Clinical trial to assess tolerability and subrogate efficacy effects of an abbreviated schedule with house dust mites mixture subcutaneous immunotherapy.

Summary: Objective. To evaluate the tolerability and efficacy of Dermatophagoides pteronyssinus/Dermatophagoides farinae mixture subcutaneous immunotherapy (SCIT). Methods. Patients received an abbreviated build-up schedule. The aims were: number, percentage, and severity of adverse reactions. Secondary outcomes included: changes in immunoglobulin titers and changes in dose-response skin prick tests. Results. Out of 289 administrations, 17% elicited any clinically relevant adverse reaction. Most of them were local reactions (LR) (9.4%) and the rest (7.6%) were systemic. Significant increases in sIgG and sIgG4 were detected in serum samples. Cutaneous reactivity decreased significantly. Conclusions. SCIT with house dust mites mixture of ROXALL Medicina España S.A. seems to have an acceptable tolerability profile, induces blocking IgG and decreases skin reactivity.

Heterogeneity in allergy to mollusks: a clinical-immunological study in a population from the North of Spain

Background: Allergy to mollusks has been the focus of fewer studies than allergy to crustaceans. Furthermore, allergy to mollusks is less well characterized. Objectives: To describe the clinical characteristics of mollusk-allergic patients, to identify the responsible allergens, and to assess crossreactivity. Methods: We performed a prospective multicenter study including 45 patients with mollusk allergy, which was diagnosed based on a suggestive clinical history and a positive skin test result with the agent involved. Fractions were identified using SDS-PAGE and immunoblotting. The proteins responsible were subsequently identified using mass spectrometry. ELISA inhibition studies were performed with mollusks, dust mites, and crustaceans. Results: We found that 25 patients (55%) were allergic to cephalopods, 14 (31%) to bivalves, and 11 (24%) to gastropods. Limpet was the third most frequent cause of allergy (15% of cases). In 31 patients (69%), the manifestation was systemic; 10 (22%) exhibited oral allergy syndrome, and 7 (15%) experienced contact urticaria. Most major allergens were found between 27 kDa and 47 kDa. ELISA inhibition assays revealed a high degree of inhibition of cephalopods and bivalves from all the groups of mollusks, mites, and crustaceans. Mass spectrometry identified tropomyosin, actin, and myosin as the major allergens. Conclusions: Cephalopods, especially squid, are the mollusks that most frequently trigger allergic symptoms. The very frequent occurrence of allergy to limpets is striking, given their low consumption in our area. It is worth highlighting the heterogeneity observed, exemplified by the gastropods. Tropomyosin appears to be responsible for the high cross-reactivity found between mollusks, mites, and crustaceans. Three new mollusk allergens were also identified, namely, actin, enolase, and a putative C1q domain-containing protein (AU)

Introducción: La alergia a moluscos ha sido menos estudiada y está peor caracterizada que la alergia a crustáceos. Objetivo: Describir las características clínicas de pacientes alérgicos a moluscos, identificar los alérgenos responsables y estudiar la reactividad cruzada entre ellos. Métodos: Estudio multicéntrico, prospectivo. Se incluyen 45 pacientes con alergia a moluscos, definida como una clínica sugestiva y prueba cutánea positiva con el molusco sospechoso. Se identificaron las bandas alergénicas mediante SDS-PAGE e inmunodetección. Las proteínas responsables se identificaron utilizando espectrometría de masas. Se realizaron ensayos de inhibición de ELISA entre moluscos, ácaros y crustáceos. Resultados: Veinticinco (55%) de los pacientes eran alérgicos a cefalópodos, 14 (31%) a bivalvos y 11 (24%) a gasterópodos. La lapa resultó ser la tercera causa de alergia (15% de los casos). Los síntomas fueron sistémicos en 31 pacientes (69%), diez (22%) tuvieron síndrome de alergia oral y siete (15%) urticaria de contacto. La mayoría de las bandas alergénicas estaban entre 27 y 47 kDa. Los ensayos de inhibición de ELISA mostraron un alto grado de inhibición de cefalópodos y bivalvos por parte de moluscos, ácaros y crustáceos. Mediante espectometría de masas se identificaron tropomiosina, actina y miosina como los alérgenos mayoritarios. Conclusiones: Los moluscos que con más frecuencia provocan reacciones alérgicas son los cefalópodos, especialmente el calamar. Llama la atención la elevada frecuencia de alergia a la lapa, a pesar de su bajo consumo. También hay que resaltar la heterogeneidad observada, por ejemplo en los gasterópodos. La tropomiosina parece ser responsable de la elevada reactividad cruzada encontrada entre moluscos, ácaros y crustáceos. Se han identificado tres nuevos alérgenos en los moluscos: actina, enolasa y putative C1q domain-containing protein (AU)

Positive allergy study (Intradermal, patch, and lymphocyte transformation tests) in a case of isoniazid-Induced DRESS

No disponible

Allergy to laxative compound (Plantago ovata seed) among health care professionals.

