Inhaled corticosteroids may have a protective effect against coronavirus infection.

BACKGROUND: Spain has been severely affected by the COVID-19 epidemic, with 195,944 persons infected and 20,453 deaths at the time of writing. Older people with respiratory or cardiac conditions are most at risk. OBJECTIVE: The aim was to compare respiratory symptoms in nursing home residents and patients with uncontrolled asthma, who are considered vulnerable to COVID-19. METHODS: We studied 134 nursing home residents and 139 patients with uncontrolled asthma, groups vulnerable to COVID-19. Demographic characteristics, clinical manifestations, outcomes, key laboratory results, and radiological images were collected from medical records. COVID-19 infection was detected by polymerase chain reaction (PCR). RESULTS: Thirteen (9.3%) patients with uncontrolled asthma, all receiving inhaled corticosteroids were infected by COVID-19. Eighty (60%) nursing home residents were infected; only 28, all of whom had received inhaled corticosteroids, had a good prognosis. CONCLUSIONS: Early treatment with inhaled corticosteroids may be helpful in COVID-19 infection. Persons with an allergy might have some protective mechanisms against coronavirus.

Germination of pollen grains in the oesophagus of individuals with eosinophilic oesophagitis.

BACKGROUND: Eosinophilic oesophagitis (EoE) is characterized by oesophageal dysfunction and, histologically, by eosinophilic inflammation. There is no a clear aetiologic treatment. EoE exacerbations are often seasonal. We hypothesized that the inflammatory response of the oesophageal mucosa in patients with high levels of antibodies to pollen allergens and worsened seasonal EoE might be due to swallowing airborne pollen and the intrusion into the oesophageal mucosa of pollen allergens and pollen tubes, which encounter a pH and humidity resembling the stigma at pollination. OBJECTIVE: The aim of our study was to demonstrate the possible pathogenic role of environmental allergens in EoE through molecular and anatomopathological studies METHODS: One hundred and twenty-nine patients with EoE were tested for environmental and food allergens. Component resolved diagnosis (CRD), histological and botanical analysis was performed. Microscopic examination of oesophageal biopsies of 129 adults patients with EoE, 82 of them with seasonal exacerbation, and 100 controls, with gastroesophageal reflux without eosinophilic infiltrate, were made to verify the presence of callose (polysaccharide abundant in pollen tubes but absent in animal tissues) in the oesophagus. RESULTS: Component resolved diagnosis detected pollen allergens in 87.6% of patients with EoE. The predominant allergens were group 1 grass (55%), Art v 3 (11.3%) and lipid transfer proteins (LTPs) (19.4%) of common Mediterranean foods such as peach, hazelnuts, walnuts and wheat. Callose from pollen tubes was found in 65.6% of biopsies. CONCLUSION: Alteration of the mucosal barrier in EoE might cause the penetration of pollen grains into the oesophageal tissues. In EoE patients, anatomopathological studies searching for intrusion to plant foods and pollen, and specific-guided diet and immunotherapy after plant structures detection in biopsies, might be effective. CLINICAL RELEVANCE: It is possible to see the intrusion into animal tissues (oesophagus mucosa) of plant structures (pollen grains or pollen tubes) using an adecuate histologic botanical analysis. Molecular and anatomopathological studies can help to demonstrate a possible pathogenic role of environmental allergens in EoE.

Component-resolved diagnosis in allergic disease: Utility and limitations.

Component resolved diagnosis (CRD) is a microarray-based diagnostic solution capable of simultaneously analysing specific IgE antibodies against 112 allergenic components, providing sensitivity patterns for multi-sensitised or complex patients. The CRD is indicated for these patients, especially those with concomitant respiratory and food allergies. This study reivews the method, its utility, limitations, and our experience in allergic diseases with difficult etiologic diagnosis (eosinophilic esophagitis, occupational asthma and drug allergy).

[Multiple birth trends in the region of Castilla y León (Spain) in a 13 year period]. / Evolución temporal de los partos múltiples en Castilla y León durante 13 años.

