Role of Periostin in Uncontrolled Asthma in Children (DADO study).

BACKGROUND AND OBJECTIVE: Asthma is the most common chronic disease in children. Cases of severe asthma (SA) are underdiagnosed. Periostin is a biomarker for SA in adults, but its role in children is poorly understood. Objectives: The aims of the study were to estimate the percentage of cases of uncontrolled severe asthma (UcSA) in children with poorly controlled asthma and to evaluate the role of periostin as a biomarker. MATERIAL AND METHODS: We performed an observational study in children aged 5 to 14 years with poorly controlled asthma. Demographic and clinical data were collected in addition to the results of the lung function test, the fraction of exhaled nitric oxide, the skin prick test, total IgE, specific IgE, blood eosinophil count, serum periostin, treatment, asthma control, and quality of life. Variables were compared between the group with UcSA and the other children. RESULTS: Fifty children with poorly controlled asthma (72% male) were included. Nineteen children (38%) had UcSA. Most children had limitations in their activities of daily living and had visited the emergency department. In addition, 38% were hospitalized. Quality of life was poor. Only 42% of the children received appropriate treatment. The UcSA group was more likely to have a total IgE >500 kUA/mL (52.6% vs 19%, P=.02) and less likely to have serum periostin >1000 ng/mL (31.2% vs 63%, P=.04). CONCLUSIONS: In our setting, 38% of children with poorly controlled asthma have UcSA, which is associated with higher levels of total serum IgE and lower levels of serum periostin.

Role of periostin in uncontrolled asthma in children (DADO study)

Background: Asthma is the most common chronic disease in children. Cases of severe asthma (SA) are underdiagnosed. Periostin is a biomarker for SA in adults, but its role in children is poorly understood. Objectives: The aims of the study were to estimate the percentage of cases of uncontrolled severe asthma (UcSA) in children with poorly controlled asthma and to evaluate the role of periostin as a biomarker. Materials and Methods: We performed an observational study in children aged 5 to 14 years with poorly controlled asthma. Demographic and clinical data were collected in addition to the results of the lung function test, the fraction of exhaled nitric oxide, the skin prick test, total IgE, specific IgE, blood eosinophil count, serum periostin, treatment, asthma control, and quality of life. Variables were compared between the group with UcSA and the other children. Results: Fifty children with poorly controlled asthma (72% male) were included. Nineteen children (38%) had UcSA. Most children had limitations in their activities of daily living and had visited the emergency department. In addition, 38% were hospitalized. Quality of life was poor. Only 42% of the children received appropriate treatment. The UcSA group was more likely to have a total IgE >500 kUA/mL (52.6% vs 19%, P=.02) and less likely to have serum periostin >1000 ng/mL (31.2% vs 63%, P=.04). Conclusions: In our setting, 38% of children with poorly controlled asthma have UcSA, which is associated with higher levels of total serum IgE and lower levels of serum periostin (AU)

Introducción: El asma es la enfermedad crónica más frecuente en niños. El asma grave (AG) está infradiagnosticada. La periostina es un biomarcador de asma grave en adultos, pero su papel en niños es pobremente conocido. El objetivo de este estudio ha sido estimar el porcentaje de casos de asma grave no controlada (AGNC) en niños con asma mal controlada y evaluar el papel de la periostina como biomarcador. Material y métodos: Estudio observacional en niños de 5 a 14 años de edad con asma mal controlada. Se recogieron datos demográficos y clínicos, pruebas de función pulmonar y fracción de óxido nítrico exhalado (FENO), prick test, IgE total, IgE específica, eosinófilos en sangre, periostina en suero, tratamiento, control del asma y calidad de vida. Se compararon las variables entre el grupo con AGNC y el resto de niños. Resultados: Se incluyeron a 50 niños con asma mal controlada (72% varones). Diecinueve niños (38%) presentaban AGNC. La mayoría de los niños tenían limitaciones en las actividades de la vida diaria, visitas a urgencias y el 38% habían necesitado ingreso hospitalario. La media de calidad de vida fue baja. Solo el 42% de los niños tenían un tratamiento adecuado. El grupo AGNC (19 niños, 38%) tenían más probabilidad de tener una IgE >500 kU/ml (52,6% frente a 19%, p=0,002) y menos probabilidad de tener periostina en suero >1000 ng/ml (31,2% frente a 63%, p = 0,04). Conclusiones: En nuestra serie, el 38% de niños con asma no controlada tenían AGNC, que está asociado con altos niveles de IgE total y menores niveles de periostina en suero (AU)

