Association between component-resolved diagnosis of house dust mite allergy and efficacy and safety of specific immunotherapy

No disponible

Heterogeneity in allergy to mollusks: a clinical-immunological study in a population from the North of Spain

Background: Allergy to mollusks has been the focus of fewer studies than allergy to crustaceans. Furthermore, allergy to mollusks is less well characterized. Objectives: To describe the clinical characteristics of mollusk-allergic patients, to identify the responsible allergens, and to assess crossreactivity. Methods: We performed a prospective multicenter study including 45 patients with mollusk allergy, which was diagnosed based on a suggestive clinical history and a positive skin test result with the agent involved. Fractions were identified using SDS-PAGE and immunoblotting. The proteins responsible were subsequently identified using mass spectrometry. ELISA inhibition studies were performed with mollusks, dust mites, and crustaceans. Results: We found that 25 patients (55%) were allergic to cephalopods, 14 (31%) to bivalves, and 11 (24%) to gastropods. Limpet was the third most frequent cause of allergy (15% of cases). In 31 patients (69%), the manifestation was systemic; 10 (22%) exhibited oral allergy syndrome, and 7 (15%) experienced contact urticaria. Most major allergens were found between 27 kDa and 47 kDa. ELISA inhibition assays revealed a high degree of inhibition of cephalopods and bivalves from all the groups of mollusks, mites, and crustaceans. Mass spectrometry identified tropomyosin, actin, and myosin as the major allergens. Conclusions: Cephalopods, especially squid, are the mollusks that most frequently trigger allergic symptoms. The very frequent occurrence of allergy to limpets is striking, given their low consumption in our area. It is worth highlighting the heterogeneity observed, exemplified by the gastropods. Tropomyosin appears to be responsible for the high cross-reactivity found between mollusks, mites, and crustaceans. Three new mollusk allergens were also identified, namely, actin, enolase, and a putative C1q domain-containing protein (AU)

Introducción: La alergia a moluscos ha sido menos estudiada y está peor caracterizada que la alergia a crustáceos. Objetivo: Describir las características clínicas de pacientes alérgicos a moluscos, identificar los alérgenos responsables y estudiar la reactividad cruzada entre ellos. Métodos: Estudio multicéntrico, prospectivo. Se incluyen 45 pacientes con alergia a moluscos, definida como una clínica sugestiva y prueba cutánea positiva con el molusco sospechoso. Se identificaron las bandas alergénicas mediante SDS-PAGE e inmunodetección. Las proteínas responsables se identificaron utilizando espectrometría de masas. Se realizaron ensayos de inhibición de ELISA entre moluscos, ácaros y crustáceos. Resultados: Veinticinco (55%) de los pacientes eran alérgicos a cefalópodos, 14 (31%) a bivalvos y 11 (24%) a gasterópodos. La lapa resultó ser la tercera causa de alergia (15% de los casos). Los síntomas fueron sistémicos en 31 pacientes (69%), diez (22%) tuvieron síndrome de alergia oral y siete (15%) urticaria de contacto. La mayoría de las bandas alergénicas estaban entre 27 y 47 kDa. Los ensayos de inhibición de ELISA mostraron un alto grado de inhibición de cefalópodos y bivalvos por parte de moluscos, ácaros y crustáceos. Mediante espectometría de masas se identificaron tropomiosina, actina y miosina como los alérgenos mayoritarios. Conclusiones: Los moluscos que con más frecuencia provocan reacciones alérgicas son los cefalópodos, especialmente el calamar. Llama la atención la elevada frecuencia de alergia a la lapa, a pesar de su bajo consumo. También hay que resaltar la heterogeneidad observada, por ejemplo en los gasterópodos. La tropomiosina parece ser responsable de la elevada reactividad cruzada encontrada entre moluscos, ácaros y crustáceos. Se han identificado tres nuevos alérgenos en los moluscos: actina, enolasa y putative C1q domain-containing protein (AU)

Are basophil activation and sulphidoleukotriene determination useful tests for monitoring patients with peach allergy receiving sublingual immunotherapy with a Pru p 3-enriched peach extract?

