Analysis of the effectiveness of training school personnel in the management of food allergy and anaphylaxis.

BACKGROUND: Food allergy is a very frequent and increasingly common disease in children and adolescents. It affects quality of life and can even be life-threatening. Given that 10-18% of allergic/anaphylactic food reactions take place in schools, it is essential to provide school personnel with training on the management of reactions. METHODS: The Allergy Unit of Hospital Universitario de Fuenlabrada, Spain, organized a conference entitled "Management of Food Allergy in Children and Adolescents in School Centers" during which teachers, cooks, cafeteria monitors, and summer-camp leaders underwent a training course. Attendees filled out a questionnaire with eight questions before and after the course to assess their self-efficacy in management of food allergy and anaphylaxis. The results were compared. RESULTS: A total of 191 people participated (51% dining-room monitors, 24% teachers, 13% cooks, and 12% other professions). The areas in which the attendees presented the lowest confidence before receiving the course were recognition of symptoms and treatment of the reactions/anaphylaxis. The mean score for each of the eight concepts evaluated improved after the training course. This improvement was significant in the management of anaphylaxis. CONCLUSIONS: Our study demonstrates the usefulness of a self-efficacy scale in school personnel as a tool to assess the ability to manage food allergy and anaphylaxis. It can help to identify problem areas in which more specific training programs can be implemented.

Comparison of two diagnostic techniques, skin-prick test and component resolved diagnosis in the follow-up of a cohort of paediatric patients with pollinosis. Multicentre pilot study in a highly exposed allergenic area.

BACKGROUND: Over the last years, different works have been published about the importance of incorporating new diagnosis techniques in allergic patients such as component-resolved diagnosis (CRD). The objective of this study is to compare the evolution of allergic sensitisation profiles by means of CRD and cutaneous tests (SPT) on pollen-allergic patients. METHODS: A total of 123 patients aged between 2 and 14 years were included in an open, prospective, multicentre study. All the children had symptoms suggestive of seasonal respiratory allergic disease, with the diagnosis confirmed by cutaneous tests. Specific-IgE to major pollen-allergens (CRD) and SPT were performed at basal and after three years of follow-up. RESULTS: Out of 123 patients included, a total of 85 were analysed. The mean age was 8±3 years. Significant changes in the allergic sensitisation profiles were observed for the most prevalent allergens (Olea and grass) but it is in grass, the most relevant allergen in terms of allergen pressure, where changes in both absolute and relative frequencies between SPT and CRD were more evident. CONCLUSION: CRD seems to be an essential tool to carry out an appropriate follow-up of patients with allergic respiratory disease, as well as to decide on the immunotherapy composition that best matches the allergic sensitisation profile of patients.

Prevalence of sensitization to lipid transfer proteins and profilins in a population of 430 patients in the south of Madrid.

BACKGROUND: Lipid transfer proteins (LTPs) and profilins are the most important panallergens in the management of patients who are allergic to pollen and plant food in our area. LTPs are highly stable proteins that can induce systemic symptoms after ingestion. Profilins are labile proteins that are present in pollens and vegetables. Considered markers of several types of pollen sensitization, they are responsible for cross-reactivity between pollens and vegetables. The objective of this study was to assess the frequency of sensitization to LTP and profilin using skin prick tests (SPTs) in patients referred to our allergy unit for any complaint (not only pollen and plant food allergy). METHODS: The study sample comprised 430 consecutive patients who were evaluated using their medical history and SPTs with pollen, date palm profilin, and peach extract enriched in Pru p 3 (30 g/mL) as an LTP marker. RESULTS: We found that 52 (12.1%) patients were sensitized to profilin and 53 (12.3%) to LTP. Pollen allergy was diagnosed in 53% and plant food allergy in 11%. In the LTP-sensitized group and the profilin-sensitized group, 37.7% and 34.6% of the patients had plant food allergy, respectively. Thirty-three patients (62.3%) were sensitized to LTP but had no symptoms after eating vegetables. CONCLUSIONS: To the best of our knowledge, this is the first study to analyze the real rate of sensitization to profilin and LTP in a population sensitized to allergens other than pollens and plant foods. Twelve percent of patients were sensitized to both profilin and LTP. A large proportion of LTP-sensitized patients had no symptoms at the time of the study.

