ABSTRACT
The clinical history is the cornerstone of the doctor´s work. When assessing patients consulting for a suspected hypersensitivity reaction to a drug, the details collected in the patient´s clinical history are essential when deciding which tests to perform and for making recommendations about which drugs the patient should avoid and which can be taken. This area is especially important today, since many patients are labeled as allergic to drugs, especially penicillins, without this being the case. This article reviews the importance of the clinical history in a patient with a hypersensitivity reaction to a drug and considers which data should be collected. Likewise, a record-based model is proposed to help standardize the clinical history.
Subject(s)
Drug Hypersensitivity , Drug Hypersensitivity/diagnosis , Humans , Penicillins/adverse effects , Skin TestsABSTRACT
Little is known about the impact of proning on oxygenation and ventilatory efficiency on patients with severe Covid-19. In this retrospective observational study we calculated Pa/FiO2 ratio (P/F) as a marker of oxygenation and dead space fraction (Vd/Vt) to assess ventilation. 12 patients who were proned twice or more were included. There was a significant improvement in P/F ratio when prone (110.18 ± 28.11) compared to supine (88.95 ± 19.34) (p < 0.01). There was no improvement in Vd/Vt on proning (p > 0.05). Vd/Vt as a function of time displayed a positive linear correlation in those who did not survive (n = 9) (Rs = 0.48, p < 0.01) but no observed correlation in those who survived (n = 3) (Rs = 0.002, p = 0.97). Our findings indicate that prone position in patients with Covid-19 has little effect on dead space fraction but does improve oxygenation. Rise in dead space with time appears to be a prognostic factor for death in patients with severe Covid- 19.
ABSTRACT
The clinical history is the cornerstone of the doctor's work. When assessing patients consulting for a suspected hypersensitivity reactionto a drug, the details collected in the patient's clinical history are essential when deciding which tests to perform and for makingrecommendations about which drugs the patient should avoid and which can be taken. This area is especially important today, since manypatients are labeled as allergic to drugs, especially penicillins, without this being the case. This article reviews the importance of the clinicalhistory in a patient with a hypersensitivity reaction to a drug and considers which data should be collected. Likewise, a record-based modelis proposed to help standardize the clinical history (AU)
La historia clínica es la piedra angular del trabajo del médico. En el estudio de los pacientes que consultan por una supuesta reacción dehipersensibilidad a un fármaco, los detalles recogidos en la historia clínica del paciente son fundamentales para decidir el estudio quehay que realizar y para, al final, dar recomendaciones al paciente sobre los fármacos que debe evitar o que puede tomar. Actualmentecobra especial importancia este tema, dado que hay un elevado porcentaje de la población que, sin serlo, está etiquetada de alergiaa fármacos, sobre todo a las penicilinas. En este artículo se revisa la importancia que tiene la historia clínica ante un paciente con unareacción de hipersensibilidad a un fármaco y qué datos deben ser recogidos. Asimismo, se propone un modelo de ficha que puede ayudara la estandarización de la historia clínica (AU)
Subject(s)
Humans , Drug Hypersensitivity , Medical Records/standardsABSTRACT
INTRODUCTION AND OBJECTIVES: Allergy to galactose-α-1,3-galactose (alpha-gal) is a peculiar form of food allergy generally manifesting as an anaphylactic reaction hours after mammalian meat consumption, due to the presence of specific IgE against this oligosaccharide. In addition, immediate anaphylaxis may develop after exposure to other sources of alpha-gal, such as monoclonal antibody cetuximab, vaccines, plasma expanders or anti-snake venoms. Sensitization to alpha-gal has also been implicated in the rapid degeneration of biological valve implants, and recognized as a cause of occupational disease in cattle raisers. The implication of tick bites in this type of sensitization has been accepted by all the research groups dedicated to this disease. PATIENTS AND METHOD: The present study describes the clinical and sensitization characteristics of 39 patients diagnosed with alpha-gal allergy in the hospitals of our province (Lugo, Monforte de Lemos and Burela, Spain). RESULTS: Most patients were middle-age males. Of note, is the fact that the series includes the first pediatric patient reported in Spain to date. The predominant clinical manifestations were urticaria or delayed anaphylaxis after consumption of mammalian meat. Seventy-four percent of the patients reported having suffered a previous tick bite, and the clinical presentation of anaphylaxis was significantly more prevalent in those with a persistent local reaction following the bite than in those with no such reaction (p = 0.032). CONCLUSIONS: A review is also made of the disorder which, due to its variable clinical expression, is referred to as alpha-gal syndrome. The study concludes that a diagnosis of alpha-gal allergy should be considered in patients with urticaria-anaphylaxis of uncertain origin or manifesting after the administration of vaccines or products of bovine/porcine origin
No disponible
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Galactose/immunology , Food Hypersensitivity/immunology , Allergens/immunology , Food Hypersensitivity/diagnosis , Galactose/adverse effects , Hypersensitivity, Delayed/immunology , Spain , Immunoglobulin E/immunology , Anaphylaxis/immunology , Skin Tests , Antibodies, Monoclonal/immunologyABSTRACT
