Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery.

BACKGROUND: Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. OBJECTIVES: To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. METHODS: Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. RESULTS: We studied 203 patients, with mean age 35.1±17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p<0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. CONCLUSIONS: Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids.

Clinical value of morphine, pholcodine and poppy seed IgE assays in drug-abusers and allergic people.

BACKGROUND: The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms. METHODS: We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed. RESULTS: Overall, 149 patients and 200 controls, mean age 32.9 ± 14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy. CONCLUSIONS: Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles.

Clinical significance of cross-reactivity between tobacco and latex.

BACKGROUND: Allergen cross-reactivity between tobacco and other species of Solanaceae family (tomato, potato, aubergine and egg plant) have been reported. We have recently studied IgE response to tobacco in asthmatic patients sensitised to Lolium perenne (Perennial rye grass pollen) and have found that 30% of the tobacco responsive patients also have latex sensitisation. OBJECTIVE: The aim of our study was to investigate the possibility of cross-reactivity between tobacco and latex in asthmatic patients with IgE response to latex. METHODS: A study was performed on tobacco and latex exposure in 15 patients who suffered from asthma and latex sensitisation and who were randomly chosen from our database of latex-sensitive patients. To identify tobacco and latex as possible allergens that might cause clinical specific responses, all these patients were tested with prick-tests, specific IgE to tobacco, latex and related allergens, bronchial challenge, and patch tests with tobacco, latex and nicotine. Immunological response was evaluated with immunoblotting, immunoblotting-inhibition and EAST-inhibition tests. RESULTS: Positive prick and bronchial challenge with specific IgE>0.35 kU/L to tobacco was demonstrated in 11 asthmatics who were also sensitised to rye grass. Tobacco IgE level was related with sensitisation to latex (p<0.002), but not to other vegetables belonging to the Solanaceae family. EAST-inhibition and immunoblotting-inhibition showed the existence of cross-reactivity between tobacco and latex. CONCLUSIONS: Cross-reactivity exists between latex and tobacco allergens. Smoker patients with IgE response to tobacco may be a risk population for latex sensitisation.

Dimetilarginina asimétrica (ADMA) en diferentes enfermedades / Asymmetric dimethylarginine (ADMA) in different pathologies

La dimetilarginina asimétrica (ADMA) se forma como subproducto metabólico del almacenamiento continuo de proteínas en las células del cuerpo. Hace más de una década se propuso que ADMA ejerce efectos biológicos sin inhibir la síntesis de NO. El papel fisiopatológico de ADMA ha sido elucidado según los esfuerzos de colaboración de diferentes grupos de investigación en el mundo. Hoy por hoy, se admite que ADMA puede desempeñar un papel prominente en la patogenia y en la progresión de enfermedades cardiovasculares, específicamente en la aterosclerosis. La ADMA es un inhibidor competitivo endógeno de la eNOS, descubierto en pacientes con insuficiencia renal. La denominación se debe a que los 2 metilos están unidos a un solo nitrógeno del grupo guanido. ADMA está aumentada en la insuficiencia renal y en otras situaciones patológicas como la hipercolesterolemia, la aterosclerosis y la hipertensión arterial. El aumento en las concentraciones de ADMA supone un importante efecto inhibidor en la enzima. Algunos estudios de intervención indican que la suplementación con arginina mejora la función endotelial en pacientes con enfermedad coronaria(AU)

Asymmetric dimethylarginine (ADMA) is formed as a metabolic byproduct of continuous protein turnover in the cytoplasm of all human cells. For more than a decade it was proposed that ADMA exerted its biological effects by inhibiting the synthesis of NO. The pathophysiological role of ADMA has been clarified in more detail by collaborative efforts of different research groups around the world. Today, it is recognized that the ADMA can play a prominent role in the pathogenesis and progression of cardiovascular diseases, specifically atherosclerosis. Asymmetrical dimethyl-arginine (ADMA) is a competitive inhibitor of endogenous eNOS, discovered in patients with renal insufficiency. Its name comes from the methyl groups bound to the guanidine nitrogen. ADMA is increased in kidney failure and other pathological situations such as hypercholesterolemia, atherosclerosis and hypertension. The increase in the concentrations of ADMA shows a significant inhibitory effect on the eNOS enzyme. Inhibition can be reduced by increasing the concentration of substrate available. Indeed, some intervention studies indicate that arginine supplements improve endothelial function in patients with coronary heart disease(AU)

