RESUMO
In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis.
Assuntos
Venenos de Artrópodes/imunologia , Himenópteros/imunologia , Hipersensibilidade/imunologia , Mordeduras e Picadas de Insetos/imunologia , Animais , Venenos de Artrópodes/uso terapêutico , Hipersensibilidade/diagnóstico , Hipersensibilidade/epidemiologia , Hipersensibilidade/terapia , Testes Imunológicos , Imunoterapia/métodos , Mordeduras e Picadas de Insetos/diagnóstico , Mordeduras e Picadas de Insetos/epidemiologia , Mordeduras e Picadas de Insetos/terapia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Resultado do TratamentoRESUMO
INTRODUCTION: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. MATERIALS AND METHODS: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. RESULTS: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. CONCLUSIONS: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach.
Assuntos
Venenos de Artrópodes/administração & dosagem , Dessensibilização Imunológica/métodos , Himenópteros/imunologia , Hipersensibilidade/terapia , Mordeduras e Picadas de Insetos/terapia , Adolescente , Adulto , Idoso , Animais , Venenos de Artrópodes/efeitos adversos , Venenos de Artrópodes/imunologia , Criança , Dessensibilização Imunológica/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Tolerância Imunológica , Mordeduras e Picadas de Insetos/diagnóstico , Mordeduras e Picadas de Insetos/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Espanha , Fatores de Tempo , Resultado do Tratamento , Adulto JovemAssuntos
Alérgenos/imunologia , Antígenos de Fungos/imunologia , Aspergilose Broncopulmonar Alérgica/microbiologia , Aspergillus fumigatus/imunologia , Erros de Diagnóstico , Contaminação de Equipamentos , Música , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Microbiologia do Ar , Anticorpos Antifúngicos/sangue , Antifúngicos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/imunologia , Aspergilose Broncopulmonar Alérgica/terapia , Desinfecção , Contaminação de Equipamentos/prevenção & controle , Humanos , Imunoglobulina E/sangue , Exposição por Inalação/efeitos adversos , Testes Intradérmicos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Testes de Função Respiratória , Testes Sorológicos , Tomografia Computadorizada por Raios XAssuntos
Apomorfina/imunologia , Apomorfina/uso terapêutico , Tolerância a Medicamentos/imunologia , Hipersensibilidade/imunologia , Hipersensibilidade/prevenção & controle , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/imunologia , Apomorfina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: Blood component transfusion is a common procedure used during hospital admissions; however, it is not risk-free. The evaluation of correct use of blood products (BP) is of vast importance considering the risks and costs implied in their use. Our principal objective was to evaluate the adherence to national guidelines for blood transfusion in pediatric patients at a third level university hospital. MATERIAL AND METHODS: A prospective and retrospective descriptive analytical study was conducted to report the incidence of incorrect use of BP in pediatric patients (1 month to 16 years of age). In a timeline period of 4 years, 579 medical records were randomly selected from a total of 6575 transfusions realized to create a statistically significant sample. The variables studied were volume, infusion time, and transfusion criteria. Indications were evaluated in patient's medical records according to national guidelines. RESULTS: Of the transfusions analyzed, 54% were classified as incorrect mainly due to lack of transfusion criteria fulfillment. Blood transfusion indications in pediatric patients adhered poorly to national guidelines. CONCLUSION: The implementation of effective programs for education and information on the use of BP are needed to increase compliance with current guidelines.
Assuntos
Transfusão de Componentes Sanguíneos , Transfusão de Sangue , Criança , Hospitais Universitários , Humanos , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Denosumab is a human monoclonal antibody indicated for the treatment of osteoporosis in postmenopausal women with a high risk of fractures. To our knowledge, no cases of desensitization to this drug have been described in the literature. We report the first case of generalized urticarial reaction and facial angioedema after therapy with denosumab. A subcutaneous desensitization protocol was successfully completed in this patient. Rapid desensitization is a promising method for the delivery of denosumab after a hypersensitivity reaction, and should be considered in osteoporosis treatment when no acceptable therapeutic alternatives are available.