INTRODUCTION: Treatment of food allergy essentially consists of food avoidance, but immunotherapy with food is emerging as a new therapeutic option. OBJECTIVE: To evaluate clinical improvement and immunological changes in patients with peach allergy following sublingual immunotherapy (SLIT) with a Prup3 quantified peach extract. METHODS: A randomized, double-blind, placebo-controlled clinical trial with peach SLIT was conducted. We assessed clinical efficacy after 6 months of treatment by means of double-blind, placebo-controlled oral challenges with peach and also evaluated immunological changes (basophil activation test [BAT] and determination of sulphidoleukotriene production) following stimulation with peach peel and pulp, rPrup3, rMald 1, and rMal d 4 stimulation. We also measured specific IgE and IgG4 to Pru p3. RESULTS: After 6 months of SLIT (T6), the active group showed a 3-fold improvement in tolerance to Prup3 and a significant increase in IgE to rPrup3 and in sLT production following stimulation with peach peel and rPrup3. There was also a significant increase in BAT results after stimulation with rPrup3 at 1 month of SLIT (T1). Statistically significant between-group differences were only observed for BAT with peach peel and pulp at T1 and T6 and for BAT with rPru p3 at T6. No changes were observed in BAT with rMal d 1 or rMal d 4 or in IgG4 levels to nPrup3. CONCLUSIONS: SLIT with a Pru p 3 quantified peach extract is clinically effective and leads to an increase in basophil activation and sulphidoleukotriene production following stimulation with rPru p3 and peach peel in the first months of treatment.

Are basophil activation and sulphidoleukotriene determination useful tests for monitoring patients with peach allergy receiving sublingual immunotherapy with a pru p 3-enriched peach extract?

Introduction: Treatment of food allergy essentially consists of food avoidance, but immunotherapy with food is emerging as a new therapeutic option. Objective: To evaluate clinical improvement and immunological changes in patients with peach allergy following sublingual immunotherapy (SLIT) with a Pru p 3 quantified peach extract. Methods: A randomized, double-blind, placebo-controlled clinical trial with peach SLIT was conducted. We assessed clinical efficacy after 6 months of treatment by means of double-blind, placebo-controlled oral challenges with peach and also evaluated immunological changes (basophil activation test [BAT] and determination of sulphidoleukotriene production) following stimulation with peach peel and pulp, rPru p 3, rMal d 1, and rMal d 4 stimulation. We also measured specific IgE and IgG4 to Pru p 3. Results: After 6 months of SLIT (T6), the active group showed a 3-fold improvement in tolerance to Pru p 3 and a significant increase in IgE to rPru p 3 and in sLT production following stimulation with peach peel and rPru p 3. There was also a significant increase in BAT results after stimulation with rPru p 3 at 1 month of SLIT (T1). Statistically significant between-group differences were only observed for BAT with peach peel and pulp at T1 and T6 and for BAT with rPru p 3 at T6. No changes were observed in BAT with rMal d 1 or rMal d 4 or in IgG4 levels to nPru p 3. Conclusions: SLIT with a Pru p 3 quantified peach extract is clinically effective and leads to an increase in basophil activation and sulphidoleukotriene production following stimulation with rPru p 3 and peach peel in the first months of treatment (AU)

Introducción: El tratamiento de la alergia alimentaria se basa en la evitación del alimento. La inmunoterapia con alimentos está emergiendo como una nueva opción terapéutica. Evaluar la mejoría clínica y los cambios inmunológicos de una inmunoterapia sublingual (ITSL) de melocotón (cuantificada en Pru p 3) en pacientes con alergia a melocotón. Métodos: Ensayo clínico doble-ciego controlado con placebo con una SLIT de melocotón. Valoramos la eficacia clínica a los 6 meses del tratamiento mediante provocaciones orales doble-ciego controladas con placebo (PODCCP) y los cambios inmunológicos (test de activación de basófilos -BAT- y liberación de sulfidoleucotrienos -sLT-) tras estimulación celular con piel y pulpa de melocotón, rPru p 3, rMal d 1 y rMal d 4, IgE e IgG4 a Pru p 3. Resultados: A los 6 meses del tratamiento (T6), la tolerancia a Pru p 3 mediante PODCCP en el grupo activo fue 3 veces superior a la basal (T0), se observó un incremento significativo en la IgE específica a rPru p 3 y en la liberación de sLT tras estimulación con piel de melocotón y rPru p 3, así como en el TAB tras estimulación con rPru p 3 al mes del tratamiento (T1). Se observaron diferencias intergrupo (activo-placebo) en T1 y T6 para piel y pulpa de melocotón y en T6 para rPru p 3 mediante TAB. No se observaron modificaciones en rMal d 1 y rMal d 4 o en los niveles de IgG4 a nPru p 3. Conclusiones: La ITSL con un extracto de melocotón cuantificado en Pru p 3, es clínicamente efectiva y provoca un incremento en la activación basófila y en la liberación de sLT tras estimulación celular con rPru p 3 y piel de melocotón en los primeros meses de tratamiento (AU)

