Prevalence of asthma and severity of allergic rhinitis comparing 2 perennial allergens: house dust mites and Parietaria judaica pollen.

BACKGROUND: Allergic rhinitis (AR) is an increasingly prevalent worldwide disease that has a considerable impact on quality of life and health care costs. Asthma and AR may be part of the same disease, with AR leading to an increased risk of asthma. OBJECTIVES: To assess the prevalence of asthma in patients with AR due to house dust mites (HDMs) or Parietaria judaica and analyze the characteristics of asthma and AR in each group. METHODS: Cross-sectional, multicenter study with recording of demographic and clinical characteristics. All patients had AR confirmed by symptoms and a positive skin prick test to HDMs or P judaica. They were classified according to the severity and frequency ofAR following the Allergic Rhinitis and its Impact on Asthma (ARIA) and modified ARIA criteria and according to the severity of asthma following the Global Initiative for Asthma criteria. RESULTS: We studied 395 patients (226 in the HDM group and 169 in the Pjudaica group) with a mean (SD) age of 43 (15.3) years. Using the modified ARIA criteria, we detected more severe and persistent AR in the P judaica group than in the HDM group (44.5% vs 24.8%, P < .001). Nevertheless, there were no statistically significant differences between the groups in terms of the severity or prevalence (50% in HDM vs 47.9% in P judaica, P = .685) of asthma. CONCLUSION: AR due to P judaica pollen, which behaves like a perennial allergen, is associated with the same prevalence of asthma and with more severe rhinitis than AR due to HDMs.

Sensitization to tomato peel and pulp extracts in the Mediterranean Coast of Spain: prevalence and co-sensitization with aeroallergens.

BACKGROUND: Tomatoes (Lycopersicon esculentum) are consumed world-wide. The prevalence of sensitization to tomatoes remains unknown. OBJECTIVE: To determine the prevalence of skin test reactivity to tomato and to describe the characteristics of tomato-sensitized subjects. METHODS: Individuals attending for the first time during the period of the study to six Allergy centres, located along the Mediterranean coast of Spain, reporting respiratory and/or cutaneous symptoms, were included. All patients were skin prick tested with a battery of inhalant allergens and with peel and pulp of Canary tomato extracts. RESULTS: The study included 1734 individuals (757 males, 977 females; 31.9+/-17.8 years old). The prevalence of sensitization to tomato was 6.52% (113 patients; 65 males, 48 females; 29.5+/-13 years old). The peel extract was positive in 110 patients and the pulp extract in 47 patients; three patients were positive exclusively to pulp. Only 1.8% of individuals reported symptoms with tomato; 44% of them had skin test negative to both extracts. Among tomato-sensitized subjects, 16% reported symptoms with tomato, 97% were sensitized to inhalant aeroallergens, including 84% to pollens (mainly Artemisia vulgaris and Platanus hybrida), with differences between Northern and Southern centres. CONCLUSIONS: The prevalence found of skin test sensitivity to tomato is high. Peel extracts detected most of the sensitized subjects. Most of the sensitized subjects were asymptomatic and some patients reported symptoms without skin test sensitivity. Positive subjects were very frequently sensitized to pollens, suggesting allergen cross-reactivity. Regional differences may exist, possibly related to the pattern of sensitization to cross-reacting pollens.

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.

Exotic pets are new allergenic sources: allergy to iguana.

Although furry animals are known sources of respiratory allergy, scaly animals are assumed not to be allergenic. Exotic animals such as iguanas are becoming increasingly common pets. Nevertheless, these animals are not suspected to be allergenic. We present the case of a 42-year-old woman suffering from allergic rhinoconjunctivitis and asthma caused by a pet iguana. Clear IgE-sensitization and respiratory allergy to iguana scales is demonstrated, suggesting that scaly pets should be taken into account as possible allergenic sources.

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.

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.

IgE reactivity to profilin in Platanus acerifolia pollen-sensitized subjects with plant-derived food allergy.