Successful desensitization to cetuximab in a patient with a positive skin test to cetuximab and specific IgE to alpha-gal

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Anaphylactic reaction to bell pepper ( Capsicum annuum) in a patient with a latex-fruit syndrome

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Type IV reaction due to phenylephrine administered nasally with cross-reactivity with ethylephrine.

Type IV hypersensitivity eye reactions have been described after the administration of the sympathomimetic agent phenylephrine. We report the case of an atopic woman who developed nasal congestion and discharge, dysphagia, and dyspnea 1 hour after the administration of Stopcold pills and Disneumon Pernasal nasal spray for otitis. The same symptoms reappeared after the accidental administration of Rinobanedif ointment in the nasal mucosa. Skin patch tests were performed with a standard True Test panel, preservatives, Disneumon Pernasal, pseudoephedrine, eyedrops (tropicamide, cyclopentolate, and phenylephrine), and other sympathomimetic agents. The patient also underwent oral, ocular, and nasal controlled challenges with the same drugs. Finally, patch tests were performed in 11 controls with phenylephrine and ethylephrine. Our patient had a positive outcome in patch testing with nickel sulphate, fragrance mix, phenylephrine, and ethylephrine. To our knowledge, this is the first report of a type IV reaction to nasally administered phenylephrine with cross-reactivity with ethylephrine detected by patch testing.

Hypersensitivity reaction to mizolastine: study of cross reactions.

A 26-year-old male suffering from acute rhinitis took the first dose of Zolistan (mizolastine, 10 mg), orally, and 15 minutes later he developed intense generalized pruritus, cutaneous rash, oropharyngeal pruritus, edema on his face, difficulty in swallowing, and mild dyspnea. He was treated with methylprednisolone and epinephrine and improved within 30 minutes. The patient had not taken mizolastine before and he has avoided it since the reaction. Cutaneous tests with Zolistan and its excipients proved negative. Simple-blind oral challenge tests with the excipients and then with Zolistan were positive only with Zolistan. In order to confirm the absence of cross-reactivity between mizolastine and other benzimidazoles, we tested omeprazole, domperidone and mebendazole, all of which yielded negative results. To our knowledge, this is the second case of immediate hypersensitivity to mizolastine documented to date. In our case, the clinical history, physical examination and provocation tests allow us to establish the diagnosis of hypersensitivity to mizolastine and exclude the cross reactivity with other benzimidazole derivatives.

Epileptic attacks associated with wasp sting-induced anaphylaxis.

We report the case of a patient who suffered two epileptic attacks, each one associated with an anaphylactic shock due to wasp venom. He had no history of atopy nor any known diseases. Previous wasp stings had been well tolerated. An IgE-mediated hypersensitivity to the venom was shown both by cutaneous and immunologic tests. Specific IgE against Polistes spp. venom was 0.86 kU/I (RAST method), and intradermal tests with Polistes spp. venom were positive at a concentration of 1 microgram/ml. Cutaneous tests and serum specific IgE against Vespula spp. and Apis mellifera venoms were negative. In addition to that, wasp venom immunotherapy has been a highly effective treatment. Although convulsions may occur as a complication of anaphylaxis, only a few cases have been reported in the literature because of wasp venom. In our patient, it seems more likely that the epileptic attacks were due to anoxemia due to hypotension caused by vasodilatation and cardiac involvement in anaphylaxis.

Allergic contact dermatitis due to Centella asiatica: a new case.

