The efficacy of a medication review programme conducted in an emergency department.

Background Older age and inappropriate prescribing is related to a greater rate of emergency department visits and hospitalisations. Objective To assess the efficacy of an interprofessional collaboration programme in which a review of the medication of older patients seen in the emergency observation unit was carried out. Setting Emergency departments at four Spanish hospitals. Method Randomised, controlled study. Patients over 65 years of age presenting to the emergency department were randomised to a control or an intervention group. In the intervention group, a pharmacist reviewed the patients' chronic medication and identified any potentially inappropriate prescriptions based on the STOPP/START criteria. Each case was discussed with the emergency specialist and a recommendation to modify the treatment was sent to the general practitioner. Main outcome measure Rate of emergency visits and hospital admissions. Results The adjusted rate ratio of emergency visits and hospital admissions was 0.808 (95% CI 0.617 to 1.059) at 3 months, 0.888 (95% CI 0.696 to 1.134) at 6 months and 0.954 (95% CI 0.772 to 1.179) at 12 months. There was a statistically significant reduction at 3 months in two of the hospitals that participated in the study [adjusted rate ratio at 3 months was 0.452 (95% CI 0.222 to 0.923) in hospital 3 and 0.567 (95% CI 0.328 to 0.983) in hospital 4]. Conclusion Overall, the intervention did not reduce the number of emergency visits and hospital admissions. However, a significant effect was observed in centres were a high acceptance rate of treatment recommendations was achieved.

Diagnostic use of recombinant Tha p 2 in the allergy to Thaumetopoea pityocampa.

Thaumetopoea pityocampa causes allergies and skin and ocular lesions. No commercial tools are currently available for the clinical diagnosis of this allergy. We aimed to develop an in vitro method for the diagnosis of this allergy to avoid patients undergoing in vivo tests with insect extracts. Recombinant Tha p 2 was produced and used in an ELISA validated with 15 allergic patients. Subsequently, 42 subjects recruited from a random sampling cross-sectional study were analysed. The ELISA sensitivity and specificity were 93.3% and 100%, respectively, for the allergic patients and 71.4% and 95.3%, respectively, for the epidemiological study. The positive ELISA results correlated with the skin prick test areas with the whole body and the setae extracts. Professional exposure and short latency of symptoms onset were risk factors for a positive result in the ELISA. In conclusion, our ELISA is very useful for T. pityocampa allergy diagnosis and for epidemiologic testing.

Latex allergy in fruit-allergic patients.

The purpose of this study was to investigate the prevalence of latex allergy in fruit-allergic patients, and to assess its clinical significance. Fifty-seven fruit-allergic patients and 50 non-fruit-allergic atopic patient controls were studied. All patients were questioned about conventional immediate symptoms after contact with latex products. Patients also underwent skin prick testing and determination of specific serum IgE to latex, as well as a screening test for environmental allergens. Immunologic latex sensitization occurred in 49/57 (85.9%) fruit-allergic patients, who showed a positive STP and/or CAP to latex, but in only two controls (P < 0.001). Six out of 57 (10.5%) fruit-allergic patients suffered from clinically relevant latex allergy. Symptoms included contact urticaria, angioedema, conjunctivitis, generalized urticaria, and moderate anaphylactic reactions. No control reported symptoms with latex products (P = 0.052). In all patients, clinical symptoms to fruits preceded a history of latex allergy. The fruits most associated were melon, peach, and banana. From our data, we conclude that there is a potential for allergic reactions to latex in patients with allergy to fruit. All patients with fruit allergy should be screened for individual risk of latex allergy.

Contact allergy to henna.

Vegetable dyes can be recommended to patients sensitized to oxidative dyes due to their low allergenic power. The most important of these is henna which is used as a reddishbrown hair dye in some parts of the world. Different pathologies have been described caused by henna but the incidence of contact dermatitis appears to be extremely rare. In the present paper, we describe the case of a 30-year-old woman who developed allergic contact dermatitis following application of henna, but who did not work with the dye professionally.

Allergy to foods in patients monosensitized to Artemisia pollen.