[Allergic sensitization profile in the immigrant population living in the central region of Spain]. / Perfil de sensibilización alérgica en inmigrantes residentes en la zona centro de España.

INTRODUCTION: The prevalence of allergic diseases has increased worldwide in the last two decades, particularly in developed countries. Respiratory allergy is determined by genetic heredity, influenced by environmental factors. Migration is a good epidemiological model for assessing the influence of the environment. We present the clinical characteristics of respiratory allergy in immigrants in the central region of Spain. METHODS: We prospectively collected data on all immigrants referred to the allergy units of 7 different hospitals in Madrid, Cuenca and Ciudad Real in March 2010. Respiratory Allergy was diagnosed using a standard study for allergic diseases. Results in immigrants were compared with data from a similar Spanish population. RESULTS: Sixty-two immigrants and 32 Spanish patients were evaluated (63% female, mean age 28.4 years). Their countries of origin were uniformly distributed among 3 macroareas (North of Africa, Latin America, and Eastern Europe). More than 96% presented rhinitis, although persistent rhinitis was more prevalent amongst Latin Americans (76.9%) than in the Spanish population (48%). No differences were observed in asthma prevalence, although immigrants had higher rates of non-controlled and partially controlled asthma. The mean time of onset of symptoms after immigration was 43 months. Grass pollen was the most relevant allergen with the exception of Arab patients. Sensitization to polcalcin was rare. Otherwise, 44.1% of the Spanish population was sensitized to profilin (only 4.88% among immigrants) although this sensitization did not associate allergy to fruits or other vegetables. CONCLUSIONS: In summary, a multicentric study is presented where significant differences have been observed in the sensitization pattern and clinical evolution of respiratory allergy in immigrants and the Spanish population.

Perfil de sensibilización alérgica en inmigrantes residentes en la zona centro de España / Allergic sensitization profile in the immigrant population living in the central region of Spain

Introducción. La prevalencia de las enfermedades alérgicas ha aumentado últimamente, especialmente en países industrializados. Puesto que la alergia está influenciada por factores genéticos y ambientales, la población inmigrante constituye un buen modelo epidemiológico para valorar influencia del ambiente. Presentamos las características clínicas de alergia respiratoria en población inmigrante del centro de España. Métodos. Se recogieron datos prospectivamente de 62 pacientes inmigrantes y 33 españoles que acudieron en marzo de 2010 a 7 hospitales de Madrid, Cuenca y Ciudad Real, diagnosticados de alergia respiratoria mediante un estudio alergológico estándar. Resultados. El 63% eran mujeres, edad media 28,4 años. Sus países de origen se distribuyeron en 3 grupos (Norte de África, Latinoamérica, Europa del Este). El 96% presentaban rinitis, aunque sólo el 48% de españoles frente al 76,9% de hispanos sufrían rinitis persistente. La prevalencia de asma fue similar, aunque entre hispanos el porcentaje de asma controlada fue menor. El tiempo de evolución fue menor en pacientes inmigrantes. El polen de gramíneas resultó el alérgeno más relevante salvo en pacientes árabes. La incidencia de sensibilización a polcalcina fue muy baja. Por el contrario, el 44,1% de españoles presentaban sensibilización aprofilina, frente al 4,88 de hispanos, aunque no implicaba sintomatología al tomar vegetales en la mayoría de casos. Conclusiones. Este estudio multicéntrico muestra diferencias significativas en tiempo de evolución y perfiles de sensibilización entre pacientes españoles e inmigrantes con alergia respiratoria. Además, diferencias en la expresión clínica de la rinitis y peor control del asma, pueden condicionar peor evolución clínica en el colectivo inmigrante(AU)

