Severe Allergy as a Chronic Inflammatory Condition From a Systems Biology Perspective.

Persistent and unresolved inflammation is a common underlying factor observed in several and seemingly unrelated human diseases, including cardiovascular and neurodegenerative diseases. Particularly, in atopic conditions, acute inflammatory responses such as those triggered by insect venom, food or drug allergies possess also a life-threatening potential. However, respiratory allergies predominantly exhibit late immune responses associated with chronic inflammation, that can eventually progress into a severe phenotype displaying similar features as those observed in other chronic inflammatory diseases, as is the case of uncontrolled severe asthma. This review aims to explore the different facets and systems involved in chronic allergic inflammation, including processes such as tissue remodelling and immune cell dysregulation, as well as genetic, metabolic and microbiota alterations, which are common to other inflammatory conditions. Our goal here was to deepen on the understanding of an entangled disease as is chronic allergic inflammation and expose potential avenues for the development of better diagnostic and intervention strategies.

Microbiome and Allergy: New Insights and Perspectives.

The role of the microbiome in the molecular mechanisms underlying allergy has become highly relevant in recent years. Studies are increasingly suggesting that altered composition of the microbiota, or dysbiosis, may result in local and systemic alteration of the immune response to specific allergens. In this regard, a link has been established between lung microbiota and respiratory allergy, between skin microbiota and atopic dermatitis, and between gut microbiota and food allergy. The composition of the human microbiota is dynamic and depends on host-associated factors such as diet, diseases, and lifestyle. Omics are the techniques of choice for the analysis and understanding of the microbiota. Microbiota analysis techniques have advanced considerably in recent decades, and the need for multiple approaches to explore and comprehend multifactorial diseases, including allergy, has increased. Thus, more and more studies are proposing mechanisms for intervention in the microbiota. In this review, we present the latest advances with respect to the human microbiota in the literature, focusing on the intestinal, cutaneous, and respiratory microbiota. We discuss the relationship between the microbiome and the immune system, with emphasis on allergic diseases. Finally, we discuss the main technologies for the study of the microbiome and interventions targeting the microbiota for prevention of allergy.

Clinical Approach to Mast Cell Activation Syndrome: A Practical Overview.

The diagnosis of mast cell activation syndrome (MCAS) is defined by 3 criteria: (1) typical clinical signs and symptoms of acute, recurrent (episodic), and systemic mast cell activation (MCA); (2) increase in tryptase level to >20% + 2 ng/mL within 1-4 hours after onset of the acute crisis; and (3) response of MCA symptoms to antimediator therapy. Classification of MCAS requires highly sensitive and specific methodological approaches for the assessment of clonal bone marrow mast cells at low frequencies. The Spanish Network on Mastocytosis score has been used successfully as a predictive model for selecting MCAS candidates for bone marrow studies based on a high probability of an underlying clonal mast cell disorder. In this article, we propose a diagnostic algorithm and focus on the practical evaluation and management of patients with suspected MCAS.

Allergic asthma: an overview of metabolomic strategies leading to the identification of biomarkers in the field.

Allergic asthma is a prominent disease especially during childhood. Indoor allergens, in general, and particularly house dust mites (HDM) are the most prevalent sensitizers associated with allergic asthma. Available data show that 65-130 million people are mite-sensitized world-wide and as many as 50% of these are asthmatic. In fact, sensitization to HDM in the first years of life can produce devastating effects on pulmonary function leading to asthmatic syndromes that can be fatal. To date, there has been considerable research into the pathological pathways and structural changes associated with allergic asthma. However, limitations related to the disease heterogeneity and a lack of knowledge into its pathophysiology have impeded the generation of valuable data needed to appropriately phenotype patients and, subsequently, treat this disease. Here, we report a systematic and integral analysis of the disease, from airway remodelling to the immune response taking place throughout the disease stages. We present an overview of metabolomics, the management of complex multifactorial diseases through the analysis of all possible metabolites in a biological sample, obtaining a global interpretation of biological systems. Special interest is placed on the challenges to obtain biological samples and the methodological aspects to acquire relevant information, focusing on the identification of novel biomarkers associated with specific phenotypes of allergic asthma. We also present an overview of the metabolites cited in the literature, which have been related to inflammation and immune response in asthma and other allergy-related diseases.

