Reacciones de hipersensibilidad a antiinflamatorios no esteroideos y su tolerancia a fármacos alternativos / Hypersensitivity reactions to non-steroidal anti-inflammatory drugs and tolerance to alternative drugs

INTRODUCCIÓN: Las reacciones de hipersensibilidad (HS) a los antiinflamatorios no esteroideos (AINE) son las reacciones a drogas más frecuentes. Su prevalencia en la población general varía del 0,6 al 5,7%, no teniendo datos en niños. El objetivo de este estudio fue determinar la frecuencia de pacientes diagnosticados de HS a AINE, características clínicas, tipo de HS y tolerancia a fármacos alternativos. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo de niños con sospecha de HS a AINE realizado entre enero de 2012 y diciembre de 2013. El diagnóstico se realizó mediante prueba de exposición controlada (PEC) al fármaco implicado cuando tenían historia de episodio único, y basado en la clínica si había habido más de un episodio con un mismo fármaco. Posteriormente se realizó una PEC al ácido acetilsalicílico, para diferenciar en HS selectiva o múltiple. En los casos con resultado positivo se hizo una PEC a fármacos alternativos. RESULTADOS: Se estudiaron 93 niños, de los que 26 fueron diagnosticados de HS a AINE (7 confirmados mediante PEC y 19 basados en la clínica). Un 50% presentó HS múltiple. El ibuprofeno estuvo involucrado en todas las reacciones. La clínica observada con mayor frecuencia en la PEC fue el angioedema (44%). El paracetamol fue el fármaco alternativo mejor tolerado. CONCLUSIONES: Un 28% de la población estudiada fue diagnosticada de HS a AINE, y el 50% presentó una HS múltiple. El paracetamol es una alternativa segura en niños con HS a AINE. El meloxicam podría considerarse como una alternativa en los casos que no toleran el paracetamol

INTRODUCTION: Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most common reactions to drugs. The prevalence varies from 0.6 to 5.7% in general population, but there are no data available in children. The aim of this study is to determine the frequency of patients diagnosed with hypersensitivity to NSAIDs, and describe their clinical characteristics, type of hypersensitivity, and tolerance to alternative drugs. METHODS: Retrospective study was conducted on children with suspected hypersensitivity to NSAIDs from January 2012 to December 2013. The diagnosis was confirmed by oral drug provocation test (DPT) to the drug involved in the group with a history of one episode, while in the group with a history of more than one episode with the same drug the diagnosis was based on clinical data. Subsequently, a DPT with acetylsalicylic acid (ASA) was done in order to classify hypersensitivity into selective or multiple. In those cases with a positive result, a DPT was performed with alternative drugs. RESULTS: Out of a total of 93 children studied, 26 were diagnosed with hypersensitivity to NSAIDs: 7 confirmed by oral DPT, and 19 based on clinical data. Multiple hypersensitivity was diagnosed in 50% of patients. Ibuprofen was involved in all reactions. The most common clinical manifestation was angioedema (44%). Acetaminophen was the best tolerated alternative drug. CONCLUSIONS: More than one quarter (28%) of the population studied was diagnosed with hypersensitivity to NSAIDs, and 50% had multiple hypersensitivity. Acetaminophen is a safe alternative in children with hypersensitivity to NSAIDs. Meloxicam may be an alternative in cases that do not tolerate acetaminophen

Perioperative anaphylactic reactions: Review and procedure protocol in paediatrics

Perioperative anaphylactic reactions are immediate, hypersensitive reactions that are potentially life-threatening resulting from a sudden release of mediators from mast cells and basophiles, due to either immune (IgE or non-IgE mediated) or non-immune mechanisms. The most frequent causing agents are neuromuscular blocking agents (NMBAs), latex and antibiotics, with latex being the first cause in paediatrics. With regard to perioperative anaphylactic reactions, the usual early signs and symptoms of an anaphylactic reaction could be overlooked or erroneously interpreted and non-severe anaphylaxis could go undetected, with a risk of more severe reactions in the future. Using the data registered on the anaesthesia sheet, it is essential to establish a chronological relationship between drugs and/or substances administered and the reaction observed. An elevated level of tryptase confirms an anaphylactic reaction, but this does not usually increase in the absence of compromised circulation. An allergy study should be carried out preferably between 4 and 6 weeks after the reaction, using a combination of specific IgE, skin and controlled exposure tests (if indicated). Test sensitivity is good for NMBAs, latex, antibiotics, chlorhexidine, gelatine and povidone, and poor for barbiturates, opiates (these can give false positives since they are histamine releasers) and benzodiazepines. Special preventive measures should be taken, especially in the case of latex. We present the maximum concentrations recommended for skin tests, the recommended dosage to treat anaphylactic reactions in paediatrics and a procedure algorithm for the allergological study of these reactions