Introduction. The prevalence of allergic diseases has increased worldwide in the last two decades, particularly in developed countries. Respiratory allergy is determined by genetic heredity, influenced by environmental factors. Migration is a good epidemiological model for assessing the influence of the environment. We present the clinical characteristics of respiratory allergy in immigrants in the central region of Spain. Methods. We prospectively collected data on all immigrants referred to the allergy units of 7 different hospitals in Madrid, Cuenca and Ciudad Real in March 2010. Respiratory Allergy was diagnosed using a standard study for allergic diseases. Results in immigrants were compared with data from a similar Spanish population. Results. Sixty-two immigrants and 32 Spanish patients were evaluated (63% female, mean age 28.4 years). Their countries of origin were uniformly distributed among 3 macro areas (North of Africa, Latin America, and Eastern Europe). More than 96% presented rhinitis, although persistent rhinitis was more prevalent amongst Latin Americans (76.9%) than in the Spanish population (48%). No differences were observed in asthma prevalence, although immigrants had higher rates of non-controlled and partially controlled asthma. The meantime of onset of symptoms after immigration was 43 months. Grass pollen was the most relevant allergen with the exception of Arab patients. Sensitization to polcalcin was rare. Otherwise, 44.1% of the Spanish population was sensitized to profilin (only 4.88% among immigrants) although this sensitization did not associate allergy to fruits or other vegetables. Conclusions. In summary, a multicentric study is presented where significant differences have been observed in the sensitization pattern and clinical evolution of respiratory allergy in immigrants and the Spanish population(AU)

Site specific ligand substitution in cubane-type Mo3FeS(4)(4+) clusters: kinetics and mechanism of reaction and isolation of mixed ligand Cl/SPh complexes.

The synthesis, crystal structure and solution characterization of the cubane-type [Mo(3)(FeCl)S(4)(dmpe)(3)Cl(3)] (1) (dmpe = 1,2-bis(dimethylphophane-ethane)) cluster are reported and the ligand substitution processes of chloride by thiophenolate investigated. The kinetics and the intimate mechanism of these substitutions reveal that compound 1 undergoes a number of Fe and Mo site specific ligand substitution reactions in acetonitrile solutions. In particular, PhS(-) coordination at the tetrahedral Fe site proceeds in a single resolved kinetic step whereas such substitutions at the Mo sites proceed more slowly. The effect of the presence of acids in the reaction media is also investigated and reveals that an acid excess hinders substitution reactions both at the Fe and Mo sites; however, an acid-promoted solvolysis of the Fe-Cl bonds is observed. Electrospray ionization (ESI) and tandem (ESI-MS/MS) mass spectrometry allow the identification of all the reaction intermediates proposed on the basis of stopped-flow measurements. The distinctive site specific reactivity made it possible to isolate two new clusters of the Mo(3)FeS(4)(4+) family featuring mixed chlorine/thiophenolate ligands, namely Mo(3)S(4)(FeSPh)(dmpe)(3)Cl(3) (2) and [Mo(3)S(4)(FeSPh)(dmpe)(3)(SPh)(3)] (3). A detailed computational study has also been carried out to understand the details of the mechanism of substitution at the M-Cl (M = Mo and Fe) bonds as well as the solvolysis at the Fe-Cl sites, with particular emphasis on the role of acids on the substitution process. The results of the calculations are in agreement with the experimental observations, thus justifying the non-existence of an accelerating effect of acids on the thiophenolate substitution reaction, which differs from previous proposals for the Fe(4)S(4) and MoFe(3)S(4) clusters and some related compounds.

[Epidural anesthesia for coronary revascularization in the conscious patient]. / Revascularización coronaria en el paciente despierto bajo anestesia epidural.

