Spanish Society of Allergology and Clinical Immunology (SEAIC) Vision of Drug Provocation Tests.

The controlled drug provocation test (DPT) is currently considered the gold standard for the diagnosis of drug allergy. Adverse drug reactions (ADRs) are an increasingly common presenting complaint in both primary and specialized care. In Spain, ADRs are usually assessed via the allergology department, which rules out immunological mechanisms in up to 90% of cases. An adequate approach to ADRs clearly impacts the costs and efficacy of the treatments prescribed by other specialists. Consequently, if we did not use DPTs, patients would require more expensive, more toxic, and less effective treatments in many cases. In recent years, many new drugs have been developed. This document is intended to be a practical guideline for the management of DPTs according to the vision of the Spanish Allergology Society. The diagnostic work-up begins with a detailed clinical history. Skin tests are only useful for some medications, and in most cases the diagnosis can only be confirmed by DPT. Although cross-reactivity is common, DPTs can confirm the diagnosis and help to find an alternative drug. Programmed individualized patient management based on the type of drug to be studied and the patient´s comorbidities usually enables a solution to be found in most cases.

Spanish Society of Allergology and Clinical Immunology (SEAIC) Vision of Drug Provocation Tests

The controlled drug provocation test (DPT) is currently considered the gold standard for the diagnosis of drug allergy. Adverse drug reactions (ADRs) are an increasingly common presenting complaint in both primary and specialized care. In Spain, ADRs are usually assessed via the allergology department, which rules out immunological mechanisms in up to 90% of cases. An adequate approach to ADRs clearly impacts the costs and efficacy of the treatments prescribed by other specialists. Consequently, if we did not use DPTs, patients would require more expensive, more toxic, and less effective treatments in many cases. In recent years, many new drugs have been developed. This document is intended to be a practical guideline for the management of DPTs according to the vision of the Spanish Allergology Society. The diagnostic work-up begins with a detailed clinical history. Skin tests are only useful for some medications, and in most cases the diagnosis can only be confirmed by DPT. Although cross-reactivity is common, DPTs can confirm the diagnosis and help to find an alternative drug. Programmed individualized patient management based on the type of drug to be studied and the patient's comorbidities usually enables a solution to be found in most cases (AU)

La prueba de exposición controlada a fármacos (DPT) se considera actualmente el estándar de oro para el diagnóstico de alergia amedicamentos. Las reacciones adversas inducidas por medicamentos (RAM) son un motivo creciente de consulta tanto en atención primariacomo especializada. Las consultas de Alergología en España son las que habitualmente estudian estas RAM y descartan mecanismosinmunológicos implicados hasta en el 90% de los casos consultados. Un abordaje adecuado de estos casos repercute de una maneraevidente en los costes y la eficacia de los tratamientos requeridos por otros especialistas, de modo que, si no empleáramos los DPT, lospacientes requerirían tratamientos más costosos, más tóxicos y menos eficaces en la mayoría de los casos.En los últimos años se han desarrollado un gran número de nuevos fármacos y este documento pretende ser una guía práctica en lagestión de las DPT con la visión de la Sociedad Española de Alergología. El trabajo de diagnóstico comienza con un historial detalladodel paciente. Las pruebas cutáneas solo son útiles en algunos medicamentos y, en la mayoría de los casos, el diagnóstico solo puedeconfirmarse mediante el DPT. Aunque suele haber reactividad cruzada, las DPT pueden confirmar el diagnóstico y también contribuir aencontrar un fármaco alternativo tolerable. El manejo individual de los pacientes de forma programada, teniendo en cuenta tanto eltipo de fármaco a estudiar como las comorbilidades del paciente, suele permitir encontrar una solución para la mayoría de los pacientes (AU)

Caracterización ecográfica de un modelo experimental de metástasis hepáticas de carcinoma de colon / Ultrasonographic characterization of an experimental model of liver metastases from colon carcinoma in rats