Dry EEG electrodes.

Electroencephalography (EEG) emerged in the second decade of the 20th century as a technique for recording the neurophysiological response. Since then, there has been little variation in the physical principles that sustain the signal acquisition probes, otherwise called electrodes. Currently, new advances in technology have brought new unexpected fields of applications apart from the clinical, for which new aspects such as usability and gel-free operation are first order priorities. Thanks to new advances in materials and integrated electronic systems technologies, a new generation of dry electrodes has been developed to fulfill the need. In this manuscript, we review current approaches to develop dry EEG electrodes for clinical and other applications, including information about measurement methods and evaluation reports. We conclude that, although a broad and non-homogeneous diversity of approaches has been evaluated without a consensus in procedures and methodology, their performances are not far from those obtained with wet electrodes, which are considered the gold standard, thus enabling the former to be a useful tool in a variety of novel applications.

Identification of sole parvalbumin as a major allergen: study of cross-reactivity between parvalbumins in a Spanish fish-allergic population.

BACKGROUND: Fish allergy is becoming an important health problem in Spain, a country with the third highest level of fish consumption after Japan and Portugal. The most common fish allergens are parvalbumins. In our area, the most widely consumed fish species are lean, such as whiff (Lepidorhombus whiffiagonis) and sole (Solea solea). Adverse reactions to fish are usually related to these species, a fact that is largely unknown to allergists in other countries. OBJECTIVE: The aim of this study was to identify and purify the major allergen implicated in allergic response to sole and evaluate the IgE cross-reactivity of purified parvalbumins from whiff and sole, which are phylogenetically close, and more distant species (i.e. cod and salmon). METHODS: Eighteen Spanish fish-allergic patients with a positive history of type I allergy to fish were recruited from the clinic. Total protein extracts and purified parvalbumins from whiff and sole were tested for their IgE-binding properties by combining two-dimensional Western blotting and mass spectrometry. The extent of cross-reactivity between these parvalbumins along with cod and salmon parvalbumins was investigated by IgE ELISA inhibition assay. RESULTS: An IgE-binding spot of approximately 14 kDa was identified as parvalbumin and confirmed as a major allergen in sole extract, which is recognized by almost 70% of the patients. Whiff parvalbumin was recognized by 83.4% of the patients. High cross-reactivity was determined for all purified parvalbumins by IgE inhibition assay. CONCLUSIONS AND CLINICAL RELEVANCE: Sole and whiff parvalbumin were confirmed as major allergens. The parvalbumins of sole, whiff, cod and salmon were highly cross-reactive, thus suggesting a high amino acid sequence identity between them.

Phosphorylation reduces the allergenicity of cow casein in children with selective allergy to goat and sheep milk.

This study aimed to characterize the role of phosphorylation of caseins in selective allergy to goat milk (GM) and sheep milk (SM) in patients with good tolerance to cow milk (CM). We performed skin prick tests with milk and caseins from CM, GM, and SM and immunoblotting and specific immunoglobulin (Ig) E determinations with milk and casein from cow and GM and SM. Sensitization to milk and caseins from goat and sheep was demonstrated in all 3 patients by skin tests, determination of specific IgE, or both. Immunoblotting confirmed that GM/SM proteins but not CM proteins were involved in the allergic symptoms. IgE reacted with several protein bands from the caseins and milk extracts of both sheep and goat. Phosphorylation was involved in the different allergenicity of CM caseins. We report the implication of phosphorylation in the allergenicity of caseins involved in selective allergy to GM and SM.

Radiologic aspects of COVID-19 pneumonia: outcomes and thoracic complications. / Aspectos radiológicos de la neumonía COVID-19: evolución y complicaciones torácicas.

Outcomes vary widely in patients with COVID-19. Whereas some patients have only mild symptoms of short duration, others develop severe disease that leads to acute respiratory distress syndrome requiring prolonged stays in intensive care units. Radiologically, the initial stage is characterized by viral pneumonia with mild expression. In some patients, however, the onset of the immune response results in acute lung damage with organizing pneumonia and diffuse alveolar damage. Moderate-severe disease is associated with a high incidence of pulmonary embolisms, generally peripherally distributed and associated with endothelial damage, prolonged stays in bed, and coagulopathy. Other relatively common complications are spontaneous pneumothorax and pneumomediastinum due to the rupture of alveolar walls and barotrauma in mechanically ventilated patients. Superinfection, generally bacterial and less commonly fungal, is more common in patients with severe disease.