BACKGROUND: The presence of profilin-specific IgE antibodies is a cause of cross-reactivity between botanically-unrelated allergen sources. Recently, the association between Platanus acerifolia pollinosis and plant-derived food allergy has been described. The aim of this study was to ascertain whether the P. acerifolia profilin is involved in such cross-reactivity. METHODS: Twenty-three patients suffering from Platanus acerifolia pollinosis and plant-derived food allergy were evaluated in an allergy department. Specific IgE levels to P. acerifolia pollen, P. acerifolia profilin and food extracts were measured. Molecular masses of IgE-binding proteins were calculated by Western blotting and cross-reactivity studies among P. acerifolia profilin and different food extracts were evaluated by Enzyme AllergoSorbent Test (EAST)-inhibition assays. Also, EAST-inhibition assays with the two known P. acerifolia allergens, Pla a 1 and Pla a 2, were performed. RESULTS: Surprisingly, a high IgE-binding prevalence (90%) of P. acerifolia profilin was found. EAST-inhibition showed high inhibition values when Platanus acerifolia pollen extract was used as free phase and plant-derived food extracts as solid phase, whereas the other way round showed low inhibition values. IgE reactivity to profilin was studied using a pool of patient sera, by EAST-inhibition assays with hazelnut, apple peel, peanut, chickpea and peanut extracts as solid phase and no inhibition was obtained when P. acerifolia profilin was used as inhibitor phase. The same results were obtained when purified Pla a 1 and Pla a 2 were also used as inhibitor phase. CONCLUSIONS: The clinical association observed between Platanus acerifolia pollen and plant-derived food could be explained by the in vitro IgE cross-reactivity detected by EAST-inhibition. However, it appears that neither P. acerifolia profilin nor the two major allergens described (Pla a 1 and Pla a 2) can explain such a strong cross-reactivity.

[Nephroblastoma and polycystic dysplastic kidney]. / Nefroblastoma e rene displasico multicistico.

The Authors pass on the case of a nephroblastoma, associated to Wilms Tumorlet and combined nephroblastomatosis, arose on a multicystic dysplastic kidney. They examine the relationships between the nephroblastoma and the kidney malformations, the possibility of malignant degeneration of a multicystic dysplastic kidney and the necessity of the nephrectomy as a prevention of the degeneration. At the moment the statistic data don't justify the nephrectomy a the birth to prevent the arising of a nephroblastoma.

Pharmacological characterizationof synthetic cannabinoid MAM-2201:radioligand binding and abuse-related effects / 中国药理学与毒理学杂志

OBJECTIVE Over 30% of all new psychoactive substances identified by the UN Office on Drugs and Crime in 2016 were synthetic cannabinoids. The recent emergence of MAM-2201 on the illicit market is troubling because this drug has no precedent in either the scientific or patent literature, and appears to be a novel compound developed specifically as a ″graymarket″ drug of abuse bystruc?turally combining the known synthetic cannabinoids JWH- 122 and AM- 2201. There is currently no published information regarding the pharmacology of MAM-2201. METHODS The present studies characterized cannabinoid-like effects of MAM-2201 in vitro (interactions with cannabinoid type 1 receptors [CB1Rs]) and in vivo (in mice and rats). RESULTS In a radioligand binding assay using [3H]CP55,940 in HEK cell membranes transfected with the CB1R, MAM-2201 (Ki=5.4 nmol·L- 1), had higher binding affinity than WIN 55,212-2 (Ki=80 nmol·L-1), and D9-THC (Ki=8.3 nmol·L-1). The Emax values for MAM-2201 and WIN 55,212-2 in an assay of agonist inhibition of forskolin-stimulated cAMP were 85% (EC50=0.45 nmol·L-1) and 95%, respectively, as compared with the D9-THC Emax of 74%. In mice, MAM-2201 (0.003-1.0 mg·kg-1, IP) produced dose-dependent cannabimimetic effects which were both more potent and more effective than those of D9-THC. MAM-2201 and D9-THC dose-dependently produced hypothermia:ED50=0.287 and 25.4 mg·kg-1, analgesia: ED50=0.125 and 29.4 mg·kg-1, and catalepsy: ED50=0.301 and 18.9 mg·kg-1 in adult male CD1 mice. Importantly, MAM-2201 also elicited convulsant effects at a dose of 1.0 mg·kg-1 in 8/8 murine subjects. In rats, MAM-2201 produced dose-dependent D9-THC-like intero?ceptive effects in subjects trained to discriminate 3.0 mg·kg-1 (IP) D9-THC from saline. CONCLUSION MAM-2201 binds CB1Rs with high affinity and agonist efficacy, and functions as a potent cannabinoid agonist in vivo across several complementary measures of cannabinoid activity in two rodent species.

Purified allergens vs. complete extract in the diagnosis of plane tree pollen allergy.

BACKGROUND: Plane tree pollen allergy is a clinical disorder affecting human population in cities of Europe, North America, South Africa, and Australia. OBJECTIVE: To compare IgE-reactivity of the natural and recombinant forms of two major plane allergens, Pla a 1 and Pla a 2, with the reactivity of Platanus acerifolia pollen extract. METHODS: Forty-seven patients with P. acerifolia allergy, 15 of them monosensitized, and 24 control subjects were included in the study. Natural Pla a 1 and Pla a 2 were purified by standard chromatographic methods and recombinant proteins were expressed in Escherichia coli. Skin prick test and determination of specific IgE were performed with commercial P. acerifolia extract and natural and recombinant purified allergens. RESULTS: Pla a 1 and Pla a 2 were responsible for 79% of the IgE-binding capacity against P. acerifolia pollen extract. A high correlation has been found between the IgE response to nPla a 1 (R = 0.80; P < 0.001) or nPla a 2 (R = 0.79; P < 0.001) vs. P. acerifolia extract as well as between natural and recombinant Pla a 1 (R = 0.89; P < 0.001). Skin testing showed no significant differences between extract and nPla a 2, whereas a higher reactivity was found with nPla a 1. In contrast, rPla a 1 revealed markedly reduced sensitivity in comparison with extract by skin prick test and specific IgE. The sensitivity of the mix Pla a 1+Pla a 2 was 100% and 87.5% for monosensitized and polysensitized patients, respectively, with no false-positive reactions detected. Conclusion Pla a 1 and Pla 2 are sufficient for a reliable diagnosis of P. acerifolia in most patients and induce comparable skin test reactivity as a whole extract.

