Tomato nsLTP as an "In Vivo" Diagnostic Tool: Sensitization in a Mediterranean Population.

BACKGROUND: Tomato allergies have been extensively studied but component-resolved in vivo diagnosis with purified allergens has yet to be performed. OBJECTIVES: To evaluate the prevalence of sensitization to Sola l 3 in a Mediterranean population, and to compare the resulting sensitization profile with that of individuals sensitized to tomato, peach, and/or purified lipid transfer protein (LTP). METHODS: Sola l 3 was purified, characterized, and used to prepare skin prick tests (SPTs). Two groups of patients were selected. Group 1 consisted of patients with at least 1 positive SPT to tomato, peach, or LTP mixture (marker extracts) who were subsequently tested with Sola l 3 (n = 280). Group 2 (prevalence study) consisted of patients who underwent simultaneous SPT with the 3 marker extracts and Sola l 3 (n = 658). Patients from either group who were positive to any of the 4 extracts were studied in detail (study group, n = 1 23). ELISA and immunoblot assays were performed in individuals with a positive SPT to Sola l 3 to detect the presence of specific IgE antibodies to this allergen. RESULTS: Prevalence of sensitization to Sola l 3 was 3.2% overall and 54.7% in tomato-positive patients. Most tomato-sensitized patients were asymptomatic. Symptoms were more common in Sola l 3-positive individuals. Sensitization to peach and the LTP mixture did not discriminate between Sola l 3-positive and Sola l 3-negative patients. CONCLUSIONS: This study confirms that LTP, not only from peach but also from other fruit and vegetables, including tomato, is an important allergen in the Mediterranean area. Sensitization to Sola l 3 is associated with more symptoms in tomato-sensitized patients.

Goji berries (Lycium barbarum): risk of allergic reactions in individuals with food allergy.

BACKGROUND: New foods are frequently introduced in Western diets for their healthy properties; however, they may produce adverse effects. OBJECTIVE: After attending a patient who experienced an allergic reaction to Goji berries, we evaluated the allergenic potential of this food in plant food-allergic individuals, a group that is considered to be at high risk of experiencing a reaction. METHODS: We recruited 30 additional plant food-allergic individuals in Spain during 3 months in 2010. Four patients reported symptoms on intake, 6 tolerated the berries, and 20 had never tried Goji berries. Patients underwent skin prick tests with Goji berries, as well as with peach peel and plant food panallergens as markers of cross-reactivity between unrelated foods. We carried out in vitro tests in symptomatic patients. RESULTS: Skin tests to Goji berries were positive in 24 patients (77%): 5 symptomatic patients and 19 asymptomatic patients. Positivity to Goji berries was associated with positivity to peach peel and to the panallergen nonspecific lipid transfer protein (LTP). Nearly half of the patients reported symptoms (45%), but 89% of the skin test-positive patients had never eaten Goji berries. We detected specific immunoglobulin E to Goji berries in all cases, and several individuals recognized 2 protein bands in the immunoblot. Addition of LTP to sera mostly inhibited immunoglobulin E binding to an LTP-like band, suggesting a role for this panallergen in sensitization to Goji berries. CONCLUSIONS: Our results demonstrate the allergenic potential of Goji berries in high-risk individuals, which is probably due to cross-reactivity with LTP from other foods. The risks of Goji berries should be taken into consideration in individuals with food allergy, especially those who are allergic to LTP.

Acidic ribosomal protein 60S: A new tomato allergen.

Three tomato allergens (Lyc e 1, Lyc e 2 and Lyc e 3) have been characterised until now. Previous studies have demonstrated the existence of other proteins with capacity to bind IgE. The objective of this study was to identify new tomato allergens by molecular biology techniques. A tomato peel cDNA library was screened using a specific pool of sera from sensitised individuals. A clone was obtained and its sequence compared to other described allergens. This clone contained 34 aminoacids from the C-terminal region of an acidic ribosomal protein 60S. This protein showed more than 85% of homology with fungal allergens and 93.8% of homology with the almond allergen Pru du 5. The clone also contains 169 base pairs without homology with other known genes and could correspond to non-coding sequences. The IgE detection with a pool of sera was positive which confirms that is a new tomato allergen.