Infection rates and genotypes of Trypanosoma rangeli and T. cruzi infecting free-ranging Saguinus bicolor (Callitrichidae), a critically endangered primate of the Amazon Rainforest.

Parasites of wild primates are important for conservation biology and human health due to their high potential to infect humans. In the Amazon region, non-human primates are commonly infected by Trypanosoma cruzi and T. rangeli, which are also infective to man and several mammals. This is the first survey of trypanosomiasis in a critically endangered species of tamarin, Saguinus bicolor (Callitrichidae), from the Brazilian Amazon Rainforest. Of the 96 free-ranging specimens of S. bicolor examined 45 (46.8%) yielded blood smears positive for trypanosomes. T. rangeli was detected in blood smears of 38 monkeys (39.6%) whereas T. cruzi was never detected. Seven animals (7.3%) presented trypanosomes of the subgenus Megatrypanum. Hemocultures detected 84 positive tamarins (87.5%). Seventy-two of 84 (85.7%) were morphologically diagnosed as T. rangeli and 3 (3.1%) as T. cruzi. Nine tamarins (9.4%) yielded mixed cultures of these two species, which after successive passages generated six cultures exclusively of T. cruzi and two of T. rangeli, with only one culture remaining mixed. Of the 72 cultures positive for T. rangeli, 62 remained as established cultures and were genotyped: 8 were assigned to phylogenetic lineage A (12.9%) and 54 to lineage B (87.1%). Ten established cultures of T. cruzi were genotyped as TCI lineage (100%). Transmission of both trypanosome species, their potential risk to this endangered species and the role of wild primates as reservoirs for trypanosomes infective to humans are discussed.

[Use of laparoscopy in neonatal pathology: our experience]. / Uso de la laparoscopia en la patología duodenal: nuestra experiencia.

The neonatal duodenal pathology has been diagnosed and treated with open surgery for many years. The use of minimally invasive techniques is widely use today on pediatric surgery, but its use on neonatal pathology poses a challenge. We have conducted a study of the 8 neonatal patients with duodenal obstruction that were operated with a laparoscopy in our hospital between 2001 and 2007. The analyzed parameters were the gender, prenatal diagnostic, type of duodenal malformation, weight at birth, hospitalization stay, start of feeding, complications and follow-up. In our sample (6 girls and 2 boys) the 62.5% of the cases was diagnosed after a prenatal ultrasound scan. The duodenal malformations discovered were 5 atresias, 2 webs and 1 anular pancreas. In all the cases, the feeding started by means of a trans-anastomotic probe 48 hours postoperatives. There were 3 complications: one re-surgery and 2 stenosis of anastomosis. The average hospitalization stay was of 27 days with a mean follow-up of 3 years. We think that laparoscopy is a good method for the treatment of the neonatal duodenal pathology, although the scarce volume of our sample does not allow us to generalize the technique.

[Thoracoscopic lobectomy in patients with congenital cystic adenomatoid malformation]. / Lobectomía toracoscópica en pacientes con malformación adenomatoidea quística.

BACKGROUND: The management of asymptomatic patients with congenital cystic adenomatoid malformation (CCAM) is controversial. This report evaluates the video-assisted thoracoscopic (VAT) lobectomy in children with this malformation, and the different intraoperative complications and their resolution are discussed. METHODS: Six patients with CCAM underwent video-assisted thoracoscopic lobectomy. All the patients were under one year and all of them were asymptomatic at the diagnosis. The procedures were performed with single lung ventilation and the chest was insufflated with a low flow and pressure to complete collapse of the lung. We used 3 or 4 thoracoscopic ports depending on the difficulty of the dissection. A bipolar sealing device was the preferred mode of vessel ligation and bronchi were closed with interrupted sutures. The following features have been taken into account: age at diagnosis, localization, surgical technique, complications, hospital stay, results, and time of follow-up. RESULTS: Four lesions were on the right lower lobe (66.7%) and two (33.3%) in the middle lobe. All the procedures were completed thoracoscopically. Chest tubes were left in all cases. Two patients (33.3%) showed postoperative hemothorax but it didn't need blood transfusion. Mean hospital stay was 6 days. At the moment all the patients are asymptomatic with and the mean time of follow-up has been 2 years and 8 months. CONCLUSIONS: VAT lobectomy avoids the long-term morbidity associated to an open thoracotomy and therefore it is a safe and efficacious technique in asymptomatic children with CCAM. Moreover, a greater number of cases are necessary to validate and to improve the technique.