El ligando CD40 soluble: marcador potencial de riesgo cardiovascular / Soluble CD40 ligand: a potencial marker of cardiovascular risk

El ligando CD40 soluble, también denominado CD145 o gp 39, es un complejo formado por una proteína transmembrana estructural y una molécula soluble de adherencia tisular. Se expresa en los linfocitos y las plaquetas activadas y constituye el nexo entre el sistema inflamatorio y los procesos trombóticos vasculares. Su gen se localiza en el brazo largo del cromosoma X humano. Pertenece a la familia del factor de necrosis tumoral. La evaluación de la placa aterosclerótica fija residual es insuficiente para predecir la evolución clínica. Actualmente, ya se han realizado estudios demostrando la participación del sistema inmuno-inflamatorio en la génesis y las complicaciones del proceso aterosclerótico. En el futuro, los biomarcadores más específicos de vulnerabilidad serán de gran utilidad en la práctica cotidiana (interleucinas, CD40, etc.). El ligando CD40 soluble y su receptor CD40 están sobreexpresados en las lesiones ateroscleróticas, lo que conduce a un incremento de los mediadores del desarrollo de la placa de ateroma, y ambos contribuyen de manera importante al proceso inflamatorio que conduce a la aterosclerosis y a la trombosis

Recombinant human soluble CD40 ligand, also named CD145 or gp 39, is a 16.3 kD glycoprotein containing 149 aa residues comprising the receptor binding TNF-like domain of CD40 ligand. It is expressed on antigen-presenting cells such as B cells, macrophages, dendritic cells and thymic epithelial cells and it constitutes the nexus between the inflammatory system and the vascular thrombotic processes. Its gene is located in the long arm of the human X chromosome. Prognostic evaluation of the residual fixed atherosclerotic plaque is insufficient to predict clinical course. Currently, studies have been done that demonstrate the participation of the immunoinflammatory system in the genesis and complications of the atherosclerotic condition. In the future, the most specific biomarkers of vulnerability will be very useful in the daily practice (interleukins, CD40, etc.). The soluble CD40 ligand together with its CD40 receptor are overexpressed in experimental and human atherosclerotic lesions. This leads to an increase of mediators for the development of atherosclerosis. Both significantly contribute to the inflammatory processes that leads to atherosclerosis and thrombosis

[Soluble CD40 ligand: a potential marker of cardiovascular risk]. / El ligando CD40 soluble: marcador potencial de riesgo cardiovascular.

Recombinant human soluble CD40 ligand, also named CD145 or gp 39, is a 16.3 kD glycoprotein containing 149 aa residues comprising the receptor binding TNF-like domain of CD40 ligand. It is expressed on antigen-presenting cells such as B cells, macrophages, dendritic cells and thymic epithelial cells and it constitutes the nexus between the inflammatory system and the vascular thrombotic processes. Its gene is located in the long arm of the human X chromosome. Prognostic evaluation of the residual fixed atherosclerotic plaque is insufficient to predict clinical course. Currently, studies have been done that demonstrate the participation of the immunoinflammatory system in the genesis and complications of the atherosclerotic condition. In the future, the most specific biomarkers of vulnerability will be very useful in the daily practice (interleukins, CD40, etc.). The soluble CD40 ligand together with its CD40 receptor are overexpressed in experimental and human atherosclerotic lesions. This leads to an increase of mediators for the development of atherosclerosis. Both significantly contribute to the inflammatory processes that leads to atherosclerosis and thrombosis.

Anisakis simplex allergy after eating chicken meat.

