[Comparison two blood culture bottles for the recovery of Enterobacteriaceae].

OBJECTIVE: The objective of the present study was to compare the suitability of the B BACTEC™ Lytic/10 Anaerobic/F versus B BACTEC™ Plus Aerobic/F vials at the time of both Enterobacteriaceae recovery rate and detection time. METHODS: Prospective observational study from September 2018 to January 2019 in which 150 bacteremia. The samples were incubated in the automated BD BACTEC ™ FX system (Becton Dickison). RESULTS: A total of 180 Enterobacteriaceae were isolated: 93 B BACTEC™ Plus Aerobic/F and 87 from B BACTEC™ Lytic/10 Anaerobic/F belonging to 106 patients The urinary focus was the most frequent origin. The average detection time in both cases was not more than 15 hours. CONCLUSIONS: The combination of both bottles seems to be the best diagnostic strategy, thus reducing the detection time as well as increasing the recovery of Enterobacteriaceae. The combination of both vials could be implemented especially in selected situation of special urgency such as the sepsis code or critical patients.

Relevance of Allergenic Sensitization to Cynodon dactylon and Phragmites communis: Cross-reactivity With Pooideae Grasses.

BACKGROUND AND OBJECTIVES: The homologous group of sweet grasses belongs to the Pooideae subfamily, but grass pollen species from other subfamilies can also cause allergy, such as Cynodon dactylon (Chloridoideae) and Phragmites communis (Arundinoideae). C dactylon and P communis have not been included in the sweet grasses homologous group because of their low cross-reactivity with other grasses. The aims of this study were to investigate the profile of sensitization to C dactylon and P communis in patients sensitized to grasses and to analyze cross-reactivity between these 2 species and temperate grasses. METHODS: Patients were skin prick tested with a grass mixture (GM). Specific IgE to GM, C dactylon, P communis, Cyn d 1, and Phl p 1 was measured by ImmunoCAP. A pool of sera was used for the immunoblot assays. Cross-reactivity was studied by ELISA and immunoblot inhibition. RESULTS: Thirty patients had sIgE to GM. Twenty-four (80%) had positive results for C dactylon, 27 (90%) for P communis, 22 (73.3%) for nCyn d 1, and 92.9% for rPhl p 1. Bands were detected in the 3 extracts by immunoblot. Inhibition of GM was not observed with C dactylon or P communis by immunoblot or ELISA inhibition. When C dactylon or P communis were used in the solid phase, GM produced almost complete inhibition. CONCLUSIONS: Eighty percent of patients sensitized to grasses were also sensitized to C dactylon and 90% were sensitized to P communis. Sensitization to these species seems to be induced by allergens different to those in sweet grasses.

Relevance of allergenic sensitization to cynodon dactylon and Phragmites communis: cross-reactivity with pooideae grasses

Background and Objectives: The homologous group of sweet grasses belongs to the Pooideae subfamily, but grass pollen species from other subfamilies can also cause allergy, such as Cynodon dactylon (Chloridoideae) and Phragmites communi (Arundinoideae). C dactylon and P communis have not been included in the sweet grasses homologous group because of their low cross-reactivity with other grasses. The aims of this study were to investigate the profile of sensitization to C dactylon and P communis in patients sensitized to grasses and to analyze cross-reactivity between these 2 species and temperate grasses. Methods: Patients were skin prick tested with a grass mixture (GM). Specific IgE to GM, C dactylon, P communis, Cyn d 1, and Phl p 1 was measured by ImmunoCAP. A pool of sera was used for the immunoblot assays. Cross-reactivity was studied by ELISA and immunoblot inhibition. Results: Thirty patients had sIgE to GM. Twenty-four (80%) had positive results for C dactylon, 27 (90%) for P communis, 22 (73.3%) or nCyn d 1, and 92.9% for rPhl p 1. Bands were detected in the 3 extracts by immunoblot. Inhibition of GM was not observed with C dactylon or P communis by immunoblot or ELISA inhibition. When C dactylon or P communis were used in the solid phase, GM produced almost complete inhibition. Conclusions: Eighty percent of patients sensitized to grasses were also sensitized to C dactylon and 90% were sensitized to P communis. Sensitization to these species seems to be induced by allergens different to those in sweet grasses (AU)