Contribution of malolactic fermentation by Oenococcus oeni and Lactobacillus plantarum to the changes in the nonanthocyanin polyphenolic composition of red wine.

The changes in the nonanthocyanin phenolic composition during red wine malolactic fermentation carried out spontaneously and by four different starter cultures of the species Oenococcus oeni and Lactobacillus plantarum were examined to determine whether differences in nonanthocyanin polyphenolic compounds could be attributed to the lactic acid bacteria (LAB) strain that performs this important step of the wine-making process. The polyphenolic compounds were analyzed by high-performance liquid chromatography with photodiode array detection and HPLC with electrospray ionization-mass spectrometry detection. The malolactic cultures selected for this study were indigenous wine LAB strains from the A.O.C. Rioja (Spain). Results showed different malolactic behaviors in relation to wine phenolic compositions for O. oeni and L. plantarum, and also, a diversity was found within each group. The hydroxycinnamic acids and their derivatives, the flavonols and their glycosides, the flavanol monomers and oligomers, and trans-resveratrol and its glucoside were the main compounds modified by the different LAB. The wild LAB population exerted a greater impact in the wine content of some of these phenolic compounds than the inoculated selected monocultures of this study.

[The role of tracheobronchial stenting in the management of pediatric airway obstruction]. / El papel de las prótesis traqueobronquiales endoluminales en la patología obstructiva de la vía aérea del niño.

PURPOSE: Tracheobronchial stenting can aid in the management of pediatric airway problems. We reviewed our experience to determine the role of endoscopic airway stents in children. METHODS: Sixteen children (Age range: 10 days- 19 years) underwent 28 tracheobronchial stents in the period 1991-2006. The stent type chosen depended on patient age and location. All procedures were done under general anesthesia with bronchoscopy. The following features have been taken into account: etiology, obstruction diagnosis, stent type, localization,,associated anomalies, complications, results, and time of follow-up. RESULTS: Etiology of the tracheobronchial obstruction included tracheobronchiomalacia in 13 patients (81.3%), tracheal stenosis in 2 (12.5%) and glotic stenosis in one case (6.2%). The stent used were 15 Palmaz (53.5%), 7 Dumon (25%), 4 Montgomey (14.5%), 1 Poliflex (3.5%) and one Dynamic stent (3.5%). More than one stent were undertaken in seven cases (43.7%). 16 patients had tracheal stents, 11 children had bronchial stent and one infant a carinal stent. Five complications are reported (two patients developed granulation tissue, two stents migrated, and a child presented a left lung atelectasis) and five patients died (only one case related to tracheobronchial stenting). Results have been satisfactory in 14 patients (87.5%) and the mean time of follow-up has been two years and ten months (range 2 months- 12 years and 6 months). CONCLUSIONS: The tracheobronchial stenting in children may represent a valid treatment option for many sick children in particular circumstances. The long-term outcome remains uncertain but the medium-term outlook is encouraging.

[Laparoscopy for ovarian tumors in children]. / La laparoscopia en el manejo de los tumores ováiricos en la infancia.

