Can component-based microarray replace fluorescent enzimoimmunoassay in the diagnosis of grass and cypress pollen allergy?

BACKGROUND: Few data on the diagnostic accuracy in pollinosis of the microarray ISAC of allergens are available. OBJECTIVE: We aim to comparatively analyse ISAC CRD103 with the whole-extract ImmunoCAP in grass and cypress pollen allergy, evaluating the suitability of the manufacturer's recommended cut-off points for both techniques. METHODS: We studied 120 atopic patients grouped into grass and cypress pollen-allergic patients and controls based on clinical history and skin prick tests. Specific IgE against Phleum pratense and Cupressus arizonica by ImmunoCAP and ISAC CRD103 were performed on all subjects. RESULTS: In the grass pollen group (43 allergic/26 controls), both microarray and CAP showed high sensitivity (Se) and specificity (Sp) values (ISAC: Se 97.7, Sp 92.3; CAP: Se 95.3, Sp 96.1) for recommended cut-off points. Comparing the optimal (ISAC: 0.4 ISU; CAP: 0.33 kU/L) with the recommended cut-off points within the same technique, diagnostic agreement was observed in both techniques. Thus, CAP and ISAC showed similar diagnostic performance in grass pollen allergy when using recommended cut-off points. In cypress pollen group (12 allergic/92 controls), the microarray (Se: 91.7, Sp 91.3) showed similar Se but significantly higher Sp (P=0.034) than CAP (Se: 91.7, Sp: 80.4) using recommended cut-off points. However, although diagnostic performance of the microarray did not change when comparing the optimal (0.82 ISU) with the recommended cut-off point, CAP improved diagnosis of cypress pollen allergy, when applying the optimal (0.66 kU/L)(CAP Se: 91.7, Sp: 89.1) instead of the manufacturer's recommended cut-off point. Thus, when the most suitable cut-off point for both techniques (ISAC: 0.3 ISU; CAP: 0.66 kU/L) is selected, microarray and CAP provide equivalent diagnoses. CONCLUSIONS AND CLINICAL RELEVANCE: Component-based microarray ISAC CRD103 and whole-allergen CAP showed high Se and Sp diagnosing equally grass and cypress pollen allergy. The cut-off point for each allergen should be properly applied for both techniques.

A new rapid desensitization protocol for chemotherapy agents.

BACKGROUND: Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar efficacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years. OBJECTIVE: To assess the efficacy of a new desensitization protocol in patients allergic to chemotherapy drugs. METHODS: We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used. RESULTS: We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carboplatin that reverted with treatment. One patient had dyspnea after a paclitaxel cycle. One patient experienced dyspnea due to chronic pulmonary thromboembolism related to her disease. CONCLUSION: Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents.

Delphi project in bronchial asthma. Two stages

From the paediatric point of view, we have undertaken two Delphi studies into bronchial asthma. The first is related to the consensus known as the consensus document of the five associations. The second is more recent and has been undertaken with GEMA (the Spanish Guidelines on the Management of Asthma).The aim of this paper is to carry out a descriptive study comparing the 2 Delphi processes and to objectively assess if in some way behaviour over the past two years has changed as far as expert opinion is concerned.In the consensus document those points giving rise to most controversy were the treatment of children under three years of age and treatment with immunotherapy in allergic asthma. It is also necessary to highlight how important it was at that particular point in time to define the phenotypes of wheezing and the predictive index of asthma in children of less than 3 years of age. Of the 52 questions in the questionnaire, in 13.6% the panel of experts reached no consensus in their positions.Following GEMA the Delphi methodology, 56 questions were asked in the first round of the questionnaire, and consensus was reached in 87.5%. As regards the paediatric part relating to diagnosis and treatment in children, agreement was reached on all the questions in the first round. Agreement was reached in 8.92% questions in the second round.Clinical guidelines and consensus documents can modify behaviour towards an illness, both in the diagnosis and treatment

Delphi project in bronchial asthma. Two stages.

