Measurement of serum levels of eosinophil cationic protein in the diagnosis of acute gastrointestinal anisakiasis.

Thirty-two patients with abdominal pain and/or intestinal pseudo-obstruction who had consumed raw or undercooked fish in the previous 72 h, were included in a study of anisakiasis, a parasitation of the human gastrointestinal tract by third stage Anisakis simplex larvae. Skin prick test (SPT) against A. simplex were positive in all the patients. High median eosinophil cationic protein (ECP) serum concentrations (> 15 mg/L) at day 0 with normal serum levels at day 30 and a rise of median total and specific IgE against A. simplex at day 30, were observed. We conclude that a raised serum level of ECP in the first 72 h from the onset of symptoms coinciding with a positive SPT against A. simplex and high total and specific immunoglobulin (IgE) in the first month after the parasitation, could be a useful tool in the diagnosis of gastrointestinal anisakiasis, even if the parasite cannot be isolated.

Desensitization to azathioprine.

Azathioprine is an immunosuppressant drug which is an analog to 6-mercaptopurine and has been used in the last 20 years to prevent organ transplant rejection. It has also been used in the treatment of some autoimmunological diseases. We present a case of a 24-year-old woman with systemic lupus erythematosus, suffering from nephritis, who developed angioedema after using azathioprine to control her illness. She had never reported similar episodes. The involvement of the drug was demonstrated by positive oral challenge test without changes in biochemical and complement blood determinations. She reached tolerance to the drug after a desensitization procedure (increasing 5 mg each day to reach 125 mg daily). We are not able to propose the involvement of an IgE-mediated mechanism, but rather a hypersensitive one with a non-dose-dependent effect. These desensitization procedures show great potential as therapeutic safeguards against harmful drugs in some patients. We have not found any other desensitization procedure for this drug.

Fluorocytometric analysis of induced sputum cells in an asthmatic population.

BACKGROUND: Bronchial mucosal inflammation is the major pathogenic process in asthma. In the latest years, induced sputum (IS) examination has become an important non-invasive method of assessing airway inflammation. Flow cytometry has been recently applied to the study of IS though it is not exempt of methodological difficulties. The aim of the present study was to further study if the fluorocytometric analysis of IS could represent a reliable tool to assess the presence of bronchial activated lymphocytes in stable mild asthmatic patients. METHODS: Induced sputa from controls and asthmatic patients were processed in isotonic 3mM dithiothreitol (DTT), a mucolytic agent required for cell dispersion. The individualized cells were then stained with monoclonal antibodies for three-colour flow-cytometric analysis. Total IgE and ECP were measured in serum and in the sputum fluid phase. RESULTS: The cellularity of asthmatic sputa is enriched in eosinophils (mean, 26.63%) with respect to controls, but not in lymphocytes. However, lymphocytes from asthmatics show increased surface expression of activation markers (CD25 in T cells, CD23 in B cells). Surprisingly, no differences were observed in the detected levels of CD54 on IS lymphocytes and eosinophils between asthmatics and non-asthmatics. Furthermore, there was a significantly higher concentration of ECP and total IgE in the sputum from the asthmatic group. CONCLUSION: Fluorocytometric analysis of induced sputum is a reliable non-invasive method for the study of bronchial immune cells. It could provide complementary information on activated cells in the bronchial mucosa even in non-smokers, mild and stable asthmatics and it is reasonable to speculate that it will be useful in monitoring the effect of the treatment in these patients.

Anaphylaxis due to hypersensitivity to Anisakis simplex.

Anaphylactic reactions are among the most frequent causes for requests for emergency medical care. It is possible that no clear precipitating factor can be found delaying the onset of adequate treatment and increasing the risk of new episodes of anaphylaxis in the future. Hypersensitivity to Anisakis simplex, an intestinal parasite found in fish, is an unusual cause of anaphylaxis but it should always be borne in mind in countries where a great deal of fish is consumed, especially if it is eaten raw or undercooked. 3 cases of anaphylaxis due to hypersensitivity to A. simplex are described.

[Morbidity of childhood bronchial asthma in the emergency room]. / Estudio de la morbilidad del asma bronquial infantil en un servicio de urgencias.

