Early Skin Test after Anaphylaxis during Induction of Anesthesia: A Case Report.

BACKGROUND: It is recommended that a skin test be performed 4-6 weeks after anaphylaxis. However, there is little evidence about the timing of the skin test when there is a need to identify the cause within 4-6 weeks. CASE REPORT: A 57-year-old woman was scheduled to undergo surgery via a sphenoidal approach to remove a pituitary macroadenoma. Immediately after the administration of rocuronium, pulse rate increased to 120 beats/min and blood pressure dropped to 77/36 mmHg. At the same time, generalized urticaria and tongue edema were observed. Epinephrine was administered and the surgery was postponed. Reoperation was planned two weeks after the event. Four days after the anaphylactic episode, rocuronium was confirmed to be the cause by the skin prick test. Cisatracurium, which showed a negative reaction, was selected as an alternative agent for future procedures. Two weeks later, the patient underwent reoperation without any adverse events. CONCLUSIONS: The early skin test can be performed if there is a need even earlier than 4-6 weeks after anaphylaxis.

Determining Levers of Cost-effectiveness for Screening Infants at High Risk for Peanut Sensitization Before Early Peanut Introduction.

Importance: Early peanut introduction reduces the risk of developing peanut allergy, especially in high-risk infants. Current US recommendations endorse screening but are not cost-effective relative to other international strategies. Objective: To identify scenarios in which current early peanut introduction guidelines would be cost-effective. Design, Setting, and Participants: This simulation/cohort economic evaluation used microsimulations and cohort analyses in a Markov model to evaluate the cost-effectiveness of early peanut introduction with and without peanut skin prick test (SPT) screening in high-risk infants during an 80-year horizon from a societal perspective. Data were analyzed from April to May 2019. Exposures: High-risk infants with early-onset eczema and/or egg allergy underwent early peanut introduction with and without peanut SPT screening (100 000 infants per treatment strategy) using a dichotomous 8-mm SPT cutoff value (stipulated in the current US guideline). Main Outcomes and Measures: Cost, quality-adjusted life-years (QALYs), net monetary benefit, peanut allergic reactions, severe allergic reactions, and deaths due to peanut allergy. Results: In the simulated cohort of 200 000 infants and using the base case during the model horizon, a no-screening approach had lower mean (SD) costs ($13 449 [$38 163] vs $15 279 [$38 995]) and higher mean (SD) gain in QALYs (29.25 [3.28] vs 29.23 [3.30]) vs screening but resulted in more allergic reactions (mean [SD], 1.07 [3.15] vs 1.01 [3.02]), severe allergic reactions (mean [SD], 0.53 [1.66] vs 0.52 [1.62]), and anaphylaxis involving cardiorespiratory compromise (mean [SD], 0.50 [1.59] vs 0.49 [1.47]) per individual. In deterministic SPT sensitivity analyses at base-case sensitivity and specificity rates, screening could be cost-effective at a high disutility rate (the negative effect of a food allergic reaction) (76-148 days of life traded) for an at-home vs in-clinic reaction in combination with high baseline peanut allergy prevalence among infants at high risk for peanut allergy and not yet exposed to peanuts. If an equivalent rate and disutility of accidental and index anaphylaxis was assumed and the 8-mm SPT cutoff had 0.85 sensitivity and 0.98 specificity, screening was cost-effective at a peanut allergy prevalence of 36%. Conclusions and Relevance: The results of this study suggest that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, SPT sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to realistically achieve. Further research is needed to define the health state utility associated with reaction location.

