Clinical impact and immunological alterations in asthmatic patients allergic to grass pollen subjected to high urban pollution in Madrid.

BACKGROUND: The prevalence of asthma has increased in recent decades. Among the reasons for this increase is environmental pollution. Pollutants cause bronchial inflammation and introduce modifications in the pollen, making it more allergenic. OBJECTIVE: Assess symptoms and medication requirements of asthmatic patients with grass allergies in Madrid (high urban pollution) and Ciudad Real (low pollution), and simultaneously evaluate the in vitro effects that pollen collected in both areas has on the immune cells of patients. METHODS: During two pollen seasons, patients from both cities were included. The patients recorded their symptoms and the asthma medication they took daily. In both cities, pollen data, pollutants and meteorological variables were evaluated. The response to different cell populations from patients in both areas were analysed after "in vitro" stimulation with pollen from both cities. RESULTS: The symptoms and medication use of the patients in Madrid was 29.94% higher. The NO2 concentration in Madrid was triple that of Ciudad Real (33.4 vs. 9.1 µg/m3 of air). All other pollutants had very similar concentrations during the study period. Pollen from the high pollution area caused a significant enhancement of T-CD8+ and NK cells proliferation compared with pollen of low pollution area, independently of the patient's origin. CONCLUSION: Asthmatic patients from Madrid have a worse clinical evolution than those from Ciudad Real because of higher levels of urban pollution, and this could be driven by the higher capacity of pollen of Madrid to activate T-CD8+ and NK cells.

[Anaphylaxis sugammadex-induced in a pediatric patient]. / Anafilaxia por sugammadex en paciente pediátrico.

INTRODUCTION: Sugammadex is a cyclodextrin that reverses neuromuscular blockade, especially of rocuronium. The occurrence of anaphylaxis produced by its use is of 1:1000 and 1:20000; it is observed mainly in subjects of Asian origin. CASE REPORT: A 9-year-old boy of Asian origin who, after the administration of sugammadex, immediately manifested an episode of anaphylaxis, which was reverted by using adrenaline and antihistamines. The serum tryptase at two hours was 27.7 µg/L; at 6 weeks, it was 3 µ/L. The sugammadex 100 mg/mL skin test was positive. The basophil activation test was positive with sugammadex 20 mg/mL. CONCLUSION: The temporal relationship between the administration of the drug, the clinical manifestations, the elevation of tryptase, and the diagnostic tests performed, disclosed the episode of anaphylaxis associated with hypersensitivity to sugammadex.

Introducción: Sugammadex es una ciclodextrina que revierte el bloqueo neuromuscular, especialmente de rocuronio. La incidencia de anafilaxia producida por su uso es de 1:1.000 y 1:20.000, se observa principalmente en sujetos de origen asiático. Reporte de caso: Niño de 9 años, de raza asiática que tras la administración de sugammadex, inmediatamente manifestó un episodio de anafilaxia, la cual revirtió con el uso de adrenalina y antihistamínicos. La triptasa sérica a las 2 h fue de 27.7 µg/L; a las 6 semanas fue 3 µg/L. La prueba cutánea a sugammadex 100 mg/mL fue positiva. La prueba de activación de basófilos fue positiva con 20 mg/mL sugammadex. Conclusión: La relación temporal de la administración del medicamento, las manifestaciones clínicas, la elevación de la triptasa y las pruebas diagnósticas realizadas, identificaron el episodio de anafilaxia asociado con hipersensibilidad por sugammadex.

[Biological differences on onset among type 1A diabetics in relation to HLA-DQ genetic markers]. / Diferencias biológicas en la presentación de la diabetes 1A, en relación con los marcadores genéticos HLA-DQ.

BACKGROUND AND OBJECTIVE: The hypothesis that diabetes mellitus presentation partially depends on the genetic characteristics of the patient has been proposed. Up to date this kind of studies have been made by serology, so there are no data about the role played by DQ haplotypes in the presentation and clinical importance of DM1. This fact is analysed in the present study. PATIENTS AND METHOD: We studied DQ haplotypes (molecular biology) in 86 patients affected by DM1. Their relationship with several parameters found on illness debut, such as age, sex, C peptid and clinical importance are analysed. RESULTS: 89% of the patients showed a DQ that increases the risk of diabetes. Average age on onset was 16 years and the median age 9 years. No differences in relation to sex were observed. DQA1*0501, 0301/DQB1*0201, 0302 heterocygotes show an earlier onset (9 years, opposite to 17 in the rest) and the youngest (smaller than 16 years) they have to the onset a smaller pancreatic reservation (peptid C of 0.37 ng/dl in front of 1.4 of those bigger than this age). CONCLUSIONS: DQA1*0501, 0301/DQB1*0201 heterocygocity increases the probability of an earlier and more aggressive debut of the illness, being related this characteristic younger debut to a smaller pancreatic reservation.