Severe dermatitis caused by diltiazem

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Occupational rhinitis and bronchial asthma due to TBTU and HBTU sensitization.

Exposure to an increasing amount of products in the work environment is leading to new cases of occupational asthma among workers. We report the case of a worker at a pharmaceutical plant who developed occupational rhinitis and bronchial asthma due to HBTU: 2-(1H-benzotriazol-1-yl)-1,1,3,3-tetramethyluronium hexafluorophosphate and TBTU: 2-(1H-benzotriazol-1-yl)-1,1,3,3-tetramethyluronium tetrafluoroborate sensitization, two chemical products widely used in peptide synthesis and coupling. Skin tests (prick test) with HBTU and TBTU solutions in PBS were positive at a concentration of 1 mg/ml. Skin tests with the same solutions in 10 atopic controls yielded a negative result. Nasal challenge tests with these products were positive with HBTU at a concentration of 0.01 mg/ml and TBTU at a concentration of 1 mg/ml. In both cases PNIF (peak nasal inspiratory flow) decreased by more than 60% and severe sneezing and rhinorrhea were induced. Nasal challenge tests performed on 10 atopic controls with TBTU and HBTU at a concentration of 1 mg/ml were negative. We conclude that the patient presents occupational rhinitis and bronchial asthma due to TBTU and HBTU; the operational mechanism is probably immunological IgE-mediated given the positive prick tests and nasal challenge with these products.

Cross-reactivity between Platanus pollen and vegetables.

BACKGROUND: Several associations have been described between tree and plant pollens and certain foods. The objective of this study is to verify whether there is cross-reactivity between Platanus pollen and vegetable origin foods. METHODS: We selected 56 patients allergic to vegetable foods and subjected them to cutaneous tests with aeroallergens and vegetable foods. A statistical analysis was performed to evaluate the association of Platanus pollen with foods and with other aeroallergens. Later, a specific IgE determination was performed as well as a RAST (radioallergosorbent) inhibition experiment, to verify the existence of cross-reactivity in vitro. RESULTS: In the cutaneous tests we found a positive correlation between Platanus pollen and hazelnut, peanut, banana and celery. The results of the RAST inhibition experiment indicate an important cross-reactivity between the pollen of Platanus acerifolia and hazelnut and banana fruit, and an intermediate cross-reactivity with celery and peanut. CONCLUSION: We have described an association between the pollen of the Platanus tree and some vegetable foods such as hazelnut, banana, peanut and celery. This association could be explained by the in vitro IgE cross-reactivity detected.

Facial edema associated with thyroid autoimmunity.

BACKGROUND: There is growing evidence that some cases of chronic urticaria and angioedema are associated with thyroid autoimmunity. We present the case of a 42-year old woman with a two month long evolution of edema in the right hemiface associated with thyroid antibodies. METHODS: Skin tests were performed with a standard series of aeroallergens and foods and were negative. Epicutaneous tests were performed with a series of contact allergens with a negative result. The chest X-ray was normal. A complete blood count was performed with ESR, biochemistry study, proteinogram, coagulation, complement, rheumatoid factor, anti-nuclear antibodies, hydatidosis and hepatitis serologies, urine sediment and stool parasitology, which were normal. The TSH was normal and, among the thyroid antibodies, the thyroglobulin ones (492 IU/mL) were positive and the microsomal ones were negative. RESULTS: The edema remitted with the 2-month long thyroxin treatment. In spite of the clinical response, and although the thyroglobulin antibodies initially suffered a small decrease, they increased to values which greatly surpassed the initial ones, coinciding with a relapse of the facial edema, so that treatment was re-initiated with thyroxin, and the picture subsided again. CONCLUSIONS: Some cases of localized edema can be associated with thyroid antibodies and respond to treatment with thyroxin.

Comparison of the efficacy and safety of two preseasonal regimens of glutaraldehyde modified, tyrosine-adsorbed parietaria pollen extract over a period of three years in monosensitive patients.