The personal digital assistant, a new medical instrument for the exchange of clinical information at the point of care.

Personal digital assistants can provide a portable, integrated platform for point-of-care clinical reference, patient management and data communication. Clinical reference programs allow the user to access information from the Internet and guidelines. Patient management programs allow doctors to access and store clinical information. Wireless technologies have potential for rapid exchange of clinical laboratory results and efficient "electronic patient handovers". Thus, these devices provide the potential for true continuity of care across the healthcare system.

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.

Prevalence of Asthma and Severity of Allergic Rhinitis Comparing 2 Perennial Allergens: House Dust Mites and Parietaria judaica Pollen

Antecedentes: La rinitis alérgica (RA) es una enfermedad de prevalencia creciente en todo el mundo, con un importante impacto en la calidad de vida, generando un elevado coste sanitario. La rinitis y el asma pueden ser consideradas como parte de una misma enfermedad y por tanto, la RA puede conducir a un incremento del riesgo de desarrollar asma. Objetivos: Evaluar la prevalencia de asma en pacientes con RA por ácaros del polvo doméstico (APD) y en pacientes con RA por Parietaria judaica y evaluar las características de la rinitis y del asma en cada grupo. Métodos: Estudio multicéntrico, transversal. Se registraron las características demográficas y clínicas de todos los pacientes. Todos los pacientes tenían RA confirmada por síntomas y pruebas positivas a APD o a Parietaria judaica. Los pacientes se clasificaron según la gravedad y la frecuencia de la rinitis siguiendo los criterios del ARIA y ARIA modificada y la gravedad del asma según los criterios de la GINA. Resultados: Se incluyeron un total de 395 pacientes, 226 en el grupo de APD y 169 en el grupo de la Parietaria judaica, con una media de edad de 43±15,3 años. La clasificación ARIA modificada nos permitió detectar que el grupo de Parietaria presentaba una rinitis más persistente y grave comparado con el grupo de APD (44,5% versus 24,8%, p<0,001). Sin embargo, no se obtuvieron diferencias estadísticamente significativas entre la gravedad y la prevalencia (50% en APD vs 47,9% en Parietaria, p=0,685) del asma en los dos grupos. Conclusiones: La RA por polen de Parietaria judaica, que se comporta como un alérgeno perenne, puede causar la misma prevalencia de asma y una rinitis más grave que APD (AU)

Background: Allergic rhinitis (AR) is an increasingly prevalent worldwide disease that has a considerable impact on quality of life and health care costs. Asthma and AR may be part of the same disease, with AR leading to an increased risk of asthma. Objectives: To assess the prevalence of asthma in patients with AR due to house dust mites (HDMs) or Parietaria judaica and analyze the characteristics of asthma and AR in each group. Methods: Cross-sectional, multicenter study with recording of demographic and clinical characteristics. All patients had AR confirmed by symptoms and a positive skin prick test to HDMs or P judaica. They were classified according to the severity and frequency of AR following the Allergic Rhinitis and its Impact on Asthma (ARIA) and modified ARIA criteria and according to the severity of asthma following the Global Initiative for Asthma criteria. Results: We studied 395 patients (226 in the HDM group and 169 in the P judaica group) with a mean (SD) age of 43 (15.3) years. Using the modified ARIA criteria, we detected more severe and persistent AR in the P judaica group than in the HDM group (44.5% vs 24.8%, P<.001). Nevertheless, there were no statistically significant differences between the groups in terms of the severity or prevalence (50% in HDM vs 47.9% in P judaica, P=.685) of asthma. Conclusion: AR due to P judaica pollen, which behaves like a perennial allergen, is associated with the same prevalence of asthma and with more severe rhinitis than AR due to HDMs (AU)

Sensibilización a piel y pulpa de tomate en pacientes residentes en la costa mediterranea remitidos a consultas de alergia / Direct costs derived from healthcare assistance of a patient in an ambulatory allergology service of an University Hospital