Alergia a drogas: Experiencia en 771 procedimientos / Allergy to drugs. Experience in 771 procedures

Las reacciones de hipersensibilidad a drogas (RHD) son aquellas que se presentan clínicamente como alérgicas. Las mismas pueden involucrar o no un mecanismo inmunológico de lesión. Las RHD son frecuentes y en ocasiones pueden poner en riesgo la vida. Los pacientes con RHD a una droga repiten la reacción ante una nueva exposición, limitando el arsenal terapéutico y exponiendo al sujeto a drogas más caras y/o más tóxicas. La identificación de la droga responsable de una RHD es difícil cuando la historia clínica no es reciente u ocurrió en el contexto de múltiples drogas y enfermedades concurrentes. El diagnóstico puede establecerse por la historia clínica, pruebas cutáneas y desafíos progresivos a drogas. Describimos nuestra experiencia en 771 procedimientos, 331 pruebas cutáneas y 440 desafíos progresivos a drogas, con un 11% de pruebas positivas. Las manifestaciones de positividad fueron prurito, rash, urticaria, angioedema, rinitis, broncoespasmo, náuseas y anafilaxia. Todos respondieron efectivamente al tratamiento de rescate. Las pruebas con drogas, realizadas en un contexto correcto, son seguras y sirven para confirmar o descartar el diagnóstico en un paciente con sospecha de alergia a drogas.

Drug hypersensitivity reactions (RHD) are those that present clinically as allergic. They can or cannot involve an immunologic mechanism of lesion. They are frequent and, occasionally, life threatening. Patients with RHD repeat the reaction when they are re-exposed to the drug, limiting the therapeutic options and exposing them to more expensive and toxic drugs. It is difficult to identify the responsible drug when the reaction was not recent or when it occurred in the context of therapy with multiple drugs or confusing concurrent diseases. The diagnosis should be based on clinical history, followed by drug skin tests and drug provocation tests. We describe our experience in 771 procedures, 331 cutaneous and 440 drug provocation tests, 11% of them were positive. Positive symptoms included generalized pruritus, rash, urticaria, angioedema, rhinitis, bronchospasm, nausea and anaphylaxis. All the patients with positive tests had a good response to treatment. It can therefore be concluded that drug tests undertaken on individuals with suspected drug allergy, performed by experienced personnel and in controlled settings, are useful and safe to confirm drug hypersensitivity.

Is orienteering associated with allergic rhinitis in adolescents?

BACKGROUND: Allergic rhinitis (AR) is a disease that reduces athletic performance. Environmental allergen exposure is higher in outdoor sports (such as orienteering) than indoor sports. The main purpose of this study was to investigate the AR frequency in orienteers comparing with indoor athletes. METHODS: Sixty adolescent athletes (33 orienteers, 27 basketball players) enrolled this prospective study. AR diagnosis was made by both history (ISAAC questionnaire) and physical examination. Nasal endoscopy was performed to observe objective findings (concha hypertrophy, mucosal paleness, serosity, septum deviation, adenoid hypertrophy). Epidermal prick test, pulmonary function test, total IgE and serum eosinophil levels were also assessed. RESULTS: AR was diagnosed in 21 (35%) athletes. 14 (42.4%) were orienteers and 7 (25.9%) were basketball players (P=0.144). Endoscopic findings and skin test positivity were also seen at higher percentages in orienteers with no significance. Training age (sport duration), total IgE levels and skin test positivity were significantly higher in rhinitic orieenters than non-rhinitic orieenters (P=0.046, P=0.0001, and P=0.004, respectively). CONCLUSIONS: Although adolescent orieenters had some higher allergic parameters than indoor athletes, they were not found more susceptible to AR. It seems that the frequency of AR increases with longer training age in orieentering sport. This study is the first report about AR in adolescent orienteers. Future researchs should more focus on comparing allergic conditions between outdoor and indoor sports.

Comprehensive allergy evaluation is useful in the subsequent care of patients with drug hypersensitivity reactions during anesthesia.