Thoracic epidural anesthesia has been widely used to complement general anesthesia in coronary artery bypass grafting. The main advantages of the combination are excellent pain control and a less pronounced stress response to surgery. The invasiveness of surgery to treat ischemic heart disease has been attenuated thanks to the use of the mini-sternotomy and coronary anastomosis without extracorporeal circulation. In 4 patients, coronary artery revascularization was carried out via a mini-sternotomy, grafting the anterior descending artery to the left internal thoracic artery under high thoracic epidural anesthesia (block of segments T1-T8) with a perfusion of 0.75% ropivacaine and fentanyl in a conscious patient. There were no hemodynamic or respiratory complications during surgery. The mean duration of stay in the intensive care unit was less than 18 hours and the mean hospital stay was less than 5 days. Postoperative coronary arteriograms demonstrated the patency of all grafts and all patients were asymptomatic at 1 month. Our initial experience suggests that the use of only high thoracic epidural anesthesia is feasible in coronary revascularization in selected, cooperative patients who require a single coronary bypass graft.

Revascularización coronaria en el paciente despierto bajo anestesia epidural / Epidural anesthesia for coronary revascularization in the conscious patient

La anestesia epidural torácica ha sido ampliamenteutilizada en cirugía cardiaca como coadyuvante a laanestesia general en pacientes intervenidos de revascularizacióncoronaria. Sus principales ventajas son el excelentecontrol del dolor postoperatorio y la disminuciónde la respuesta al estrés quirúrgico. En el tratamientoquirúrgico de la cardiopatía isquémica la agresión quirúrgicase ha atenuado al reducir del tamaño de la esternotomíay a la realización de las anastomosis coronariassin circuito de circulación extracorpórea.Se han intervenido 4 pacientes de revascularizacióncoronaria a través de mini-esternotomía, revascularizandola arteria descendente anterior con la arteria mamariaizquierda, bajo anestesia epidural torácica alta (bloqueosegmentario T1-T8) con perfusión de ropivacaína0,75% y fentanilo y con el paciente consciente. No hubocomplicaciones hemodinámicas, ni respiratorias durantela cirugía. El tiempo medio de estancia en CuidadosIntensivos fue menor de 18 horas y la estancia mediahospitalaria menor de 5 días. La coronariografía postoperatoriamostró permeabilidad de los injertos en todoslos casos y los 4 pacientes permanecieron asintomáticosal mes.CONCLUSIÓN: Nuestra experiencia inicial indica que eluso exclusivo de la epidural torácica alta para la revascularizacióncoronaria sin circuito de circulación extracorpórea,supone una opción en pacientes seleccionados,colaboradores y que precisen revascularización coronariade un solo vaso

Thoracic epidural anesthesia has been widely used to complement general anesthesia in coronary artery bypass grafting. The main advantages of the combination are excellent pain control and a less pronounced stress response to surgery. The invasiveness of surgery to treat ischemic heart disease has been attenuated thanks to the use of the mini-sternotomy and coronary anastomosis without extracorporeal circulation. In 4 patients, coronary artery revascularization was carried out via a mini-sternotomy, grafting the anterior descending artery to the left internal thoracic artery under high thoracic epidural anesthesia (block of segments T1-T8) with a perfusion of 0.75% ropivacaine and fentanyl in a conscious patient. There were no hemodynamic or respiratory complications during surgery. The mean duration of stay in the intensive care unit was less than 18 hours and the mean hospital stay was less than 5 days. Postoperative coronary arteriograms demonstrated the patency of all grafts and all patients were asymptomatic at 1 month. Our initial experience suggests that the use of only high thoracic epidural anesthesia is feasible in coronary revascularization in selected, cooperative patients who require a single coronary bypass graft

[Cell saver devices in coronary revascularization surgery without extracorporeal circulation reduce transfusion requirements]. / El Recuperador Celular (Cell Saver) en cirugía de revascularización coronaria sin circulación extracorpóea reduce necesidades transfusionales.