INTRODUCTION AND OBJECTIVES: Allergy to galactose-α-1,3-galactose (alpha-gal) is a peculiar form of food allergy generally manifesting as an anaphylactic reaction hours after mammalian meat consumption, due to the presence of specific IgE against this oligosaccharide. In addition, immediate anaphylaxis may develop after exposure to other sources of alpha-gal, such as monoclonal antibody cetuximab, vaccines, plasma expanders or anti-snake venoms. Sensitization to alpha-gal has also been implicated in the rapid degeneration of biological valve implants, and recognized as a cause of occupational disease in cattle raisers. The implication of tick bites in this type of sensitization has been accepted by all the research groups dedicated to this disease. PATIENTS AND METHOD: The present study describes the clinical and sensitization characteristics of 39 patients diagnosed with alpha-gal allergy in the hospitals of our province (Lugo, Monforte de Lemos and Burela, Spain). RESULTS: Most patients were middle-age males. Of note, is the fact that the series includes the first pediatric patient reported in Spain to date. The predominant clinical manifestations were urticaria or delayed anaphylaxis after consumption of mammalian meat. Seventy-four percent of the patients reported having suffered a previous tick bite, and the clinical presentation of anaphylaxis was significantly more prevalent in those with a persistent local reaction following the bite than in those with no such reaction (pâ¯=â¯0.032). CONCLUSIONS: A review is also made of the disorder which, due to its variable clinical expression, is referred to as alpha-gal syndrome. The study concludes that a diagnosis of alpha-gal allergy should be considered in patients with urticaria-anaphylaxis of uncertain origin or manifesting after the administration of vaccines or products of bovine/porcine origin.
Subject(s)
Anaphylaxis/immunology , Food Hypersensitivity/immunology , Tick Bites/epidemiology , Urticaria/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Allergens/immunology , Anaphylaxis/epidemiology , Female , Food Hypersensitivity/epidemiology , Humans , Male , Meat , Middle Aged , Spain/epidemiology , Urticaria/epidemiology , Young Adult , alpha-Galactosidase/immunologySubject(s)
Allergens/immunology , Amniotic Fluid/immunology , Galactose/immunology , Hypersensitivity/immunology , Occupational Diseases/immunology , Occupational Exposure/adverse effects , Adult , Animals , Cattle , Female , Galactose/adverse effects , Humans , Hypersensitivity/diagnosis , Immunoglobulin E/blood , Immunoglobulin E/immunology , Immunoglobulin M/immunology , Male , Middle Aged , Occupational Diseases/diagnosisSubject(s)
Bee Venoms/immunology , Beekeeping , Bees/immunology , Hypersensitivity/immunology , Immunoglobulin E/blood , Immunoglobulin G/blood , Insect Bites and Stings/immunology , Occupational Exposure/adverse effects , Occupations , Adult , Aged , Aged, 80 and over , Animals , Bee Venoms/adverse effects , Biomarkers/blood , Case-Control Studies , Female , Humans , Hypersensitivity/blood , Hypersensitivity/prevention & control , Immune Tolerance , Insect Bites and Stings/blood , Male , Middle Aged , Serologic Tests , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Bee Venoms/adverse effects , Bee Venoms/immunology , Hypersensitivity, Immediate/complications , Immunoglobulin E/analysis , Allergy and Immunology/instrumentation , Immunotherapy/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Amniotic Fluid/immunology , Galactose/analysis , Urticaria/diagnosis , Urticaria/immunology , Electrophoresis, Polyacrylamide Gel/methods , Hypersensitivity, Immediate/complications , Hypersensitivity, Immediate/immunology , Immunoglobulin E/analysisSubject(s)
Anaphylaxis/immunology , Coloring Agents/adverse effects , Drug Hypersensitivity/immunology , Methylene Blue/adverse effects , Rosaniline Dyes/adverse effects , Aged , Aged, 80 and over , Anaphylaxis/diagnosis , Drug Hypersensitivity/diagnosis , Female , Humans , Intradermal Tests , Male , Middle Aged , Plasma , Predictive Value of Tests , Risk Factors , Rosaniline Dyes/immunology , Sentinel Lymph Node Biopsy/adverse effectsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Methylene Blue/adverse effects , Azure Stains/adverse effects , Immunoglobulin A/immunology , IgA Deficiency/immunology , Anaphylaxis/complications , Anaphylaxis/immunology , Dermatitis, Contact/complications , Dermatitis, Contact/immunology , Skin Tests/methods , Urticaria/complications , Urticaria/immunologySubject(s)
Humans , Male , Female , Drug Hypersensitivity/complications , Anaphylaxis , Skin Tests/adverse effects , Intradermal Tests , Signs and SymptomsABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Extreme Heat/adverse effects , Urticaria/drug therapy , Antibodies, Monoclonal/therapeutic use , Angioedema/etiology , Hypersensitivity, ImmediateABSTRACT
The Drug Allergy Committee of the Spanish Society of Allergology and Clinical Immunology reviewed the allergenic potential of several substances of food origin that are found in the composition of some drugs. Despite recent legislation on labeling, many labels do not clearly state whether the drug contains raw material (active ingredients, excipient, or other manufacturing intermediate) with an origin in any of the substances in the list of the 14 groups of food allergens that are subject to mandatory declaration. The objective of legislation is that the drug package, the Summary of Product Characteristics, and the patient information leaflet clearly state the food content in order to improve the safety of allergic patients. Therefore, any food or allergen derivative that must be declared should be clearly stated on the drug label. Of all the evaluated products, egg and milk derivatives are the most frequently discussed in literature reviews. The natural or synthetic origin of potentially allergenic substances such as lysozyme, casein, lactose, albumin, phosphatide, and aromatic essences should be clearly stated. Providing this information has 2 clear advantages. First, allergic reactions to drugs in patients with food allergy could be avoided (if the substances have a natural origin). Second, prescription would improve by not restricting drugs containing synthetic substances (which do not usually induce allergic reactions).
