Allergic reaction after ingestion of orange blossom pollen.

A 31-year-old atopic subject with allergic rhinoconjunctivitis with sensitization to several pollens, presented with urticaria and angioedema after ingestion of orange blossom pollen (Citrus sinensis). A positive skin prick test for orange blossom pollen extract (BIAL-Aristegui, Bilbao, Spain) at a concentration of 1.2 mg/ml was obtained. Serum specific IgE antibodies to orange blossom pollen were shown (Unicap Pharmacia System, Uppsala, Sweeden). A conjunctival provocation test was negative with orange blossom pollen extract dilutions of 1:1000, 1:100 and 1:10 w/v. We describe a patient with an IgE-mediated reaction caused by hypersensitivity to orange blossom pollen. Although the pollen is an aeroallergen and the way of sensitization and entrance is the airway, and therefore the symptoms appear in this location, when contact is through some other route such as the digestive tract, it is also able to sensitize reporting urticaria and angioedema like in our case, instead of respiratory symptoms.

La rinitis a la luz de los consensos internacionales / Rhinitis in the light of international consensuses

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Consensos sobre rinitis / Consensuses on rhinitis

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Urticaria a frigore: características clínicas y diagnósticas / Urticaria a frigore: clinical characteristic and diagnostics

Fundamento: La urticaria por frío, caracterizada por la rápida aparición de prurito, eritema, lesiones habonosas y angioedema tras la exposición a un estímulo frío, forma parte las urticarias físicas y representa el 2-3 por ciento del conjunto de las urticarias. Se abordará la revisión de los aspectos clínicos y diagnósticos más destacados de esta entidad, junto con la descripción de las características clínicas de 8 pacientes con este tipo de urticaria. La secuencia básica de eritema, edema y prurito puede desencadenarse en respuesta a diferentes estímulos fríos como bajas temperaturas ambientales, viento frío, o manipulación de objetos fríos. La ingesta de comidas o bebidas frías puede provocar tumefacción a nivel de mucosa labial y con menos frecuencia edema en lengua, faringe o laringe. Asimismo, la exposición masiva como la que acontece durante la natación es capaz de causar hipotensión marcada y pérdida de conciencia debido a la liberación masiva de mediadores. La anamnesis en estos pacientes debe ir encaminada, por tanto, a la detección de signos de gravedad de la urticaria a frigore como la afección de mucosa bucofaríngea, o la presencia de signos generales como cefalea, artralgias, dolor abdominal o repercusión hemodinámica durante el baño en aguas frías, aspecto que debe ser explicado a los pacientes. En esta revisión se propone una clasificación y se describen las características clínicas y diagnósticas de la urticaria por frío, junto con los datos clínicos más destacados de 8 pacientes afectos de este tipo de urticaria. Únicamente en dos pacientes se objetivó un ligero y transitorio incremento de las cifras de IgE e inmunocomplejos circulantes, que se hallaron en el intervalo normal en determinaciones posteriores. Asimismo, no se encontraron hallazgos patológicos en la radiología de tórax ni en el examen parasitológico de las heces. (AU)

Etiologic role of unapparent exposure in cat allergy.

To determine the importance of unnoticed exposure to cat, we studied 20 patients with a history of respiratory allergy. All the patients had a positive prick test to cat dander extract, and none of them kept cats as pets. The prick test was carried out with a dander extract from cat at a concentration of 100 BU/ml. The specific IgE was determined by the commercially available Pharmacia CAP System. We carried out a conjunctival challenge test. The concentration of Fel d 1 was quantified in dust samples from the patients' homes by a commercially available method. The patients were reassessed in order to establish a relation between exposure and symptoms, and concealed allergen sources. Sixteen patients showed significant levels of Fel d 1 in their homes (mean of 3.35 micrograms/g of dust). The conjunctival challenge test was positive in 15 patients. These patients showed an exposure mean of 0.4 microgram/g of dust. The mean levels of specific serum IgE were higher in those patients with a positive challenge than in those with a negative challenge (P = 0.0145). In nine reassessed patients, a relation was established between natural exposure and the onset of the symptoms. A possible hidden allergen source was established in 11 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of the RAST, indirect haemagglutination, basophil degranulation and latex tests in the diagnosis of human hydatid disease.

In order to compare the diagnostic efficacy of the, basophil degranulation, RAST, indirect haemagglutination and latex tests, we carried out these four tests on 50 patients with confirmed hydatid disease due to Echinococcus granulosus. As a control group we employed 50 subjects who showed no evidence of hydatid disease or any other parasitic disease. The test which displayed the highest degree of diagnostic efficacy was the basophil degranulation test with a sensitivity of 93% and an accuracy of 97%. Next in diagnostic efficacy were the haemagglutination and RAST tests with very similar results-a sensitivity of 82% and an accuracy of 91% for the former, and for the latter a sensitivity of 80% and an accuracy of 90%. The latex test, with a sensitivity of 67% and an accuracy of 83%, possessed the lowest degree of diagnostic efficacy. There is an obvious decrease in the sensitivity of the tests when the localization of the cyst exclusively pulmonary; in these cases the RAST test was positive in only 50%, and the degranulation test in 77.7%.