[Henna tattooing in children: natural or temporary?]. / Tatuaje de henna en niños: ¿natural y temporal?

BACKGROUND: Tattoos of natural red/brown henna obtained from the indigenous tree Lawsonnia have been traditionally performed with a few side-effects. Nowadays black henna tattoos are usually performed even in children. The addition of several chemical agents to improve its cosmetic properties has increased the risk of developing contact dermatitis after exposure. Our aim is to determine the causative agents of contact dermatitis in two children wearing henna tattoos. MATERIAL AND METHODS: Case 1: A 12-year-old girl with no atopy presented local vesicles 10 hours after a black henna tattoo was applied. She had presented similar symptoms with a previous tattoo. Case 2: A 7-year-old atopic boy presented vesicles 2 weeks after a black henna tattoo was applied. He had dyed his hair previously without side effects. Both patients cured, after 3-4 weeks of treatment with topic corticosteroids, with residual hypo-pigmentation. Skin prick test with natural and commercial henna and epicutaneous test with TRUE-TEST, PABA derivatives compounds tests, textile dyes and natural and commercial henna were performed. RESULTS: The epicutaneous tests were positive for p-Metilaminophenol, p-Aminobencene, p-Phenilendiamine and p-Toluenodiamine in both patients. The first patient had also positive tests for Benzocaine, Hydroquinone, Isobutyl p-aminobenzoate, Yellow 1 and Orange 1 disperse; the second one for Red 1 and Orange 1 disperse. In both cases the prick and epicutaneous tests for henna were negative. CONCLUSIONS: Two children presented contact dermatitis after black henna tattoo due to added additives such as paraphenilendiamine.

Tatuaje de henna en niños: ¿natural y temporal? / Henna tattooing in children: natural or temporary?

Fundamento. Los tatuajes de henna natural marrón/rojo, obtenida del arbusto indígena Lawsonnia, se llevan realizando tradicionalmente con escasos efectos secundarios. Actualmente se utilizan tatuajes de henna negra (denominados tatuajes temporales o pseudotatuajes), incluso en niños. Debido a los agentes químicos añadidos para mejorar sus propiedades estos tatuajes tienen alto poder sensibilizante y causan dermatitis de contacto. Nuestro objetivo es determinar los agentes causantes de dermatitis de contacto tras pseudotatuaje en dos niños. Material y métodos. Caso 1: Niña de 12 años, sin atopia, presentó vesículas locales a las 10 horas de tatuaje de henna negra. Tatuaje previo con igual sintomatología. Caso 2: Niño de 7 años, atópico, presentó a las 2 semanas de tatuaje con henna negra vesiculación en zonas de contacto. Antecedente de tinción de pelo sin incidencias. Ambos curaron a las 3-4 semanas de tratamiento quedando hipopigmentación residual. Se realizó prick con henna natural y comercial, y pruebas epicutáneas con la batería estándar de contactantes y las baterías de compuestos del grupo para derivados del ácido paraaminobenzoico (PABA) y colorantes textiles así como henna natural y comercial. Resultados. Las pruebas epicutáneas mostraron resultados positivos con p-Metilaminofenol, p-Aminobenceno, p-Fenilendiamina y p-Toluenodiamina en ambos pacientes. Además, la paciente 1 tuvo positividades con benzocaína, hidroquinona, isobutil p-aminobenzoato, Amarillo 1 y Naranja 1 dispersos, y el paciente 2 con Rojo 1 y Naranja 1 dispersos. En ambos casos el prick y las pruebas epicutáneas con henna fueron negativas. Conclusión. Los dos niños presentados sufrieron dermatitis de contacto tras tatuaje de henna negra debido a los aditivos añadidos a la henna natural, como la parafenilendiamina