No disponible

X-linked agammaglobulinaemia. Mutation A1246G (R372G)

No disponible

Lymphoma as presentation of common variable immunodeficiency

No disponible

Allergy to quail’s egg without allergy to chicken’s egg. Case report

Introduction: We present a case of quail’s egg allergy without allergy to chicken’s egg. Case: Girl of 10.5 years old who presents anaphylactic reaction after she ate an uncooked quail’s egg. She had eaten boiled quail’s egg before. She eats chicken’s eggs without clinical symptoms. Methods: We made a prick to chicken’s egg and prick-by-prick to uncooked quail’s and raw chicken’s egg. We determined specific IgE to chicken’s egg; electrophoresis and IgE by inmunoblot to eggs from chicken, duck, goose, and quail. Results: We obtained negative results to prick, prick-by-prick and specific IgE to chicken’s egg. Prick-by-prick to quail’s egg was positive. By immunoblotwe recognised a protein in quail’s eggwhite, which is ovotransferrin without any similar bands in other species’ eggs. Conclusions: The protein that we recognised is a specific protein of quail’s egg. These proteins did not cross-react with proteins of chicken’s egg. Cooking may degrade such proteins

No disponible

Risk factors of developing asthma in children with recurrent wheezing in the first three years of life / Factores de riesgo para el desarrollo de asma en niños con dificultad respiratoria recurrente en los tres primeros años de vida

Introduction: recurrent wheezing is a common problem during the first years of life, but it is still difficult to identify which of these children may develop asthma in the future. Objectives: To study risk factors of developing asthma in a group of patients with frequent wheezing during the first three years of life. Material and methods: A prospective study was performed of a group of 60 patients, aged below three, referred to our Hospital for recurrent wheezing. Age, sex, parental and personal history of atopy, clinical features, laboratory tests, evolution and response to treatment were analyzed. Results: 60 patients were enrolled in study. Most of children were boys and have had the first episode of wheezing after the 6 months of life. 63 % had personal history of atopy and 55 % parental history of allergy. The group of atopic children had more wheezing exacerbations and worse evolution than the group of non atopic. They also had more treatment necessities. Conclusions: The identification of young children at high risk of developing asthma could permit an early intervention before irreversible changes in the airway appeared

Introducción: Las sibilancias recurrentes son un problema frecuente en los primeros años de vida. Sin embargo, es aún dificultoso identificar cuáles de estos niños van a desarrollar asma en el futuro. Objetivos: estudiar cuáles son los factores de riesgo de desarrollar asma en un grupo de pacientes con broncoespasmo de repetición durante los primeros tres años de vida. Material y métodos: Estudio prospectivo de 60 pacientes con edad igual o inferior a los 3 años, remitidos a nuestro centro por crisis de broncoespasmo repetidas. Se recoge información acerca de: edad, sexo, antecedentes familiares y personales de atopia, exploración física y pruebas alergológicas. Asimismo, evolución clínica y respuesta al tratamiento. Resultados: De los 60 pacientes implicados en el estudio, la mayor parte eran varones y presentaron el primer episodio de broncoespasmo antes de los 6 meses de vida. El 63% tenían antecedentes personales de atopia y el 55% antecedentes familiares de alergia. Los pacientes atópicos presentaron más crisis de sibilancias y peor evolución a corto plazo que los no atópicos. Asimismo, requirieron más tratamiento de mantenimiento. Conclusiones: La identificación precoz de los niños con elevado riesgo de desarrollar asma permitiría una intervención temprana antes de que se desarrollaran cambios irreversibles en la vía aérea

Polysensitization to aeroallergens and food in eosinophilic esophagitis in a pediatric population / Polisensibilización a aeroalergenos y alimentos en la esofagitis eosinofílica en una población pediátrica

There are few studies on eosinophilic esophagitis (EE) in the pediatric population in Europe. We present our data and emphasize the following findings: a) all patients had symptoms of allergic respiratory disease prior to receiving a diagnosis of EE with polysensitization (aeroallergens, food allergens); and b) in contrast with the results of earlier studies, food sensitization in our series most often corresponded to legumes

Hay pocos estudios sobre esofagitis eosinofílica (EE) en la población pediátrica en Europa. Presentamos nuestros datos, destacando los siguientes hallazgos: a) presencia de enfermedad alérgica respiratoria en todos los pacientes previamente diagnosticados de EE, polisensibiizados (aeroalergenos, alimentos); b) sensibilización a alimentos en nuestra serie, la mayoría a legumbres, en contraste con el resultado de estudios anteriores