The purpose of this study was to evaluate the clinical efficacy over a period of three years (1988-90) of two preseasonal dosage regimens of a Parietaria allergoid (Bencard Tyrosine Parietaria) in patients who were only sensitive to this pollen. Fifty patients were included (14 men and 36 women, age: mean, 28 years; range, 14-47 years). Twenty five patients (group A) were treated each january with the basic course of Bencard Tyrosine Parietaria. This consisted of injecting subcutaneously 0.5 ml from each of three vials, with one week between each injection. A further injection using the vial with the highest dose was given one week later. Each january and february, twenty five patients (group B) were treated with the basic course of Bencard Tyrosine Parietaria, repeating the last dose five times, with one week between each injection. Immunotherapy with a tyrosine-adsorbed Parietaria judaica allergoid is an effective method for mitigating nasal (p < 0.0001), bronchial (p < 0.005), conjunctival (p < 0.001) and palatal itching symptoms (p < 0.0001) in patients who are sensitive to this pollen. Sensitivity to Parietaria pollen, as verified by skin test and nasal challenge, decreased during immunotherapy (p < 0.001). Histamine release by peripheral blood basophils decreased during the course of the study, falling from 43.5 ng/ml to 12.3 ng/ml in group A and from 42.9 ng/ml to 10.0 ng/ml in group B; during the second and third years, IgG levels were increased one and four months after starting treatment with the extract, while this was not the case after ten months; IgE levels were also increased. Finally, overall tolerance to this immunotherapy product was good in almost all patients.

Biosynthesis inhibitors for leukotrienes in bronchial asthma.

This article reviews the literature on the effects of leukotrienes in asthma. In particular, the ability of recently developed synthesis inhibitors to attenuate the asthma causing effects of leukotrienes is examined. MEDLINE (1966-1996), EMBASE (Excerpta Medica; 1974-1996), and other biomedical and drug directory databases were searched to identify English-language articles (basic science, clinical trial research, and review articles) and abstracts of conference proceedings on biosynthesis inhibitors for leukotrienes and related terms. Leukotrienes are endogenous molecules formed by the breakdown of a membrane constituent, arachidonic acid, via the 5-Lipoxygenase enzyme pathway. This pathway ultimately produces several species of leukotrienes with various biologic activities, including generalized inflammatory effects associated with asthma: increased vascular permeability, enhanced mucous production, and decreased mucociliary transport. The biosynthesis inhibitors for leukotrienes attenuated the response to inhaled leukotrienes and allergen challenges (MK-0591; MK-886; AA-681; A-64077; ZD-2138). These agents produced beneficial effects in cold, exercise (A-64077) and aspirin-induced asthma (A-64077; ZD-2138), as well as clinical asthma. Many of these medications appear to be effective in the treatment of asthma (BAYX-1005; MK-0591; MK-886; AA-681; A-64077; ZD-2138; U-60257; FR-110302; BI-6239; A-78773; ABT-761; L-746530; L-699333; ZM-230487). Further clinical research is needed to determine which patients would benefit most from their use.

Leukotrienes and their antagonists in allergic disorders.

Cysteinyl leukotrienes are important mediators of asthma, and inhibition of their effects may represent a potential breakthrough in the therapy of allergic rhinitis and asthma. Strategies for inhibition of cysteinyl leukotriene receptors and inhibition of 5-lipoxygenase activity. The leukotrienes antagonists, with particular reference to asthma and allergic rhinitis, is reviewed in this paper. In studies in asthmatic patients, these compounds can inhibit bronchoconstriction in response to exercise, aspirin and allergen. Results from clinical studies using receptor antagonists, such as LY-171883, SK&F-104353, ICI-204219, ONO-1078, MK-751, MK-0679, demonstrate beneficial effects, with improvement in symptoms and forced expiratory volume in one second (FEV1), and a reduction in the use of beta 2-adrenergic relief medication. NZ-107 was studied for its effect on airway inflammation caused by intratracheal injection of LTB4 or IL-5, or by inhalation of PAF, and by cell activation. Analysis of the BAL fluid revealed that both induced eosinophilia and neutrophilia were suppressed. Surprisingly, although PAF and superoxide generation were inhibited in macrophages and eosinophils, NZ-107 had no effect on neutrophil activation. U-75302 was studied in guinea pigs and inhibited LTB4 induced chemotaxis of eosinophils in vitro and antigen-induced lung eosinophilia in vivo. Further studies are needed to clarify the exact mechanism by which these compounds provide beneficial effects.