BACKGROUND: Allergic reactions to food can be produced by contaminants that induce sensitization. Among these, Anisakis simplex can cause seafood infestation, and allergic symptoms (urticaria-angioedema, anaphylaxis, and asthma) can follow the eating or handling of affected fish. Although seafood is the principal source of human infections by this parasite, we have found allergic symptoms in 8 patients previously diagnosed as having A simplex sensitization after they ate chicken meat. Chicken feed usually has a high proportion of fishmeal, which might possibly be contaminated by this nematode. OBJECTIVE: The aim of our study was to determine whether parasite proteins present in chicken meat could be responsible for the symptoms reported by these subjects. METHODS: We carried out in vivo tests (prick, bronchial challenge, and double-blind placebo-controlled challenge with meat chicken) in these 8 patients. We performed immunoblotting using the sera from the 8 patients and controls in order to detect A simplex sensitization. We also investigated the presence of A simplex proteins in sera from chickens fed with fishmeal and in other sera from chickens fed only with cereals. We excluded sensitization to other chicken nematodes by serologic methods. RESULTS: All 8 patients presented positive prick and challenges to A simplex. When we used serum from chickens fed with fishmeal as the antigen in blotting, patients 3, 4, 5, 6, 7, and 8 recognized a band of 16 kd, also obtained when using pools of fish-shellfish and A simplex larva. No detection was observed with sera from chickens fed with only cereals. CONCLUSION: We provide evidence, based on in vivo and in vitro tests, that subjects highly sensitized to A simplex can detect the presence of Anisakis species allergens in chicken meat.

Principales marcadores diagnósticos en la enfermedad de Alzheimer / Main biological parameters in the study of Alzheimer’disease

La enfermedad de Alzheimer afecta en el mundo a unas 25millones de personas, siendo la causa mas frecuente dedemencia en los paises occidentales. Su prevalencia va enaumento, debido al envejecimiento de la población. Por la edadde aparición la EA se puede clasificar en presenil ó de iniciotemprano si aparece antes de los 60-65 años y senil o de iniciotardio si aparece después.En esta revisión se estudian los principales parámetros biológicosa utilizar en la enfermedad de Alzheimer e intentar diferenciarlade otras patologías degenerativas, ya que el diagnosticoprecoz de la EA es de gran importancia.El gen Apo E esta localizado en el cromosoma humano 19 ycontiene 4 exones que codifica la apolipoproteina E de 299 aminoácidos.Las tres isoenzimas de la Apo E son la Apo E2, E3 yE4 y son productos de los tres alelos de cada locus génico. Tresfenotipos homozigoticos (apo E2/2, E3/3 y E4/4) y tres heterizigóticos(apo E3/2, E4/3 y E4/2) resultan de la expresión decada uno de los tres alelos. La sustitución de los aminoácidosen los codones 112 y 158 conllevan a las diferencias entre apoE2, E3 y E4.La presencia abundante de ambas placas seniles y marañasen el cerebro de pacientes con EA es el único criterio aceptadopara un diagnóstico inequivoco de esta patología. El mayorcomponente de las placas seniles es un péptido llamado betaamiloide.Este péptido se trata de un fragmento proteolítico deuna proteína precursora larga conocida como proteína precursoraamiloide (APP). Dado que este péptido es por tanto producidobajo condiciones normales su presencia no es especificade EA.Las marañas están compuestas por estructuras filamentosashelicoidales y su componente principal es una formafosforilada anormal del microtúbulo asociado a la proteínatau. Normalmente esta proteína tiene una presencia abundanteen las neuronas y sirve para estabilizar el microtúbuloen los axones. En el Alzheimer y particularmente en aquellasregiones del cerebro afectadas la proteína tau esta fosforiladade forma anormal conduciendo a un incremento en la cantidadde tau.Como la tau se trata de una proteína intracelular el nivelhallado en LCR es bajo. El desarrollo de una elevada afinidadpor los anticuerpos monoclonales altamente específicos para latau ha conducido al desarrollo de test para la detección de latau en LCR y un número elevado de pacientes con Alhzeimer ycontroles han mostrado una elevada expresión de la tau en lascélulas neuronales afectadas. Además los test basados en ladeterminación cuantitativa de la proteína tau en el LCR puedeser de gran ayuda en el diagnóstico de la EA.En la actualidad, el marcador en LCR que muestra mayorespecificidad es fosfo-tau. No obstante la determinación conjuntade los tres marcadores tau, fosfo-tau y AB42 en LCR,aumenta la especificidad y sensibilidad respecto a su utilizaciónindividual