Introducción: El consumo de tomate es muy frecuente en España, tanto ensaladas y sopas frías, como en productos elaborados. Objetivos: Estudiar la prevalencia de sensibilización cutánea al tomate en pacientes con clínica respiratoria, cutánea o de ambos tipos (rinitis,a sma, urticaria, dermatitis...). Material y Métodos: Se evaluaron todos los pacientes estudiados por primera vez en las consultas de alergia de varios hospitales del Mediterráneo: dos comarcas de Alicante (Vega Baja, Marina Baixa), una de Murcia (Campo de Cartagena) y otra de Gerona entre septiembre de 2004 y julio de 2005. Se incluyeron todos aquéllos que referían síntomas respiratorios, cutáneos o de ambos tipos independientemente del motivo de consulta. En todos se realizaron pruebas cutáneas mediante técnicas prick con una batería habitual de aeroalergenos estandarizados (Laboratorios LETI, SL) y con extractos (10 mg/ml) de piel y pulpa de tomate canario preparados mediante extracción en PBS/PVPP, centrifugado, recogida de sobresaliente, diálisis con punto de corte en 3,5 kDa, filtrado, centrifugado y liofilizado. Resultados: Se incluyeron 1.498 pacientes (675 varones y 823 mujeres, edad estudiada 31,4 +/-17,8). La prevalencia de sensibilización al tomate en la población estudiada fue del 5,94% (89 pacientes); respecto al extracto de piel fue del 5,81% y al de pulpa del 2,2%. Se observaron pruebas cutáneas positivas a aeroalérgenos en el 63,6% de la población estudiada y en el 95,5% (p<0,001) de los pacientes sensibilizados al tomate. Referían clínica con la ingestión o contacto con el tomate el 1,4% de la población (21 pacientes). Nueve de ellos tuvieron una prueba cutánea positiva con el extracto del tomate (0,6%). De los 89 pacientes sensibilizados al tomate, 77 (86,5%) presentarion sensibilización a los pólenes, 52 (58,4%) a los ácaros, 33 (37,1%) a los epitelios y 16 (18%) a los hongos (p<0,001 en todos los casos). Conclusiones: La prevalencia de pruebas cutáneas positivas frente al tomate en la población estudiada es alta, pero la relevancia clínica de esta sensibilización parece baja. El extracto de piel de tomate ha sido más sensible que el extracto de pulpa. La mayoría de los pacientes sensibilizados al tomate es atópica y está sensibilizada a los pólenes

Introduction: Tomatoes (Lycopersicon esculentum) are widely consumed in Spain, either in salads, cold soups (gazpacho), or cooked. Objective: To study the prevalence of skin sensitisation to tomato in patients with respiratory or cutaneous symptoms. The objective of this study was to determine the prevalence of skin test reactivity to tomato allergens in this group of patients living in the Mediterranean coast of Spain. Methods: All the patients evaluated for respiratory and/or cutaneous symptoms (independently of the reason for submission) at the allergy units of 4 hospitals located in the Mediterranean coast in Spain between September 2004 and July 2005 were included in the study. All patients were skin prick tested with a battery of standardized common inhalant allergens and with extracts of peel and pulp of ripe Canary Islands tomatoes at 10 mg/ml. After tomatoes were peeled, homogenisation in PBS/PVPP, extraction under continuous magnetic stirring, centrifugation, dialysis, filtration and freeze-drying were performed separately with the peel and pulp to elaborate the extracts used. The X2, Fisher exact test and OR were used to evaluate the results. Results: One thousand and four hundred ninety-eight consecutive individuals (675 males and 823 females; mean age, 31.4 +/- 17.8 years-old) were included in the study. The prevalence of sensization to tomato was 5.94% (89 patiens; 51 males and 38 females; mean age, 30.2+/-12.9 years). The tomato peel extract was positive in 87 patients (5.81%) and the pulp extract in 33 patients (2.2%); 2 patients were positive exclusively to pulp. In the totalpopulation, skin prick tests to inhalants were positive in 953 subjects (63.6%), whereas 85 (95.5%) of the tomato sensitised patients were positive to at least one inhalant allergen (p<0.001): 77 (86.5%) to pollens; 52 (58.4%) to mites, 33 (37.1%) to epithelia, and 16 (18.0%) to moulds (p<0.01 in all cases compared with the non-sensitized population). Most of the sensitised subjects (91.1%) were asymptomatic and did not refer symptoms after tomato contact or ingestion. Twenty one subjects, 9 positive and 12 negative to both tomato extracts, referred mild symptoms with tomato ingestion or contact (1.4%, o.6%, and 0.8%, respectively of the total population). Conclusions: The prevalence of sensitisation to tomato in this population is high. However, most sensitised subjects are asymptomatic. Peel extract has been more sensitive than pulp extract. Sensitisation to tomato is more prevalent among atopic and pollen sensitised individuals, suggesting allergen cross-reactivity