From the paediatric point of view, we have undertaken two Delphi studies into bronchial asthma. The first is related to the consensus known as the consensus document of the five associations. The second is more recent and has been undertaken with GEMA (the Spanish Guidelines on the Management of Asthma). The aim of this paper is to carry out a descriptive study comparing the 2 Delphi processes and to objectively assess if in some way behaviour over the past two years has changed as far as expert opinion is concerned. In the consensus document those points giving rise to most controversy were the treatment of children under three years of age and treatment with immunotherapy in allergic asthma. It is also necessary to highlight how important it was at that particular point in time to define the phenotypes of wheezing and the predictive index of asthma in children of less than 3 years of age. Of the 52 questions in the questionnaire, in 13.6% the panel of experts reached no consensus in their positions. Following GEMA the Delphi methodology, 56 questions were asked in the first round of the questionnaire, and consensus was reached in 87.5%. As regards the paediatric part relating to diagnosis and treatment in children, agreement was reached on all the questions in the first round. Agreement was reached in 8.92% questions in the second round. Clinical guidelines and consensus documents can modify behaviour towards an illness, both in the diagnosis and treatment.

The importance of in vitro component-resolved diagnosis in paediatric patients

In recent years, thanks to advances in molecular biology, allergological diagnosis has improved and specific IgE (sIgE) against an allergenic source has been transformed into sIgE against an allergenic protein or glycoprotein. This change, which has resulted in a more precise diagnosis of sensitisation, could explain the different dangers of certain molecular sensitisations and in many cases cross-reactivity phenomena, and could change indications for immunotherapy or clinical management. Here, we present two cases of children where the indication for immunotherapy and management of the disorder changed due to component-resolved diagnosis. However, the clinical history and skin prick tests should complement molecular in vitro diagnosis to improve routine clinical practice

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The importance of in vitro component-resolved diagnosis in paediatric patients.

In recent years, thanks to advances in molecular biology, allergological diagnosis has improved and specific IgE (sIgE) against an allergenic source has been transformed into sIgE against an allergenic protein or glycoprotein. This change, which has resulted in a more precise diagnosis of sensitisation, could explain the different dangers of certain molecular sensitisations and in many cases cross-reactivity phenomena, and could change indications for immunotherapy or clinical management. Here, we present two cases of children where the indication for immunotherapy and management of the disorder changed due to component-resolved diagnosis. However, the clinical history and skin prick tests should complement molecular in vitro diagnosis to improve routine clinical practice.

El tabaco como factor de riesgo asociado a la prevalencia del asma bronquial en adolescentes / Tobacco as a risk factor associated to the prevalence of bronchial asthma in adolescents

Siguiendo la metodología del ensayo ISAAC, estudiamos a 4.644 escolares con edades comprendidas entre los 11 y los 16años (2.435 niños y 2.209 niñas).El objetivo de nuestro estudio es determinar la influencia del hábito tabáquico en el grupo de adolescentes que alguna vez han tenido asma o síntomas de asma. Un 66,5% de los adolescentes que habían tenido asma alguna vez convivía con algún fumador en el domicilio (un 59,5% en fase I). Un 69% de los adolescentes con sibilancias en los últimos 12 meses convivía con algún fumador en el domicilio (un 58,2% en fase I). Haber tenido asma alguna vez (p= 0,074; odds ratio [OR]=0,83), o haber presentado sibilancias en los últimos 12 meses (p= 0,54; OR= 0,91) no se asocia con la presencia de algún fumador en el domicilio. El 5,6% de los adolescentes estudiados eran fumadores, en un 60,7% de los casos fumaban los padres (un 73,9% en faseI). Entre los adolescentes no fumadores, en el 53,1% de los casos fumaban los padres (un 56,8% en fase I). Existe una asociación significativa entre que fumen los padres y fumen los adolescentes (p= 0,034)En la fase I, el 8,1% fumaba 1-8 cigarrillos al día, frente a un 4,2% en la fase III, con diferencias estadísticamente significativas (p <0,05).Existe una asociación estadísticamente significativa entre haber tenido asma alguna vez y el hábito de fumar (p <0,001; OR= 1,75); no así entre haber padecido sibilancias en los últimos 12 meses y el hábito tabáquico. Estos resultados son muy similares a los de la fase I (AU)