It is known that patients with pollinosis may display clinical characteristics caused by allergy to certain fruits and vegetables, but subjects allergic to Artemisia seem to show particularly peculiar characteristics. The clinical features of 84 patients with rhinitis, asthma, urticaria, and/or anaphylaxis whose inhalant allergy was exclusively to Artemisia vulgaris were studied and compared with a control group of 50 patients monosensitized to grass pollen. The mean age for the beginning of symptoms was 30.2 years, and this was higher than in the control group (P < 0.05). We found the main incidence to be in women (70.2%). Some 42.3% had family history of atopia, lower than in the control group (P < 0.05), while the prevalence of asthma and urticaria was significantly higher (P < 0.05). Food hypersensitivity was reported by 23 patients (27.3%) allergic to Artemisia. The foods responsible (with respective numbers of cases) were honey (14), sunflower seeds (11), camomile (four), pistachio (three), hazelnut (two), lettuce (two), pollen (two), beer (two), almond (one), peanut (one), other nuts (one), carrot (one), and apple (one). None of the patients monosensitized to grass had food allergy. CAP inhibition experiments were carried out on a single patient. Results showed the existence of common antigenic epitopes in pistachio and Artemisia pollen for this patient. We concluded that mugwort hay fever can be associated with the Compositae family of foods, but that it is not normally associated with other foods.

An immunoblotting analysis of cross-reactivity between melon, and plantago and grass pollens.

It is known that most patients with type I allergy to pollens also suffer intolerance to fruits. Recently, an epidemiological and CAP-inhibition study has shown a new clustering of allergy between melon and Plantago and grass pollens. The aim of the present study was to confirm these results by immunoblotting analysis and inhibition of immunoblotting. Sera from 3 patients with confirmed allergy to melon, and Dactylis glomerata and Plantago lanceolata pollens were used for the in vitro studies. SDS-PAGE and immunoblotting analysis with a pool of sera revealed that several distinct protein bands were shared by the three extracts at 14, 31, and a spectrum between 40 and 70 kDa, approximately. Immunoblotting inhibition experiments, performed with extracts of melon, Plantago and Dactylis, showed that all allergens of melon blotting were almost completely inhibited by grass and Plantago pollen extracts. Inversely, the melon extract was capable of inhibiting IgE-binding to various allergens of Dactylis at high mol mass and partially to the band at 14 kDa. Moreover, the melon almost totally inhibited the IgE-binding capacity to the proteins of Plantago extract. Taken together, the results support the presence of structurally similar allergens in melon, Plantago and grass pollens, and that all allergenic epitopes of the melon are present in these pollens.

Melon sensitivity shares allergens with Plantago and grass pollens.

Possible associations between allergy to pollen and that to food allergens were studied in 262 patients sensitized to pollen. Forty-four patients (16.7%) showed some allergic symptoms after testing with fruits and vegetables, melon being the food most frequently involved (24 patients), followed by sunflower seed (12 patients). Skin testing was done by the prick method with natural fruit or vegetable, and also with commercial food extracts. We found in our region that the distribution of sensitivity to pollens in the group of patients with allergy to fruits or vegetables does not coincide with the prevalence in pollen-allergic subjects in general, since in the first group--subjects allergic to food--there was a major prevalence of allergy to Plantago (P < 0.01). In particular, in the group of subjects allergic to melon, the prevalence of sensitivity to grass and especially to Plantago was larger than in pollen-allergic subjects in general (P < 0.05 and P < 0.001, respectively). The use of fresh food produced better results than commercial extracts. A positive skin test to fresh melon closely correlated with positive CAP results. CAP inhibition experiments were carried out, and we found that Dactylis and Plantago extracts inhibited the binding of the melon-positive pool to solid-phase melon. The results suggest the existence of common antigenic epitopes in melon and Plantago pollen, and in melon and grass pollen.

Bronchial asthma induced by hypersensitivity to legumes.

We report the case of a 54-year-old female patient, diagnosed of nasal polyposis and intrinsic corticodependent bronchial asthma, who since a year has developed episodes of asthma when exposed to vapours from cooking some kinds of legumes (peas, chick-peas, beans, lentils) and an oral allergy syndrome with peanuts. We prepared extract with these legumes. The skin tests were clearly positive for legumes but negative for pneumoallergens. Specific IgE by CAP was strongly positive for legumes. CAP inhibition was preformed and the results show the presence of cross-reactivity among legumes.