Unraveling the Diagnosis of Kiwifruit Allergy: Usefulness of Current Diagnostic Tests.

OBJECTIVES: To determine the usefulness of the in vitro and in vivo methods used in the diagnosis of kiwifruit allergy and to specifically assess the impact of seed proteins on sensitivity. METHODS: We performed skin prick tests (SPTs) using various commercial extracts, homemade pulp, and seed extracts and prick-prick tests with kiwifruit on 36 allergic patients. The presence of specific IgE (sIgE) was assessed using the ImmunoCAP (kiwifruit extract), ELISA (Act d 1, Act d 2), ISAC, and FABER assays. Immunoblotting of seed extract was carried out, and a single-blind oral food challenge was performed with whole seeds in seed-sensitized individuals. RESULTS: The prick prick test with kiwifruit demonstrated the highest diagnostic capacity (81.8% sensitivity and 94.1% specificity) among the in vivo tests. The sIgE levels measured using ImmunoCAP (kiwifruit extract) showed a similar sensitivity to that of global ISAC and FABER (63.9%, 59.5%, and 58.3%, respectively). Act d 1 was the major allergen. Sensitization to Act d 1 was associated with positive sIgE results to whole kiwifruit extract detected by ImmunoCAP (P<.000). A positive SPT result to kiwifruit seeds was associated with severe symptoms induced by kiwifruit (P=.019) as a marker of advanced disease, but not with clinically relevant sensitization. Challenge testing with kiwifruit seeds performed on 8 seed-sensitized patients yielded negative results. CONCLUSION: Sensitization to Act d 1 is associated with a positive result in conventional diagnostic techniques, whereas kiwifruit seed sensitization does not increase the sensitivity of the diagnostic techniques evaluated.

Unraveling the Diagnosis of Kiwifruit Allergy: Usefulness of Current Diagnostic Tests

Objectives: To determine the usefulness of the in vitro and in vivo methods used in the diagnosis of kiwifruit allergy and to specificallyassess the impact of seed proteins on sensitivity.Methods: We performed skin prick tests (SPTs) using various commercial extracts, homemade pulp, and seed extracts and prick-prick testswith kiwifruit on 36 allergic patients. The presence of specific IgE (sIgE) was assessed using the ImmunoCAP (kiwifruit extract), ELISA(Act d 1, Act d 2), ISAC, and FABER assays. Immunoblotting of seed extract was carried out, and a single-blind oral food challenge wasperformed with whole seeds in seed-sensitized individuals.Results: The prick prick test with kiwifruit demonstrated the highest diagnostic capacity (81.8% sensitivity and 94.1% specificity) amongthe in vivo tests. The sIgE levels measured using ImmunoCAP (kiwifruit extract) showed a similar sensitivity to that of global ISAC andFABER (63.9%, 59.5%, and 58.3%, respectively). Act d 1 was the major allergen. Sensitization to Act d 1 was associated with positivesIgE results to whole kiwifruit extract detected by ImmunoCAP (P<.000). A positive SPT result to kiwifruit seeds was associated withsevere symptoms induced by kiwifruit (P=.019) as a marker of advanced disease, but not with clinically relevant sensitization. Challengetesting with kiwifruit seeds performed on 8 seed-sensitized patients yielded negative results.Conclusions: Sensitization to Act d 1 is associated with a positive result in conventional diagnostic techniques, whereas kiwifruit seedsensitization does not increase the sensitivity of the diagnostic techniques evaluated (AU)