Following the ISAAC methodology, we studied 4,644 school children between the ages of 11 and 16 (2,435 boys and 2,209girls).The objective of our study is to determine the influence of the habit of tobacco smoking in the group of adolescents that at some point has suffered from asthma or from asthma symptoms. Of the adolescents who at some point had suffered from asth ma 66.5% cohabited with a smoker in the home (59.5% in phase I). Of the adolescents who suffered from wheezing in the last 12 months 69% cohabited with a smoker in the home (58.2% in phase I).Having suffered from asthma at some point (p= 0.074; OR0.83), or having suffered from wheezing in the last 12 months (p= 0.54; OR 0.91) is not associated with the presence of a smoker in the home. Of the adolescents studied 5.6% were smokers, and in60.7% of the cases the parents were smokers (73.9% in phase I).Among the non-smoking adolescents, in 53.1% of the cases the parents smoked (56.8% in phase I). A significant association was found between the parents smoking and the adolescents smoking (p= 0.034).In phase I, 8.1% smoked between 1-8 cigarettes per day, compared to 4.2% in phase III, showing significant statistical differences (p <0.05).A significant statistical association was found between having suffered from asthma at some point and the habit of tobacco smoking (p <0.001; OR 1.75), although not between having suffered from wheezing in the last 12 months and the habit of tobacco smoking. These results are very similar to those of phase I (AU)

Consensus Statement on the Management of Paediatric Asthma. Update 2007

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Anaphylaxis induced by anisakis

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Risk factors associated to the prevalence of asthma in adolescence.

The ISAAC project (International Study of Asthma and Allergies in Childhood) was developed with the purpose of determining the prevalence of asthma in schoool children, with the definition of two age groups: infancy, when asthma is more frequent, and adolescence, when mortality associated to asthma is greater. However, the study does not address the risk factors associated with this pathology. Our aim is to comparatively analyze the prevalence of respiratory symptoms and the asthma epidemiological factors in the two age groups and in both sexes. Since the results of ISAAC Phase I are available, we can study the variations in risk factors, relating them to the current prevalence of asthma. The prevalence of bronchial asthma in our adolescents is 10 % - this implying a significant increase with respect to the data corresponding to ISAAC Phase I. Likewise, the prevalence of wheezing in the last 12 months has also increased significantly with respect to the data corresponding to ISAAC Phase I. It can be affirmed that familial antecedents of asthma are significantly correlated to the fact of having experienced asthma at some point in time, or to wheezing in the previous 12 months. In the same way as for bronchial asthma, the increase in rhinitis has been significant. The presence of animals in the home is significantly associated to the fact of having experienced asthma at some point in time, though the presence of animals in the home has decreased significantly. An encouraging finding in our study is the fact that smoking has decreased significantly among adolescents in comparison with the previous data. However, the same does not apply to smoking among parents, which shows results similar to those recorded in the previous study - with an influence upon the same habit in the offspring. As in other studies, active smoker status is seen to be associated with the fact of having experienced asthma at some point in time. Although a common observation, the importance of hyper-responsiveness with exercise among adolescents is still not acknowledged, despite its significant correlation to the fact of having experienced asthma at some point in time, or wheezing in the previous 12 months.

Risk factors associated to the prevalence of asthma in adolescence / Factores de riesgo asociados a la prevalencia del asma en la adolescencia

The ISAAC project (International Study of Asthma and Allergies in Childhood) was developed with the purpose of determining the prevalence of asthma in schoool children, with the definition of two age groups: infancy, when asthma is more frequent, and adolescence, when mortality associated to asthma is greater. However, the study does not address the risk factors associated with this pathology. Our aim is to comparatively analyze the prevalence of respiratory symptoms and the asthma epidemiological factors in the two age groups and in both sexes. Since the results of ISAAC Phase I are available, we can study the variations in risk factors, relating them to the current prevalence of asthma. The prevalence of bronchial asthma in our adolescents is 10 % ­ this implying a significant increase with respect to the data corresponding to ISAAC Phase I. Likewise, the prevalence of wheezing in the last 12 months has also increased significantly with respect to the data corresponding to ISAAC Phase I. It can be affirmed that familial antecedents of asthma are significantly correlated to the fact of having experienced asthma at some point in time, or to wheezing in the previous 12 months. In the same way as for bronchial asthma, the increase in rhinitis has been significant. The presence of animals in the home is significantly associated to the fact of having experienced asthma at some point in time, though the presence of animals in the home has decreased significantly. An encouraging finding in our study is the fact that smoking has decreased significantly among adolescents in comparison with the previous data. However, the same does not apply to smoking among parents, which shows results similar to those recorded in the previous study ­ with an influence upon the same habit in the offspring. As in other studies, active smoker status is seen to be associated with the fact of having experienced asthma at some point in time. Although a common observation, the importance of hyper-responsiveness with exercise among adolescents is still not acknowledged, despite its significant correlation to the fact of having experienced asthma at some point in time, or wheezing in the previous 12 months