Background. Tattoos of natural red/brown henna obtained from the indigenous tree Lawsonnia have been traditionally performed with a few side-effects. Nowadays black henna tattoos are usually performed even in children. The addition of several chemical agents to improve its cosmetic properties has increased the risk of developing contact dermatitis after exposure. Our aim is to determine the causative agents of contact dermatitis in two children wearing henna tattoos. Material and Methods. Case 1: A 12-year-old girl with no atopy presented local vesicles 10 hours after a black henna tattoo was applied. She had presented similar symptoms with a previous tattoo. Case 2: A 7-year-old atopic boy presented vesicles 2 weeks after a black henna tattoo was applied. He had dyed his hair previously without side effects. Both patients cured, after 3-4 weeks of treatment with topic corticosteroids, with residual hypo-pigmentation. Skin prick test with natural and commercial henna and epicutaneous test with TRUE-TEST®, PABA derivatives compounds tests, textile dyes and natural and commercial henna were performed. Results. The epicutaneous tests were positive for p- Metilaminophenol, p-Aminobencene, p-Phenilendiamine and p- Toluenodiamine in both patients. The first patient had also positive tests for Benzocaine, Hydroquinone, Isobutyl paminobenzoate, Yellow 1 and Orange 1 disperse; the second one for Red 1 and Orange 1 disperse. In both cases the prick and epicutaneous tests for henna were negative. Conclusions. Two children presented contact dermatitis after black henna tattoo due to added additives such as paraphenilendiamine

Estandarización de pruebas epicutáneas con aeroalergenos en la dermatitis atópica. Estudio multicéntrico / Patch test standarization with aeroallergens in atopic dermatitis. A multicentre study

En algunos pacientes con dermatitis atópica se ha demostrado que la aplicación directa de aeroalergenos sobre la piel es capaz de reproducir las lesiones características de la enfermedad. Por ello, si las pruebas epicutáneas fueran una técnica bien estandarizada, podrían constituir el modelo ideal de estudio alergológico en estos pacientes. El objetivo de este estudio fue determinar la concentración óptima para pruebas epicutáneas con varios aeroalergenos. Material y métodos: Se seleccionaron 137 pacientes con dermatitis atópica y 32 controles atópicos > 12 años en los 10 centros participantes en el estudio. Se realizaron pruebas del prick y pruebas epicutáneas con extractos de D. pteronyssinus, P. pratense, O. europaea, Alternaria alternata y epitelio de gato en concentraciones de 10, 5 y 1 HEP (Laboratorios DIATER®) y se determinó la IgE específica en el suero frente a aquellos alergenos positivos en el prick. Resultados: Los grupos de pacientes y controles fueron homogéneos. Obtuvimos un 25,7% y 9% de parches positivos con 10 HEP de D. pteronyssinus en pacientes y controles, respectivamente. Con O. europaea sólo hubo un 3% de pacientes y controles con un parche positivo. Con el resto de los alergenos la frecuencia de parches positivos en los pacientes fue del 11,2%, 8,8% y 7,5% frente a P. pratense, A. alternata y gato, respectivamente, y del 3% en los controles. Conclusión: La concentración más alta utilizada de 10 HEP con D. pteronyssinus puede considerarse adecuada para las pruebas epicutáneas. Respecto a los otros alergenos, esta concentración parece encontrarse por debajo de la óptima, sobre todo en el caso de O. europaea

In some patients with atopic dermatitis, characteristic eczematous skin lesions can be induced by patch testing with aeroallergens. However, atopy patch test is not well standardised. The aim of this study was to stablish the optimal concentration of aeroallergens for patch testing. Material and methods: We selected 137 patients with atopic dermatitis and 32 atopic controls in the 10 participant centres. Prick test and atopy patch test with D. pteronyssinus, P. pratense, O. europaea, A. alternata and cat dander extracts at 10, 5 and 1 HEP (DIATER S.A.) as well as specific IgE determination were performed. Results: The groups of patients and controls were homogeneous. A 25,7% and 9% of patients and controls, respectively, had a positive result when patch testing with D. pteronyssinus extract at 10 HEP. Only a 3% of positive patch tests were obtained with O. europaea in patients and controls. The frequency of positive patch tests with the other allergens in patients was 11,2%, 8,8% y 7,5% for P. pratense, A. alternata and cat dander, respectively, and 3% in controls. Conclusions: The highest concentration of 10 HEP could be considered optimal for the atopy patch test with D. pteronyssinus. Such concentration seems to be lower than the optimal one when patch testing the other allergens

[Hypersensitivity Pneumonitis (extrinsic allergic alveolitis)]. / Neumonitis por hipersensibilidad (alveolitis alérgica extrínseca).

