Safety and Effectiveness of a Single Multiallergen Subcutaneous Immunotherapy in Polyallergic Patients.

BACKGROUND: As the number of allergic sensitizations increases the severity of allergic respiratory diseases worsens. Multiple monoallergen immunotherapy can be accompanied by poor treatment adherence and high costs, single multiallergen immunotherapy needs to prove efficacy whilst maintaining a good safety profile. METHODS: Observational, retrospective, multicenter study using a 2-pollen single undiluted multiallergen subcutaneous immunotherapy (SCIT) in routine clinical practice in Spain. Patients with rhinoconjunctivitis, with/without controlled asthma, sensitized to grass, olive, Parietaria, Cupressus, plane tree and/or Salsola pollen were included. Primary and secondary clinical efficacy endpoints were quality of life (mini Rhinitis Quality of Life Questionnaire (miniRQLQ)) and visual analogue scale (VAS) respectively. All adverse events were documented. RESULTS: Ten centers included 97 patients, median age 32 years. SCIT treatment included combinations of grass mix with olive, Parietaria, Cupressus, plane tree or Salsola or olive with Parietaria, Cupressus or Salsola. The mean duration of SCIT was 1.8 years with a high treatment adherence (73%). Significant improvement in quality of life, nasal and ocular symptoms, activity limitations and practical problems (p< 0.0001) and other symptoms (p= 0.024) was observed. Most patients did not develop asthma-like symptoms and a significant improvement of all allergic symptom severity was perceived. VAS showed a significant improvement in rhinoconjunctivitis and asthma by patients and physicians. Twenty-nine patients experienced adverse reactions, 25 had local and 6 had systemic reactions. CONCLUSIONS: Single undiluted multiallergen SCIT treatment of two different pollens is efficacious and safe in both children and adults, showing that it is a suitable option for the treatment of polyallergic patients.

Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register.

BACKGROUND: The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. METHODS: Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. RESULTS: 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. CONCLUSION: This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified.

Incidència de la hipersensibilitat a llet de vaca en el primer any de vida a la Catalunya Centra / Incidencia de la hipersensibilidad a leche de vaca en el primer año de vida en la Cataluña Central / Incidence of cow's milk allergy in the first year of life in central Catalonia

Fonament: l'al•lèrgia a proteïnes de llet de vaca és l'al•lèrgia alimentària més freqüent en lactants. La prevalença real és difícil d'establir, donada la gran variabilitat metodològica dels estudis publicats. Objectiu: conèixer la incidència durant el primer any de vida de reaccions d'hipersensibilitat, en concret les mediades per IgE, a proteïnes de llet de vaca en una població de lactants que van fer seguiment en àrees bàsiques d'atenció primària de la Catalunya Central. Valorar si existien diferències de reaccions en lactants segons el trimestre de naixement. Mètode: estudi multicèntric, observacional i prospectiu. Àmbit: àrees bàsiques d'atenció primària del Bages i el Solsonès. Es van incloure els nascuts durant el primer i l'últim trimestre del 2012, i se'n va fer el seguiment durant un any. En cas de sospita de reacció d'hipersensibilitat (RHS) al•lèrgica, es van remetre a l'al•lergòleg. Resultats: durant el primer trimestre van néixer 153 infants, i 125 el darrer trimestre. Van completar el seguiment 139 i 119 lactants, respectivament. En el primer grup es va sospitar RHS en 3/124 (2,4%) alimentats amb fórmula artificial (FA). No es va confirmar cap cas mediat per IgE. En el segon grup, van rebre FA 111 lactants. En cinc es va sospitar una RHS (4,5%) i en quatre es va confirmar RHS al•lèrgica: 2/111 mediada per IgE (1,8%) i 2/111 no me-diada per IgE (1,8%). Els dos pacients amb al•lèrgia mediada per IgE van patir reacció en iniciar l'FA. Conclusions: de 235 infants que van rebre FA, es va sospitar RHS en cinc (2,1%), i es va confirmar mecanisme IgE en dos (0,9 %), tots dos nascuts el darrer trimestre

