Local allergic rhinitis in children: Clinical characteristics and role of basophil activation test as a diagnostic tool.

BACKGROUND: Local allergic rhinitis (LAR) is a condition involving a localized nasal allergic response in absence of systemic atopy. Most studies on LAR have been performed in adults. We aimed to describe clinical characteristics of LAR pediatric patients, its clinical evolution over a 7-year follow-up period and to study the role of basophil activation test (BAT), for its diagnosis. METHODS: Forty-four children with non-allergic rhinitis (NAR) were included (24 males, 20 females, aged under 15 years). Nasal allergen provocation test (NAPT) and BAT were performed with Dermatophagoides pteronyssinus and Phleum pratense. RESULTS: Seven patients (16%) were diagnosed of LAR. Six reacted to D pteronyssinus and one to P pratense. All LAR and 86% of NAR patients presented perennial symptoms. Fifty-seven percent of NAR and LAR patients referred persistent symptoms. Around half of NAR and LAR patients reported mild-moderate clinical manifestations. Three LAR patients associated conjunctival symptoms, proportionally more than NAR patients (19%, 7 out of 37). NAR patients presented bronchial asthma (n = 10) more frequently than LAR children (n = 1). More than half of LAR and NAR patients presented family history of atopy. BAT was negative in all LAR patients. On follow-up, 3 LAR patients and 10 of the 25 NAR patients who agreed to be retested, presented systemic sensitization. Dust mites were the most frequent allergen involved. CONCLUSIONS: LAR should be ruled out in children with NAR. Almost half of children with LAR develop systemic sensitization over time. BAT shows low sensitivity for the diagnosis of LAR in children.

Anafilaxia perioperatoria / Perioperative anaphylaxis

La anafilaxia perioperatoria es un cuadro clínico que puede amenazar la vida del paciente, producido por fármacos o sustancias usados durante la anestesia. Después de una anafilaxia debe realizarse un estudio alergológico para identificar el agente responsable y prevenir recurrencias. La incidencia global se estima de 1 entre 10.000-20.000 anestesias. Los agentes más frecuentemente implicados son los bloqueantes neuromusculares, látex y antibióticos. El diagnóstico inicial es clínico y en el tratamiento es esencial la adrenalina. En este artículo se describe la clínica, pruebas diagnósticas, así como protocolos de prevención y tratamiento del cuadro de anafilaxia perioperatoria. Será importante desarrollar protocolos de detección y manejo precoz de estas reacciones en circuitos de cirugía ambulatoria y establecer un adecuado seguimiento posterior (AU)

Perioperative anaphylaxis may be a life threatening clinical condition and is typically due to the results of drugs used for anesthesia. Once anaphylaxis occurs, allergy studies are essential to identify the responsible agent so to prevent recurrences. The overall incidence is estimated at 1 in 10,000-20,000 anesthetic procedures. The most commonly involved agents are neuromuscular blocking agents, latex and antibiotics. The initial diagnosis is presumptive; including clinical signs and adrenalin is the treatment of choice. The aim of this article is to review etiology, diagnosis, prevention and treatment of perioperative anaphylaxis. It will be important to produce action protocols to ensure the detection of these reactions of anaphylaxis in outpatient surgery and to establish the correct follow-up (AU)