Farmer's lung was first described in 1932. We can define hypersensitivity pneumonitis as a pulmonary and systemic disease that is accompanied by dyspnoea and coughing; it is caused by an immunological type of inflammation of the alveolar walls and the terminal airways and it is secondary to the repeated inhalation of a variety of antigens by a susceptible host. It can be said that it is an underdiagnosed disease and only a high degree of clinical manifestations and a detailed history of exposure can lead to an early diagnosis and satisfactory treatment. A combination among clinical-radiological, functional, cytological or pathological findings leads in some cases to a diagnosis. Treatment is based on avoiding further exposure to the causal agent and in the more serious cases the administration of systemic corticoid treatment.

Neumonitis por hipersensibilidad (alveolitis alérgica extrínseca) / Hypersensitivity Pneumonitis (extrinsic allergic alveolitis)

El pulmón del granjero se describió por primeravez en 1932. Podemos definir la neumonitis por hipersensibilidadcomo una enfermedad pulmonar y sistémicaque cursa con disnea y tos, y que se produce porla inflamación de tipo inmunológico de las paredesalveolares y vías aéreas terminales y que es secundariaa la inhalación repetida de una variedad de antígenospor un huésped susceptible. Puede decirse que es unaenfermedad infradiagnosticada y sólo un alto grado desospecha clínica y una historia detallada de la exposiciónpueden llevar a un diagnóstico precoz y un tratamientosatisfactorio. Una combinación entre los hallazgosclínico-radiológicos, funcionales, citológicos o anatonomopatológicos,en algunos casos, nos llevarán aldiagnóstico

Farmer’s lung was first described in 1932. We candefine hypersensitivity pneumonitis as a pulmonaryand systemic disease that is accompanied by dyspnoeaand coughing; it is caused by an immunological type ofinflammation of the alveolar walls and the terminalairways and it is secondary to the repeated inhalationof a variety of antigens by a susceptible host. It can besaid that it is an underdiagnosed disease and only ahigh degree of clinical manifestations and a detailedhistory of exposure can lead to an early diagnosis andsatisfactory treatment. A combination among clinicalradiological,functional, cytological or pathologicalfindings leads in some cases to a diagnosis

Epidemiology of urticaria in Spain.

BACKGROUND: In spite of the frequency of chronic urticaria there are very few epidemiological studies of its prevalence and distribution. OBJECTIVE: We wanted to approach the real prevalence of chronic urticaria in a population-based study and to depict demographic distribution and personal perception of the disease. We also wanted to describe the frequency of acute urticaria episodes in the population studied. METHODS: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a sample size for a maximum variability (conservative approach p=q=0.5). RESULTS: We found a 0.6% (95% CI: 0.4-0.8) prevalence of chronic urticaria. The prevalence is significantly higher in women than in men with a OR=3.82 (95%CI 1.56-9.37). Chronic urticaria is a self-limited disease, yet in 8.7% of cases chronic urticaria lasts from one to 5 years and in 11.3%, for more than 5 years. The average age of onset is 40 years. CONCLUSIONS: We offer large epidemiology study data on the prevalence of chronic urticaria. The prevalence of chronic urticaria has not yet been defined in an adult population-based study. With this work we offer such data to describe the prevalence and features of this disease.