Antecedentes y Objetivos: Desde un punto de vista taxonómico, el grupo homólogo de las gramíneas pertenece a la sub-familia Pooideae. Sin embargo, existen también otras especies de gramíneas alergénicas que pertenecen a sub-familias diferentes como son Cynodon dactylon (Chloridoideae) o Phragmites communis (Arundinoideae). C. dactylon y P. communis no están incluidas en este grupo homólogo debido a que la reactividad cruzada con otras gramíneas es limitada. Los objetivos del estudio fueron investigar el perfil de sensibilización a C. dactylon y P. communis en pacientes sensibilizados a gramíneas y analizar la reactividad cruzada entre estas dos especies y las gramíneas más comunes. Métodos: A los pacientes se les realizó una prueba cutánea con una mezcla de gramíneas (MG). Mediante ImmunoCAP se midió la IgE específica para MG, C. dactylon P. communis , Cyn d 1 y Phl p 1. Un pool de sueros se utilizó para ensayos de inmunoblot. La reactividad cruzada se estudió mediante ELISA e inmunoblot inhibición Resultados: Treinta pacientes tuvieron IgE específica para MG. Veinticuatro (80%) fueron positivos a C. dactylon, 27 (90%) a P. communis, 22 (73,3%) a nCyn d 1 y 92,9% fueron positivos a rPhl p 1. Se detectaron bandas en los tres extractos mediante inmunoblot. No se observó inhibición de MG con las otras dos especies mediante inmunoblot o ELISA inhibición. Cuando C. dactylon o P. communis se usaron en fase sólida, MG produjo una inhibición casi completa. Conclusiones: El 80% de los pacientes sensibilizados a gramíneas estaban también sensibilizados a C. dactylon y el 90% a P. communis. La sensibilización a estas especies parece estar inducida por diferentes alérgenos que en el caso de gramíneas (AU)

Caso clínico de seguimiento farmacoterapéutico a paciente con dolor crónico / No disponible

No disponible

The association between leptin and insulin levels in adults with cystic fibrosis.

UNLABELLED: Cystic fibrosis (CF)-related diabetes is an important complication of CF caused by a decrease in insulin secretion that is associated with weight loss, poor nutritional status and increased mortality. Leptin, a hormone secreted from white adipose tissue, has an important role in energy homoeostasis by inhibiting food intake and increasing energy expenditure. Leptin secretion can be increased by nutrient signals such as insulin. AIMS: Considering that leptin plays a role in energy homoeostasis and that CF is associated to poor weight gain and decreased insulin secretion, leptin levels in CF patients with different glucose tolerances were investigated and compared with those of healthy control subjects. METHODS: Two-hour oral glucose tolerance tests (OGTT) were performed in 82 patients with CF and various glucose tolerances as well as in 17 healthy control subjects during which blood was withdrawn every 30 min to measure glucose and insulin. Fasting leptin, fibrinogen and fat mass were also measured, and body mass index (kg/m(2)) calculated for all participants. Early and late insulin secretion was separated by calculating the area under the curve from time 0 to 30 min and 30 to 120 min of the OGTT (AUC(0-30) and AUC(30-120)). RESULTS: Leptin levels were comparable between CF patients and healthy control subjects. Interestingly, correlations were observed between leptin levels and insulin (AUC(0-120) and AUC(30-120)) after adjusting for gender and fat mass (P<0.05). CONCLUSION: This study suggests a potential role of insulin in regulating leptin levels in adults with stable CF.

Normal adiponectin levels despite abnormal glucose tolerance (or diabetes) and inflammation in adult patients with cystic fibrosis.