RESUMO
In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis (AU)
En esta revisión el Comité de Alergia a Himenópteros de la SEAIC ha analizado la literatura científica más reciente sobre los principales problemas diagnósticos de la alergia a himenópteros, así como sobre las dificultades que pueden surgir durante la inmunoterapia con venenos. Se revisan especialmente las novedades relacionadas con el diagnóstico molecular y los perfiles moleculares de riesgo. También se describe la alergia a himenópteros poco habituales y los problemas diagnósticos y terapéuticos que esta conlleva. Por último, se tratan los síndromes de activación mastocitaria clonal, íntimamente relacionados con la alergia a himenópteros, que se han convertido en un nuevo reto diagnóstico para el alergólogo (AU)
Assuntos
Humanos , Masculino , Feminino , Alergia e Imunologia/instrumentação , Hipersensibilidade/diagnóstico , Comitê de Profissionais/organização & administração , Comitê de Profissionais/normas , Biologia Molecular/métodos , Imunoterapia/métodos , Mordeduras e Picadas de Insetos/imunologia , Himenópteros , Mastocitose/complicações , Mastocitose/diagnóstico , Mastocitose/imunologia , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Anafilaxia/terapia , Venenos/imunologia , Venenos de Abelha/imunologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Aspergilose Broncopulmonar Alérgica/imunologia , Aspergillus fumigatus/imunologia , Aspergillus fumigatus/isolamento & purificação , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose Broncopulmonar Alérgica/fisiopatologia , Testes Cutâneos/métodos , Fungos/imunologia , Fungos/isolamento & purificação , FungosRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/imunologia , Apomorfina/efeitos adversos , Doença de Parkinson/complicações , 35170/análise , 35170/métodosRESUMO
Introduction: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. Materials and Methods: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. Results: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. Conclusions: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach (AU)
Introducción: La inmunoterapia con veneno de himenópteros (ITV) es un tratamiento eficaz, pero no está desprovisto de riesgo ya que pueden ocurrir reacciones adversas locales o sistémicas, especialmente en las etapas iniciales del tratamiento. Comparamos la tolerancia de tres protocolos de inicio de ITV y analizamos los factores de riesgo asociados con las reacciones adversas que se produjeron en esta fase. Métodos: Se incluyeron 165 pacientes divididos en tres grupos según el protocolo de iniciación utilizado (3, 4 o 9 semanas). Evaluamos la gravedad de las reacciones sistémicas de acuerdo con el modelo de la Organización Mundial de Alergia. Analizamos los resultados mediante estadística descriptiva exploratoria y comparamos variables mediante el análisis de la varianza. Resultados: Cincuenta y tres pacientes (32%) experimentaron algún tipo de reacción adversa; 43 eran locales y 10 sistémicas. Las reacciones locales fueron inmediatas en 27 pacientes (63%) y tardías en 16 (37%). La gravedad de la reacción local fue leve o moderada en 15 pacientes y grave en 13. Las reacciones sistémicas fueron de grado 1 o 2. No encontramos asociación significativa entre la modalidad de tratamiento y la aparición de reacciones adversas locales o sistémicas o el tipo de reacción local. Solo encontramos una asociación estadísticamente significativa de la gravedad de la reacción local con el sexo femenino. En cuanto a los factores de riesgo asociados con las reacciones sistémicas en la fase de inicio, no se encontraron diferencias significativas en estos valores en función del protocolo utilizado o el insecto responsable. Conclusiones: Los protocolos de inicio comparados demostraron ser seguros y no difirieron significativamente entre sí. En la población estudiada, el protocolo de 9-semanas no produjo reacciones sistémicas, por lo que se puede considerar el protocolo más seguro (AU)
Assuntos
Humanos , Masculino , Feminino , Mordeduras e Picadas de Insetos/imunologia , Venenos/imunologia , Imunoterapia/métodos , Imunoterapia , Dessensibilização Imunológica/métodos , Fatores de Risco , Himenópteros/imunologia , 35170/métodos , Espanha/epidemiologia , Estudos ProspectivosRESUMO
Clopidogrel is a new antiplatelet prescribed for the secondary prevention of atherosclerotic events. The literature shows that the clinical manifestations of clopidogrel hypersensitivity include urticaria1, skin rash2-4, and angioedema5. The precise immunological mechanism underlying clopidogrel hypersensitivity has not been established. We describe two cases of hypersensitivity reaction due to clopidogrel. The first constituted an immediate reaction after clopidogrel intake. In this case we demonstrated type 1 hypersensitivity using cutaneous tests. The second case represented a delayed hypersensitivity reaction confirmed by oral challenge testing, in which good tolerance to other antiplatelet drugs such as ticlopidine was demonstrated.
Assuntos
Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Imediata/diagnóstico , Inibidores da Agregação Plaquetária/efeitos adversos , Ticlopidina/análogos & derivados , Idoso de 80 Anos ou mais , Clopidogrel , Humanos , Hipersensibilidade Tardia/imunologia , Hipersensibilidade Imediata/imunologia , Masculino , Pessoa de Meia-Idade , Ticlopidina/efeitos adversosRESUMO
Clopidogrel is a new antiplatelet prescribed for the secondary prevention of atherosclerotic events. The literature shows that the clinical manifestations of clopidogrel hypersensitivity include urticaria1, skin rash2-4, and angioedema5. The precise immunological mechanism underlying clopidogrel hypersensitivity has not been established. We describe two cases of hypersensitivity reaction due to clopidogrel. The first constituted an immediate reaction after clopidogrel intake. In this case we demonstrated type 1 hypersensitivity using cutaneous tests. The second case represented a delayed hypersensitivity reaction confirmed by oral challenge testing, in which good tolerance to other antiplatelet drugs such as ticlopidine was demonstrated
El Clopidogrel (Plavit), es un nuevo antiagregante plaquetario, indicado en la prevención secundaria de eventos ateroescleróticos. En la bibliografía, las manifestaciones clínicas descritas por hipersensibilidad al clopidogrel incluyen urticaria, rash cutáneo y angioedema. El mecanismo inmunológico preciso de la hipersensibilidad al Clopidogrel no ha sido elucidado. Describimos dos casos de reacciones de hipersensibilidad por Clopidogrel. El primer caso se trata de una reacción inmediata tras la administración de Clopidogrel, en él demostramos hipersensibilidad de tipo I mediante pruebas cutáneas. El segundo caso se trata de una reacción tardía por sensibilización tipo IV al Clopidogrel, confirmada con prueba de provocación oral en el cual además demostramos buena tolerancia a otros antiagregantes plaquetarios como la Ticlopidina