INTRODUCTION: Multiple pregnancy has increased in prevalence in the last few years, which could lead to more foetal and maternal morbidity issues. The aim of this study is to describe the trend of multiple pregnancy deliveries in Castilla y León during the last 13years and the subsequent impact on foetal and maternal health. MATERIAL AND METHODS: Data was collected from the hospital discharge reports registered in the Regional Health-care database (SACYL: Health care in Castilla y León) between 2001 and 2013. A cross sectional descriptive study was conducted, including trend analysis with log-linear joint point model, a rhythm metric study, as well as a risk assessment with multivariate analysis. RESULTS: A pronounced upward trend was observed in the proportion of multiple deliveries in this time period, compared to single ones, with an annual percentage change of 3.4% (95% CI: 2.5-4.4). Multiple pregnancy was significantly correlated with advanced maternal age, abnormal glucose tolerance, dystocia and caesarean section delivery, premature birth, foetal malposition, foetal macrosomia, stillbirth, in vitro fertilisation, and hypertensive episodes of pregnancy. In vitro fertilization showed a 9.3 fold increased risk in multiple pregnancy (95% CI: 7.4-11.5), with maternal age increasing the risk up to 5% per year of age (OR: 1.05: 95%CI: 1.04-1.05). No seasonal rhythm was observed in multiple deliveries compared with single ones. CONCLUSION: Multiple pregnancy has experienced a continuous increase, with no seasonal trend, and is associated with the increase in assisted reproductive technology and advanced maternal age. This involves more problems regarding foetal and maternal morbidity and mortality.

Cocaine Allergy in Drug-Dependent Patients and Allergic People.

BACKGROUND: Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine. OBJECTIVE: To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation. METHODS: We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard. RESULTS: After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy. CONCLUSIONS: Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.

Inhaled corticosteroids may have a protective effect against coronavirus infection

BACKGROUND: Spain has been severely affected by the COVID-19 epidemic, with 195,944 persons infected and 20,453 deaths at the time of writing. Older people with respiratory or cardiac conditions are most at risk. OBJECTIVE: The aim was to compare respiratory symptoms in nursing home residents and patients with uncontrolled asthma, who are considered vulnerable to COVID-19.METHODS: We studied 134 nursing home residents and 139 patients with uncontrolled asthma, groups vulnerable to COVID-19. Demographic characteristics, clinical manifestations, out-comes, key laboratory results, and radiological images were collected from medical records. COVID-19 infection was detected by polymerase chain reaction (PCR).RESULTS: Thirteen (9.3%) patients with uncontrolled asthma, all receiving inhaled corticoste-roids were infected by COVID-19. Eighty (60%) nursing home residents were infected; only 28, all of whom had received inhaled corticosteroids, had a good prognosis CONCLUSIONS: Early treatment with inhaled corticosteroids may be helpful in COVID-19 infection. Persons with an allergy might have some protective mechanisms against coronavirus

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Nuevas medidas de diagnóstico eficiente en la hipersensibilidad alérgica al látex / New tests for an efficient diagnosis in allergic hypersensitivity to latex

La alergia al látex es una respuesta alterada de nuestro organismo al contactar con las proteínas que se encuentran en el látex de caucho natural. Los síntomas de la hipersensibilidad alérgica al látex son bastante parecidos a los de la alergia a los alimentos, siendo menos frecuentes los síntomas digestivos y más típicos los cutáneos tras el uso de guantes de látex, y los nasales y/o el asma tras la inhalación del polvo de los guantes de látex o de los globos. En caso de pacientes muy sensibles puede provocar reacciones alérgicas graves si entra en contacto con mucosas o cavidades internas. Se da la paradoja de que el medio hospitalario, es el lugar de más riesgo dada la cantidad existente de látex, tanto directo como indirecto. Las personas alérgicas al látex presentan a menudo reacciones alérgicas cruzadas, a veces graves, tras ingerir determinadas frutas y vegetales. Las reacciones cruzadas se deben a los alérgenos comunes presentes en el látex y en los diferentes alimentos. Es importante utilizar el análisis molecular de alérgenos para detectar falsos diagnósticos a látex por problemas de reactividad cruzada con proteínas de frutas. Indicamos cómo estas nuevas pruebas han sustituido a análisis menos precisos y eficientes, logrando un considerable ahorro de recursos

