Anaphylaxis to Etoricoxib

No disponible

Esophageal dysfunction and immunological changes induced by grass sublingual immunotherapy.

Sublingual immunotherapy frequently causes local oropharyngeal adverse events which are usually of mild severity, and tend to be self-limited and disappear within the first weeks of therapy. The mechanism of action involves changes in the specific humoral response to allergens, with increases in allergen-specific immunoglobulin G4 (IgG4) and blunting of the seasonal increase in allergen-specific IgE. We describe the case of a 25-year-old man diagnosed with grass pollen induced allergic rhinoconjunctivitis, who was treated with a lyophilisate of Phleum pratense by sublingual route. After 5 weeks of therapy he developed repeatedly intense symptoms of esophageal dysfunction immediately after the administration. Symptoms recurred every day, subsided in some hours without treatment and disappeared with the termination of therapy. The episode coincided with a marked elevation of total and specific IgE. The immunological changes gradually declined during the three years of follow up. The reported case suggests the need to evaluate the role of the immunological changes detected after the first weeks of sublingual therapy with Phleum pratense, in the induction of esophageal disorders.

Chronic urticaria after implantation of a mitral annuloplasty ring in a nickel-allergic patient

No disponible

Medical audit on children with asthma in an Emergency Department.

OBJECTIVE: To carry out a medical audit or evaluation and improvement procedure on the management of children with asthmatic crises in our Emergency Department (ED). MATERIAL AND METHODS: We carried out a retrospective audit between January and March 2007, analysing the medical records of a random sample of 50 patients aged 2-14 years consulting our ED for asthmatic crises. Following the international guides, we first selected 17 explicit indicators divided into four domains: "evaluation", "examination", "diagnostic resources", and "treatment and conditions at discharge". RESULTS: Indicators' compliance proved unequal; it was scarce for cause of asthma crisis (32%); degree of severity (18%); and supportive treatment (24%). Auscultation was registered in 100%, but respiratory frequency only in 49%, and peak flow in 0%. A total of 78% of the patients were treated in the ED, in all cases with beta-mimetic agents, and with systemic corticosteroids in 12%. The result of treatment was registered in only 69% of cases. The medical documentation of resident doctors was not signed by the staff. CONCLUSIONS: We identified the following weak points: failure to determine the degree of severity; lack of specification of the details of the crisis (prior duration, treatment at home, supportive treatment); scant asthma background history; and deficient recording of respiratory frequency and peak flow. We propose improving the anamnesis, recording respiratory frequency, with the introduction of tools to measure peak flow, specification of treatment response, and the development of a simpler and more practical protocol, with the performance of a re-audit.

Medical audit on children with asthma in an Emergency Department

Objective: To carry out a medical audit or evaluation and improvement procedure on the management of children with asthmatic crises in our Emergency Department (ED). Material and methods: We carried out a retrospective audit between January and March 2007, analysing the medical records of a random sample of 50 patients aged 2–14 years consulting our ED for asthmatic crises. Following the international guides, we first selected 17 explicit indicators divided into four domains: “evaluation”, “examination”, “diagnostic resources”, and “treatment and conditions at discharge”. Results: Indicators’ compliance proved unequal; it was scarce for cause of asthma crisis (32%); degree of severity (18%); and supportive treatment (24%). Auscultation was registered in 100%, but respiratory frequency only in 49%, and peak flow in 0%. A total of 78% of the patients were treated in the ED, in all cases with beta-mimetic agents, and with systemic corticosteroids in 12%. The result of treatment was registered in only 69% of cases. The medical documentation of resident doctors was not signed by the staff. Conclusions: We identified the following weak points: failure to determine the degree of severity; lack of specification of the details of the crisis (prior duration, treatment at home, supportive treatment); scant asthma background history; and deficient recording of respiratory frequency and peak flow. We propose improving the anamnesis, recording respiratory frequency, with the introduction of tools to measure peak flow, specification of treatment response, and the development of a simpler and more practical protocol, with the performance of a re-audit (AU)