Objetivos: Determinar la rentabilidad diagnóstica de las técnicas in vitro e in vivo utilizadas en el diagnóstico de alergia al kiwi y estudiarla influencia de las proteínas alergénicas de las semillas en su sensibilidad.Métodos: Se seleccionaron 36 pacientes alérgicos a kiwi. Se les realizó prick test con cuatro extractos comerciales diferentes y prick-prickcon kiwi. Se determinó IgE específica mediante ImmunoCAP (extracto de kiwi), ELISA (Act d 1, Act d 2), las micromatrices ISAC y FABER eImmunoblotting de extracto de semilla de kiwi. Se realizó exposición oral simple ciego frente a semilla de kiwi en pacientes sensibilizadosa la semilla.Resultados: El prick-prick de kiwi fue la prueba in vivo con mayor rendimiento (sensibilidad 81,8%, especificidad 94,1%). El ImmunoCAPde extracto de kiwi mostró una sensibilidad similar a la global del ISAC y del FABER (63,9%, 59,5% y 58,3%, respectivamente). Act d 1fue el alérgeno mayoritario. Se encontró asociación entre los niveles de IgE específica frente a Act d 1 (ISAC) y el extracto de kiwi medianteImmunoCAP (p <0,000). La prueba cutánea positiva con semilla se asoció con mayor gravedad de síntomas frente a kiwi (p = 0,019),como marcador de enfermedad avanzada, pero no como sensibilización clínicamente relevante. La prueba de provocación con semillasfue negativa en los ocho pacientes provocados.Conclusiones: La sensibilización a Act d 1 se asocia con resultados positivos con las técnicas diagnósticas convencionales. La sensibilizaciónfrente a semillas no mejora el rendimiento de las técnicas evaluadas (AU)

Diagnostic capacity of commercial extracts vs prick-by-prick in the study of sensitization to peanut: which technique should we use?

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IgE-Mediated Sensitization to Galactose-α-1,3- Galactose (α-Gal) in Urticaria and Anaphylaxis in Spain: Geographical Variations and Risk Factors.

BACKGROUND: The objectives of this study were to investigate the prevalence of sIgE to galactose-α-1,3-galactose (α-gal) in individuals with acute urticaria or anaphylaxis from different geographical areas of Spain and to evaluate the relevance of demographics and lifestyle as risk factors for this immune response. METHODS: Participants were recruited from allergy departments at 14 Spanish hospitals. Patients aged 18 years or older presenting with urticaria or anaphylaxis were enrolled into one of 2 arms: cases and controls. An interviewer-administered questionnaire collecting demographic data, lifestyle habits, and the presence of cofactors was obtained from each participant. sIgE to α-gal and total IgE were determined using ImmunoCAP. sIgE levels ≥0.35 kU/L were considered a positive result. RESULTS: The study population comprised 160 cases and 126 controls. The median age was 44 years. The overall prevalence of a positive result of sIgE to α-gal was 15.7%; this was higher in cases (26.3%) than in controls (2.4%). The sIgE anti-α-gal positivity rate ranged from 37.68% (rural) to 15.38% (semiurban), and 7.85% (urban). The rates of positivity were 46.32%, (Northern), 0.72% (Center), and 0% (Mediterranean). A positive result for sIgE to α-gal was associated with a history of tick bites, participation in outdoor activities, pet ownership, and ingestion of mammalian meats or innards before the onset of symptoms. Only alcohol consumption could be implicated as a cofactor. CONCLUSION: Sensitization to α-gal in patients with urticaria or anaphylaxis differs considerably between the 3 geographical areas studied and is related to tick bites.

IgE-mediated sensitization to galactose-alfa-1.3-galactose (alfa-Gal) in urticaria and anaphylaxis in Spain: geographical variations and risk factors

BACKGROUND: The objectives of this study were to investigate the prevalence of sIgE to galactose-alfa-1,3-galactose (alfa-gal) in individuals with acute urticaria or anaphylaxis from different geographical areas of Spain and to evaluate the relevance of demographics and lifestyle as risk factors for this immune response. METHODS: Participants were recruited from allergy departments at 14 Spanish hospitals. Patients aged 18 years or older presenting with urticaria or anaphylaxis were enrolled into one of 2 arms: cases and controls. An interviewer-administered questionnaire collecting demographic data, lifestyle habits, and the presence of cofactors was obtained from each participant. sIgE to alfa-gal and total IgE were determined using ImmunoCAP. sIgE levels ≥0.35 kU/L were considered a positive result. RESULTS: The study population comprised 160 cases and 126 controls. The median age was 44 years. The overall prevalence of a positive result of sIgE to alfa-gal was 15.7%; this was higher in cases (26.3%) than in controls (2.4%). The sIgE anti-alfa-gal positivity rate ranged from 37.68% (rural) to 15.38% (semiurban), and 7.85% (urban). The rates of positivity were 46.32%, (Northern), 0.72% (Center), and 0% (Mediterranean). A positive result for sIgE to alfa-gal was associated with a history of tick bites, participation in outdoor activities, pet ownership, and ingestion of mammalian meats or innards before the onset of symptoms. Only alcohol consumption could be implicated as a cofactor. CONCLUSION: Sensitization to alfa-gal in patients with urticaria or anaphylaxis differs considerably between the 3 geographical areas studied and is related to tick bites