BACKGROUND: The seeds of Plantago ovata (psyllium, ispaghula) used in the manufacture of bulk laxatives are known to be the cause of occupational allergy (rhinitis, asthma) in health care and pharmaceutical workers. OBJECTIVE: We studied the prevalence of P ovata seed allergy among health care workers in geriatric care homes and compared it with a group of health care professionals not exposed to P ovata seed. Cross reactivity with Plantago lanceolata pollen was also studied. METHODS: Two groups of health professionals were recruited: 58 health care workers from geriatric care homes who were exposed daily to laxatives containing P ovata and 63 nonexposed health care professionals. The prevalence of allergy and sensitization to P ovata seed was determined based on clinical history, skin prick test, and analysis of specific immunoglobulin (Ig) E. IgE immunoblotting was performed to calculate the molecular weights of the P ovata seed allergens. Cross reactivity to P lanceolata pollen was studied by enzyme allergosorbent test (EAST) and immunoblot inhibition techniques. RESULTS: The prevalence of sensitization and clinical allergy to P ovata seed in the exposed group was 13.8% and 8.6%, respectively. No sensitization was observed in the nonexposed group. IgE-binding proteins of 17, 20, 25, 32-34, 54, 73-77, and > 97 kDa were identified. EAST inhibition and immunoblot inhibition demonstrated the existence of cross reactivity between P ovata seed and P lanceolata pollen extracts. CONCLUSIONS: The rate of sensitization to P ovata seed is high among health care workers in geriatric care homes (13.8%). A mild cross reactivity between P ovata seed and P lanceolata pollen was observed.

Alergia al polen de las oleáceas en un lugar donde no hay olivos / Oleaceae pollen allergy in a place where there’s no olive trees

Antecedentes y objetivos: El polen del fresno (Fraxinus excelsior), árbol perteneciente a la familia Oleaceae, se ha descrito recientemente como un alérgeno relevante en algunos países centroeuropeos. El objetivo de este trabajo es estudiar la importancia que este polen tiene como factor desencadenante de los síntomas alérgicos que sufren, al final del invierno y principio de la primavera, algunos pacientes que viven en País Vasco, donde no existen olivos pero el fresno es un árbol abundante. Métodos: Se seleccionaron 48 pacientes que se clasificaron en tres grupos en función de la sensibilización predominante: pacientes alérgicos a oleáceas (O), alérgicos a gramíneas (G) y alérgicos a ambos pólenes (M). Los pacientes se dividieron además en dos grupos en función de la época en la que tenían los síntomas: pacientes con síntomas tempranos o pacientes con síntomas tardíos. Se les realizó la prueba del prick con una batería de pólenes, pruebas de exposición conjuntival con extractos de polen de olivo y de fresno y la determinación de IgE específica (EAST) frente a varios pólenes. Resultados: En el grupo O, el 100% de los pacientes tuvo síntomas tempranos, esto es, coincidiendo con la floración del fresno y antes de aparecer el polen de las gramíneas. En los grupos M y G los porcentajes de pacientes con síntomas tempranos fueron del 40% y 16%, respectivamente. Las pruebas de provocación conjuntival con polen de olivo y fresno resultaron positivos en el 100% y 70%, respectivamente, de los pacientes del grupo O, en el 78% y 50% del grupo M y en el 58% y 31% del grupo G. Los pacientes con síntomas tempranos tuvieron con mayor frecuencia pruebas cutáneas positivas frente al polen de F. excelsior (p < 0,05) y unas concentraciones de IgE específica frente a F. excelsior significativamente mayores (p < 0,05) que los pacientes con síntomas tardíos. Las pruebas de provocación conjuntival con polen de O. europaea fueron de mayor intensidad en los pacientes con síntomas tempranos. Conclusión: Los pacientes que residen en País Vasco y sufren síntomas durante el final del invierno y el comienzo de la primavera tenían una sensibilización predominante al polen del fresno y del olivo, en comparación con los pacientes que únicamente tenían síntomas tardíos (en mayo y junio). El polen del fresno puede considerarse una posible causa de polinosis en aquellos lugares donde su presencia es frecuente