INTRODUCTION: Laparoscopic techniques play a major role in pediatric surgery. We reported our experience in the laparoscopic management of ovarian tumors. PATIENTS AND METHODS: 22 patients with ovarian tumor were treated with laparoscopy in our hospital from 1998 to 2005. The following features have been taken into account: surgical techniques in the dissection and extraction of the tumors, time of surgery, hospital stay, complications and time of follow- up. RESULTS: 21 benign teratomas and one osteosarcoma metastasis were observed in this group of 22 patients. The average of age at diagnosis was 9.5 years (range 1.5-17 years) The chief symptom was acute abdominal pain in 47.3% of cases, in 10.5% was chronic pain and in 42.2% of patients was an incidental finding. In 8 girls (36.4%) were performed adnexectomy, in 11 (50%) ooforectomy and in three cases (13.6%) the cyst was enucleated with preservation on the ovary. In one patient a haemorrhage cyst was found and it was treated in the same time and in four patients an inguinal hernia as seen in the laparoscopic surgery and they were repaired subsequently. CONCLUSIONS: Laparoscopic management of ovarian tumor is safe and effective. It allows the surgeon to dissect the tumor, to determine respectability in ovarian cancer and taking biopsy under direct vision. This approach lets to diagnose other lesions that can be repaired in the same procedure or subsequently.

[Minimally invasive surgery for the management of congenital diaphragmatic patology]. / Manejo de la patología diafragmáitica congénita con cirugía mínimamente invasiva.

INTRODUCTION: Minimally invasive surgery (MIS) plays a major role in pediatric surgery. We reported our experience in MIS management of congenital diaphragmatic patology (CDP). PATIENTS AND METHODS: The authors collected date on children who underwent a MIS for CDP repair from 1998 until 2006. The following features have been taken into account: lesion type, approach, surgical technique, complications, hospital stay and time of follow-up. RESULTS: From 1998 until 2006 11 patients (age range: 2 days-6 years and 6 months) with CDP had undergone an attempt at MIS repair: 6 patients with posterolateral hernia (36.4%), 4 with Morgagni hernia ( 54.5%) and a congenital diaphragmatic eventration case (9%). Eight patients 8 (72.7%) were treated using laparoscopy and three cases using thoracoscopy. Three patients were treated as newborns (27.2%). Four patients presented complications (36.3%): two patients who were repaired initially laparoscopically were converted to a transabdominally approach and two patients had recurrent herniation, which were repaired with MIS. Actually all cases were asymptomatic with a mean time of follow-up of 1 year and 8 months (range: 3 months-two years). CONCLUSIONS: MIS is a feasible, safe, easy to perform and efficient approach to repair CDP but it needs selection criteria for successful outcome.

[Laparoscopic inguinal herniorrhaphy in children. First results]. / Resultados iniciales del tratamiento de la hernia inguinal por vía laparoscópica.

INTRODUCTION: The inguinal hernia repair in the child has a new alternative, the laparoscopic repair. We study our initial results obtained with this technique. We evaluate the indications and the efficiency. MATERIAL AND METHODS: 150 patients have been operated with an initial diagnosis of hernia inguinal or crural. Usually this technique is realized with three ports: we put the umbilical one (5mm) for the scope and two ports (3 mm) placed in flanks. The repair was realized in purse string fashion or interrupted or noninterrupted suture with non-absorbable suture (polipropylen) 3-4/0. RESULTS: Indications of the herniorraphy were: (12%) recurrent hernia, bilateral hernia (28%), association inguinal hernia inguinal and umbilical (39%), crural hernia (4%) and in 16% incidental hernia. Most of them (137) was treated in purse string fashion, (11) non interrupted suture and 12 interrupted suture. No conversion to open was require in any case. Haematoma for puncture of the spermatic vessels was seen in 6 cases (1,4%). Today we do this surgery in ambulatory way. We have had 2 recurrent hernias (1%) that were treated again laparoscopicaly. CONCLUSIONS: We can't extract conclusion from this study because of the number of patients but we think that the laparoscopic treatment of inguinal hernias can offer advantages in selected cases.

[Pleural empyema. Thoracoscoopic treatment]. / Empiema pleural. Tratamiento toracoscópico.

OBJECTIVE: To compare the use of primary and secondary thoracoscopy in children with parapneumonic empyema. MATERIAL AND METHODS: We present a retrospective study of 24 children entered our hospital between years 1998 and 2003. RESULTS: Early thoracoscopy doesn't influence in length of stay. 12 children (50%) were treated with previous chest tube and other 12 children (50%) without it. There is statistical significance in length of hospital stay. The days with postoperative fever didn't decrease, but it was seen if we compare it from the beginning of the disease. CONCLUSIONS: An early thoracoscopy decrease length of hospital stay and the duration of fever postoperative.