Prevalencia de alergia en la población adulta española / Allergy prevalence in adult spanish population

Introduccián: En lo últimos decenios se está registrando un aumento de las enfermedades alérgicas en todo el mundo. Sin embargo hay pocos estudios de prevalencia de alergia en la población general española. Objetivos: Establecer la prevalencia de enfermedades alérgicas en una muestra de población general adulta del estado español. Así como establecer las causas y las manifestaciones de esta alergia. Material y métodos: Se realizó un estudio observacional de tipo tranversal. El tamaño de la muestra. suponiendo un nivel máximo de indeterminación prevalencia = 50%) y aceptando un error del 1.4% y un nivel de confianza del 95%. Fue de 5.003 sujeto . La muestra e seleccionó de forma aleatoria y automática del listín de teléfono, aplicando el control de cuotas de zona. el número de habitantes, el sexo y la edad. La recogida 1:1e datos se efectuó mediante encuesta telefónica siguiendo la técnica CATI (Computer-assisted Telephone Interview technique) con oporte Omnibus Phonebus de Taylor Ne/son Sofres Market Research. Resultados: De los 4.949 sujetos incluidos en el análisis. un 21,6% (IC 95% 20,4- 22,7%) refirieron ser alérgicos. La prevalencia fue mayor en mujeres (24,6%), en el grupo de 18 a 24 años de edad (26.9%) y en poblaciones de más de 500.000 habitantes (24,3%). mientras que fue menor en los varones (18,3%), en la región norte-centro ( 17 ,8%) y en poblaciones con menos de 10.000 habitantes ( 18.7% ). o hubo diferencia significativa en relación al nivel socioeconómico. La rinoconjuntivitis fue la manifestación alérgica más frecuente (45,4%) seguida del asma bronquial (24.9% ), la urticaria (24.6% ), la dermatitis (21,5%) y el angioederna (6% ). Las tres causas más frecuente de alergia fueron con diferencia los pólenes (31,5%). los medicamento (29,4%) y los ácaros del polvo domé tico (25.3%). Mucho menos frecuentes fueron los animales (6,8%). los metales (4.9%). los alimentos (4.8%), los hongos (3%), las picadura de insecto (2.5%), la exposición al sol (1,9%) y el látex (0,8%). Conclusiones: La prevalencia de alergia en la población adulta española es del 21,6%, y es más frecuente en las mujeres y en los núcleos urbanos de más de 500.000 habitantes. La manifestación más frecuente es la rinoconjuntivitis. Las manifestaciones cutáneas de la alergia no son despreciables. Las causas más frecuentes de alergia con los aeroalérgeno (pólenes y ácaros) y lo medicamentos (AU)

Background: In spite of the worldwide increase in allergic diseases over the recent years, few epidemiological studies have been conducted in Spain. Objective: We wanted to establish the real prevalence of allergy in a sample of adult general population. We then wanted to describe the profile. the causes and the type of caused disease. Methods: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a simple size for a máximum undetermination level of (p = 50%). assuming a 1.4 error for global results and a 95% confidence interval (95% CI) l. Five thousands and three individual: were randomly selected from the telephone directory and matched according to sex, age and area. The phone survey was performed with each individual employing the Computer-assisted Telephone lnterview technique supported by Taylor elson Phonebus Company (Barcelona, Spain). Results: We found a 21.6% (95% CI: 20.4-22, 7%) prevalence of allergy. The prevalence was higher in wornen (24.6%) than in men (18.3%). Allergy condition was higher from 18 to 24 years old (26.9%). As it was expected. the prevalence was also higher in urban cities > 500.000 habitants (24.3%) than in rural cities with less than 10.000 habitants ( 18. 7% ). We did not find differences among economical status. The most cornrnon manifestation of allergic disease was rhinoconjunctivitis (45..+%) followed by bronchial asthrna (24.99'c), urticaria (24.6%). Dermatitis (21.5% ), and angioedema (6

Respiratory allergy to peach leaves and lipid-transfer proteins.

BACKGROUND: Several lipid-transfer proteins (LTPs) have been identified as important food allergens, especially in fruits of the Rosaceae family. The major peach (Prunus persica) allergen has been identified, sequenced and designated Pru p 3. OBJECTIVE: To present Pru p 3 as an aeroallergen able to induce occupational asthma. METHODS: A thorough investigation was performed in a fruit grower with occupational asthma. Skin prick-prick tests with peach leaves and prick tests with perennial respiratory allergens and pollens, fruits and peach leaf extracts were done. Serum-specific IgE was tested for peach leaf, peach fruit, peach skin and respiratory allergens that were positive in skin prick tests. Specific bronchial provocation tests (BPTs) with extracts of peach leaf were also done. Before and 24 h after the BPT, BPTs with methacholine and sputum induction were done. The IgE reactivity pattern to peach leaf and fruit extracts and to Pru p 3 was identified by using SDS-PAGE and immunoblotting. Blotting inhibition of peach leaf extract by Pru p 3 was also performed. The putative allergen was quantified in leaf and fruit skin extracts with ELISA based on an anti-Pru p 3 antibody. RESULTS: Skin tests were positive for peach leaf and fruit. The BPT was positive, with immediate and delayed response. This test induced a decrease in PD20 (dose of agonist that induces a 20% fall in FEV1) methacholine and an increase in eosinophils and eosinophil cationic protein in sputum. Peach leaf extract contained concentrations of Pru p 3 similar to those found in peach skin. Specific IgE immunodetection showed that patient's sera reacted with Pru p 3, and with a single major band from the peach leaf extract fully inhibited by Pru p 3. CONCLUSION: Pru p 3 from peach leaves can act as a respiratory allergen and cause occupational rhinoconjunctivitis and asthma.