OBJECTIVES: To analyze the effectiveness of a cell saver device in reducing transfusion requirements in patients undergoing off-pump coronary artery bypass surgery. PATIENTS AND METHODS: Fifty-six consecutive ASA class 4-5 patients who underwent coronary surgery without extracorporeal circulation in our cardiac surgery department between June 2004 and January 2005 were included in this retrospective study; the series comprised 28 patients who received conventional management (control group) without use of the cell saver device and 28 who received cell saver treatment. Variables analyzed were preoperative and discharge hemoglobin levels and hematocrit values, age, weight, height, ejection fraction, packed red blood cells transfused, exitus, and adverse events. RESULTS: The groups were similar with respect to preoperative characteristics. Fewer patients in the cell saver group required transfusions (6 vs 18 in the control group; relative risk 0.33, 95% confidence interval, 0.16-0.71). The mean amount of packed red cells transfused was greater in the control group than in the cell saver group (2.5 L vs 1.2 L, P = 0.03). No deaths or adverse events occurred in either group. CONCLUSIONS: The routine use of a cell saver device during off-pump coronary artery bypass surgery reduces the need for postoperative transfusions and is not associated with adverse events. Cell saver devices should be used routinely, especially in situations where the ability to provide blood transfusions may be compromised.

El Recuperador Celular (Cell Saver) en cirugía de revascularización coronaria sin circulación extracorpórea reduce necesidades transfusionales / Cell saver devices in coronary revascularization surgery without extracorporeal circulation reduce transfusión requirements

OBJETIVOS: Comprobar la eficacia en la reducción detransfusiones del recuperador celular en cirugía coronariaen pacientes que no se someten a circulación extracorpórea.PACIENTES Y MÉTODOS: 56 pacientes consecutivos conriesgo ASA III-IV operados desde junio de 2004 hastaenero de 2005 de cirugía coronaria sin circulación extracorpóreaen un Servicio de Cirugía Cardiaca. Estudioobservacional de cohortes retrospectivo. 28 pacientes(Grupo Control) fueron intervenidos de forma convencionalsin recuperador celular, y en 28 pacientes (GrupoEstudio) se empleó el recuperador celular (Cell Saver).Se determinó: Hemoglobina y Hematocrito preoperatoriosy al alta, edad, peso, talla, fracción de eyección, concentradosde hematíes trasfundidos, exitus y resultadosadversos.RESULTADOS: Las dos poblaciones han resultadohomogéneas en cuanto a criterios demográficos preoperatorios.En el grupo II (con recuperador) precisarontransfusiones menos pacientes (6 vs. 18, RR 0,33 IC 95%0,16-0,71). Se transfundieron más concentrados dehematíes de media en el grupo sin recuperador (2,5 vs1,2, p=0,03). No hubo exitus ni resultados adversos enninguno de los dos grupos.CONCLUSIONES: El uso rutinario de recuperador celularen cirugía coronaria sin bomba reduce las necesidadestransfusionales postoperatorias y no está asociadocon efectos adversos. Su empleo debe considerarse comoprocedimiento habitual de actuación, especialmente enmedios o situaciones en los que la disponibilidad de sangrepuede estar comprometida

OBJECTIVES: To analyze the effectiveness of a cellsaver device in reducing transfusion requirements inpatients undergoing off-pump coronary artery bypasssurgery.PATIENTS AND METHODS: Fifty-six consecutive ASAclass 4-5 patients who underwent coronary surgery withoutextracorporeal circulation in our cardiac surgerydepartment between June 2004 and January 2005 wereincluded in this retrospective study; the series comprised28 patients who received conventional management(control group) without use of the cell saver deviceand 28 who received cell saver treatment. Variablesanalyzed were preoperative and discharge hemoglobinlevels and hematocrit values, age, weight, height, ejectionfraction, packed red blood cells transfused, exitus,and adverse events.RESULTS: The groups were similar with respect topreoperative characteristics. Fewer patients in the cellsaver group required transfusions (6 vs 18 in the controlgroup; relative risk 0.33, 95% confidence interval,0.16-0.71). The mean amount of packed red cells transfusedwas greater in the control group than in the cellsaver group (2.5 L vs 1.2 L, P=0.03). No deaths oradverse events occurred in either group.CONCLUSIONS: The routine use of a cell saver deviceduring off-pump coronary artery bypass surgery reducesthe need for postoperative transfusions and is notassociated with adverse events. Cell saver devicesshould be used routinely, especially in situations wherethe ability to provide blood transfusions may be compromised