BACKGROUND: For patients with a history of drug hypersensitivity reaction (HSR) during anesthesia, strategies to minimize risk with subsequent anesthesia are unclear. Identification of the cause of HSR during anesthesia remains challenging. OBJECTIVE: To determine the success of a comprehensive allergy evaluation and management plan for patients with HSR during anesthesia, including identification of the causative agent and review of outcomes during subsequent anesthesia exposure. METHODS: We performed chart reviews of patients referred for the evaluation of HSR during anesthesia between 2003 and 2012. Data collection included patient characteristics, signs/symptoms of HSR during anesthesia, and subsequent outcomes. Patients underwent comprehensive allergy evaluation including skin testing for identifying potential culprit agents, and the results were used to provide recommendations for any subsequent anesthesia. RESULTS: Over the 10-year study period, 73 patients with HSR during anesthesia were referred for further evaluation. Thirteen patients (18%) had positive skin test results to a drug received during anesthesia. One patient with a positive skin test result was diagnosed with mastocytosis. The causative agents identified in these 13 patients included latex, ß-lactam antibiotics, neuromuscular blockers, tetracaine, odansetron, and fentanyl. On follow-up, 47 of the 73 patients (64%) subsequently underwent procedures requiring anesthesia. Using our recommendations from evaluation and testing, 45 of these 47 patients (96%) successfully tolerated subsequent anesthesia. The 2 patients who developed recurrent HSR during anesthesia were later diagnosed with mast cell disorders. CONCLUSIONS: Our comprehensive evaluation and management plan minimizes risk with subsequent anesthesia even when the cause of HSR could not be identified. Baseline tryptase levels may be helpful in this patient population to diagnose mast cell disorders.

Skin test reactivity to female sex hormones in women with primary unexplained recurrent pregnancy loss.

The objective was to examine the hypothesis that primary unexplained recurrent pregnancy loss might be associated with an inappropriate immunologically mediated response to progesterone and/or estrogen. This prospective study included 47 women with two or more documented consecutive early pregnancy losses of unknown etiology, and no previous history of deliveries. Intradermal skin testing was performed in the luteal phase of the cycle (days 16-20) using estradiol benzoate, progesterone, and a placebo of refined sesame oil. Immediate (20 min) and late (24h and 1 week) skin test readings for all cases were compared with those of 12 parous women of comparable age with no history of spontaneous miscarriages, premenstrual disorders, pregnancy, or sex hormone-related allergic or autoimmune diseases. Main outcome measure was skin test reactivity to estradiol and/or progesterone. Immediate skin test reactivity to both hormones was observed among half of the cases at 20 min. A papule after 24h, which persisted for up to 1 week, was observed among 32 (68.1%) and 34 (72.3%) cases at the sites of estrogen and progesterone injection, respectively. 55.3% of cases had combined skin test reactivity to both estradiol and progesterone at 1 week. All women in the control group showed absence of skin test reactivity for both estradiol and progesterone at 20 min, 24h, and 1 week. None of the subjects in either group showed skin test reactivity to placebo. There is an association between primary unexplained recurrent pregnancy loss and skin test reactivity to female sex hormones.

Dermatite alérgica de contato a medicamentos de uso tópico / Contact dermatitis to topical medications

Fundamentos: A dermatite de contato é uma dermatose comum e suas múltiplas causas dificultam o tratamento. Objetivos: Avaliar a freqüência de sensibilização aos medicamentos tópicos em um serviço universitário; estudar as características da população afetada e identificar os principais sensibilizantes. Métodos: Realizou-se um estudo retrospectivo dos pacientes com hipótese diagnóstica de dermatite alérgica de contato e que foram submetidos a testes epicutâneos. Avaliaram-se os que tiveram diagnóstico final de dermatite alérgica de contato a medicamentos tópicos. Resultados: Em um grupo de 889 pacientes submetidos a testes de contato, 98 (11%) tiveram testes de contato positivos e relevantes para medicamentos tópicos, pelo princípio ativo e/ou por outros componentes. Entre os testes positivos, 79 (57%) corresponderam aos princípios ativos e 60 (43%) aos excipientes, com alguns pacientes apresentando mais de um teste positivo. Entre os princípios ativos, a neomicina foi o mais freqüente. Conclusões: Entre os pacientes estudados, a sensibilização aos medicamentos tópicos ocorreu em 11% dos casos, com discreta preferência pelo sexo feminino. Houve elevada freqüência de dermatite alérgica de contato pela neomicina, agente de uso comum como automedicação e também como prescrição médica.

Bronchoalveolar lavage enzyme-linked immunospot for a rapid diagnosis of tuberculosis: a Tuberculosis Network European Trialsgroup study.