RATIONALE: Circulating adiponectin levels are negatively associated with glucose intolerance, inflammation and central adiposity. Since these conditions are common in cystic fibrosis (CF), we examined whether adiponectin values are altered in these patients. AIM: To determine if CF patients have altered adiponectin levels and if these levels correlate with glucose tolerance categories (normal, impaired glucose tolerance (IGT) and cystic fibrosis-related diabetes (CFRD)), insulin resistance or inflammatory markers such as fibrinogen and C-reactive protein (CRP). METHODS: Oral glucose tolerance tests (OGTTs) were performed and adiponectin levels were measured in 90 CF patients not known to be diabetic and 15 healthy controls matched for age, sex and body mass index (BMI). Inflammatory markers, serum albumin concentrations and the clinical status of CF patients (i.e. pulmonary function) were also examined. RESULTS: CF pathology was characterized by a high prevalence (43.5%) of glucose tolerance abnormalities: 26.5% of IGT and 17.0% of newly diagnosed CFRD. CF patients also presented systemic inflammation as revealed by a significant increase of fibrinogen (P=0.029) in all patients and higher CRP levels in CFRD patients compared to the controls (P<0.05). On the other hand, CF and control subjects had similar albumin serum concentration. While CF patients and controls had similar serum adiponectin values, women had significantly higher hormone levels than men (P<0.001). Adiponectin levels did not correlate with glucose tolerance, inflammatory markers or insulin resistance. On the other hand, they correlated positively with both total and HDL-cholesterol (P<0.001). CONCLUSION: CF patients did not show any alterations in adiponectin levels despite insulin resistance, glucose intolerance and sub clinical chronic inflammation. Thus, CF appears to be one of the rare conditions in which discordance between adiponectin values and insulin resistance or inflammation is evident.

Purified allergens vs. complete extract in the diagnosis of plane tree pollen allergy.

BACKGROUND: Plane tree pollen allergy is a clinical disorder affecting human population in cities of Europe, North America, South Africa, and Australia. OBJECTIVE: To compare IgE-reactivity of the natural and recombinant forms of two major plane allergens, Pla a 1 and Pla a 2, with the reactivity of Platanus acerifolia pollen extract. METHODS: Forty-seven patients with P. acerifolia allergy, 15 of them monosensitized, and 24 control subjects were included in the study. Natural Pla a 1 and Pla a 2 were purified by standard chromatographic methods and recombinant proteins were expressed in Escherichia coli. Skin prick test and determination of specific IgE were performed with commercial P. acerifolia extract and natural and recombinant purified allergens. RESULTS: Pla a 1 and Pla a 2 were responsible for 79% of the IgE-binding capacity against P. acerifolia pollen extract. A high correlation has been found between the IgE response to nPla a 1 (R = 0.80; P < 0.001) or nPla a 2 (R = 0.79; P < 0.001) vs. P. acerifolia extract as well as between natural and recombinant Pla a 1 (R = 0.89; P < 0.001). Skin testing showed no significant differences between extract and nPla a 2, whereas a higher reactivity was found with nPla a 1. In contrast, rPla a 1 revealed markedly reduced sensitivity in comparison with extract by skin prick test and specific IgE. The sensitivity of the mix Pla a 1+Pla a 2 was 100% and 87.5% for monosensitized and polysensitized patients, respectively, with no false-positive reactions detected. Conclusion Pla a 1 and Pla 2 are sufficient for a reliable diagnosis of P. acerifolia in most patients and induce comparable skin test reactivity as a whole extract.

Gastrointestinal stromal tumors.

BACKGROUND: We reviewed radiologic features of gastrointestinal stromal tumors (GISTs) and correlated them with clinical and pathologic findings. METHODS: We investigated a series of 39 c-Kit-positive GISTs. Clinical and radiologic findings and management of these patients were recorded. RESULTS: Twenty women and 19 men (mean age 64 years) had histologically proved GIST. Tumor locations were the small bowel (n = 20), stomach (n = 14), rectum (n = 4), and omentum (n = l). Symptoms at presentation were most frequently gastrointestinal bleeding (n = 14) and abdominal pain (n = l1). Tumors were classified as very low risk (n = 2), low risk (n = 10), intermediate risk (n = 12), and high risk (n = 11). Ultrasonography, computed tomography, magnetic resonance, digital subtraction angiography, and barium series were used in the evaluation of these tumors. Most tumors were seen as well-delineated soft tissue masses with heterogeneous contrast enhancement. Necrosis, calcification, and ulceration were most commonly seen in large tumors that presented a more aggressive behavior. CONCLUSION: GISTs can arise anywhere in the gastrointestinal tract and present a great variety of clinical and radiologic features, depending mostly on size and location.