Con el objetivo de conocer la prevalencia del asma en la edad escolar surge el proyecto ISAAC, en el que se incluyen dos grupos de edad, la infancia cuando el asma es más frecuente y la adolescencia periodo en que la mortalidad por asma es mayor. Sin embargo el estudio no incide en los factores de riesgo que están asociados a esta patología. Nuestro objetivo es analizar comparativamente los dos grupos de edad y en ambos sexos, la prevalencia de la sintomatología respiratoria y de los factores relacionados con la epidemiología del asma. Como disponemos de los resultados de la Fase I, podemos estudiar las variaciones en cuanto a los factores de riesgo y relacionarlo con la prevalencia del asma en la actualidad. La prevalencia de asma bronquial en nuestros adolescentes es de 10% habiéndose incrementado de forma significativa en relación con la Fase I del ISAAC. De la misma forma, encontramos que la prevalencia de sibilancias en los últimos doce meses también se ha incrementado de forma significativa con relación a los estudios de la Fase I. Se puede seguir afirmando que los antecedentes familiares de asma se asocian de forma significativa con haber presentado asma alguna vez o sibilancias en los últimos 12 meses. Al igual que ocurre con el asma bronquial, el incremento de la rinitis ha sido significativo La presencia de animales en el domicilio se asocia significativamente con haber presentado asma alguna vez, sin embargo la presencia de animales en las casas ha disminuido de forma significativa. Analizando nuestros resultados podemos decir, gratamente, que el hábito de fumar en los adolescentes ha disminuido de forma significativa en relación con nuestros datos anteriores. No ocurre lo mismo con el hábito de fumar en los padres que se mantiene similar al primer estudio, influyendo en el mismo hábito de los hijos. Al igual que en otros estudios, encontramos que ser fumador activo se asocia con haber presentado asma alguna vez. La hiperreactividad con el ejercicio en los adolescentes, tan frecuentemente observada, sigue sin ser reconocida a pesar de que se asocia de forma significativa a haber presentado asma alguna vez, o sibilancias en los últimos 12 meses

Seasons and other factors affecting the quality of life of asthmatic children.

OBJECTIVE: To study the effect of seasons on the health-related quality of life (HRQL) of asthmatic children. METHODS: Four groups of asthmatic children 7 to 14 years old were recruited by pediatricians during each season of the year. Their HRQL was assessed by means of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ). Other factors surveyed were asthma severity, atopy, medical treatment, immunotherapy, obesity, parental smoking, and anti-allergic measures. RESULTS: The mean (SD) overall PAQLQ score was highest in summer at 6.2 (1.0) and lowest in autumn at 5.5 (1.2). The same trend was found for domains in summer and autumn, respectively: symptoms, 6.2 (1.0) vs 5.4 (1.4); emotions, 6.5 (0.8) vs 6.0 (1.0); and activities, 5.9 (1.4) vs. 5.0 (1.5). Factors such as male gender (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.41-0.87), being on immunotherapy (OR, 0.59; 95% CI, 0.38-0.92), living in an urban environment (OR, 0.56; 0.33-0.93), and residing on the northern coast of Spain along the Bay of Biscay (OR, 0.56; 0.36-0.89) were independent protective factors against having a total PAQLQ score in the lower tertile. Conversely, being recruited in a primary care setting (OR, 1.55; 1.01-2.38) and having more severe asthma were risks for being in the lower tertile. CONCLUSIONS: Irrespective of the severity of the disease, season has a significant influence on the HRQL of asthmatic children.