RATIONALE: The rapid diagnosis of pulmonary tuberculosis (TB) is difficult when acid fast bacilli (AFB) cannot be detected in sputum smears. OBJECTIVES: Following a proof of principle study, we examined in routine clinical practice whether individuals with sputum AFB smear-negative TB can be discriminated from those with latent TB infection by local immunodiagnosis with a Mycobacterium tuberculosis-specific enzyme-linked immunospot (ELISpot) assay. METHODS: Subjects suspected of having active TB who were unable to produce sputum or with AFB-negative sputum smears were prospectively enrolled at Tuberculosis Network European Trialsgroup centers in Europe. ELISpot with early-secretory-antigenic-target-6 and culture-filtrate-protein-10 peptides was performed on peripheral blood mononuclear cells (PBMCs) and bronchoalveolar lavage mononuclear cells (BALMCs). M. tuberculosis-specific nucleic acid amplification (NAAT) was performed on bronchoalveolar lavage fluid. MEASUREMENTS AND MAIN RESULTS: Seventy-one of 347 (20.4%) patients had active TB. Out of 276 patients who had an alternative diagnosis, 127 (46.0%) were considered to be latently infected with M. tuberculosis by a positive PBMC ELISpot result. The sensitivity and specificity of BALMC ELISpot for the diagnosis of active pulmonary TB were 91 and 80%, respectively. The BALMC ELISpot (diagnostic odds ratio [OR], 40.4) was superior to PBMC ELISpot (OR, 10.0), tuberculin skin test (OR, 7.8), and M. tuberculosis specific NAAT (OR, 12.4) to diagnose sputum AFB smear-negative TB. In contrast to PBMC ELISpot and tuberculin skin test, the BALMC ELISpot was not influenced by previous history of TB. CONCLUSIONS: Bronchoalveolar lavage ELISpot is an important advancement to rapidly distinguish sputum AFB smear-negative TB from latent TB infection in routine clinical practice.

[Epidemiology of atopic dermatitis in general population of the Lodz province's citizens]. / Epidemiologia atopowego zapalenia skóry w populacji ogólnej mieszkanców województwa lódzkiego.

INTRODUCTION: Nowadays about 12 to 26% of European citizens suffer from atopic dermatitis. The aim of this study was to evaluate the prevalence and to identify risk factors of atopic dermatitis in general population of Lodz province' citizens. MATERIAL AND METHODS: A random sample of 1522 subjects aged from 30 to 80 years was taken from general population of Lodz inhabitants. Demographic data and the anamnesis were collected from all the participants on the basis of standardised questionnaires. Additionally, skin prick tests were performed with 10 aeroallergens. The diagnosis was established on the basis of collected data. The additional examinations were performed in the doubtful cases. RESULTS: The complete data from 1340 (1057 adults and 283 children) were included into the further analysis. Prevalence of atopic dermatitis was assessed on the level 9.2% in children and 0.9% in adults. Atopic family history and passive smoking were strong risk factors for AD development in children (OR respectively 3.69 and 3.4). The difference between the prevalence of atopic dermatitis in the city and rural areas was only observed in adults (OR = 2.3 for living in the city), while in children equally high prevalence was observed in both areas. Earlier, atopic dermatitis was not correctly diagnosed in 38% of examined children and 10% of adults. CONCLUSIONS: Results of our epidemiological study show that atopic dermatitis has become an important clinical and sociological problem in Lodz province. The high prevalence of atopic dermatitis in rural areas may predict an increase of other atopic diseases' prevalence and the disappearance of differences between city and rural areas.

Occupational exposure and sensitization to fungi among museum workers.