Diversity of asparagus allergy: clinical and immunological features.

BACKGROUND: Asparagus (Asparagus officinalis) is an extensively grown and consumed vegetable. To a lesser extent than other Liliaceae vegetables, allergic contact dermatitis (ACD) due to asparagus has been reported. However, only a few case reports of asparagus IgE-mediated allergy have been published. In a previous study, we demonstrated that two lipid transfer proteins (LTPs) (Aspa o 1.01 and Aspa o 1.02) were relevant allergens of asparagus. OBJECTIVE: We retrospectively analysed the 27 patients diagnosed with asparagus allergy during the last 5 years. All of them reported adverse symptoms after either asparagus ingestion or handling. We describe their clinical features and evaluate whether they were associated to immunological findings (immunoblot pattern and skin reactivity to LTPs). METHODS: Patients underwent skin prick and patch tests with standard panels of vegetables and aeroallergens. Besides crude asparagus extract, two purified LTPs were prick and patch tested. Total and specific IgE measurements and asparagus extract IgE immunoblotting were performed. Patients reporting asthma symptoms underwent specific inhalation challenge to asparagus. RESULTS: Of the 27 subjects, eight had ACD, 17 had IgE-mediated allergy and two had both ACD- and IgE-mediated allergy. Positive patch tests with the crude asparagus extract but not with LTPs were observed in subjects with ACD (n=10). Of 19 patients with IgE-mediated disease, 10 had contact urticaria after asparagus handling. Of them, five subjects and five others without skin allergy showed respiratory symptoms; of them, eight were diagnosed with occupational asthma confirmed by positive asparagus inhalation challenge, whereas the remaining two had isolated rhinitis. Four patients suffered from immediate allergic reactions related to asparagus ingestion (food allergy); three of them reported anaphylaxis whereas the other had oral allergic syndrome. Positive IgE immunoblotting (bands of 15 and 45-70 kDa) was observed in 10 subjects. Of 10 subjects with positive prick test to LTPs, six showed bands at 15 kDa. Either IgE-binding bands or positive prick tests to LTPs were observed in asthma (62%) and anaphylaxis (67%). CONCLUSION: Asparagus is a relevant source of occupational allergy inducing ACD and also IgE-mediated reactions. Severe disease (anaphylaxis or asthma) is common and LTPs seem to play a major role. The clinical relevance of LTP sensitization among patients with mild disease or symptom-free subjects should be addressed in prospective studies.

Occupational asthma from natural rubber latex. Specific inhalation challenge test and evolution.

BACKGROUND: Natural rubber latex (NRL) is the most frequent cause of occupational respiratory problems in hospital workers. OBJECTIVE: To describe the diagnostic methodology, including the specific inhalation challenge (SIC), used on patients diagnosed as having occupational asthma due to NRL in our Allergy Department during a 6-year period from 1989 to 1995. METHODS: In 19 patients diagnosed as having occupational asthma due to NRL, clinical severity was assessed with a combined score for symptoms and medication use. Skin prick tests with aeroallergens, latex, papain, kiwi and chestnut, total IgE, serum-specific latex IgE, respiratory function study, methacholine test, specific conjunctival test, and SIC test with latex were done. RESULTS: All but three patients worked in hospitals. All presented urticaria and rhinoconjunctivitis, and six also suffered anaphylaxis, usually preceded by asthma. Clinical fruit allergy was present in eight patients. The latency period was variable (0.25-27 years). The intensity of symptoms was low to moderate. Specific IgE, skin prick, and conjunctival tests to latex were positive in all cases. SICs were done in 12 patients. All of them presented isolated immediate reactions. No adverse reactions were observed. Duration of follow-up ranged from 1 to 7 years. Twenty-six percent of the patients kept their job, 26% changed jobs but remained in health care, and 48% switched to jobs unrelated to health care. Only 16% were free of symptoms without treatment, while 32% needed bronchodilators and 52% needed inhaled steroids. The specific bronchial challenge test was safe, but it did not predict the course of the illness. Duration of exposure and intensity of symptoms did correlate with prognosis, however. CONCLUSIONS: NRL acts as a common aerollergen. Minor symptoms often precede occupational asthma. The SIC test was safe in the hands of trained technicians. Occupational asthma due to NRL seems to have a poor prognosis.

