Fungal allergens in a saxophonist who had never smoked with allergic bronchopulmonary aspergillosis previously diagnosed as COPD

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Bleeding and Shock in a 44-Year-Old Woman With Systemic Mastocytosis

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Occupational asthma due to carrot in a cook

Background: Few previous reports of carrot-induced asthma have been confirmed by objective tests. Hypersensitivity to carrot is frequently associated with allergy to Apiaceae spices and sensitization to birch and mugwort pollens. Clinical case: A 40-year-old cook woman was seen with sneezing, rhinorrhea, contact urticaria and wheezing within few minutes of handling or cutting raw carrots. She needed to leave out of the kitchen while the other cooks cut raw carrots. Methods and results: Skin tests were positive to carrot, celery, aniseed and fennel. Rubbing test with fresh carrot was positive. Specific IgE to carrot was 4.44 kU/L. Determinations of specific IgE to mugwort, grass and birch pollens were negative. Inhalative provocation test, performed as a handling test, was positive. The IgE-immunoblotting showed two bands in carrot extract: a band with apparent molecular weight of 30 kd and other band of 18 kd. This band of 18 kd was Dau c 1. The band of 30 kd could correspond a phenylcoumaran benzylic ether reductase. Dau c 1 did not appear to be the unique allergen in this case. Additional allergens may induce the sensitization. Primary sensitization due to airborne allergens of foods and the lack of pollen allergy in this patient are notorious events

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Carbamazepine induced transient monoclonal gammopathy and immunodeficiency

Immune abnormalities have been found in many patients receiving anti-epileptic drugs. However, the effects of carbamazepine are still conflicting. We report the case of a 31-year-old woman who began carbamazepine treatment because of idiopathic epilepsy of adulthood. After three years of treatment she developed arthralgias and malaise. Complete immunologic evaluation showed a total absence of immunoglobulin M with decreased levels of immunoglobulin A, positive antinuclear antibodies and monoclonal paraproteinemia type IgG-kappa. The possibility of B cell lymphoma or myeloma was ruled out. Skin testing was negative. Bone marrow examination was normal. After carbamazepine discontinuation, levels of IgA and IgM increased until reaching normal values over 3 years. The monoclonal gammopathy of undetermined significance also disappeared over this period. During this period of immunodeficiency, the patient did not complain of any infectious complications (AU)

Se han detectado alteraciones inmunitarias en muchos pacientes que reciben antiepilépticos; sin embargo, los efectos de carbamacepina siguen siendo contradictorios. Describimos el caso de una mujer de 31 años que empezó a tomar carbamacepina por epilepsia idiopática en adultos. Después de tres años de tratamiento, experimentó artralgias y malestar. Una evaluación inmunológica completa reveló la ausencia total de inmunoglobulina M y disminución de la concentración de inmunoglobulina A, anticuerpos antinucleares positivos y una paraproteinemia monoclonal de tipo IgG-kappa. Se descartó la posibilidad de linfoma de los linfocitos B o mieloma. Las pruebas cutáneas fueron negativas. La exploración de la médula ósea fue normal. Después de suspender la carbamacepina, las concentraciones de IgA e IgM aumentaron hasta alcanzar sus valores normales a lo largo de 3 años. La gammapatía monoclonal de significación indeterminada también desapareció a lo largo de ese período. Durante ese período de inmunodeficiencia, la paciente no experimentó ninguna complicación infecciosa (AU)

Anaphylactoid reaction to carboplatin: successful "desensitization"

Carboplatin (CP) hypersensitivity reactions have been reported in nearly 12 % of patients treated with this drug. The pathophysiologic mechanisms of these reactions have not been entirely elucidated. Various hypotheses are under discussion. CP hypersensitivity reactions could be IgE-mediated, caused by low-molecular platinum compounds acting as haptens. Platinum salts are also able to release histamine from basophils and mast cells, and some events seem to be non-immune-mediated direct histamine release. We report a case of CP tolerance induction in a 65-year-old man. During the third course of CP he experienced an anaphylactic reaction. Skin testing was negative. Suspecting the possibility of an anaphylactoid reaction due to histamine release, we developed a protocol to induce tolerance. Pre-medication with corticosteroid and antihistaminic was performed before intravenous CP infusion. The bag with CP was first infused 60 ml/h for 30 minutes; the infusion was well tolerated and infusion was continued at 100 ml/h for the next 60 minutes and thereafter at 120 ml/h until the bag was finished. Following this "desensitization", monthly courses of CP using the same protocol have been well tolerated (AU)

En cerca del 12 por ciento de los pacientes tratados con carboplatino (CP) se han descrito reacciones de hipersensibilidad a este fármaco. Los mecanismos patofisiológicos de estas reacciones no se han esclarecido del todo, y se barajan varias hipótesis. Las reacciones de hipersensibilidad a la CP podrían ser mediadas por la IgE, o provocadas por compuestos de platino de bajo peso molecular que actúen como haptenos. Las sales de platino son asimismo capaces de liberar histamina de los basófilos y mastocitos, y algunas reacciones parecen proceder de una liberación directa de histamina no inmunomediada. Se expone el caso de una inducción de tolerancia a la CP en un varón de 65 años. Durante el 3.er tratamiento con CP, el paciente experimentó una reacción anafiláctica. La prueba cutánea resultó negativa. Pensando en la posibilidad de una reacción anafilactoide debida a la liberación de histamina, desarrollamos un protocolo para inducir la tolerancia. Se realizó una premedicación con corticosteroides y antihistamínicos previa a la infusión intravenosa de CP. La primera infusión con una bolsa de CP se realizó a 60 ml/h durante 30 minutos; la infusión fue bien tolerada y procedimos a administrar 100 ml/h durante 60 minutos más, para después pasar a 120 ml/h hasta terminar la bolsa. Los ciclos mensuales con CP han sido bien tolerados tras esta "desensibilización" mediante la aplicación del mismo protocolo (AU)