ANTECEDENTES: Investigar la prevalencia de IgE específica a galactosa-alfa-1,3-galactosa (alfa-gal) en sujetos con urticaria aguda o anafilaxia de diferentes zonas geográficas de España y evaluar la relevancia de factores demográficos y de estilo de vida como factores de riesgo para esta respuesta inmunológica. MÉTODOS: Pacientes de 18 años o mayores con urticaria o anafilaxia fueron reclutados en los Departamentos de Alergia de 14 hospitales españoles e incluidos en uno de dos grupos; casos o controles. Se recogieron datos demográficos, de estilo de vida y la presencia de cofactores. La IgE total e IgE especifica a alfa-gal se determinaron mediante ImmunoCAP. Niveles de IgE específica ≥0,35 kU/L fueron considerados como positivos. RESULTADOS: Se reclutaron 160 casos y 126 controles. La mediana de edad fue 44 años. La prevalencia global de positividad de IgE específica a alfa-gal fue 15,7%; siendo mayor en casos (26,3%) que en controles (2,4%) y oscilando entre 37,68% (rural) a 15,38% (semiurbano) y 7,85% (urbano). Las frecuencias de positividad fueron 46,32%, (Norte), 0,72% (Centro), y 0% (Mediterráneo). La positividad de IgE específica a alfa-gal se asoció a haber experimentado picadura de garrapata, participación en actividades de exterior, tenencia de mascotas e ingestion de carne de mamíferos o visceras previo al inicio de los síntomas. Solo el consumo de alcohol podía ser implicado como cofactor. CONCLUSIÓN: La sensibilización a alfa-gal en pacientes con urticaria o anafilaxia difiere considerablemente entre las tres zonas estudiadas y está relacionada con picadura de garrapata

Ultrasound-guided plasma rich in growth factors injections and scaffolds hasten motor nerve functional recovery in an ovine model of nerve crush injury.

In the present study we evaluated the motor recovery process of peripheral nerve injury (PNI), based on electrophysiological and histomorphometric criteria, after treatment with plasma rich in growth factors (PRGF) injections and scaffolds in an ovine model. Three groups of sheep underwent a nerve crush lesion: the first group (n = 3) was left to recover spontaneously (SR); the second group was administered saline injections (SI; n = 5) and a third group (n = 6) received PRGF injections and scaffolds immediately after the crush injury. At post-intervention week 8, 70% of sheep in the PRGF group were CMAP-positive, with no electrophysiological response in the rest of the groups. Histomorphometric analysis 12 weeks after the surgical intervention revealed that the average axonal density of the SR (1184 ± 864 axons/µm2 ) and SI (3109 ± 2450 axons/µm2 ) groups was significantly inferior to the control (8427 ± 2433 axons/µm2 ) and also inferior to the PRGF group (5276 ± 4148 axons/µm2 ), showing no significant differences between the control and PRGF groups. The axonal size of the SR and SI groups was significantly smaller compared with the control group (18 ± 4 µm2 ), whereas the axonal size of the PRGF group (6 ± 5 µm2 ) did not show statistical differences from the control. Morphometry of the target muscles indicated that the PRGF group had the lowest percentage volume reduction 12 weeks after the crush injury. The PRGF group had larger muscle fibre areas than the SI and SR groups, although the differences did not reach statistical significance. Overall, these data suggest that the PRGF injections and scaffolds hastened functional axon recovery and dampened atrophy of the target muscles in an ovine model. Copyright © 2015 John Wiley & Sons, Ltd.