Allergenic differences among pollens of three Salsola species.

BACKGROUND: Sensitivity to Chenopodiaceae is a frequent cause of allergic respiratory diseases in geographic areas where sensitization to Salsola kali and Chenopodium album has been reported. The objective of this study was to evaluate the pattern of sensitization to 3 Salsola species in patients residing on the Mediterranean coast of south-eastern Spain. METHODS: S. kali, S. vermiculata and S. oppositifolia pollen extracts were prepared. Patients reporting respiratory and/or cutaneous symptoms were skin prick tested with the 3 Salsola extracts. Individuals with positive skin prick tests to at least 1 of the 3 Salsola species were included. Specific IgE was determined by direct ELISA. SDS-PAGE and 2-D analysis were conducted to elucidate the protein profile. The allergenic profile was investigated by immunoblot. Inhibition experiments were conducted to establish cross-reactivity between different species. RESULTS: 246 patients were included. 237 patients (96.3%) tested positive to S. oppositifolia, 189 (76.8%) to S. kali and 185 (75.2%) to S. vermiculata. Protein profile and immunoblot demonstrated similar patterns in all extracts, except in low-molecular-weight allergens of S. oppositifolia. Immunoblot inhibition experiments demonstrated that most high-molecular-weight allergens of S. oppositifolia were inhibited by S. kali whereas low-molecular-weight allergens were totally inhibited only by C. album. CONCLUSIONS: This study confirms the allergenic importance of other Salsola species, especially S. oppositifolia. We have demonstrated that the 3 species show a high degree of cross-reactivity, but S. oppositifolia shares more allergenic similarities with C. album than S. kali.

Sensitization to tomato peel and pulp extracts in the Mediterranean Coast of Spain: prevalence and co-sensitization with aeroallergens.

BACKGROUND: Tomatoes (Lycopersicon esculentum) are consumed world-wide. The prevalence of sensitization to tomatoes remains unknown. OBJECTIVE: To determine the prevalence of skin test reactivity to tomato and to describe the characteristics of tomato-sensitized subjects. METHODS: Individuals attending for the first time during the period of the study to six Allergy centres, located along the Mediterranean coast of Spain, reporting respiratory and/or cutaneous symptoms, were included. All patients were skin prick tested with a battery of inhalant allergens and with peel and pulp of Canary tomato extracts. RESULTS: The study included 1734 individuals (757 males, 977 females; 31.9+/-17.8 years old). The prevalence of sensitization to tomato was 6.52% (113 patients; 65 males, 48 females; 29.5+/-13 years old). The peel extract was positive in 110 patients and the pulp extract in 47 patients; three patients were positive exclusively to pulp. Only 1.8% of individuals reported symptoms with tomato; 44% of them had skin test negative to both extracts. Among tomato-sensitized subjects, 16% reported symptoms with tomato, 97% were sensitized to inhalant aeroallergens, including 84% to pollens (mainly Artemisia vulgaris and Platanus hybrida), with differences between Northern and Southern centres. CONCLUSIONS: The prevalence found of skin test sensitivity to tomato is high. Peel extracts detected most of the sensitized subjects. Most of the sensitized subjects were asymptomatic and some patients reported symptoms without skin test sensitivity. Positive subjects were very frequently sensitized to pollens, suggesting allergen cross-reactivity. Regional differences may exist, possibly related to the pattern of sensitization to cross-reacting pollens.

Polinosis por proximidad, un concepto a tener en cuenta ¿El polen como alérgeno domiciliario? / Pollinosis op proximity, a concept to be taken into account. Pollen as a domestic allergen?

No disponible

Epidemiology of urticaria in Spain.