[Comparative study] of beclomethasone and budesonide, with same posology (400 micrograms every 12 hours), in the control of cortico-dependent intrinsic asthma]. / Estudio comparativo entre beclometasona y budesonida, a igual posología (400 micrograms cada 12 horas), en el control del asma intrínseco corticodependiente.

Inhaled steroids have rendered an undoubtful benefit in the control of airway inflammation of the asthmatic patients. Our objective was to compare clinical efficacy between budesonide (BUD) and beclomethasona depropionate (BDP), when administered at equal doses (800 micrograms/24 hours). A two ways crossed open clinical trial was designed. Thirty-three steroid dependent chronic asthmatic patients (18 females, 15 males) were included. Ages ranged from 29 to 73 years (mean = 52.5 +/- 11.7). All subjects suffered a severe asthma, with several years of activity (mean = 11.7 +/- 7.8), insufficiently controlled by inhaled steroids and bronchodilators, who required regular systemic steroids supply. The parameters compared were: the patients subjective symptoms punctuation (cough, expectoration, thoracic noises, exercise induce dyspnea and dyspnea at rest), salbutamol needs (number of inhalations/day), additional prednisone needs, sputum eosinophil counts, FEV1 measurement and inespecific bronchial reactivity control (PD20 methacoline). After a baseline week patients received one of the drugs for 6 weeks and, after a lavage week, the other drug was administered for another 6 weeks. All patients improved with both therapies. We got the following conclusions: 1) a significative decrease in salbutamol (p < 0.05-0.001) and prednisone needs (p < 0.05-0.001); 2) this decrease has been more important during BUD therapy, although without significative differences; 3) no significant variations in sputum eosinophils, FEV1 or bronchial reactivity were observed; 4) both drugs, when administered at equal doses, have probed to be equally effective in severe steroid dependent asthma control.

[Non-sedative antihistaminics in the treatment of chronic urticaria]. / Los antihistamínicos no sedantes en el tratamiento de la urticaria crónica.

Antihistamines are the drugs of choice in the symptomatic relief of chronic idiopathic urticaria; however, the usefulness of classic antihistamines has been limited by side effects. In the 1980s a new class of antihistamines has been developed that maintains effectiveness and produces less side effects (eg anticholinergic side effects, daytime sedation, etc). This review analyzes each of the new nonsedating antihistamines commercially available in Spain (astemizole, ebastine, cetirizine, loratadine and terfenadine) and evaluates its clinical efficacy and safety in the treatment of chronic idiopathic urticaria.

[Comparative study between 10 and 20 mg of cetirizine in the symptomatic treatment of seasonal allergic rhinoconjunctivitis]. / Estudio comparativo entre 10 y 20 mg de cetirizina en el tratamiento sintomático de la rinoconjuntivitis alérgica estacional.

Our patients with seasonal allergic rhinoconjunctivitis usually present severe clinical symptoms. A single daily dose of cetirizine 10 mg might be insufficient for these patients. To investigate this hypothesis we compared clinical efficacy and adverse side effects between two daily doses of cetirizine, 10 and 20 mg. We designed a comparative open randomized study, including 38 patients, with hay fever sensitized to local pollens (grass, olive, parietaria judaica, chenopodium album, artemisia vulgaris and plantago lanceolata) diagnosed by clinical history and a positive skin prick test (wheal > 3 mm), 20 women and 18 men, aged 17 to 57 years (x: 31.32 +/- 9.73), living in the same geographic area. Randomly, after a week run in period, 21 subjects received a daily dose of cetirizine 10 mg during 2 weeks, and the other 17 received 10 mg twice a day. The symptomatic score used was based on: sneezes number, nasal itching, nasal secretion, nasal congestion, ocular itching, lacrimation, weight gain, sedation and additional methylprednisolone usage. All symptoms were scored on a 0-3 scale (0: absent; 1: mild; 2: moderate; 3: severe). A mean 8 points daily score during the previous week was required for recruitment. Nasal eosinophilia was determined at baseline and at the end of treatment. The study was conducted in may 1992. We did not find significant differences between the two groups, except in sneezes number and sedation. Both groups improved their symptoms, in comparison with the basal week (p < 0.01) and reduced their oral steroid use (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)