Challenge testing in children with allergy to cow's milk proteins

Objectives: to evaluate clinical response after challenge testing in infants with allergy to cow's milk proteins at diagnosis and again when these infants were aged 1 year old and had been fed an exclusion diet. Material and methods: we performed a prospective study of 49 infants aged less than 6 months with a clinical history suggestive of cow's milk protein allergy, positive skin prick test and specific IgE for a -lactalbumin, b -lactoglobulin and casein. In all children challenge test with cow-milk adapted formula was carried out at diagnosis. The same procedures were repeated when the children were aged 1 year but challenge testing was repeated only in children with a negative skin prick test and specific IgE antibodies to cow's milk proteins. Results: At diagnosis, challenge tests produced immediate hypersensitivity reactions in 94 % of infants. Late reactivity (i.e., more than 2 hours after challenge) was found in only 6 % of infants, all of whom presented dyspepsia. When the infants were aged 1 year, and after results of immunological study were negative, a further challenge test was performed in 24 (49 %) of lactating infants included in the study. Of these 24 infants, positive challenge was found in 5 (21 %). None of the infants presented immediate symptomatology (clinical features appeared 7 days after the reintroduction of cow's milk proteins). Conclusions: Ninety-four percent of challenge tests performed at diagnosis provoked immediate reactions. The results of challenge tests after a negative skin prick test in children with normal concentrations of specific IgE were positive in 21 % infants, who presented late reactivity (a mean of 7 days after milk ingestion) (AU)

Objetivo: Evaluar la respuesta clínica tras la prueba de provocación, en niños con alergia a proteínas de leche de vaca, efectuada al diagnóstico y tras dieta exenta de proteínas de leche de vaca, al año de edad.Material y métodos: Estudio prospectivo que incluye 49 niños, menores de seis meses de edad, con historia clínica sugestiva de alergia a proteínas de leche de vaca, prick e IgE específica positivos para -lactoalbúmina, -lactoglobulina y caseína a los que se les efectúa una prueba de provocación con leche de vaca adaptada en el momento del diagnóstico. Al año de edad se repite la misma metodología de estudio y se efectúa prueba de provocación sólo a los que presentan prick e IgE específica a proteínas de leche de vaca negativos en ese momento.Resultados: Al diagnóstico el 94 por ciento de las provocaciones tuvieron una respuesta positiva inmediata, únicamente el 6 por ciento presentaron una respuesta positiva tardía (más de dos horas después de la provocación) todas como dispepsia. Al año de edad y tras la negativización del estudio inmunológico se efectuó una nueva prueba de provocación a 24 (49 por ciento) de los lactantes incluidos en el estudio y presentaron prueba de provocación positiva el 21 por ciento de las efectuadas a esta edad (5 de 24), ninguna de ellas presentó sintomatología inmediata, la clínica apareció a los 7 días de estar tomando leche de vaca.Conclusiones: La mayoría (94 por ciento) de provocaciones al diagnóstico presentan una clínica inmediata. Las provocaciones efectuadas tras la negativización de las pruebas de prick e IgE específica que fueron positivas (21 por ciento), lo fueron todas tardíamente (media de 7 días tras la ingesta de leche) (AU)

Common variable immunodeficiency, insulin-dependent diabetes mellitus and celiac disease

Common variable immunodeficiency is a disorder characterised by hypogammaglobulinemia with Blymphocytes in peripheral blood and repeated infections. We report a child with a diagnosis of diabetes mellitus and celiac disease during lactation, and in whom common variable immunodeficiency was diagnosed at the age of 5. During evolution of the disease he presented multiple respiratory infections in spite of substitution therapy with gamma globulins. He presented pulmonary fibrosis with a pulmonary volume reduced, and a spirometric restrictive patron. Immunologically, he presents reduction in CD4 lymphoid population. He expresses the alleles DQ2 A1 0501 and B1 which are strongly associated with susceptibility to insulin - dependent diabetes mellitus and celiac disease, but don’t express antigens HLA class II DR3 and DR4 that are more frequent in these entities. The main disease and all the complications had affected his curve pondostatural (AU)

La inmunodeficiencia común variable es un trastorno caracterizado por hipogammaglobulinemia con linfocitos B en sangre periférica e infecciones de repetición. Describimos un niño diagnosticado a la edad de cinco años de inmunodeficiencia común variable que de lactante se diagnosticó diabetes mellitus y enfermedad celíaca. Ha presentado durante su evolu ción múltiples infecciones respiratorias a pesar de la terapia de sustitución con gammaglobulinas. Inmunológicamente ha presentado disminución de la población linfoide CD4. Expresa los alelos DQ2 A1 0501 y B1 los cuales están fuertemente asociados con susceptibilidad a diabetes mellitus insulinodependiente y enfermedad celíaca, pero no expresa los alelos que más frecuentemente se describen en esta asociación HLA clase II DR3 y DR4. Su crecimiento pondoestatural se ha visto afectado debido a su enfermedad de base y a todas las complicaciones secundarias. (AU)