Objetivo: Determinar las características ultrasonográficas de la patología metastásica hepática inducida en un modelo múrido, para evaluar la utilidad de la ecografía en la valoración no invasiva de la infiltración tumoral. Material y métodos: El hígado de 46 ratas WAG/RijCrl fue diseminado con células singénicas de carcinoma colorrectal CC-531 mediante inoculación intraesplénica. En los días 21, 28, 35, 42 y 70 posteriores a la siembra tumoral, se realizaron series de ecografías para valorar inducción tumoral en diferentes grupos de animales; 37 ratas se estudiaron mediante sonda lineal de 10Mhz y 9 con sonda multifrecuencia de 6–18Mhz. Como signos ecográficos de desarrollo tumoral se consideró la detección de nódulos intrahepáticos, festoneado del contorno hepático, megalias de lóbulos y masas extrahepáticas. Los hallazgos ecográficos se verificaron tras necropsia, y en ambas técnicas se determinó el número de implantes, tamaño (<3, entre 3–7 y >7mm) y localización lobular. Resultados: Comparado con los resultados de la necropsia, en ecografía se detectaron lesiones en el 64% de los animales con patología. Todas las masas extrahepáticas fueron correctamente diagnosticadas. Se identificaron metástasis en el 90% de ratas afectadas por lesiones>7mm, en el 75% de animales con implantes de 3–7mm y en el 25% con lesiones<3mm. Con la sonda de 6–18Mhz se detectaron el 50% de lesiones

Objective: To determine the ultrasonographic characteristics of liver metastases induced in a rat model; to evaluate the usefulness of ultrasonography in the noninvasive evaluation of tumor infiltration. Material and methods: We seeded the livers of 46 WAG/RijCrl rats with CC-531 syngeneic colorectal carcinoma cells by intrasplenic inoculation. At 21, 28, 35, 42, 70 days after tumor seeding, we performed a series of ultrasonographic examinations to evaluate tumor induction in different groups of animals: 37 rats were studied with a 10MHz linear probe and 9 were studied with a 6–18MHz multifrequency probe. The following signs were considered indicative of tumor development: intrahepatic nodules, sinuate liver borders, lobe enlargement, and extrahepatic masses. Ultrasonographic findings were verified at autopsy. We determined the number of implants, size (less than 3mm, between 3 and 7mm, or greater than 7mm), and lobe location for each technique. Results: Compared to the autopsy results, ultrasonography detected 64% of the animals with disease. All the extrahepatic masses were correctly diagnosed. Metastases were identified in 90% of the rats with lesions greater than 7mm, in 75% of those with implants between 3 and 7mm, and in 25% of those with lesions less than 3mm. In the group in which we used the 6–18 MHz probe, we detected 50% of the lesions less than 3mm.ConclusionUltrasonography was useful for monitoring the experimental model and enabled the noninvasive oncologic evaluation of the rat liver with reasonable sensitivity (AU)

[Ultrasonographic characterization of an experimental model of liver metastases from colon carcinoma in rats]. / Caracterización ecográfica de un modelo experimental de metástasis hepáticas de carcinoma de colon.

OBJECTIVE: To determine the ultrasonographic characteristics of liver metastases induced in a rat model; to evaluate the usefulness of ultrasonography in the noninvasive evaluation of tumor infiltration. MATERIAL AND METHODS: We seeded the livers of 46 WAG/RijCrl rats with CC-531 syngeneic colorectal carcinoma cells by intrasplenic inoculation. At 21, 28, 35, 42, 70 days after tumor seeding, we performed a series of ultrasonographic examinations to evaluate tumor induction in different groups of animals: 37 rats were studied with a 10 MHz linear probe and 9 were studied with a 6-18 MHz multifrequency probe. The following signs were considered indicative of tumor development: intrahepatic nodules, sinuate liver borders, lobe enlargement, and extrahepatic masses. Ultrasonographic findings were verified at autopsy. We determined the number of implants, size (less than 3mm, between 3 and 7 mm, or greater than 7 mm), and lobe location for each technique. RESULTS: Compared to the autopsy results, ultrasonography detected 64% of the animals with disease. All the extrahepatic masses were correctly diagnosed. Metastases were identified in 90% of the rats with lesions greater than 7 mm, in 75% of those with implants between 3 and 7 mm, and in 25% of those with lesions less than 3mm. In the group in which we used the 6-18 MHz probe, we detected 50% of the lesions less than 3mm. CONCLUSION: Ultrasonography was useful for monitoring the experimental model and enabled the noninvasive oncologic evaluation of the rat liver with reasonable sensitivity.

Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire.

OBJECTIVES: To develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations. METHODS: An initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test-retest (2-4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: The new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score. CONCLUSIONS: This new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.