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)

Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study.

OBJECTIVE: To obtain preliminary information about the effectiveness of intra-articular injections of an autologous preparation rich in growth factors (PRGF) for knee OA treatment to be explored further in future studies. METHODS: We have characterized PRGF treatment by platelet count and concentration of relevant growth factors (TGF-Beta1, PDGF-AB, VEGF-A; HGF and IGF-I) involved in healing mechanisms. We have performed an observational retrospective cohort study using hyaluronan injections as a control. Each group included 30 patients with OA of the knee, matched according to age, sex, body mass index and radiographic severity. Both treatments were based on three weekly injections. Clinical outcome was examined using the WOMAC questionnaires prior to treatment and at 5 weeks after treatment. RESULTS: The observed success rates by week 5 for the pain subscale reached 33.4% for the PRGF group and 10% for the hyaluronan group. The difference was attributed exclusively to the treatment modality, p = 0.004. The percent reductions in the physical function subscale and overall WOMAC at 5 weeks were also associated solely with treatment modality in favour of PRGF, p = 0.043 and p = 0.010 respectively. CONCLUSIONS: Although these preliminary results need to be evaluated in a randomized clinical trial, they provide useful infomration about the safety of PRGF and open new perspectives on autologous treatments for joint diseases.

Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients.

OBJECTIVES: Autologous platelet-secreted growth factors (GFs) may have therapeutic effects in osteoarthritis (OA) capsular joints via multiple mechanisms. Our aim was to examine the effect of a platelet-derived preparation rich in growth factors (PRGFs) in OA synovial cell biology. METHODS: Synovial cells were isolated from 10 osteoarthritic patients and cultured in serum-free media (basal conditions) and exposed to either a platelet-poor preparation or PRGF for 72 h. Cells activated with interleukin-1beta (IL-1beta) for 48 h were also exposed to PRGF. Changes in several events relevant to joint homeostasis including (i) hyaluronic acid (HA) secretion, (ii) the balance between metalloproteinase-1, -3 and -13 (MMP-1, MMP-3 and MMP-13) and tissue inhibitor-1 (TIMP-1) and (iii) the secretion of transforming growth factor-beta1(TGF-beta1), vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF), were all assessed. RESULTS: PRGF significantly enhanced HA secretion compared with platelet-poor preparations, P < 0.05; at the same time release of TIMP-1, MMP-1, MMP-3 and MMP-13 were not affected. An increased HGF production was observed (P < 0.05) but VEGF and TGF-beta1 levels remained unchanged. PRGF significantly enhanced the secretion of HA induced by IL-1beta activation, P < 0.05, but it did not modify the IL-1beta-induced rise in MMP-1, MMP-3 and VEGF. In contrast, PRGF-induced HGF production was abolished by the presence of IL-1beta during PRGF treatment, P < 0.05. CONCLUSIONS: Intra-articular administration of PRGF might be beneficial in restoring HA concentration and switching angiogenesis to a more balanced status but does not halt the effects of IL-1beta on synovial cells.

Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus.

BACKGROUND: Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established. METHODS: We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done. RESULTS: All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa. CONCLUSIONS: We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated.

Trastornos menstruales en tripulantes de cabina de pasajeros (TCP) / Menstrual disorders in flight attendants

INTRODUCCIÓN:El objetivo de este estudio es determinar la incidencia de alteraciones en el ciclo menstrual de las azafatas de una compañía aérea y su relación con factores propios del medio aeronaútico tales como, la exposición mantenida a un medio hipobárico y a un determinado ambiente de cabina, duración y recorrido de vuelos y otros factores como, ambiente de trabajo (estrés, cambios horarios...), edad, patología médico y/o ginecológica y toma de fármacos. MATERIAL Y MÉTODO: Realizamos un estudio mediante un cuestionario anónimo y voluntario entre las azafatas que pertenencían a la plantilla de la compañía Iberia. RESULTADOS: Respondieron a la encuesta 614 azafatas con edades comprendidas entre los 20 y 58 años siendo la media de 37,38 años. Del total de la muestra un 44,1 por ciento referían alteraciones menstruales. Encontramos una relación estadística significativa entre la presencia de transtornos menstruales y la edad, los años efectivos de vuelo y otros factores tales como el vuelo en aviones que realizan trayectos intercontinentales y continentales. Según los resultados obtenido la edad juega un papel fundamental en la presencia de estos trastornos (AU)