BACKGROUND: Museum employees are exposed to fungi and storage mites in the workplace. AIMS: To evaluate the prevalence and risk factors of sensitization to moulds, as well as clinical symptoms associated with allergy in museum workers. METHODS: A total of 103 employees of the Polish National Museum (NM) in Warsaw, potentially exposed to fungi during their work, were assessed using a questionnaire and skin prick tests to common allergens and fungal extracts. The level of total and serum-specific IgE to moulds was evaluated, and spirometry was performed in all subjects. Mycological analysis of the workplace was also performed. RESULTS: Penicillium, Aspergillus, Cladosporium, Alternaria, Trichoderma, Acremonium and Paecilomyces were the most frequent species isolated from investigated exhibits of NM. Thirty per cent of museum employees were sensitized to at least one of the fungal allergens. Logistic regression analysis revealed that duration of occupational exposure lasting >5 years, family history of atopy, presence of a cat at home, sinusitis, allergic rhinitis and a history of frequent respiratory infections were risk factors for the development of sensitization to fungi in this working group. CONCLUSIONS: This study suggests an important role of fungi as occupational allergens for museum workers. The prevalence of allergic symptoms among employees of NM was relatively high. Further studies are necessary to elucidate the importance of particular fungal species in the development of occupational allergy.

Lack of correlation between minimal erythema dose and skin phototype in a Colombian scholar population.

BACKGROUND: Sun exposure and skin phototype are the most relevant risk factors for skin cancer. Colombia has high levels of ultraviolet radiation during the whole year, therefore, both, high UVI's and outdoor worker's daily activities, in our country are very important risk factors for the development of cutaneous cancer. To date no study has evaluated the usefulness of Fitzpatrick's skin phototype classification in Colombians and its correlation with the minimal erythema dose (MED) and constitutional skin color. Such information is gaining importance in other nations due to the fact that several country's population is becoming more ethnically diverse. OBJECTIVES: To determine the skin phototype, accumulated sun exposure, sun protection behavior, MED and phenotype in a Colombian school population. METHODS: Last year high school students from the western Antioquia were invited to participate by phone and letter through their respective school directors. A self-questionnaire was handled to each student. A representative sample of the universe was selected for a medical examination by a dermatologist in order to validate the results of the self-questionnaire. The constitutional skin color was determined with the chromameter CR 300 Minolta. The MED was defined as the minimal dose of UVB being able to induce erythema 24 h later. RESULTS: Eight schools of the area agreed to participate in the study, and a total of 911 students (58% girls and 42% boys) filled-out the self-questionnaire. Sun exposure in the majority of individuals was in a level between moderate and very high. Ninety percent of students do not use any sun protection device or cream. Only a 50% of concordance between self-assessed skin phototype vs. medical skin phototype was found, and the highest concordance corresponded to skin phototype II (82%). There was a marked difference in skin photosensitivity of Colombians compared with reports in Caucasians. We observed a marked overlapping in MED's and L* values in phototypes II and III. CONCLUSIONS: The Fitzpatrick's classification was not useful in Hispanic populations such as ours. Therefore, a new skin-phototype classification system is required. In our population the constitutional color was a good predictor of the MED but it did not correlate with skin phototype. The self-assessed questionnaire method was not useful to determine skin cancer risk in our population. The majority of this population has light skin phototypes and is highly exposed to solar UV radiation without proper protection.

Tuberculosis screening of travelers to higher-incidence countries: a cost-effectiveness analysis.

BACKGROUND: Travelers to countries with high tuberculosis incidence can acquire infection during travel. We sought to compare four screening interventions for travelers from low-incidence countries, who visit countries with varying tuberculosis incidence. METHODS: Decision analysis model: We considered hypothetical cohorts of 1,000 travelers, 21 years old, visiting Mexico, the Dominican Republic, or Haiti for three months. Travelers departed from and returned to the United States or Canada; they were born in the United States, Canada, or the destination countries. The time horizon was 20 years, with 3% annual discounting of future costs and outcomes. The analysis was conducted from the health care system perspective. Screening involved tuberculin skin testing (post-travel in three strategies, with baseline pre-travel tests in two), or chest radiography post-travel (one strategy). Returning travelers with tuberculin conversion (one strategy) or other evidence of latent tuberculosis (three strategies) were offered treatment. The main outcome was cost (in 2005 US dollars) per tuberculosis case prevented. RESULTS: For all travelers, a single post-trip tuberculin test was most cost-effective. The associated cost estimate per case prevented ranged from $21,406 for Haitian-born travelers to Haiti, to $161,196 for US-born travelers to Mexico. In all sensitivity analyses, the single post-trip tuberculin test remained most cost-effective. For US-born travelers to Haiti, this strategy was associated with cost savings for trips over 22 months. Screening was more cost-effective with increasing trip duration and infection risk, and less so with poorer treatment adherence. CONCLUSION: A single post-trip tuberculin skin test was the most cost-effective strategy considered, for travelers from the United States or Canada. The analysis did not evaluate the use of interferon-gamma release assays, which would be most relevant for travelers who received BCG vaccination after infancy, as in many European countries. Screening decisions should reflect duration of travel, tuberculosis incidence, and commitment to treat latent infection.