We report a new case of allergic contact dermatitis due to Centella asiatica, a weak sensitizer. Patch tests with Centella asiatica at different vehicles and in different concentrations were carried out. Regarding our results, we suggest as a routine procedure to start with 1% pet, and when the test remains negative 10% pet and 2% eth 70 degrees could be used.

Cutaneous reaction to naproxen.

A 28-year-old woman with a previous atopic history had been complaining of itching and burning erythematous plaques or blister eruptions on her face and neck for the last 2 years. These lesions became red-brown and then disappeared in 1-2 weeks. However, the site of two of them had remained heavily pigmented after resolution. Sometimes, vesicular lesions affected the oral mucosa causing a burning sensation. She had noticed that these eruptions reappeared in the same location and related to menstruation (when she used to take naproxen sodium because of dysmenorrhea). Furthermore, pigmented sites became red-brown, elevated and itchy. These findings suggested a fixed drug eruption (FDE) due to naproxen, a sporadic clinical event previously reported only once. Patch tests were performed on the back (normal skin) with a series of NSAIDs, and with naproxen both on the back and on previous FDE sites. The test were negative on the back, and on previous FDE sites the skin got dark. The value of this result as a diagnostic tool was unclear so we performed an oral challenge test with naproxen which proved the diagnosis definitely.

Anaphylactic shock following povidone.

OBJECTIVE: To report a patient with an anaphylactic reaction related to povidone administration. CASE SUMMARY: A 37-year-old man with a history of allergic rhinitis presented with urticaria, dyspnea, wheezing, rhinorrhea, and dysphonia 20 minutes after the intraarticular administration of mepivacaine hydrochloride and paramethasone acetate in his right knee. Two months after this episode, he was admitted for controlled provocation tests. Tests on mepivacaine were negative. The preparation of paramethasone contained the excipients benzalkonium chloride, polysorbate 80, and povidone. In vitro tests and provocation were negative with polysorbate 80 and benzalkonium chloride, but positive with povidone. DISCUSSION: Povidone, a mixture of synthetic polymers, is commonly used as an excipient in pharmaceutical products, an additive in food products, and a dispersant and stabilizer in hairsprays. Although it is well tolerated when used topically or parenterally, local and systemic effects have been reported. Furthermore, multiorgan involvement resulting from accumulation of the drug in the reticuloendothelial system has been described. The immunologic properties of povidone have not been explored in humans, but have been in animals. In fact, the capacity of povidone to release histamine and its immunogenicity are proportional to its molecular weight. An immunoglobulin (Ig) E-mediated hypersensitivity reaction in asthma has been reported. In our case, povidone was responsible for the syndrome. However, we cannot determine the exact mechanism. An unspecific histamine release and/or an IgE-mediated hypersensitivity could be involved. CONCLUSIONS: Povidone was responsible for a severe anaphylactic reaction in our patient. The possibility of an iatrogenic adverse effect caused by the excipient but not by the active ingredient should be considered in patients exhibiting similar symptoms. We believe that the excipients used in the preparation of all medicines should be disclosed.

Cutaneous-mucosal allergic contact reaction due to topical corticosteroids.

We report the case of a 41-year-old nonatopic women with a previous history of eczematous reaction due to hydrocortisone who suffered worsening of her perennial rhinitis in association with perinasal dermatitis from the use of budesonide in nasal spray form, and stomatitis and pharyngitis due to budesonide in a bronchial inhaler. Patch tests with a series of 25 corticosteroids, some of them at different concentrations and in different vehicles, were positive to tixocortol pivalate, hydrocortisone, budesonide, prednisolone, hydrocortisone butyrate propionate, triamcinolone acetonide, and fluocinolone acetonide. For some of them, a 1% solution in ethanol gave a positive reaction when a 20% mixture in petrolatum did not. Like other authors, we suggest that some multiple positives may represent sensitization to several steroids independently, true cross-reactions, or both, and that ethanol is a better vehicle than petrolatum.