Eosinophil cationic protein in feces: reference values in healthy and atopic individuals and patients with digestive diseases.

Eosinophil cationic protein (ECP) is a good indicator of eosinophilic activity and turnover, serving as a marker of activity in allergic and gastrointestinal diseases characterized by predominantly eosinophilic tissue infiltration. Our aim was to compare ECP levels infeces from healthy individuals, atopic patients, and patients with digestive diseases and establish reference values for this clinical setting. Thirty-nine healthy adults, 28 atopic patients, and 14 patients with digestive diseases were enrolled. The atopic patients had been diagnosed with allergic rhinoconjunctivitis and/or asthma. ECP concentrations in the supernatants from processed feces adjusted for semidry weight (microg/g feces) were determined by fluorescent enzyme immunoassay. Between-group comparisons were performed of medians and interquartile ranges (IQR) by nonparametric tests. Median (IQR) ECP levels were 8.16 (4.11-17.61), 10.83 (5.18-18.49), and 13.02 (5.17-21.97) microg/g feces in controls, atopic patients, and digestive disease patients, respectively; mean (SD) levels were 14.53 (13.77), 13.93 (11.30), and 16.51 (14.79) microg/g of feces. No significant differences in the medians were observed between the atopic group and controls (p = 0.725), the atopic group and digestive disease patients (p = 0.513), or the controls versus the digestive disease patients (p = 0.694). We provide reference values for ECP levels in feces for normal and atopic adults. There is considerable variability in ECP levels in feces and the median levels are similar in healthy and atopic individuals and patients with digestive diseases.

Hypersensitivity reactions to metronidazole.

BACKGROUND: Hypersensitivity reactions to metronidazole are infrequently described. However, we believe that such reactions are increasing due to growing use of the drug for the treatment of amebiasis and anaerobe infections combined with other antibiotics. The present study assesses the need for oral provocation in patients with probable hypersensitivity reactions to metronidazole. METHODS: We performed cutaneous prick tests with spiramycin and metronidazole as well as epicutaneous tests with metronidazole at different concentrations in four patients with cutaneous reactions to Rhodogil (metronidazole plus spiramicyn). Controlled oral challenges were then carried out with placebo using erythromycin, spiramycin and metronidazole except in the last patient due to a positive prick test. RESULTS: Only one patient showed a positive metronidazole prick test. The epicutaneous tests were negative. All patients tolerated erythromycin and spiramycin up to therapeutic doses. Oral provocation with metronidazole proved positive, the first patient presenting a delayed exanthema and the other two early erythema and itching. CONCLUSIONS: We present four cases of cutaneous exanthemas caused by metronidazole (two early and two delayed) and probably mediated by an immune mechanism which we have only been able to demonstrate in one case. Taking into account the low sensitivity of the cutaneous tests (prick tests and epicutaneous tests), oral provocation must be considered the "gold standard" for establishing the diagnosis in many cases of hypersensitivity reactions to metronidazole.

Hypersensitivity reactions to metronidazole / Reacciones de hipersensibilidad a metronidazol

Background: Hypersensitivity reactions to metronidazole are infrequently described. However, we believe that such reactions are increasing due to growing use of the drug for the treatment of amebiasis and anaerobe infections combined with other antibiotics. The present study assesses the need for oral provocation in patients with probable hypersensitivity reactions to metronidazole. Methods: We performed cutaneous prick tests with spiramycin and metronidazole as well as epicutaneous tests with metronidazole at different concentrations in four patients with cutaneous reactions to Rhodogil® (metronidazole plus spiramicyn). Controlled oral challenges were then carried out with placebo using erythromycin, spiramycin and metronidazole except in the last patient due to a positive prick test. Results: Only one patient showed a positive metronidazole prick test. The epicutaneous tests were negative. All patients tolerated erythromycin and spiramycin up to therapeutic doses. Oral provocation with metronidazole proved positive, the first patient presenting a delayed exanthema and the other two early erythema and itching. Conclusions: We present four cases of cutaneous exanthemas caused by metronidazole (two early and two delayed) and probably mediated by an immune mechanism which we have only been able to demonstrate in one case. Taking into account the low sensitivity of the cutaneous tests (prick tests and epicutaneous tests), oral provocation must be considered the "gold standard" for establishing the diagnosis in many cases of hypersensitivity reactions to metronidazole

Antecedentes: Las reacciones de hipersensibilidad por metronidazol descritas no son frecuentes. Sin embargo, creemos que están aumentando debido a su mayor uso para el tratamiento de amebiasis e infecciones por anaerobios combinado con otros antibióticos. Nuestro objetivo fue valorar la necesidad de la provocación oral en pacientes con probables reacciones de hipersensibilidad por metronidazol. Métodos: Se realizaron pruebas cutáneas en prick con espiramicina y metronidazol así como pruebas epicutáneas con éste último a distintas concentraciones en cuatro pacientes que consultaron por reacciones cutáneas con Rhodogil® (metronidazol más espiramicina. A continuación se llevaron a cabo provocaciones orales controladas con placebo con eritromicina, espiramicina y metronidazol. Resultados: El prick sólo fue positivo para metronidazol en uno de los casos. Las pruebas epicutáneas fueron negativas. Todos los pacientes toleraron la eritromicina y espiramicina hasta dosis terapeúticas. La provocación oral con metronidazol fue positiva (excepto en el último paciente por la positividad del prick), presentando el primer paciente un exantema tardío y los otros dos eritema y prurito de forma precoz. Conclusiones: Presentamos cuatro casos de exantemas cutáneos por metronidazol (dos precoces y dos tardíos) probablemente mediados por un mecanismo inmunológico que sólo hemos podido demostrar en uno de ellos. Teniendo en cuenta la baja sensibilidad de las pruebas cutáneas, tanto en prick como epicutáneas, la provocación oral debe considerarse como el “gold standard” necesario para llegar al diagnóstico de muchos casos de reacciones de hipersensibilidad por metronidazol