Latex allergy is an altered response of the body on contact with proteins found in natural rubber latex. The symptoms of allergic hypersensitivity to latex are quite similar to those of food allergy, with the gastrointestinal symptoms being less frequent and the cutaneous ones being more typical after the use of latex and nasal gloves and / or the asthma after the inhalation of the dust from latex gloves or balloons. In the case of very sensitive patients it can cause severe allergic reactions if it comes in contact with mucous membranes or internal cavities. There is a paradox that the hospital environment is the most risky place, given the existing amount of latex in direct and indirect use. People who are allergic to latex often have cross-allergic reactions, sometimes severe, after eating certain fruits and vegetables. The cross-reactions are due to the common allergens present in latex and in different foods. It is important to use molecular allergen analysis to detect false latex diagnoses due to problems of cross-reactivity with fruit proteins. It is indicated how these new tests have replaced less accurate and efficient analyses, achieving a considerable saving of resources

Evolución temporal de los partos múltiples en Castilla y León durante 13 años / Multiple birth trends in the region of Castilla y León (Spain) in a 13 year period

Introducción: La prevalencia del embarazo múltiple está experimentando un ascenso en los últimos años, lo que conlleva un aumento de la morbimortalidad fetal y de la morbilidad materna. El objetivo de este estudio es analizar la evolución de los partos múltiples en Castilla y León durante 13 años y sus implicaciones maternas y fetales. Material y métodos: Estudio de asociación cruzada, sobre el conjunto mínimo básico de datos (CMBD), de altas hospitalarias de la red Sanidad de Castilla y León (SACYL) entre 2001 y 2013. Se realizó un análisis de tendencias mediante regresión lineal de joinpoint, un análisis ritmométrico y un análisis multivariante mediante regresión logística binaria. Resultados: A lo largo de los 13 años de estudio se observa una tendencia creciente en la proporción de partos múltiples, en contraste con los únicos, con un porcentaje anual de cambio del 3,4% (IC del 95%: 2,5-4,4%). Se encontró asociación estadística entre la edad materna, la tolerancia anormal a la glucosa, el parto operatorio, la macrosomía fetal, el parto prematuro, la muerte fetal, las malposiciones fetales, la fecundación in vitro y los estados hipertensivos maternos y el parto gemelar, destacando que la fecundación in vitro se asocia con un exceso de riesgo de 9,3 veces de parto múltiple (IC del 95%: 7,4-11,5), así como la edad de la madre se asocia con un exceso de riesgo del 5% por cada año de edad (OR: 1,05; IC 95%: 1,04-1,05). No se evidenció estacionalidad en los partos múltiples en contraposición con los únicos. Conclusiones: Los partos múltiples experimentaron un continuo ascenso, sin seguir un ritmo estacional, asociados a la extensión del uso de las técnicas de reproducción asistida y al retraso en la edad de la maternidad, lo que conlleva mayor morbimortalidad fetal y materna

Introduction: Multiple pregnancy has increased in prevalence in the last few years, which could lead to more foetal and maternal morbidity issues. The aim of this study is to describe the trend of multiple pregnancy deliveries in Castilla y León during the last 13years and the subsequent impact on foetal and maternal health. Material and methods: Data was collected from the hospital discharge reports registered in the Regional Health-care database (SACYL: Health care in Castilla y León) between 2001 and 2013. A cross sectional descriptive study was conducted, including trend analysis with log-linear joint point model, a rhythm metric study, as well as a risk assessment with multivariate analysis. Results: A pronounced upward trend was observed in the proportion of multiple deliveries in this time period, compared to single ones, with an annual percentage change of 3.4% (95% CI: 2.5-4.4). Multiple pregnancy was significantly correlated with advanced maternal age, abnormal glucose tolerance, dystocia and caesarean section delivery, premature birth, foetal malposition, foetal macrosomia, stillbirth, in vitro fertilisation, and hypertensive episodes of pregnancy. In vitro fertilization showed a 9.3 fold increased risk in multiple pregnancy (95% CI: 7.4-11.5), with maternal age increasing the risk up to 5% per year of age (OR: 1.05: 95%CI: 1.04-1.05). No seasonal rhythm was observed in multiple deliveries compared with single ones. Conclusion: Multiple pregnancy has experienced a continuous increase, with no seasonal trend, and is associated with the increase in assisted reproductive technology and advanced maternal age. This involves more problems regarding foetal and maternal morbidity and mortality