Fundamento. La alergia a proteínas de leche de vaca es la alergia alimentaria más frecuente en lactantes. La prevalencia real es difícil de establecer, dada la gran variabilidad metodológica de los estudios publicados. Objetivo. Conocer la incidencia durante el primer año de vida de reacciones de hipersensibilidad, en concreto las mediadas por IgE, a proteínas de leche de vaca en una población de lactantes que hacen seguimiento en áreas básicas de atención primaria de Cataluña Central. Valorar si existen diferencias según el trimestre de nacimiento. Método. Estudio multicéntrico, observacional y prospectivo. Ámbito: áreas básicas de atención primaria del Bages y el Solsonès. Se incluyeron los recién nacidos durante el primer y el último trimestre de 2012, y se hizo seguimiento durante un año. En caso de sospecha de reacción de hipersensibilidad (RHS) alérgica, se remitieron al alergólogo. Resultados. Durante el primer trimestre nacieron 153 niños, y 125 en el último trimestre. Completaron el seguimiento 139 y 119 lactantes, respectivamente. En el primer grupo se sospechó RHS en 3/124 (2,4%) alimentados con fórmula artificial (FA). No se confirmó ningún caso mediado por IgE. En el segundo grupo, 111 lactantes recibieron FA. En cinco se sospechó una RHS (4,5%) y en cuatro se confirmó RHS alérgica: 2/111 mediada por IgE (1,8%) y 2/111 no mediada por IgE (1,8%). Los dos niños con alergia mediada por IgE sufrieron reacción al iniciar la FA. Conclusiones. De 235 niños que recibieron FA, se sospechó RHS en cinco (2,1%), y se confirmó mecanismo IgE en dos (0,9%), ambos nacidos en el último trimestre (AU)

Background. Cow's milk allergy is the most frequent food allergy in infants; however, given the methodological variability in published studies, its real prevalence is difficult to ascertain. Objective. To determine the incidence of hypersensitivity reactions, specifically those IgE mediated, to cow’s milk proteins in a population of infants seen in primary health care centers in Central Catalonia, and to assess differences in reactions according to the trimester of birth. Method. Multicenter, observational, prospective study conducted in primary healthcare centers of the Bages and Solsones. Infants born during the first and last trimesters of 2012 were included. In case of suspected allergic hypersensitivity reaction (AHR), they were referred to an allergologist for confirmation. Results. 153 infants were born during the first trimester and 125 during the last trimester; full one-year follow-up was completed in 139 and 119 infants, respectively. In the first group, an AHR was suspected in three of 124 (2.4%) children fed with artificial formula (AF). In the second group, 111 infants received AF, and an AHR was suspected in five of them (4.5%). AHR was confirmed in four, with two of them being IgE mediated. Both children with IgE-mediated allergy developed an allergic reaction upon initiation of AF. Conclusions. Of 235 children receiving AF, five (2.1%) had an AHR, which was confirmed to be IgE-mediated in two (0.9%), both born in the last trimester of the year (AU)

Anafilaxia por ingesta de anacardos / Allergic reactions to cashews, an increasing problem

Introducción. El objetivo del trabajo es presentar un caso de reacción alérgica por sensibilización a anacardos. Caso clínico. Presentamos a una paciente de 3 años de edad, la cual sufrió síntomas inmediatos de alergia (urticaria, angioedema, disnea y vómitos) tras la ingesta de anacardos. Reaccions al·lèrgiques per ingesta d’anacards. Una patologia en creixement Agustín Sansosti Viltes 1, 2, Rosa Solé Artigues 1, Catalina Gómez Galán 2, Laia Ferré Ybarz 2, Mariano de la Borbolla 2, Santiago Nevot Falcó 1, 2 1 Hospital Nostra Senyora de Meritxell, Escaldes Engordany, Andorra. 2 Althaia. Hospital Sant Joan de Déu. Manresa (Barcelona) Se realizó prueba de la picadura frente a frutos secos y neumoalergenos habituales en nuestra área, prick by prick con diversos frutos secos con prueba de tolerancia oral, y medición de IgE específica en el suero de la paciente. Las pruebas cutáneas frente a neumoalergenos y frutos secos fueron negativas, excepto para pistacho. El prick by prick y la prueba de tolerancia oral con cacahuete, avellana, almendra, nuez y pipas de girasol también fueron negativos, mientras que el prick by prick con anacardo fue positivo. Además se efectuó prick by prick, IgE específica en suero, y prueba de tolerancia oral con mango, con resultado negativo. La IgE en suero específica frente a anacardo fue de 24,4 kU/ l (clase 4), y la IgE frente a pistacho fue de 21,1 kU/ l, sin efectuar tolerancia oral. Comentarios. Los anacardos pueden provocar reacciones alérgicas severas, y se ha visto que los pacientes con alergia a dicho fruto seco también pueden reaccionar con la ingesta de pistacho, lo cual es el resultado de la reactividad cruzada entre ambos, dado que forman parte de la familia de las anacardiáceas(AU)

