacientes con crisis asmática tratados de forma habitual en 6 hospitales españoles durante un período de 3 meses (del 1 de enero al 31 de marzo de 2000). Resultados: Siguiendo los criterios de la Global Initiative for Asthma, el 33,3% de las crisis fueron leves, el 38,9% moderadas, el 26,2% graves y el 1,6% con riesgo de parada respiratoria inminente. La utilización de corticoides era generalizada en los pacientes con asma moderada y grave, pero sólo el 68% de los pacientes con asma grave seguían tratamiento con agonistas β2 de larga duración. El coste medio fue de 1.555,7 (intervalo de confianza [IC] del 95%, 1.237,6-1.907), el 93,8% (1.460,6 ; IC del 95%, 1.152,5-1.779,4) debido a costes directos y el 6,2% (95,1 ; IC del 95%, 35,5-177) a costes indirectos. El coste se incrementaba a medida que la crisis era más grave: 292,6 para una crisis leve, 1.230,5 para la crisis moderada y 3.543,1 para la crisis grave. Conclusiones: El coste medio fue de 1.555,7 . Los costes de las crisis moderadas y graves eran 4 y 12 veces mayores que los de la leve, respectivamente. Se observó una infrautilización de los β2 de larga duración con respecto a las recomendaciones de las guías en el tratamiento del asma persistente moderada y grave que originaba crisis de asma
Objective: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. Patients and Methods: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). Results: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting β2 agonists. The mean cost was 1555.70 (95% confidence interval [CI], 1237.60-1907.00), of which 93.8% (1460.60; 95% CI, 1152.50-1779.40) was due to direct costs, and 6.2% (95.10; 95% CI, 35.50-177.00) to indirect costs. Cost rose with increasing severity of the exacerbation 292.60 for a mild exacerbation, 1230.50 for a moderate exacerbation, and 3543.10 for a severe exacerbation. Conclusions: The mean cost was s1555.70. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting β2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations