Asunto(s)
Alérgenos/inmunología , Antígenos Fúngicos/inmunología , Aspergilosis Broncopulmonar Alérgica/microbiología , Aspergillus fumigatus/inmunología , Errores Diagnósticos , Contaminación de Equipos , Música , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Microbiología del Aire , Anticuerpos Antifúngicos/sangre , Antifúngicos/uso terapéutico , Aspergilosis Broncopulmonar Alérgica/diagnóstico , Aspergilosis Broncopulmonar Alérgica/inmunología , Aspergilosis Broncopulmonar Alérgica/terapia , Desinfección , Contaminación de Equipos/prevención & control , Humanos , Inmunoglobulina E/sangre , Exposición por Inhalación/efectos adversos , Pruebas Intradérmicas , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pruebas de Función Respiratoria , Pruebas Serológicas , Tomografía Computarizada por Rayos XRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Aspergilosis Broncopulmonar Alérgica/diagnóstico , Aspergilosis Broncopulmonar Alérgica/tratamiento farmacológico , Aspergilosis Broncopulmonar Alérgica/inmunología , Aspergillus fumigatus/inmunología , Aspergillus fumigatus/aislamiento & purificación , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Aspergilosis Broncopulmonar Alérgica/complicaciones , Aspergilosis Broncopulmonar Alérgica/fisiopatología , Pruebas Cutáneas/métodos , Hongos/inmunología , Hongos/aislamiento & purificación , HongosRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adulto , Choque Hemorrágico/etiología , Mastocitosis Sistémica/complicaciones , Trastornos de la Coagulación Sanguínea/complicacionesRESUMEN
BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) has considerable implications for dental health care providers, since dental procedures may trigger severe and even life-threatening episodes. The aim of the present study was to analyze the efficacy and safety of premedication with attenuated androgens (AAs), plasma-derived human C1 esterase inhibitor concentrate (pdhC1INH), or both to prevent the development of upper airway angioedema after dental-oral procedures in patients with HAE-C1-INH. MATERIAL AND METHODS: All dental-oral procedures performed on patients with HAE-C1-INH who were followed up at La Paz University Hospital, Madrid, Spain were reviewed. Demographic data, maintenance treatment, preprocedure prophylaxis, disease severity, and occurrence of upper airway angioedema were recorded. RESULTS: Twenty-four patients (14 male/10 female; mean age, 42.6 years) underwent 66 procedures. Most procedures were performed on patients with severe HAE-C1-INH (20 procedures) or moderate HAE-C1-INH (26 procedures). Only 9 procedures were performed without short-term prophylaxis. Mild upper airway angioedema developed after 3 procedures performed without short-term prophylaxis in patients with minimal or asymptomatic HAE-C1-INH. A statistically significant association was found between development of mild postprocedure upper airway angioedema and lack of maintenance treatment with AA, lack of increased dose of preprocedure AA, and failure to administer preprocedure pdhC1INH (P = .002, Fisher exact test). CONCLUSIONS: Increased doses of prophylactic AA, administration of pdhC1INH, or both were good options for ambulatory management of dental-oral procedures in patients with HAE-C1-INH. Prophylaxis with pdC1INH or increased doses of AA is advisable before dental-oral procedures, even in patients with low disease severity.
Asunto(s)
Andrógenos/uso terapéutico , Proteína Inhibidora del Complemento C1/uso terapéutico , Angioedema Hereditario Tipos I y II/tratamiento farmacológico , Angioedema Hereditario Tipos I y II/etiología , Complicaciones Posoperatorias , Premedicación , Enfermedades Estomatognáticas/complicaciones , Adulto , Andrógenos/efectos adversos , Proteína Inhibidora del Complemento C1/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Estomatognáticas/cirugía , Adulto JovenRESUMEN
Antecedentes: El angioedema hereditario por déficit de C1 Inhibidor (AEH-C1-INH) tiene unas importantes implicaciones para los profesionales de la salud bucodental ya que una cirugía dental puede desencadenar episodios de angioedema potencialmente mortales. El objetivo del estudio fue analizar la eficacia y seguridad de los andrógenos atenuados (AAs) y/o del concentrado plasmático de C1 Inhibidor derivado de humanos (pdhC1INH) para prevenir el desarrollo de angioedema de vías respiratorias superiores tras procedimientos odontoestomatológicos en pacientes con AEH-C1-INH. Material y métodos: Se revisaron los procedimientos odontoestomatológicos realizados en el Hospital Universitario La Paz. Se consideraron datos demográfi cos, tratamiento de mantenimiento, profi laxis pre-procedimiento, grado de severidad de la enfermedad y aparición de angioedema faringolaríngeo. Resultados: Veinticuatro pacientes (14H/10M) (edad media: 42,6 años) se sometieron a 66 procedimientos. La mayor parte se realizaron en pacientes con estadio grave (20 procedimientos) o moderado (26 procedimientos) de la enfermedad. Sólo nueve procedimientos se realizaron sin profilaxis de corto plazo (PCP). En tres procedimientos realizados sin PCP se desarrolló angioedema faríngeo leve ocurriendo en pacientes en estadio asintomático o mínimo de la enfermedad. Se encontró una asociación estadísticamente significativa entre desarrollo mínimo de angioedema de vías respiratorias superiores y ausencia de tratamiento de mantenimiento con AA, ausencia de incremento de dosis y no-administración de pdhC1INH preprocedimiento (Test exacto de Fisher: P=.002). Conclusiones: El aumento de dosis preprocedimiento de AA y/o la administración de pdhC1INH son buenas opciones para el manejo ambulatorio de los procedimientos odontoestomatológicos en pacientes con AEH-C1-INH. El tratamiento profiláctico con pdC1INH o el incremento de dosis de AA es recomendable antes de la manipulación dental, incluso en pacientes con estadio bajo en la escala de gravedad de la enfermedad (AU)
Background: Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) has considerable implications for dental health care providers, since dental procedures may trigger severe and even life-threatening episodes. The aim of the present study was to analyze the efficacy and safety of premedication with attenuated androgens (AAs), plasma-derived human C1 esterase inhibitor concentrate (pdhC1INH), or both to prevent the development of upper airway angioedema after dental-oral procedures in patients with HAE-C1-INH. Material and Methods: All dental-oral procedures performed on patients with HAE-C1-INH who were followed up at La Paz University Hospital, Madrid, Spain were reviewed. Demographic data, maintenance treatment, preprocedure prophylaxis, disease severity, and occurrence of upper airway angioedema were recorded. Results: Twenty-four patients (14 male/10 female; mean age, 42.6 years) underwent 66 procedures. Most procedures were performed on patients with severe HAE-C1-INH (20 procedures) or moderate HAE-C1-INH (26 procedures). Only 9 procedures were performed without short-term prophylaxis. Mild upper airway angioedema developed after 3 procedures performed without short-term prophylaxis in patients with minimal or asymptomatic HAE-C1-INH. A statistically significant association was found between development of mild postprocedure upper airway angioedema and lack of maintenance treatment with AA, lack of increased dose of preprocedure AA, and failure to administer preprocedure pdhC1INH (P=.002, Fisher exact test). Conclusions: Increased doses of prophylactic AA, administration of pdhC1INH, or both were good options for ambulatory management of dental-oral procedures in patients with HAE-C1-INH. Prophylaxis with pdC1INH or increased doses of AA is advisable before dental-oral procedures, even in patients with low disease severity (AU)
Asunto(s)
Humanos , Angioedemas Hereditarios/complicaciones , Procedimientos Quirúrgicos Orales/métodos , Premedicación , Manejo de la Vía Aérea/métodos , Angioedema Hereditario Tipos I y II/complicaciones , Proteína Inhibidora del Complemento C1/análisis , Esterasas/antagonistas & inhibidores , Andrógenos/uso terapéuticoRESUMEN
Background: Allergen-specific immunotherapy (SIT) is a long-term treatment of respiratory allergy. Objective: To look for early predictors of the effectiveness of Dermatophagoides pteronyssinus SIT. Methods: A prospective multi-centre study was carried out in Spain. Children with D. pteronyssinus rhinitis or asthma were invited to participate. The study was divided into times: T0 (recruitment); T1 (inclusion); T2 a-f (immunotherapy times) and T3 (the end of study). Efficacy of SIT was assessed by clinical scores, visual analogue scales (VAS) and lung function tests. We performed D. pteronyssinus skin tests at T1 and T3, and determined specific serum IgE, IgG4 and IL-10 at T1, T2f and T3.Data were analysed using MannWhitney and KruskalWallis tests, compared using Wilcoxon and Chi-square tests, and correlated to Spearman test. All tests had a significance level of 0.05. Results: Thirty-eight children completed the study. At T1 all had rhinitis and 34 also had asthma. At T3, 30 patients had improved, six experienced no changes and two worsened. Improvement was associated to FEV1/FVC and VAS improvement; to a reduction in D. pteronyssinus skin prick test; to a progressive increase in serum levels of D. pteronyssinus IgE, and D. pteronyssinus, Der p1 and Der p2 IgG4. IL-10 levels showed an early increase at T2f (the end of initial build-up immunotherapy phase), and then a reduction at T3 (the end of a year of immunotherapy).Improvement associated to an early increase in IL-10 and was correlated with VAS and specific IgG4 evolution(AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Interleucina-10/administración & dosificación , Interleucina-10/inmunología , Interleucina-10/uso terapéutico , Dermatophagoides pteronyssinus , Dermatophagoides pteronyssinus/inmunología , Antígenos Dermatofagoides , Antígenos Dermatofagoides/inmunología , Antígenos Dermatofagoides/aislamiento & purificación , Inmunoterapia/métodos , Inmunoterapia , Interleucina-10/aislamiento & purificación , Interleucina-10/metabolismo , Inmunoterapia/normas , Inmunoterapia/tendencias , Estudios Prospectivos , Resultado del Tratamiento , Evaluación de Eficacia-Efectividad de IntervencionesRESUMEN
BACKGROUND: Allergen-specific immunotherapy (SIT) is a long-term treatment of respiratory allergy. OBJECTIVE: To look for early predictors of the effectiveness of Dermatophagoides pteronyssinus SIT. METHODS: A prospective multi-centre study was carried out in Spain. Children with D. pteronyssinus rhinitis or asthma were invited to participate. The study was divided into times: T0 (recruitment); T1 (inclusion); T2 a-f (immunotherapy times) and T3 (the end of study). Efficacy of SIT was assessed by clinical scores, visual analogue scales (VAS) and lung function tests. We performed D. pteronyssinus skin tests at T1 and T3, and determined specific serum IgE, IgG4 and IL-10 at T1, T2f and T3. Data were analysed using Mann-Whitney and Kruskal-Wallis tests, compared using Wilcoxon and Chi-square tests, and correlated to Spearman test. All tests had a significance level of 0.05. RESULTS: Thirty-eight children completed the study. At T1 all had rhinitis and 34 also had asthma. At T3, 30 patients had improved, six experienced no changes and two worsened. Improvement was associated to FEV1/FVC and VAS improvement; to a reduction in D. pteronyssinus skin prick test; to a progressive increase in serum levels of D. pteronyssinus IgE, and D. pteronyssinus, Der p1 and Der p2 IgG4. IL-10 levels showed an early increase at T2f (the end of initial build-up immunotherapy phase), and then a reduction at T3 (the end of a year of immunotherapy). Improvement associated to an early increase in IL-10 and was correlated with VAS and specific IgG4 evolution.
