Molecular Profile of Sensitization to Dermatophagoides pteronyssinus Dust Mite in Portugal

Objective: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas.Methods: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South.Results: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496).Conclusions: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size (AU)

Objetivo: Analizar el diagnóstico por componentes para Dermatophagoides pteronyssinus (Der p) en pacientes con alergia respiratoria ysu relación con la gravedad clínica en diferentes áreas geográficas.Métodos: Se incluyeron 217 pacientes (edad media 25,85±12,7 años; 51,16% mujeres), seleccionados de 13 centros en Portugal (5 delNorte, n = 65). Todos tenían rinitis alérgica, con o sin asma, y tenían pruebas positivas en prick a al menos un ácaro del polvo. La IgEespecífica (sIgE) para Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10 y Der p 23 se determinaronpor ImmunoCAP. El análisis estadístico (prueba U de Mann Whitney) comparó pacientes con rinitis frente a rinitis y asma; rinitis leve frentea moderada-grave; Norte frente a Sur.Resultados: La prevalencia de sensibilización fue del 98,2% para Der p, y del 72,4%, 89,4%, 9,7% y 77% para Der p 1, Der p 2, Der p 10y Der p 23, respectivamente. Las medianas de sIgE fueron de 8,56, 17,7, 0,01 y 3,95 kUA/ L. Las medianas de sIgE de todos los alérgenosfue mayor en pacientes con rinitis de moderada a grave y rinitis con asma, pero no estadísticamente significativo (NSS). El valor de Der p2 fue significativamente mayor en el Sur en comparación con el Norte (p = 0,0496).Conclusiones: La sensibilización a Der p es la más común en Portugal. Der p 2 tuvo la prevalencia más alta y los niveles medios más altos.Todos los componentes moleculares fueron mayores en pacientes más sintomáticos (NSS). El valor de Der p 2 fue mayor en el Sur, lo quepuede estar relacionado con la temperatura más cálida y/o el tamaño de muestra más grande (AU)

Síndrome de tolosa hunt: presentación de caso clínico / Tolosa Hunt syndrome: case report

El síndrome de Tolosa-Hunt es una entidad poco frecuente cuya etiopatogenia y mecanismos fi- siopatológicos son controversiales, se caracteri- za por cefalea asociada a parálisis de uno o más nervios craneales, diplopía, estrabismo y ptosis palpebral, ocasionados por el compromiso del seno cavernoso o la fisura orbitaria superior. Su diagnóstico es un reto y se aborda dentro de los diagnósticos diferenciales de las oftalmoplejías dolorosas. Con el objetivo de describir y actua- lizar el conocimiento sobre esta enfermedad se presenta el caso de una paciente de 14 años que acudió a consulta por cefalea intensa, dolor ocu- lar y afección de nervios craneales. Los hallazgos clínicos y la resonancia magnética confirmaron el diagnóstico del síndrome de Tolosa Hunt...(AU)

Molecular Profile of Sensitization to Dermatophagoides pteronyssinus Dust Mite in Portugal.

BACKGROUND AND OBJECTIVES: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas. METHODS: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South. RESULTS: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496). CONCLUSION: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size.

Allergic hypersensitivity to garlic and onion in children and adults

BACKGROUND: China and Spain are world leaders in the consumption of edible bulbs (garlic and onion), but there are few references to their capacity to cause allergic symptoms. The target was to study allergic sensitization and clinical symptoms associated with garlic and onion consumption in a large sample of allergic patients. METHODS: An observational cross-sectional study was conducted, testing garlic and onion extracts in 8109 patients of all ages seen by our allergy clinic in 2018. Forty-four aeroallergens and foods were tested, including garlic and onion, with prick test and determination of specific IgE. Oral provocation and contact tests were performed if a delayed reaction was suspected. Western Blot was performed in the serum of patients positive to garlic and onion. RESULTS: We conducted 356,798 skin tests and 4254 specific IgE determinations. Of the 8109 patients tested, 2508 (30.92%) presented with symptoms associated with food intake and, in these patients, food hypersensitivity was detected by skin test, positive specific IgE or provocation in 924 patients, and was caused by garlic or onions in 27, indicating a prevalence of 2.92%. Immunodetection showed an association between the symptoms and a specific LTP to these bulbs, without cross-reactivity with other LTPs in the Mediterranean diet (peach, wheat). CONCLUSIONS: Allergic hypersensitivity to garlic and onions should not be underestimated and, given their high consumption, should be included in the diagnostic food allergy battery

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Molecular Allergen Profiling of Dual Mite Sensitization in Severe Allergic Rhinitis.

BACKGROUND: Mites are the most prevalent source of indoor allergens. The present study used a component-resolved diagnosis (CRD) approach to investigate the mite-specific IgE sensitization profile for Dermatophagoides pteronyssinus and Blomia tropicalis. We also assessed the performance of a commercially available CRD approach in patients with severe allergic rhinitis. METHODS: We selected 63 consecutive patients with dual sensitization to D pteronyssinus and B tropicalis and persistent severe rhinitis according to the ARIA guidelines. We performed skin prick tests with standardized extracts and determined specific serum IgE to both mites, along with serum specific IgE to Der p 1, Der p 2, Der p 23, Der p 10, and Blo t 5. RESULTS: Fifty-eight and 59 patients had positive sIgE to the whole extracts of D pteronyssinus and B tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE to Der p 1, Der p 2, and/or Der p 23, specific IgE to Blo t 5 (≥0.3 ISU-E) was not detected in most of the serum samples (55%). CONCLUSIONS: Although the combination panel of the commercially available major allergens Der p 1, Der p 2, and Der p 23 identified more than 90% of the D pteronyssinus-allergic patients, Blo t 5 performed somewhat poorly in those sensitized to B tropicalis. Improvements in CRD and further research concerning the prevalence and clinical relevance of serodominant allergens are needed to achieve a genuine molecular diagnosis, as well as patient-centered mite allergy-specific immunotherapy.