BACKGROUND: In spite of the frequency of chronic urticaria there are very few epidemiological studies of its prevalence and distribution. OBJECTIVE: We wanted to approach the real prevalence of chronic urticaria in a population-based study and to depict demographic distribution and personal perception of the disease. We also wanted to describe the frequency of acute urticaria episodes in the population studied. METHODS: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a sample size for a maximum variability (conservative approach p=q=0.5). RESULTS: We found a 0.6% (95% CI: 0.4-0.8) prevalence of chronic urticaria. The prevalence is significantly higher in women than in men with a OR=3.82 (95%CI 1.56-9.37). Chronic urticaria is a self-limited disease, yet in 8.7% of cases chronic urticaria lasts from one to 5 years and in 11.3%, for more than 5 years. The average age of onset is 40 years. CONCLUSIONS: We offer large epidemiology study data on the prevalence of chronic urticaria. The prevalence of chronic urticaria has not yet been defined in an adult population-based study. With this work we offer such data to describe the prevalence and features of this disease.

Myocardial ischemia due to severe amoxicillin allergy.

A patient suffered a myocardial injury as a manifestation of anaphylactic reaction to amoxicillin-clavulanic acid administration. A cardiologic study (ergometry and catheterization) showed no obstructive coronary disease and prick test to amoxicillin was positive. Anaphylaxis may cause myocardial injury and the mechanism is likely to be vasospasm induced by mast cells and basophil mediators.

Prevalencia de alergia en la población adulta española / Allergy prevalence in adult spanish population

Introduccián: En lo últimos decenios se está registrando un aumento de las enfermedades alérgicas en todo el mundo. Sin embargo hay pocos estudios de prevalencia de alergia en la población general española. Objetivos: Establecer la prevalencia de enfermedades alérgicas en una muestra de población general adulta del estado español. Así como establecer las causas y las manifestaciones de esta alergia. Material y métodos: Se realizó un estudio observacional de tipo tranversal. El tamaño de la muestra. suponiendo un nivel máximo de indeterminación prevalencia = 50%) y aceptando un error del 1.4% y un nivel de confianza del 95%. Fue de 5.003 sujeto . La muestra e seleccionó de forma aleatoria y automática del listín de teléfono, aplicando el control de cuotas de zona. el número de habitantes, el sexo y la edad. La recogida 1:1e datos se efectuó mediante encuesta telefónica siguiendo la técnica CATI (Computer-assisted Telephone Interview technique) con oporte Omnibus Phonebus de Taylor Ne/son Sofres Market Research. Resultados: De los 4.949 sujetos incluidos en el análisis. un 21,6% (IC 95% 20,4- 22,7%) refirieron ser alérgicos. La prevalencia fue mayor en mujeres (24,6%), en el grupo de 18 a 24 años de edad (26.9%) y en poblaciones de más de 500.000 habitantes (24,3%). mientras que fue menor en los varones (18,3%), en la región norte-centro ( 17 ,8%) y en poblaciones con menos de 10.000 habitantes ( 18.7% ). o hubo diferencia significativa en relación al nivel socioeconómico. La rinoconjuntivitis fue la manifestación alérgica más frecuente (45,4%) seguida del asma bronquial (24.9% ), la urticaria (24.6% ), la dermatitis (21,5%) y el angioederna (6% ). Las tres causas más frecuente de alergia fueron con diferencia los pólenes (31,5%). los medicamento (29,4%) y los ácaros del polvo domé tico (25.3%). Mucho menos frecuentes fueron los animales (6,8%). los metales (4.9%). los alimentos (4.8%), los hongos (3%), las picadura de insecto (2.5%), la exposición al sol (1,9%) y el látex (0,8%). Conclusiones: La prevalencia de alergia en la población adulta española es del 21,6%, y es más frecuente en las mujeres y en los núcleos urbanos de más de 500.000 habitantes. La manifestación más frecuente es la rinoconjuntivitis. Las manifestaciones cutáneas de la alergia no son despreciables. Las causas más frecuentes de alergia con los aeroalérgeno (pólenes y ácaros) y lo medicamentos (AU)