Subject(s)
Drug Hypersensitivity/etiology , Food Additives/adverse effects , Food Hypersensitivity/etiology , Glucosamine/adverse effects , Humans , Lactose/adverse effects , Muramidase/adverse effects , Ovalbumin/adverse effects , Propofol/adverse effects , SpainABSTRACT
We report 3 patients (26, 31, and 33 years) who worked at the same fish farm for several years. They experienced symptoms of rhinoconjunctivitis and bronchial asthma while classifying fish by size. Their asthma gradually worsened to the extent that it became persistent and required daily medication with inhaled corticosteroids and bronchodilators. Symptoms improved during weekends and holidays. All 3 patients could eat turbot. Our study showed that the patients were allergic and that sensitization was probably by inhalation. The allergens were parvalbumin in 1 case and a different allergen in the remaining 2 patients.
Subject(s)
Allergens/immunology , Fish Proteins/immunology , Hypersensitivity/diagnosis , Hypersensitivity/immunology , Parvalbumins/immunology , Adult , Allergens/adverse effects , Animals , Asthma , Fish Proteins/isolation & purification , Fish Proteins/metabolism , Fisheries , Flatfishes/immunology , Humans , Hypersensitivity/etiology , Hypersensitivity/physiopathology , Immunoglobulin E , Male , Occupational Exposure/adverse effects , Parvalbumins/isolation & purification , Parvalbumins/metabolism , Rhinitis , Skin TestsABSTRACT
La menopausia es un estado fisiológico de la mujer, parte del proceso natural de envejecimiento, caracterizado por el cese de la secreción hormonal ovárica. La falta de secreción estrogénica por los ovarios dará lugar a una modificación funcional del eje hipotálamo-hipófisis- ovario, que se produce de manera paulatina años previos y posteriores a la última regla. Estos cambios hormonales darán lugar a una serie de síntomas psíquicos y vasomotores, y orgánicos en el aparato urogenital. Con el tiempo podrán afectarse otros órganos y sistemas, dando lugar a alteraciones metabólicas, cardiovasculares y óseas
The menopause is a physiological state of the woman, a part of the natural process of aging, characterized by the end of hormone ovarian secretion. The fall of estrogen secretion in ovaries result in a modification of hypothalamichypofise- ovarian axis, by producing progressive changes before and after years to the last menstruation. This hormonal changes will result in several vasomotor and psychological symptoms, and organic symptoms in urogenital system. After other organs and systems could be affected, by producing metabolic, cardiovascular and bone alterations
Subject(s)
Female , Adult , Humans , Menopause/metabolism , Menopause/physiology , Hormone Replacement Therapy/methods , Hormone Replacement Therapy , Menstrual Cycle/metabolism , Androgens/metabolism , Androgens , Gonadotropins/metabolism , Climacteric/metabolism , Climacteric/psychology , Hormone Replacement Therapy/mortality , Androgens/deficiency , Climacteric/geneticsABSTRACT
La enfermedad cardiovascular constituye la primera causa de morbimortalidad en los países desarrollados, asociada a diferentes alteraciones como diabetes, hipertensión arterial, obesidad, dislipemia, etc, que suelen darse en el mismo sujeto y constituyendo el síndrome metabólico. El hecho común a todas ellas es la resistencia a la insulina, situación que parte de un componente genético sobre el que se suman factores ambientales. La menopausia puede ser uno de estos factores que contribuye al desarrollo del la resistencia a la insulina y el síndrome metabólico
Cardiovascular disease results in the first cause of morbimortality in developed countries. It is asociated to different alterations, as diabetes, arterial hypertension, obesity, dyslipidemia, etc, with an occurrence into the same subject by constituting the metabolic syndrome. The common fact with all these alterations is the insulin resistance, a situation with a genetic component and ambiental factors. The menopause is a factor that can contribute in developmenting insulin resistance and metabolic syndrome