BACKGROUND: An allergic etiology could be found in more than the 80% of the patients with bronchial asthma. Specific immunotherapy is the only known etiologic treatment, reducing clinical symptoms and requirement of medication. However only a few patients are controlled by an allergist. The aim of the present study was to verify the influence of control and treatment carried out by patients in childhood asthma recruitment that came to the emergency room of our hospital (Hospital Clínico San Carlos) between December 95 and June 96. MATERIAL AND METHOD: Children to 15 years old were included in the study. We analysed: age, sex, clinical record, previous treatment (pharmacological and etiological), basal symptoms, necessity to be admitted to hospital, medical previous control. RESULTS: 163 patients came to emergency room because of asthma exacerbation. They were divided in two groups: less than 3 years (average 17.45 months) and more than 3 years (average 8 years) (Sd: 3.4). Sex: 65% male sex and 35% female sex. 44.17% came during the greater pollinization period in our field, with a statistical significance compared with other periods (p: 0.0023). 81 patients (49.7%) had been previously diagnosed of bronchial asthma. 15% of the patients were controlled by an allergist, with a stable situation in 92% of them. 68.4% of patients who were controlled by a paediatrician and 40% who were controlled in a officially approved centre (p: 0.015) were stable. 55 patients had continuous treatment and 21.8% of them were been treated with immunotherapy. 17.7% of patients without immunotherapy were admitted to hospital. None of the patients on immunotherapy were hospitalised. CONCLUSIONS: It is essential to do an early diagnosis and a combined follow-up by an allergist and a paediatrician to succeed in a good control of the disease from its beginning. In our experience, the children who were controlled by an allergist had a more stable situation and were also more easily controlled. The specific treatment should be initiated in the early stage of the disease being the only factor that modify the immune response and prevents against the development of asthma in children with rhinitis.

Occupational asthma caused by champignon flies.

BACKGROUND: Occupational bronchial asthma in mushroom (champignon) workers is unusual, although reports on it appeared in 1938 and 1951; we have not found any others since those dates. Here we report the case of a 52-year-old man who works as a champignon cultivator. He suffered rhinoconjunctivitis and asthma attacks whenever he entered the champignon culture caves. We studied flies as a possible antigen source. We collected these insects from the growing sites in order to identify them, and then prepare an extract; the samples turned out to be of two families of insects of the order Diptera, 98% from the Phoridae family (Brachycera suborder) and 2% from the Sciaridae (Nematocera suborder). METHODS: Skin prick tests, conjunctival provocation tests, serum specific IgE, specific IgE-binding fractions in immunoblotting, and monitoring of PEFR (at work and off work) were performed. RESULTS: IgE-mediated hypersensitivity to these flies was demonstrated by skin prick test, conjunctival provocation test, serum specific IgE, and IgE-binding fractions in immunoblotting. Monitoring of PEFR both at work and off work showed a clear relationship between symptoms, or fall in PEFR, and the workplace. CONCLUSIONS: We report the case of a patient suffering from asthma and rhinoconjunctivitis caused by hypersensitivity to fly proteins.

The effect of dithiothreitol on VLA-4 detection in peripheral blood and induced sputum cells.

BACKGROUND: Induced sputum has been shown to be a reliable technique for investigating airway inflammation non-invasively. Flow cytometry could provide useful information in this area. However, the viscosity of the sample entails the use of a mucolytic agent. Dithiothreitol (DDT) is the most frequently used agent although it could affect detection of different inflammatory markers. METHODS: To measure the effect of DDT on the detection of certain adhesion molecules in eosinophils and lymphocytes, sputum was induced from seven non-smoking asthmatic and non-asthmatic subjects treated with 0.1 M DDT. The samples were analyzed by flow cytometry. Whole blood samples from the same subjects were also processed with DTT and analyzed by flow cytometry. RESULTS: Very late activated antigen-4 (VLA-4) levels on eosinophils in intracellular and surface staining were much lower than expected. VLA-4 on lymphocytes was also altered but less so than on eosinophils. VLA-4 levels were also decreased on blood cells after DTT treatment. No abnormalities were found in the detection of CD29 on eosinophils and the beta7-chain in lymphocytes. CONCLUSIONS: Flow cytometry could be used as a complementary method to induced sputum in the investigation of airway inflammation. However, DTT could interfere with the detection of some inflammatory markers, as is the case with VLA-4.