[Epicutaneous test with inhalers in the study of atopic dermatitis]. / Test epicutáneos con inhalantes en el estudio de la dermatitis atópica.

In some 80% of patients with atopic dermatitis, the presence of specific IgE is found when facing food or environmental allergens. It has also been demonstrated in a sub-group of patients with atopic dermatitis that the dermatitis lesions are exacerbated following the ingestion or inhalation of allergens, and that they improve with reduction of exposure to allergens. Although the prick method and the determination of specific IgE in serum are highly sensitive techniques, epicutaneous tests, applying the allergen directly to the skin, might be the ideal diagnostic method since they reproduce the characteristic inflammatory response of the disease on the affected organ itself, the skin. However, there is great variability in the results obtained through epicutaneous tests with aeroallergens, basically due to methodological differences, which are reviewed in this paper. Finally, we present the results of carrying out epicutaneous tests with inhalant allergens on our patients with atopic dermatitis and controls, where some 27% of positive patches were obtained, basically with acari, and in those patients with more severe dermatitis, without there being complete concordance with the prick technique. For this reason, the epicutaneous test appears to be a method of allergological diagnosis that might be useful and complementary to the routine techniques of the prick method and the determination of specific IgE in serum, but it is in need of suitable standardization.

[Latex allergy. Clinical manifestations in the general population and reactivity crossed with foodstuffs]. / Alergia al látex. Manifestaciones clínicas en la población general y reactividad cruzada con alimentos.

Because of widespread latex manufacturing in the last decades, latex allergy has become an important clinical problem, not only in high-risk groups (health-workers) but also among the general population. Latex is used to produce a large variety of natural rubber products (medical equipment, household gloves, condoms, balls and balloons, footwear, baby pacifiers...) employed in the ordinary life, with high risk for patients allergic to latex. Among general population, children affected by myelomeningocele or spina bifida, have a higher risk to develop latex allergy. Clinical manifestations range from local reactions(contact dermatitis, urticaria), rhino-conjunctivitis, asthma, pharyngeal edema to severe systemic reactions such anaphylactic shock. Furthermore, latex can crossreact with some plant foods, and patients suffering from latex allergy often associate food allergy.

[Immunotherapy with grouped doses]. / Inmunoterapia con pautas agrupadas.

Once the efficacy and safety of immunotherapy with allergen extracts has been shown, recently it has become evident the need for perfecting those aspects of the treatment that can be improved, such as its dosage form. The conventional dosage of subcutaneous immunotherapy in the phase of dose increase is slow in reaching an efficient level. For this reason other alternative dosages to the conventional one have been tried out, such as grouped dosages, which shorten this period of dose increase. On condition that the safety of the treatment is guaranteed, these doses offer the advantages of reducing the economic cost and the time involved, of reducing the discomfort of the treatment and of improving the patient's adherence to the treatment, and possibly of reaching clinical efficacy more rapidly. Nonetheless, it is not easy to determine the suitable dosage of administration (the shortest and with the least number of adverse reactions) and this article reviews the existing problems when it comes to designing these grouped doses. Finally, we present the results of a comparative study between the conventional dose and a grouped dose, with a double blind design, carried out by us, which shows that the grouped dose is quicker in achieving the desired clinical efficacy, shortens the times of reduction of cutaneous sensitivity to the allergen and of modification of the immunological parameters, all with a low frequency of adverse reactions that is similar to that registered with the conventional dosage.