Background: In spite of the worldwide increase in allergic diseases over the recent years, few epidemiological studies have been conducted in Spain. Objective: We wanted to establish the real prevalence of allergy in a sample of adult general population. We then wanted to describe the profile. the causes and the type of caused disease. Methods: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a simple size for a máximum undetermination level of (p = 50%). assuming a 1.4 error for global results and a 95% confidence interval (95% CI) l. Five thousands and three individual: were randomly selected from the telephone directory and matched according to sex, age and area. The phone survey was performed with each individual employing the Computer-assisted Telephone lnterview technique supported by Taylor elson Phonebus Company (Barcelona, Spain). Results: We found a 21.6% (95% CI: 20.4-22, 7%) prevalence of allergy. The prevalence was higher in wornen (24.6%) than in men (18.3%). Allergy condition was higher from 18 to 24 years old (26.9%). As it was expected. the prevalence was also higher in urban cities > 500.000 habitants (24.3%) than in rural cities with less than 10.000 habitants ( 18. 7% ). We did not find differences among economical status. The most cornrnon manifestation of allergic disease was rhinoconjunctivitis (45..+%) followed by bronchial asthrna (24.99'c), urticaria (24.6%). Dermatitis (21.5% ), and angioedema (6

Impaired type-1 activity and increased NK cells in Gleich's syndrome.

BACKGROUND: An altered production of cytokines has been described in Gleich's syndrome. Our aim was to study the cytokine production at the single-cell level in a patient with Gleich's syndrome and to determine whether it changed during a flare episode. METHODS: Blood samples were obtained from a 30-year-old woman diagnosed with Gleich's syndrome before and during the subsequent flare of edema of trunk and arms and weight gain. The major lymphoid subsets (CD4+, CD8+, and CD19+) and natural killer (NK) cells were measured by flow cytometry. Cytokine-producing T cells (IL-2, IFN-gamma, and IL-4) were quantified in whole blood by intracellular staining with specific monoclonal antibodies and flow cytometry analysis after polyclonal stimulation with phorbol 12-myristate 13-acetate and ionomycin. RESULTS: Increased numbers of immature CD4+CD8+ T cells and NK cells were observed in peripheral blood during the asymptomatic period. The latter population significantly decreased during the flare. Type-1 cells were decreased in both asymptomatic and, more markedly, during the attack with respect to healthy subjects. CONCLUSIONS: The decreased type-1 response demonstrated in this patient might be the basis of the hypereosinophilia of Gleich's syndrome. Besides, the NK cells might play a role in the pathogenesis of these inflammatory episodes.

Stevens-Johnson syndrome from tetrazepam.

We present a case of a patient showing a cutaneous and systemic affectation compatible with the Stevens-Johnson syndrome due to the intake of tetrazepam as a muscular relaxant. The symptoms remitted after the suspension of the involved medicines and after treatment with systemic corticoids. Months later, a study with patch tests, with the standard battery and the medicines that she took (indapamide, tetrazepam, acetyl salicylic acid, botriozolam and levomepromazine) was carried out. She presented positivity to tetrazepam at 48 and 96 hours. The oral provocations with the other medicines, which she consumed, were negative. The study of cross reactivity with other benzodiazepines was negative. In the medical literature, different cutaneous affectations regarding benzodiazepine use (generalised drug eruptions, contact dermatitis, erythema multiforme, ...) have been described byt non Stevens-Johnson syndrome. The patch tests are useful in the diagnosis of this type of cutaneous reactions, avoiding in this way the achievement of oral provocations, with the potential risk for the patient that they imply. The absence of cross-reactions with other substances of the same group has to be pointed out, even with those with which keeps great structural similarity as the diazepam. In spite of the absence of cross reactions with the rest of benzodiazepines, faced with the seriousness of the case presented, it is advised to the patient to avoid this type of medicines.