Bimodal skin reactivity to histamine in atopic children in Singapore: influence of specific sensitizations.

Histamine skin prick test (SPT) is used as the 'golden standard' for positive control in in vivo immediate type hypersensitivity testing. The skin reactivity to histamine can, however, be modulated by a bevy of extraneous factors. We aimed to define whether histamine skin reactivity in atopic children in Singapore is influenced by age, ethnic origin, gender, environmental exposure or specific sensitization patterns. A retrospective analysis of children, with specific aeroallergen sensitization (as measured by at least one allergen-specific SPT with a wheal size > 3 mm compared with the negative control) from the outpatient speciality clinic of the KK Children's Hospital, during 06/2002-06/2003. A total of 315 patients were included, 235 (75%) were males, 252 (80%) were Chinese, age mean was 7.7 yr (range: 2-15). Patients were referred to the SPT with a diagnosis of one or more of: allergic rhinitis 287 (91%), asthma 112 (36%) or atopic dermatitis 60 (19%). The mean histamine response showed a bimodal distribution, independent of age, ethnic origin, gender or phenotypical expression of allergic disease. Histamine skin reactivity was higher in atopic patients with polysensitization (mean 5.0 mm vs. 2.9 mm in monosensitized patients, p < 0.001), and in patients with mould sensitization (mean 5.1 mm vs. 3.3 mm in patient not sensitized to moulds, p < 0.001). The presence of passive smoking increased the likelihood of a diminished histamine skin response. Histamine skin response data strongly suggested the presence of two heterogeneous subpopulations. Children with polysensitization and mould sensitization were more likely to show a large significant histamine response, whereas children with passive smoke exposure, showed a diminished skin reactivity to histamine.

Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey.

Asthma and allergic rhinitis are common problems in children and the causative pollen allergens vary according to the geographical area. The aim of this study was to investigate patterns of sensitization to common inhalant allergens, especially pollens, in Turkish children living in the Trakya region and to determine differences between rural and urban areas. Allergen skin testing was prospectively performed on 539 children aged between 4 and 17 years with respiratory allergy. The reaction was considered to be positive if the mean wheal diameter was at least 3 mm greater than that of the negative controls. We detected positive skin reactions in 420 (77.9%) children. Two hundred and eighty-one (52.1%) mite, 277 (51.4%) pollen, 174 (32.3%) mold, 65 (12.1%) animal dander, 12 (2.2%) cockroach and 6 (1.1%) latex skin sensitivities were detected. Among the pollen allergies 173 were cereal pollen (32.1%), 170 grass pollen (31.5%) and 144 tree pollen allergies (26.7%). The most common positive skin test among the pollens was to cultivated wheat (Titicum vulgare) (n = 116, 21,5%), followed by rye grass (Lolium perenne) and orchard grass (Dactylis glomerata). Positive skin reactions to Alternaria, to Candida albicans, and to all pollens except Ulmus competris, Pinus sylvetris, Platanus vulgaris and Tilia platyphyllos, were higher in children with allergic rhinitis than in those with asthma. In children from rural areas, allergic skin reactivity was found to be more common against Candida albicans, sheep dander and all pollens except Corylus avellana, Fraxinus excelsior, Populus alba, Pinus sylvetris, Platanus vulgaris and Chenopodium album, than in urban children. Although Trakya is close to Greece and other Mediterranean countries, this study suggests that the pollens, which sensitize children, are not similar.