Background: Ash tree belongs to the Oleaceae family; it has been recently described as a relevant allergen in some countries. The aim of this study is to demonstrate the importance of the ash pollen as a triggering factor of the allergic symptoms showed in early spring by a group of patients who live in the Basque Country, where ash are common trees and olive trees are not present. Methods: In accordance with their predominantly sensitisation we selected and classified 48 pollen-allergic-patients in three groups: oleaceae allergic patients (O), grass allergic patients (G) and oleaceae + grass allergic patients (M). Patients were also divided in two groups depending on the season when they showed the symptoms: patients with early or late symptoms respectively. Skin prick tests (SPT) and specific IgE (EAST) to Olea, Fraxinus and Lolium, patient’s scores of symptoms and rescue medication between February and July 2000, and conjunctival challenge tests with ash and olive pollen extracts were performed. Results: 100% of O patients, 40% of M patients and 16% of G patients suffered from early symptoms, coinciding with the flowering of ash, when grass pollen is not present yet. Conjunctival challenge tests with ash and olive pollen extracts were positive in 70% and 100% respectively in O patients, 50% and 78% in M patients and 31% and 58% in G patients. Conjunctival challenge tests in patients who suffered from early symptoms with olive extract were positive with lower concentrations of the extract. The patients with early symptoms had a higher rate of positive SPT with ash pollen (p < 0,05) and had significant higher levels of specific IgE to F. excelsior pollen (p < 0,05) than late symptomatic patients. Conjunctival challenge test to O. europaea pollen produced more symptoms to patients with early symptoms. Conclusion: Patients living in the Basque Country and suffering from symptoms during early spring had a predominant sensitisation to ash and olive pollen compared to those patients showing only late symptoms. Ash pollen can be considered as a potentially cause of hay fever in these areas where it is present in considerable amounts

Cross-reactivity between obeche wood (Triplochiton scleroxylon) and natural rubber latex.

BACKGROUND: Several studies have shown that allergy to natural rubber latex is associated with cross reactivity to other plants. We have investigated a possible cross reactivity with a tree belonging to the Sterculiaceae family, Tryplochiton scleroxylon, in a patient allergic to obeche wood, that began to suffer symptoms of allergy in contact with latex. METHODS: Determinations of specific IgE by CAP to obeche, natural rubber latex (NRL) and recombinant allergens of latex were done. Immunoblotting was performed to study allergens detected by serum of our patient. CAP-inhibition methods were used to study cross-reactive between NRL and obeche wood. RESULTS: In obeche extract, 4 bands were found of an apparent molecular weight of 18, 38, 75 and 199 kDa. In NRL extract the allergens have a molecular weight around 18, 21, 32, 38, 60, 70 and 199 kDa. IgE to latex was almost completely inhibited (96%) by the obeche extract in CAP-inhibition studies. Using obeche extract as inhibitor, IgE binding to native hevein (nHevb 6.02) was reduced by 25%. CONCLUSIONS: The results obtained in CAP-inhibition demonstrate the existence of cross-reactivity between proteins in NRL and obeche wood. In our patient, a band of apparent molecular weight of 38 kDa could be the most important allergen.

Hereditary angioedema and pneumomediastinum.

Gastrointestinal and respiratory involvement is common in hereditary angioedema, laryngeal edema being the main cause of mortality in these patients. We report the case of an 18 year-old woman with a history of hereditary angioedema, who presented an episode of coughing and vomiting the night before, and who was diagnosed with pneumomediastinum as a complication of an episode of angioedema. We review the causes and pathogenesis of the mediastinic emphysema.

[Role of chromoendoscopy in colorectal polyps handling]. / Rol de la cromoendoscopía en el manejo de los pólipos colorrectales.

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.

Rol de la cromoendoscopía en el manejo de los pólipos colorrectales. / [Role of chromoendoscopy in colorectal polyps handling]

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4

ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7

(p < 0.0001), sensitivity 100

and especificity 88

. Group 2: coincidence prediction/histology 65.8

(p < 0.05), sensitivity 86

and especificity 60

. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2

and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.

Rol de la cromoendoscopía en el manejo de los pólipos colorrectales / Role of chromoendoscopy in colorectal polyps handling

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.

Rol de la cromoendoscopía en el manejo de los pólipos colorrectales / Role of chromoendoscopy in colorectal polyps handling

INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.(AU)