Alzheimer´ disease (AD) affects in the World up to 25 millionpeople and it is the most common form of dementia amongolder people in the Western countries. The disease usuallybegins after age 60, and risk goes up with age. AD can be classifiedas of early beginning, if it appears before the 60-65 yearsand of late beginning, if it appears later.In this report, the main biological parameters in Alzheimer´disease are studied to try to differentiate it of other degenerativepathologies, since the precocious diagnose of the AD it isof great importance.The gene Apo E is located in the human chromosome 19 andit contains 4 exons that codes for the 299-amino acid proteinnamed Apolipoprotein (apo) E, that is genetically polymorphic.There are three common codominant alleles, designated E2(with a protective effect against AD), E3 (the predominant isoform)and E4 (which constitutes a major risk factor for AD) whosegenetic basis lies within codons 112 and 158 of the gene.The three common apo E alleles lead to six common phenotypes,three homozigotes (apo E2/2, E3/3 and E4/4) and threeheterozigotes (apo E3/2, E4/3 and E4/2), all originally disclosedby isoelectric focusing and immunoblotting.The abundant presence of both senile badges and tangles inthe brain of patient with AD is the only approach accepted foran unequivocal diagnosis of this pathology. The biggest componentin the senile badges is the called beta-amiloide peptide.This peptide is a proteolysis fragment of a protein well-knownlong precursor as amiloide protein precursor (APP). Since thispeptide is therefore taken place under normal conditions itspresence it is not it specific of AD.The tangles are composed by helicoidally filamentous structuresand their main component is a microtubule phosphoylatedabnormal form associated to the tau protein. This protein usuallyhas an abundant presence in the neurons and it is good to stabilizethe microtubule in the axons. In the AD and particularly in thoseregions of the affected brain, the tau protein is phosphorylatedin an abnormal way driving to an increment in the quantity of tau.As the tau it is a protein intracelular, decreased levels in the SCFshould be found. Nevertheless and by the reasons given in aboveparagraph, tau levels were increased in AD patients in comparisonwith healthy controls, especially in those having one or two Apo E4alleles. Therefore, the test based on the quantitative determinationof tau proteins in the CSF is of great help in the diagnosis of AD.At the present time, phospho-tau is the best marker. However,is not sensitive and specific enough to detect all the cases of AD.Therefore, the combination of Ab-42, phospho-tau and tau levelsin CSF should be used as a criteria to confirm or exclude AD

Shewanella putrefaciens in a fuel-in-water emulsion from the Prestige oil spill.

Microorganisms that colonize the fuel-in-water emulsion from the Prestige spill have been compared with those from Exxon-Valdez. Both emulsions contained non-fermentative gram-negative rods but unlike Exxon-Valdez's, the Prestige's spill contained anaerobic bacteria and no fungi. Our main finding has been the identification of Shewanella putrefaciens , a bacterium promising for bioremediation.

Diagnóstico serológico de la mononucleosis infecciosa / Serologic diagnostic of infectious mononucleosis

El virus de Epstein Barr (VEB) es el agente etiológico habitual de la mononucleosis infecciosa clásica. En este artículo recogeremos los resultados de dos ensayos utilizados en nuestro laboratorio para el diagnóstico serológico de la mononucleosis infecciosa producida por el VEB (Clearview IM y Enzywell Epstein Barr VCA IgM) junto a los de dos ensayos adicionales (Enzywell Epstein Barr EA IgG y Enzywell Epstein Barr EBNA IgG) al efecto de valorar sus ventajas relativas en el diagnóstico de la mononucleosis. La importancia del diagnóstico estriba en sus potenciales complicaciones en el paciente, que podrían llegar a provocar su muerte (AU)

Living in towers as risk factor of pollen allergy.