The epidemiology of atopic dermatitis in Italian schoolchildren.

BACKGROUND: Atopic dermatitis (AD) is common in children in industrialized countries. Only one large population study on its prevalence has been conducted in Italy, based on self-report questionnaire. The present study was designed to estimate the prevalence of AD in schoolchildren in Italy by dermatologists' assessment and by UK Working Party criteria, and to investigate associated symptoms and factors. METHODS: Cross-sectional survey on a random sample of 9-year-old schoolchildren from seven Italian cities. Children were examined by experienced dermatologists. Parents and teachers answered standardized questionnaires. RESULTS: Of the 1369 children examined, 88 had a diagnosis of AD, with an estimated point prevalence of 5.8% (95% CI 4.5-7.1) in the reference population. The reported lifetime prevalence was 15.2 (95% CI 12.2-18.2) for AD, 11.9% (95% CI 9.0-14.8) for asthma, and 17.6% (95% CI 14.6-20.7) for rhino-conjunctivitis. The strongest associated factor was the presence of AD in at least one parent. No association of AD with maternal smoking during pregnancy, birth weight, maternal age at the time of the child birth and breast-feeding was observed. The environmental characteristics of the house and the school did not correlate with the prevalence of AD. Episodes of lower respiratory tract infections were associated with asthma, and to a lower extent also with AD and rhinitis. CONCLUSIONS: The prevalence of doctor-diagnosed AD in Italian schoolchildren is comparable to those reported for other developed countries. Family history of atopy was the single most important associated factor, while the complex interplay of environmental factors remains to be elucidated.

Sensibilidad a aeroalergenos en pacientes asmáticos de la ciudad de Salta / Sensitivity to aeroallergens in asthmatic patients in Salta city

Objetivos: discriminar la frecuencia de sensibilidad a aeroalergenos y patologías alérgicas simultáneas en asmáticos de esta ciudad. Material y métodos: pacientes (pac.) con diagnóstico funcional y/o clínico de asma, registrándose edad, sexo, evolución de asma, patología alérgica concomitante, IgE total y sensibilidad por skin prick test. Se testificaron con: ácaros mix, cucarachas mix, pool hongos (Alternaria, Cladosporium, Penicillum, Aspergillus; epitelios perro y gato, pool Gramíneas, Amarantaceae, Ambrosía, Chenopodiacea, pool árboles (plátano, abedul, álamo, pino, eucalipto); control (+) fosfato histamina y (-) solución glicerinada; lancetas prick lanceter. Se consideró (+) a toda pápula > 3 mm con relación al control (-). Resultados: se analizaron 35 pac.; edad media 22,1 años (4-70), 11 masculinos y 24 femeninos, 6,9 años de evolución de asma (1-30) y nivel de IgE total de 402,6 kU/L (13-2000). Se encontró sensibilidad a ácaros en 83 por ciento, cucarachas 8,5 por ciento, hongos 20 por ciento, perro 20 por ciento, gato 26 por ciento, gramíneas 31,5 por ciento, chenopodeacea 8,5 por ciento, árboles 6 por ciento, Ambrosía y Amaranthaceae 3 por ciento cada una. Las patologías asociadas fueron rinitis en 60 por ciento, rinosinusitis en 17 por ciento, dermatitis de contacto en 6 por ciento, adenoiditis en 6 por ciento, dermatitis atópica en 3 por ciento, displasia broncopulmonar en 3 por ciento y ex tuberculosis 3 por ciento, sin otra patología 8,5 por ciento. Conclusiones: los ácaros son los alergenos más sensibilizantes en asmáticos de esta región; gramíneas, epitelio de gato, perro y hongos le siguen en forma decreciente. La coexistencia de rinitis más rinosinusitis (77 por ciento) como patologías asociadas frecuentes apoyan la conexión nariz-pulmón

Baker's asthma: still among the most frequent occupational respiratory disorders.