Gestión técnica de una unidad de inmunoterapia / Technical gestion in the immunotherapy unit

Antecedentes y objetivos: La administración de inmunoterapia (IT) por vía subcutánea es un tratamiento no exento de riesgos, por lo que su administración debe llevarse a cabo siguiendo estrictos protocolos de actuación. El objetivo del estudio es establecer los criterios de monitorización de los pacientes en una Unidad de Inmunoterapia para reducir el riesgo de aparición de reacciones adversas. Material y métodos: Un total de 378 pacientes diagnosticados de rinitis y/o asma por sensibilización a distintos aeroalergenos (ácaros, pólenes, epitelios y hongos) fueron atendidos en nuestra Unidad durante un período de 15 meses. Todos ellos fueron tratados con extractos estandarizados biológicamente. La monitorización de los enfermos se llevó a cabo con la ayuda de un programa informático (InmunoWin®). Resultados: Se administraron un total de 4.383 dosis. Aparecieron un total de 34 reacciones adversas (0,8 por ciento), de las cuales sólo una fue sistémica (0,02 por ciento). Ésta consistió en un broncoespasmo leve, que se controló inmediatamente. Conclusiones: La correcta monitorización de los pacientes, en la cual la informática juega un papel destacado, en el momento en el que se les administra una dosis de IT, reduce drásticamente el porcentaje de reacciones sistémicas y se demuestra que la IT es un tratamiento seguro cuando se administra bajo las debidas condiciones (AU)

Influence in the quality of life of the respiratory patients by environmental control and the acaricide Frontac®.

The present prospective, open, observational study assessed the effect of the use of standard environmental control measures together with the application of an acaricide-containing aerosol of esbiol/benzyl benzoate/piperonyl butoxide/2-phenylphenol (Frontac) on several clinical and environmental parameters in patients suffering from perennial allergic rhinoconjunctivitis related to house dust mites (HDM). Fifty-five patients were enrolled and studied for one year. Both symptoms and the patients' quality of life (evaluated by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)) were assessed at several clinic visits. The amount of HDM antigen was semi-quantitatively estimated using the guanine test. We found a significant decrease (p < 0.001) in most nasal symptoms scores: sneezing, runny nose, stuffy nose and itching. The overall quality of life (QoL) score also showed a significant improvement during the study period; the mean score decrease found was 0.86 (CI 95 %, 0.54-1.17) (p < 0.001). Five of the seven domains included in the questionnaire decreased significantly: non-hayfever symptoms; practical problems; nasal symptoms; eye symptoms, and emotions. These QoL score decreases were found during the first 3 months and later remained stable at lower levels than at baseline. The content of guanine in dust samples decreased significantly from 2.17 0.75 to 1.43 0.68 (p < 0.001). No toxic adverse events were recorded. In conclusion, these results show an improvement in the quality of life and a clinical benefit of the long-term use of the new chemical acaricide tested, together with environmental measures, in the home of patients suffering from allergic respiratory pathology.

Asma ocupacional por polvo de espinaca / Asthma occupational to Spinach powder

Antecedentes y objetivos: Los alimentos pueden ser causa de enfermedades respiratorias como antígenos inhalados. Se presenta un caso de un varón de 45 años, panadero, sin antecedentes de atopia, que presenta síntomas de rinoconjuntivitis y asma bronquial en relación con la manipulación de polvo de espinaca deshidratada, que utiliza para el enriquecimiento de harinas integrales en la fabricación del pan integral. El paciente tolera la ingesta de espinaca, pan y bollería. Material y métodos: Se realizó prick test con extracto de polvo de espinaca deshidratada (30 mg/ml) y prueba de provocación nasal con extracto de espinaca deshidratada, así como determinación de IgE específica mediante el método HY-TEC-EIA e SDSPAGE-immunoblotting. Resultados: El prick test con extracto de polvo de espinaca deshidratada (30 mg/ml) fue positivo. La prueba de provocación nasal con el extracto de espinaca deshidratada fue positiva a una dilución 1/1000 desencadenándose de forma inmediata síntomas clínicos de rinitis; se pudo observar aumento de las resistencias y disminución en el flujo total mayor del 50 por ciento. La IgE específica fue de 1,64 kU/L y mediante la técnica SDS-PAGE immunoblotting se determinó una banda proteica fijadora de IgE de 29,6 KDa. Conclusiones: Se describe la hipersensibilidad mediada por IgE frente a polvo de espinaca en un paciente panadero que presentaba síntomas de rinitis y asma con su manipulación. El paciente se encuentra asintomático al evitar su contacto. La sensibilización a otros vegetales utilizados en la masa del pan puede ser la causa de asma ocupacional por antígenos ocultos y poco frecuentes (AU)

Purification and characterization of Pla a 1, a major allergen from Platanus acerifolia pollen.