Asunto(s)
Antígenos Dermatofagoides/uso terapéutico , Proteínas de Artrópodos/uso terapéutico , Asma/terapia , Cisteína Endopeptidasas/uso terapéutico , Dermatophagoides pteronyssinus/inmunología , Desensibilización Inmunológica/métodos , Interleucina-10/inmunología , Rinitis Alérgica/terapia , Adolescente , Animales , Antígenos Dermatofagoides/inmunología , Proteínas de Artrópodos/inmunología , Asma/inmunología , Niño , Preescolar , Cisteína Endopeptidasas/inmunología , Femenino , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina G/sangre , Masculino , Estudios Prospectivos , Rinitis Alérgica/inmunología , España , Escala Visual AnalógicaAsunto(s)
Hemorragia/etiología , Mastocitosis Sistémica/complicaciones , Choque/etiología , Adulto , Femenino , HumanosRESUMEN
BACKGROUND: There are no previous Spanish guidelines or consensus statements on bradykinin-induced angioedema. AIM: To draft a consensus statement on the management and treatment of angioedema mediated by bradykinin in light of currently available scientific evidence and the experience of experts. This statement will serve as a guideline to health professionals. METHODS: The consensus was led by the Spanish Study Group on Bradykinin-Induced Angioedema, a working group of the Spanish Society of Allergology and Clinical Immunology. A review was conducted of scientific papers on different types of bradykinin-induced angioedema (hereditary and acquired angioedema due to C1 inhibitor deficiency, hereditary angioedema related to estrogens, angioedema induced by angiotensin-converting enzyme inhibitors). Several discussion meetings were held to reach the consensus. RESULTS: Treatment approaches are discussed, and the consensus reached is described. Specific situations are addressed, namely, pregnancy, contraception, travelling, blood donation, and organ transplantation. CONCLUSIONS: A review of and consensus on treatment of bradykinin-induced angioedema is presented.
Asunto(s)
Angioedema , Bradiquinina/antagonistas & inhibidores , Angioedema/diagnóstico , Angioedema/metabolismo , Angioedema/terapia , Bradiquinina/metabolismo , Humanos , PronósticoRESUMEN
Drug-induced aseptic meningitis (DIAM) is a diagnostic challenge. The major causative agents are nonsteroidal anti-inflammatory drugs (particularly ibuprofen), antibiotics, intravenous immunoglobulin, and OKT3 monoclonal antibodies. DIAM is more frequently observed in patients with autoimmune diseases. A 36-year-old woman was attended in our department 3 months after being diagnosed with aseptic meningoencephalitis. She had had 2 episodes in 9 months. Neurological symptoms were associated with ibuprofen. A challenge with acetylsalicylic acid was negative, whereas a drug challenge with ibuprofen was positive. Thirty minutes after ingesting 50 mg of ibuprofen, she experienced general malaise and progressively developed chills, fever (39.5 degrees C), headache, and nuchal rigidity. Lumbar puncture showed normal glucose and high protein levels. Neutrophilic pleocytosis was observed at the first admission; lymphocytosis was predominant in the second and third episodes. DIAM is a rare and severe hypersensitivity reaction. Drug challenge enabled us to make an accurate diagnosis.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Ibuprofeno/efectos adversos , Meningitis Aséptica/inducido químicamente , Meningoencefalitis/inducido químicamente , Adulto , Femenino , Humanos , Meningitis Aséptica/fisiopatología , Meningoencefalitis/fisiopatologíaRESUMEN
Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome, or drug-induced hypersensitivity syndrome (DIHS), is a life-threatening multiorgan systemic reaction characterized by rash, fever, lymphadenopathy, hepatitis, and leukocytosis with eosinophilia. Aromatic anticonvulsant drugs and allopurinol have been reported to be the most frequent eliciting agents. Our search of the literature revealed only 2 cases induced by piperacillin and 1 case by ceftriaxone.We present 2 cases of DRESS syndrome induced by the beta-lactam drugs ceftriaxone and piperacillin-tazobactam. An allergological workup including skin prick test, intradermal tests, patch tests, and lymphocyte transformation test (LTT) was performed. LTT was shown to be a useful technique in both cases to help to identify the drugs involved.