BACKGROUND: Baker's asthma and rhinitis are among the most frequent occupational respiratory disorders. OBJECTIVE: The aim of the study was to evaluate the frequency of work-related symptoms and the clinical relevance of sensitization to allergens in screened and symptomatic bakers. METHODS: Eighty-nine bakers participating in a screening study and 104 bakers filing a claim for compensation were examined with regard to occupational and clinical case history, lung function parameters, and sensitization to bakery allergens by skin prick tests, specific IgE analyses, and inhalative challenge tests. RESULTS: A high prevalence of respiratory disorders, abnormal lung function parameters, and sensitization to bakery allergens exists. Most frequently, bakers with workplace-related respiratory symptoms showed sensitization to wheat flour (64%), rye flour (52%), soy bean flour (25%), and alpha-amylase (21%). The correlation between these sensitizations and asthma case history and inhalative challenge test responses was significant. However, approximately 29% of the bakers with respiratory symptoms showed no sensitization to these bakery allergens, whereas 32% of the sensitized bakers in the screening group had no workplace-related symptoms. Atopic status defined by skin prick test sensitization to common allergens or elevated total IgE levels was found to be a risk factor for the development of sensitization to bakery allergens and respiratory symptoms. On the other hand, there is evidence for an increased frequency of elevated total IgE as the result of occupational allergen exposure because respective findings were observed in bakers without symptoms. CONCLUSION: Sensitization to bakery allergens seems to be the main cause of baker's asthma and rhinitis but cannot explain the asthma case history in each case. Further methods are required to objectively assume irritative pathomechanisms. Our findings indicate the necessity for an improved primary prevention of exposure to inhalative noxae in bakeries.

Prevalencia de sensibilización a lepidoglyphus destructor, tyrophagus putrescentiae y chortoglyphus arcuatus en pacientes con asma y/o rinitis residentes en Rosario / Prevalence of sensitization to lepidoglyphus destructor, tyrophagus putrescentiae and chortoglyphus arcuatus in patients with asthma and/or rhinitis living in Rosario, Argentine

El objetivo del presente trabajo fue evaluar la prevalencia de la sensibilización a Lepidoglyphus destructor (Ld), Tyrophagus putrescentiae (Tp) y Chortoglyphus arcuatus (Cha) en pacientes con asma y/o rinitis que residen exclusivamente en Rosario y compararla con otros ácaros estudiados previamente. En tres centros privados y tres hospitales públicos, se estudiaron 216 pacientes, 54,6 por ciento de sexo femenino, con edades comprendidas entre los 5 y 55 años (x 23,3 años). El 20,8 por ciento de ellos presentaba asma, el 38,9 por ciento rinitis y el 40,3 por ciento ambas patologías. Se confeccionó un cuestionario tipo y se realizaron prick tests (SPT) con extractos de Ld, Tp, Cha, Dermatophagoides pteronsyssinus (Dp) y Blomia tropicalis (Bt) obtenidos a partir de aislamiento y cultivos locales, y con una batería de aeroalergenos comerciales. El 79,6 por ciento (n = 172) de los pacientes presentó al menos un STP (+) y de ellos, el 94,8 por ciento mostró sensibilidad a algún ácaro y el 48,3 por ciento a otros alergenos. La prevalencia de sensibilización a alguno de los tres ácaros en estudio fue de 76,2 por ciento (Ld 69,2 por ciento, Cha 64,0 por ciento y Tp 61,6 por ciento), siendo de 66,1 por ciento en los pacientes con rinitis, de 78,9 por ciento en asma y de 82,7 por ciento para ambas patologías. No se observaron diferencias entre centros públicos y privados. El 54,6 por ciento de los pacientes (n=89) tuvo SPT (+) para los 5 ácaros testeados, el 6 por ciento (n=13) fue (-) para Dp y (+) para alguno de los otros 4 ácaros y el 3 por ciento (n=6) fue (+) sólo a Ld, Tp ó Cha. Se concluye que la prevalencia de sensibilización a Ld, Tp y Cha hallada en Rosario justifica ampliamente su inclusión en el panel de aeroalergenos, lo que permitiría identificar sensibilizaciones inaparentes