BACKGROUND: Plane trees, as Platanus acerifolia, are an important source of airborne allergens in cities of the United States and Western Europe. Little is known about the relevant allergens of this pollen. The aim of this study was to identify relevant allergens from P. acerifolia pollen and purify and characterize a major allergen of 18 kDa. METHODS: P. acerifolia pollen extract was fractionated using ion exchange, gel filtration, and reverse-phase chromatography. Analyzes were carried out by EAST, SDS-PAGE, isoelectric focusing, immunoblotting and amino-acid sequencing. RESULTS: An 18-kDa protein from the P. acerifolia pollen extract, which we named Pla a 1, was purified. This nonglycosylated protein had an isoelectric point value higher than 9.3 and was recognized by up to 92% of monosensitized Platanus allergic patients and 83% of polyzensitized patients. Sequencing of its N-terminal yielded an amino acid sequence which showed no homology to the known proteins in the databases. Other relevant allergens detected in monosensitized patients were proteins of 43 and 52 kDa, with immunoglobulin (Ig)E-binding prevalences of 83 and 42%, respectively. Profilin was an important allergen in polyzensitized patients. CONCLUSIONS: The most relevant allergens from the P. acerifolia pollen have been determined. A major allergen, specific of this pollen, and named Pla a 1, has been purified and characterized.

Influence in the quality of life of the respiratory patients by environmental control and the acaricide Frontac®

The present prospective, open, observational study assessed the effect of the use of standard environmental control measures together with the application of an acaricide-containing aerosol of esbiol/benzyl benzoate/piperonyl butoxide/2-phenylphenol (Frontac®) on several clinical and environmental parameters in patients suffering from perennial allergic rhinoconjunctivitis related to house dust mites (HDM). Fifty-five patients were enrolled and studied for one year. Both symptoms and the patients' quality of life (evaluated by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)) were assessed at several clinic visits. The amount of HDM antigen was semi-quantitatively estimated using the guanine test. We found a significant decrease (p < 0.001) in most nasal symptoms scores: sneezing, runny nose, stuffy nose and itching. The overall quality of life (QoL) score also showed a significant improvement during the study period; the mean score decrease found was 0.86 (CI 95 %, 0.54-1.17) (p < 0.001). Five of the seven domains included in the questionnaire decreased significantly: non-hayfever symptoms; practical problems; nasal symptoms; eye symptoms, and emotions. These QoL score decreases were found during the first 3 months and later remained stable at lower levels than at baseline. The content of guanine in dust samples decreased significantly from 2.17 ± 0.75 to 1.43 ± 0.68 (p < 0.001). No toxic adverse events were recorded. In conclusion, these results show an improvement in the quality of life and a clinical benefit of the long-term use of the new chemical acaricide tested, together with environmental measures, in the home of patients suffering from allergic respiratory pathology (AU)

El estudio se realizó de manera prospectiva, abierta y observacional para valorar el efecto de las normas habituales de control ambiental de forma conjunta con la aplicación de un acaricida en aerosol de esbiol/bencil benzoato/piperonil/butóxido/2-fenilfenol (Frontac®) en pacientes afectos de rinoconjuntivitis perenne relacionada con sensibilización a ácaros del polvo doméstico. Cincuenta y cinco pacientes fueron incluidos y estudiados durante un año. Se procedió a tabular la calidad de vida de los pacientes mediante el cuestionario de calidad de vida para pacientes con rinoconjuntivitis. Los niveles de ácaros domésticos fueron evaluados de forma semicuantitiva mediante el test de guanina. Encontramos un significativo descenso (p < 0,001) en la mayoría de los registros de los síntomas nasales: estornudos, rinorrea, prurito nasal y obstrucción nasal. El registro del cuestionario de la calidad de vida también constató una significativa mejoría durante dicho periodo, siendo el descenso de la media del registro del 0,86 (IC 95 %, 0,54-1,17) (p < 0,001). Cinco de los siete ítems incluidos en el registro disminuyeron significativamente (síntomas respiratorios, problemas sociales, síntomas nasales, síntomas conjuntivales y síntomas afectivos). El registro del cuestionario descendió durante los primeros tres meses y se mantuvo con posterioridad por debajo de los valores basales de forma estable. El contenido de guanina de las muestras del polvo del habitat de los pacientes disminuyó significativamente de 2,17 ± 0,75 a 1,43 ± 0,68 (p < 0,001). No se detectaron reacciones tóxicas adversas. En conclusión, estos resultados demuestran una mejoría de la calidad de vida y mejoría clínica utilizando a largo plazo la aplicación del nuevo acaricida testado de forma conjunta con la aplicación de medidas ambientales del habitat de los pacientes que sufren enfermedad respiratoria alérgica (AU)