Allergic hypersensitivity to garlic and onion in children and adults.

BACKGROUND: China and Spain are world leaders in the consumption of edible bulbs (garlic and onion), but there are few references to their capacity to cause allergic symptoms. The target was to study allergic sensitization and clinical symptoms associated with garlic and onion consumption in a large sample of allergic patients. METHODS: An observational cross-sectional study was conducted, testing garlic and onion extracts in 8109 patients of all ages seen by our allergy clinic in 2018. Forty-four aeroallergens and foods were tested, including garlic and onion, with prick test and determination of specific IgE. Oral provocation and contact tests were performed if a delayed reaction was suspected. Western Blot was performed in the serum of patients positive to garlic and onion. RESULTS: We conducted 356,798 skin tests and 4254 specific IgE determinations. Of the 8109 patients tested, 2508 (30.92%) presented with symptoms associated with food intake and, in these patients, food hypersensitivity was detected by skin test, positive specific IgE or provocation in 924 patients, and was caused by garlic or onions in 27, indicating a prevalence of 2.92%. Immunodetection showed an association between the symptoms and a specific LTP to these bulbs, without cross-reactivity with other LTPs in the Mediterranean diet (peach, wheat). CONCLUSIONS: Allergic hypersensitivity to garlic and onions should not be underestimated and, given their high consumption, should be included in the diagnostic food allergy battery.

Occupational rhinoconjunctivitis induced by unusual allergens of carrot

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Molecular allergen profiling of dual mite sensitization in severe allergic rhinitis

BACKGROUND: Mites are the most prevalent source of indoor allergens. The present study used a component-resolved diagnosis (CRD) approach to investigate the mite-specific IgE sensitization profile for Dermatophagoides pteronyssinus and Blomia tropicalis. We also assessed the performance of a commercially available CRD approach in patients with severe allergic rhinitis. METHODS: We selected 63 consecutive patients with dual sensitization to D pteronyssinus and B tropicalis and persistent severe rhinitis according to the ARIA guidelines. We performed skin prick tests with standardized extracts and determined specific serum IgE to both mites, along with serum specific IgE to Der p 1, Der p 2, Der p 23, Der p 10, and Blo t 5. RESULTS: Fifty-eight and 59 patients had positive sIgE to the whole extracts of D pteronyssinus and B tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE to Der p 1, Der p 2, and/or Der p 23, specific IgE to Blo t 5 (≥0.3 ISU-E) was not detected in most of the serum samples (55%). CONCLUSIONS: Although the combination panel of the commercially available major allergens Der p 1, Der p 2, and Der p 23 identified more than 90% of the D pteronyssinus-allergic patients, Blo t 5 performed somewhat poorly in those sensitized to B tropicalis. Improvements in CRD and further research concerning the prevalence and clinical relevance of serodominant allergens are needed to achieve a genuine molecular diagnosis, as well as patient-centered mite allergy-specific immunotherapy

INTRODUCCIÓN: Los ácaros son los alérgenos de interior más prevalentes. El presente estudio investiga el perfil de sensibilización a Dermatophagoides pteronyssinus y Blomia tropicalis, así como el rendimiento del diagnóstico por componentes (CRD) disponible comercialmente en pacientes con rinitis alérgica grave persistente. MATERIAL Y MÉTODOS: Seleccionamos 63 pacientes con rinitis grave persistente (Guía ARIA) con sensibilización dual a D. pteronyssinus y B. tropicalis. Se realizaron pruebas cutáneas en prick con extractos estandarizados, IgE sérica específica a ambos ácaros además de IgE específica a alérgenos individuales Der p 1, Der p 2, Der p 23, Der p 10 y Blo t 5. RESULTADOS: Cincuenta y ocho y 59 pacientes presentaron IgE específica positiva a extractos crudos de D. pteronyssinus y B. tropicalis, respectivamente. Aunque el 91,67% mostraron sensibilización a Der p 1, Der p 2 y/o Der p 23, Blo t 5 (≥0,3 ISU-E) no fue detectado en la mayoría (55%) de las muestras estudiadas. CONCLUSIONES: Aunque la combinación de alérgenos principales Der p 1, Der p 2 Der p 23, pudo identificar más del 90% de los pacientes sensibilizados a D. pteronyssinus, Blo t 5 presentó un rendimiento diagnóstico muy limitado para aquellos sensibilizados a B. tropicalis. Conocer la prevalencia y relevancia clínica de los alérgenos acarianos serodominantes en cada territorio contribuiría a una mejor identificación de sensibilizaciones genuinas en la era de la medicina de precisión

Allergy to ailanthus altissima pollen: a local allergen to consider

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Role of creatine kinase as an allergen in immediate selective allergy to pork meat

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