Asunto(s)
Anticonvulsivantes/efectos adversos , Ceftriaxona/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , beta-Lactamas/efectos adversos , Corticoesteroides/administración & dosificación , Adulto , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/farmacología , Ceftriaxona/administración & dosificación , Ceftriaxona/farmacología , Proliferación Celular/efectos de los fármacos , Células Cultivadas , Colitis Ulcerosa/tratamiento farmacológico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/inmunología , Hipersensibilidad a las Drogas/fisiopatología , Eosinofilia , Epilepsia/tratamiento farmacológico , Exantema , Femenino , Antagonistas de los Receptores Histamínicos/administración & dosificación , Humanos , Activación de Linfocitos/efectos de los fármacos , Masculino , Ácido Penicilánico/administración & dosificación , Ácido Penicilánico/efectos adversos , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/farmacología , Piperacilina/administración & dosificación , Piperacilina/efectos adversos , Piperacilina/farmacología , Combinación Piperacilina y Tazobactam , beta-Lactamas/administración & dosificación , beta-Lactamas/farmacologíaRESUMEN
Hypersensitivity to Anisakis is an increasingly prominent medical problem throughout the world, due to a better understanding of diseases induced by parasites and to modern culinary habits of eating raw or undercooked fish. We describe the case of a patient who presented epigastric pain, wheals, erythema, and pruritus 3 hours after the ingestion of fish. More than 200 larvae were obtained by endoscopy. However, the patient only developed an immune response with specific immunoglobulin E and eosinophilia peaking at day 18 and decreasing during the 17-month follow-up. Only eosinophilia reached normal limits.
Asunto(s)
Anisakiasis/diagnóstico , Anisakis/inmunología , Anticuerpos Antihelmínticos/inmunología , Antígenos Helmínticos/inmunología , Inmunoglobulina E/inmunología , Adulto , Animales , Anisakiasis/sangre , Anisakiasis/inmunología , Anisakiasis/fisiopatología , Anisakis/crecimiento & desarrollo , Anisakis/patogenicidad , Ingestión de Alimentos , Endoscopía Gastrointestinal , Eritema , Femenino , Mucosa Gástrica/parasitología , Mucosa Gástrica/patología , Humanos , Inmunoglobulina E/sangre , PruritoAsunto(s)
Alérgenos/inmunología , Antígenos Fúngicos/inmunología , Contaminación de Alimentos , Hipersensibilidad a los Alimentos/diagnóstico , Productos de la Carne , Penicillium/inmunología , Polen/inmunología , Angioedema , Asma/etiología , Conjuntivitis/etiología , Hipersensibilidad a los Alimentos/sangre , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/fisiopatología , Humanos , Inmunoglobulina E/sangre , Masculino , Rinitis Alérgica Estacional/sangre , Rinitis Alérgica Estacional/complicaciones , Rinitis Alérgica Estacional/diagnóstico , Rinitis Alérgica Estacional/inmunología , Rinitis Alérgica Estacional/fisiopatología , Adulto JovenAsunto(s)
Anafilaxia/inducido químicamente , Proteínas de la Leche/efectos adversos , Geles , Encía , Humanos , Lactante , MasculinoAsunto(s)
Humanos , Masculino , Lactante , Anafilaxia/inducido químicamente , Proteínas de la Leche/efectos adversos , Geles , EncíaAsunto(s)
Alérgenos/metabolismo , Biomarcadores/metabolismo , Inmunoglobulina E/metabolismo , Proteínas de Plantas/metabolismo , Rinitis Alérgica Estacional/diagnóstico , Pruebas Serológicas/métodos , Adolescente , Adulto , Alérgenos/inmunología , Antígenos de Plantas , Reacciones Cruzadas , Estudios de Factibilidad , Femenino , Humanos , Inmunoglobulina E/inmunología , Masculino , Olea/inmunología , Proteínas de Plantas/inmunología , Polen/efectos adversos , Unión Proteica , Rinitis Alérgica Estacional/sangre , Rinitis Alérgica Estacional/inmunología , Pruebas Cutáneas , EspañaAsunto(s)
Dermatitis por Contacto/etiología , Tatuaje/efectos adversos , Niño , Humanos , Masculino , Factores de TiempoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Niño , Tatuaje/efectos adversos , Tatuaje/métodos , Dermatitis por Contacto/complicaciones , Dermatitis por Contacto/diagnóstico , Dermatitis por Contacto/terapia , Corticoesteroides/uso terapéutico , Esteroides/uso terapéutico , Hipersensibilidad/complicaciones , Hipersensibilidad/diagnóstico , Compuestos de Anilina/efectos adversos , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Lawsonia (Planta)/efectos adversosAsunto(s)
Borrelia burgdorferi , Enfermedad de Lyme/diagnóstico , Viaje , Niño , Humanos , MasculinoRESUMEN
No disponible