Asma ocupacional por polvo de acacia / Ocupational asthma by gum guar

Fundamento: Trabajador de la industria farmacéutica que refiere rinitis y asma con la manipulación de los compuestos carbonato cálcico, polvo de acacia y talco, que emplea para la realización del recubrimiento de las grageas de Mycostatin®. Los síntomas desaparecen durante los fines de semana y las vacaciones. Métodos: Se realiza pricktest con extracto de polvo de acacia (10 mg/ml) con resultado positivo. Se lleva a cabo el test de provocación nasal con extracto de polvo de acacia (10 mg/ml) a una dilución 1/10, desencadenándose de forma inmediata síntomas nasales y poniéndose de manifiesto en la rinomanometría un descenso de más del 50 por ciento en el valor del flujo total nasal e incrementándose en 10 veces la resistencia total. Se determina la IgE específica mediante método HY-TEC-EIA, obteniéndose un RAST igual a 3.1 kU/l (clase 2). Mediante la técnica de SDS-PAGE Immunoblotting se determina una banda proteica fijadora de IgE de 20 kDa. Conclusiones: Mediante el estudio realizado se demuestra la existencia de un mecanismo mediado por IgE como desencadenante de los síntomas del paciente al exponerse al polvo de acacia. Con el cambio de puesto de trabajo, el paciente se encuentra asintomático. (AU)

Idiopathic pylephlebitis and idiopathic sclerosing peritonitis in a man with protein S deficiency.

Idiopathic pylephlebitis and primary sclerosing peritonitis are two highly unusual entities. To our knowledge, the association of the two diseases has not been described previously. We report a 42-year-old patient with a protein S deficiency who presented with fever and chills, in whom idiopathic pylephlebitis was diagnosed. A year later, the patient was readmitted because of recurrent vomiting and weight loss. An exploratory laparotomy yielded diagnosis of sclerosing peritonitis, which resolved after surgery. The short time interval between the processes suggests that they were related to each other, and also to the protein S deficiency.

Anaphylactic shock after intra-articular injection of carboxymethylcellulose

Background: sodium carboxymethylcellulose (SCMC) is the sodium salt of a polycarboxymethyl ether of cellulose. SCMC is widely used in pharmaceutical and food industries. We present the case of a 47-year-old man who suffered an anaphylactic shock after an intra-articular injection of Trigon depot®. Methods and results: prick and intradermal tests with Trigon depot® and its components (triamcinolone acetonide, Tween 80, benzylalcohol, SCMC), mepivacaine 2% and latex were performed. Challenge test with mepivacaine 2% was also realized. Results showed a positive intradermal test to Trigon depot® and carboxymethylcellulose, with negative results to the rest (including challenge test to mepivcaine 2%). Conclusions: our results support the diagnosis of anaphylactic shock after intra-articular injection of carboxymethylcellulose and we consider necessary to emphasize that excipients must be taken into account as a potential source of adverse reactions to drugs (AU)

Introducción: la carboximetilcelulosa sódica (SCMC) es la sal sódica de un éter policarboximetílico de la celulosa. SCMC es un producto ampliamente utilizado en industria alimentaria y farmacéutica.Presentamos el caso de un varón de 47 años que sufrió un shock anafiláctico tras recibir una inyección intraarticular de Trigon depot®.Métodos y resultados: se realizaron test cutáneos (prick e intradermorreacción) con Trigon depot® y sus componentes (triamcinolona acetónido, Tween 80, alcohol benzílico, SCMC), mepivacaína 2 por ciento y látex. Se realizó provocación con mepivacaína 2 por ciento.Los resultados de los tests cutáneos mostraron positividad de forma exclusiva al Trigon depot® y a la carboximetilcelulosa, con resultado negativo para el resto del estudio (incluyendo la provocación con mepivacaína 2 por ciento).Conclusiones: nuestros resultados sugieren el diagnóstico de shock anafiláctico tras la administración intraarticular de carboximetilcelulosa. Es importante destacar la importancia de tener en cuenta los excipientes como causa de reacciones adversas a fármacos. (AU)