Background. The aim of this study is to present a case of allergy due to sensitization to cashew nuts. Care Report. A 3 year-old girl presented with severe allergy symptoms (urticaria, facial edema, dyspnea, and vomiting) after ingestion of cashews. We performed a prick test with nuts and common aeroallergens in our area, and a prick-by-prick test with different nuts combined with oral challenge tests and measurement of specific IgE in the patient’s serum. The prick test to aeroallergens and nuts was negative, except for pistachio. The prick-by-prick and oral challenge tests with peanut, almond, hazelnut, walnut, and sunflower seed were negative, while prick-by-prick test with cashew nut was positive. We also performed prick-by-prick test, specific IgE in serum, and oral challenge with mango, which was negative. The specific serum IgE to cashew nut was 24.4 kU/l (class 4) and specific IgE to pistachio was 21.1 kU/l (class 4), without performing oral challenge. Conclusion. Cashew nuts can cause severe allergic reactions; patients may also be allergic to pistachios, which could be as a result of cross reactivity since both nuts belong to the Anacardiacea family(AU)

Allergologia a l’atenció primària / Allergology in primary care

Fonament. Actualment, els especialistes en al·lergologiaduen a terme l’assistència en l’àmbit hospitalari. Entrediferents models d’assistència proposats, la incorporacióparcial de l’al·lergòleg a primària és l’aplicada en aquestestudi.Objectiu. Reduir el temps d’espera per a la primeravisita al servei d’al·lèrgia. Quantificar el nombre i tipus depatologia derivada per estudi. Avaluar el grau de resoluciódel pla i de satisfacció dels usuaris.Mètode. L’estudi s’ha dut a terme des del setembre del2004 fins al juliol del 2005. L’al·lergòleg s’ha desplaçat auna àrea bàsica de Manresa (ABS-M3) per fer la primeravisita, les exploracions complementàries (proves cutànies,funcionalisme pulmonar) i una enquesta sobre el grau desatisfacció dels usuaris atesos. Es van incloure infants de0-14 anys remesos per a estudi al·lergològic.Resultats. Es van fer 46 primeres visites ambulatòries.La patologia respiratòria fou el motiu de consulta més freqüent(31/46; 67.4%) seguit d’al·lèrgia alimentària (14/46;30.4%), urticària i angioedema (12/46; 26.1%) i estudi defàrmacs (3/46; 6.5%). El 39.1% (18/46) dels pacients forendonats d’alta des de primària sense que calgués desplaçarsea l’hospital, mentre que el 60.9% (28/46) es derivaren al’hospital per completar l’estudi o fer seguiment clínic. Elgrau d’absentisme fou inferior a l’hospitalari (2.2%).Conclusions. El desplaçament de l’al·lergòleg a primàriaredueix el temps d’espera dels infants remesos a la consultaespecialitzada. La patologia més freqüentment derivadafou la respiratòria. L’absentisme fou inferior a l’hospitalarii el grau de satisfacció dels pacients elevat. Probablement,un model mixt que inclogui l’assistència hospitalària i ambulatòriaseria l’adequat per millorar l’assistència

Background. Currently, allergy specialists are hospitalbased.Among the different future models of primary care,some proposals include the presence of an allergy specialistin primary care centers. This is the approach that wasevaluated in this pilot study.Objective. To reduce the delay to the first visit by theallergologist. To determine the number of patients andthe type of clinical problems referred for evaluation. Toevaluate the satisfaction level of the patients.Method. This study was performed between September2004 and July 2005. An allergologist moved to one ofManresa's primary health care centers (ABS-M3) to performthe first visits, prick tests, pulmonary function tests,and a survey about the patients' satisfaction.Results. Forty-six new patients were evaluated. Themost common reason for referral was respiratory symptomatology(67.4%), followed by food allergy (30.4%),urticaria/angioedema (26.15), and drug allergy (6.5%).Twenty-eight patients (60.9%) were subsequently referredto the hospital in order to complete the evaluation. Theno-show rate decreased significantly to 2.2% when comparedto hospital visits. Conclusions. The transfer of an allergologist to primaryhealth care centers reduces the time to the first visit.Respiratory symptoms were the most common reason forreferral. No-show rates were lower, and the level of satisfactionwas high. A hybrid model including hospital andprimary health care centers would improve access to specializedcare in allergology