INTRODUCTlON: The aim of this study is to analyze the incidence of changes and disturbances in the menstrual cycle in a group of flight attendants (FA) in relation to aviation environmental factors such hipobaria exposure, cabin pressure, length and route of flight and other factors such occupational stress, age, medical, gynecological disturbances and use of medication. MATERIAL AND METHODS: We carried out a survey by voluntary and anonymous questionnaire among flight attendants currently assigned to the fleet of lBERIA Airlines. RESULTS: 614 FA answered the questionnaire. The average age of the FA was 37,38 (range 20-58). Of the 614 FA surveyed 44,1% reported menstrual disorders. We found a relation statistically significant between the presence of menstrual disorders and age, flying time, intercontinental and continental flights. The age is un important factor in menstrual disorders in night attendants (AU)

[European study of asthma. Prevalence of atopy in young adults of 5 areas in Spain. Spanish Group of European Asthma Study]. / Estudio Europeo del Asma. Prevalencia de atopia en adultos jóvenes de 5 áreas españolas. Grupo Español del Estudio Europeo del Asma.

BACKGROUND: The aim of the current study is to show the prevalence of atopy in five Spanish areas, and its variability according to area, age and gender. PATIENTS AND METHODS: From a populational based sample of 16,884 individuals aged 20 to 44 years-old, we obtained a randomized 20% subsample (n = 3,310). Participants performed specific IgE measurements, skin prick tests, forced spirometries and metacholine challenges to measure bronchial hyperresponsiveness. The response rate was 40%, and 1,313 individuals were finally included in the study. Specific atopy to the following aeroallargens was determined: cat dander, Cladosporium, Dermatophagoides, Phleum, Parietaria, birch, Alternaria, ambrosia, olive, rye grass and dog dander. RESULTS: The global prevalence of atopy (detectable specific antibodies IgE in serum and/or skin reactivity) widely varied by area, skin reactivity ranking in males from a minimum in Albacete (24.6%; 95% CI: 18-33) to a maximum in Huelva (39.6%; 95% CI: 30-53), and in females ranking from a minimun in Galdakao (10.3%; 95% CI: 6-17) to a maximum in Barcelona (28.8%; 95% CI: 19-43). Considering separately seropositivity and skin reactivity we observed a similar trend. Males showed a higher prevalence of global atopy (40.1%) than females (29.4%). Our data indicate that there is a decrease in the prevalence of atopy according to age in the general population, but only significant in men. Dermatophagoides pteronyssinus is the most common allergen in all ares but Albacete, where the most common allergen is the olive pollen. CONCLUSIONS: By means of a standard methodology, we report population data of the prevalence of atopy in five Spanish areas. The distribution of the prevalence of atopy varies widely in the five areas surveyed, according to the composition of the most common environmental allergens.

Left superior vena cava: a vascular abnormality discovered following pulmonary artery catheterization.

PURPOSE: This report deals with the case of a patient who presented persistence of left superior vena cava (LSVC). This disorder was discovered following placement of a catheter in pulmonary artery via the left subclavian vein. CLINICAL FEATURES: The patient was a 67-yr-old woman who, while in the intensive care unit after undergoing coronary revascularization with extracorporeal circulation, required pulmonary artery catheterization to guide resuscitation. Placement of the catheter proved to be difficult as the advance of the catheter was impeded. A normal pulmonary artery pressure wave was eventually detected at a distance of approximately 70 cm. Chest x-ray showed a catheter route suggestive of persistent LSVC. CONCLUSION: A diagnosis of persistent LSVC should be considered whenever there appears to be some obstacle to central venous or pulmonary artery catheterization, especially in patients with congenital heart disease, since this disorder can have important clinical consequences.