BACKGROUND: The effects of fluctuations in pollen counts have important implications for health services. Little research on the clinical implications of the vertical distribution of pollen in allergy symptoms has been carried out. METHODS: We have investigated the allergic symptoms of a population of 17 171 patients coming from our health area (Valladolid, Spain) and living in the city and villages. We compared the prevalence of sensitization to different pollens: Graminae, trees and shrub in relation with the floor of the building where they were living. RESULTS: Relative risk of pollen sensitization (confidence index, CI 95%) was higher in patients who were living at high floors than in those patients who were living in lower floors or at street level, independently of rural or urban conditions The chi-square showed a lineal trend in this relationship in the case of sensitization to grass pollen: chi(2): 1794, P > 0.00001 CONCLUSIONS: On the basis of our local investigations, natural pollen sensitization appears to increase with height where the patient lives. This paper reports clinical results on the influence of vertical pollen distribution in pollen allergy.

Identification of species of Brucella using Fourier transform infrared spectroscopy.

Fourier transform infrared spectroscopy (FTIR) is a technique that has been used over the years in chemical analysis for the identification of substances and is one that may be applied to the characterisation of microorganisms. The marked tendency of Brucella towards variation in the smooth rough phase, together with the laboriousness and risk involved in the methods used in their identification, make their classification difficult. We studied the type strains of the different species and biovars of Brucella and 11 isolates of human origin of Brucella melitensis, six corresponding to biovar 1, one to biovar 2 and five to biovar 3. The results of linear discriminant analysis performed using the data provide an above 95% likelihood of correct classification, over half of which are in fact above 99% for the vast majority of Brucella strains. Only one case of B. melitensis biovar 1 has been incorrectly classified. The rest of the microorganisms studied (Staphylococcus aureus, Strteptococcus pyogenes, Enterococcus faecalis, Corynebacterium pseudodiphtheriticum, Clostridium perfringens, Escherichia coli, Acinetobacter calcoaceticus and Pseudomonas aeruginosa) have been classified correctly in all cases to a likelihood of over 80%. In the graphic representation of the analysis, a grouping of these can be seen in clusters, which include the different species. One of these comprises B. melitensis, another Brucella abortus, and another wider one is made up of Brucella suis. The Brucella canis, Brucella ovis and Brucella neotomae strains appear separate from the previously described groups.

Enhancement of tomato allergenicity after treatment with plant hormones.

BACKGROUND: Practical applications to enhance the productivity of agriculture by using plants with improved resistance to pathogens are expected to increase in the near future. Although tomato has been widely investigated for breeding purposes, there have been no studies on tomato allergenicity after plant hormones treatments. METHODS: Prick by prick tests were carried out with different tomato samples (fruits grown under biological conditions without addition of chemical products, and treated with ethylene and salicylic acid) in eight patients with ages between 12 and 27 years who suffered from anaphylaxis episodes after eating raw tomatoes. An immunoblot experiment with the different tomato extracts was performed using sera from these eight patients and controls. RESULTS: The wheals obtained in prick tests were significantly higher with the extracts of tomato treated with ethylene and SAA (chi(2) = 31.3, p < 0.0001) and the patients who presented higher wheal diameters in skin tests were those who had more severe episodes of anaphylaxis. Neither the protein stain nor the IgE immunodetection patterns clearly varied between the untreated and the hormone-treated samples. CONCLUSIONS: In the case of anaphylaxis induced by tomato, the treatment with plant hormones induced a higher cutaneous response than with non-treated tomato, but the "in vitro" response was similar.

Is Lolium pollen from an urban environment more allergenic than rural pollen?

BACKGROUND: Allergy to grass pollen is a highly prevalent allergic disease. Hay fever is more predominant in urban than in rural areas, despite the increasingly smaller areas of surrounding grassland. The effect of vehicle exhaust pollutants, mainly diesel particles, and other industrial sources of atmospheric pollution leading to plant damage has been implicated in this phenomenon. OBJECTIVE: This study compared the in vivo and in vitro allergenicity of pooled samples of Lolium perenne grass pollen harvested from 10 different urban areas with that of samples of the same pollen from 10 neighboring rural areas. METHODS: Lolium perenne pollen from different parts of a city and from a nearby rural area was harvested in 1999 and 2000 during the peak pollination period. Protein composition was compared by SDS-PAGE and in vivo and in vitro IgE-binding capacity was compared by skin-prick tests, RAST-inhibition and measurement of the major allergen, Lol p 5. RESULTS: In the two years under study, urban samples contained approximately twice the protein content of the rural samples. Biological activity and Lol p 5 content was higher in urban pollen than in rural pollen and showed differences in the two years under study. CONCLUSIONS: The protein content and allergenicity of Lolium perenne pollen was higher in urban areas than in rural areas. These differences might explain why allergy to grass pollen is more prevalent in urban areas. This finding should be taken into account in diagnosis, preventive measures and specific immunotherapy.

Resultados de las peticiones de anticuerpos tiroideos en un Hospital Provincial de Castilla-León / Anti-thyroid antibodies results in a Provincial Hospital in Castilla-Leon

Objetivos: Valorar si la determinación conjunta de los TPOAb y TgAb aporta ventajas significativas respecto a la determinación única de los TPOAb. Materiales y métodos: Cuantificación mediante enzimoinmunoensayo en microplaca de 1236 sueros con petición de perfil tiroideo autoinmune (TPOAb y TgAb). Resultados: Distribución de las asociaciones de ambos autoanticuerpos: TPOAb (-) - TgAb (-), 61.4 por ciento; TPOAb (+) - TgAb (-), 22.8 por ciento; TPOAb (+) - TgAb (+), 13.6 por ciento y TPOAb (-) - TgAb (+), 2.2 por ciento; con una prevalencia muy superior en el sexo femeninorespecto al masculino, 30 por ciento n 6.3 por ciento para los TPOAb y del 13.6 por ciento n 2.2 por ciento en el caso de los TgAb. Conclusiones: La determinación simultánea de ambos autoanticuerpos no aporta ventajas apreciables con respecto a la valoración aislada de los TPOAb. Sólo en casosmuy concretos, como el cáncer diferenciado de tiroides, parece justificada la realización conjunta de ambos. El implantar, por tanto, un protocolo para determinar sólo los TPOAb parece pues razonable (AU)

Anaphylaxis associated with antiphospholipid syndrome.

BACKGROUND: To our knowledge, no previously published reports have described food-induced anaphylaxis associated with the antiphospholipid syndrome. OBJECTIVE: We undertook a study of four patients with thrombosis associated with the antiphospholipid syndrome after each patient experienced anaphylaxis attributable to ingestion of vegetal foods. METHODS: IgE antibody levels to various foods were determined in serum specimens from the study patients, and skin prick tests with the same allergens were conducted to determine their in vivo responses. Hematologic, cardiopulmonary, vascular, and rheumatologic studies were also performed. IgG anticardiolipin antibody levels were determined by ELISA. RESULTS: All four patients fulfilled the criteria for antiphospholipid syndrome and had high levels of specific IgE antibodies for certain food allergens. By immunoblot analysis, the presence of serum IgE specific for a 45-kD protein band in an almond extract was detected in these four patients who experienced food-related anaphylaxis. No specific IgE was detected in sera from normal subjects. No IgE antibodies specific for the food panallergen lipid transfer proteins were detected. CONCLUSIONS: This is the first report of severe food-precipitated anaphylaxis associated with the antiphospholipid syndrome and the first description of a patient with allergy to blackberry. The possible involvement of food panallergens distinct from lipid transfer proteins is also discussed.

[Otosclerosis and Van der Hoeven's syndrome: a contribution]. / Aportación al estudio de la otosclerosis y del síndrome de Van der Hoeve.

Morphological and microchemical changes that effect to the otosclerotic stape in the Van der Hoeve's syndrome were examined with a scanning electron microscope equipped with an energy dispersive X-ray fluorescence. Using the Ca/P ratio as criterion--measured by the characteristic x-ray fluorescence--it was shown that the Van der Hoeve stape had a higher Ca/P ratio (2.6:1) as compared to the normal stape (2:1). The Van der Hoeve's syndrome lesions as poorly mineralized, with low calcium salt and apparent increase of phosphates. This finding indicates a possible change from hydroxyapatite (or apatite) to brushite, which imply an acidification of bone.