[Bronchial exudate of serum proteins during asthma attack]. / Exudado bronquial de proteínas séricas en las crisis de asma.

OBJECTIVE: Although altered vascular permeability and edema of the bronchial mucosa are associated with asthma attack, their influence on its severity remains unknown. We address this issue by comparing relative indices for the concentration of albumin (RIAlb) and alpha2-macroglobulin (RIalpha2M) in induced sputum and peripheral blood from patients with exacerbated asthma, patients with stable asthma, and control subjects. PATIENTS AND METHODS: Forty-six volunteers participated in the study: 14 with exacerbated asthma (forced expiratory volume in the first second [FEV1] 74.3% [SD, 20.8%] of reference), 23 with stable asthma (FEV1 93.6% [7.5%]), and 9 controls (FEV1 101.1% [9.9%]). The concentrations of albumin and alpha2-macroglobulin were quantified by immunoturbidimetry and immunonephelometry, respectively. The relative index was then calculated by dividing the concentration in sputum supernatant by the concentration in peripheral blood. RESULTS: The mean RIAlb was 1.2 (1.1) in the control group, 2.9 (3.1) in the stable asthma group, and 6.0 (6.7) in the exacerbated asthma group. The RIalpha2M values were 11.7 (10.9), 11.9 (14.7), and 3.2 (3.8) for the control group and stable and exacerbated asthma groups, respectively. The increases in the RIAlb values between all groups, and the decrease in the RIalpha2M value between the exacerbated asthma and control groups were statistically significant (P<.05). The percentage of neutrophils, but not of eosinophils, in sputum was correlated with the RIAlb (r=0.39; P=.008) but not the RIalpha2M (r=-0.035; P=.82). FEV1 displayed an inverse relationship with the RIAlb (r=-0.43; P=.009) but not with the RIalpha2M (r=-0.206; P=.24). No correlation was found between oxyhemoglobin saturation and either the RIAlb (r=-0.33; P=.19) or the RIalpha2M (r=-0.12; P=.84). CONCLUSIONS: Vascular permeability is altered during asthma exacerbations and appears to be correlated with the presence of neutrophils and the degree of bronchial obstruction.

Exudado bronquial de proteínas séricas en las crisis de asma / Bronchial exudate of serum proteins during asthma attack

Objetivo: La alteración de la permeabilidad vascular y el edema de la mucosa bronquial se asocian con las crisis de asma. Hay pocos datos publicados y además no se conoce su relación con la gravedad de éstas. Así se propuso comparar los índices relativos de albúmina (IRAlb) y de macroglobulina α2 (IRMα2), entre esputo inducido y sangre periférica, de asmáticos agudizados (AA), asmáticos estables (AE) y controles. Pacientes y métodos: Se estudió a 46 voluntarios: 14 del grupo AA (volumen espiratorio forzado en el primer segundo [FEV1]: 74,3 ± 20,8), 23 del AE (FEV1: 93,6 ± 7,5) y 9 controles (FEV1: 101,1 ± 9,9). Se cuantificó la concentración de albúmina (turbidimetría inmunoquímica) y de macroglobulina α2 (nefelometría inmunoquímica) en el sobrenadante del esputo y en sangre venosa periférica y se calcularon los índices relativos. Resultados: La media ± desviación estándar del IRAlb fue de 1,2 ± 1,1 en el grupo control, de 2,9 ± 3,1 en AE y de 6,0 ± 6,7 en AA. El IRMα2 fue 11,7 ± 10,9, 11,9 ± 14,7 y 3,2 ± 3,8, respectivamente. El incremento del IRAlb entre los grupos AA, AE y control, y el descenso del IRMα2 entre AA y control fueron estadísticamente significativos (p < 0,05). Se relacionó el porcentaje de neutrófilos, y no el de eosinófilos, con el IRAlb (r = 0,39; p = 0,008), pero no con el IRMα2 (r = -­0,035; p = 0,82). El FEV1 se relacionó inversamente con el IRAlb (r = ­-0,43; p = 0,009) y no con el IRMα2 (r = -­0,206; p = 0,24), y tampoco se relacionó la saturación de oxihemoglobina con el IRAlb (r = ­0,33; p = 0,19) o el IRMα2 (r = ­-0,12; p = 0,84). Conclusiones: La permeabilidad vascular está alterada en las agudizaciones de asma y parece relacionarse con la presencia de neutrófilos y el grado de obstrucción bronquial

Objective: Although altered vascular permeability and edema of the bronchial mucosa are associated with asthma attack, their influence on its severity remains unknown. We address this issue by comparing relative indices for the concentration of albumin (RIAlb) and α2-macroglobulin (RIα2M) in induced sputum and peripheral blood from patients with exacerbated asthma, patients with stable asthma, and control subjects. Patients and methods: Forty-six volunteers participated in the study: 14 with exacerbated asthma (forced expiratory volume in the first second [FEV1] 74.3% [SD, 20.8%] of reference), 23 with stable asthma (FEV1 93.6% [7.5%]), and 9 controls (FEV1 101.1% [9.9%]). The concentrations of albumin and α2-macroglobulin were quantified by immunoturbidimetry and immunonephelometry, respectively. The relative index was then calculated by dividing the concentration in sputum supernatant by the concentration in peripheral blood. Results: The mean RIAlb was 1.2 (1.1) in the control group, 2.9 (3.1) in the stable asthma group, and 6.0 (6.7) in the exacerbated asthma group. The RIα2M values were 11.7 (10.9), 11.9 (14.7), and 3.2 (3.8) for the control group and stable and exacerbated asthma groups, respectively. The increases in the RIAlb values between all groups, and the decrease in the RIα2M value between the exacerbated asthma and control groups were statistically significant (P<.05). The percentage of neutrophils, but not of eosinophils, in sputum was correlated with the RIAlb (r=0.39; P=.008) but not the RIα2M (r=-­0.035; P=.82). FEV1 displayed an inverse relationship with the RIAlb (r=­-0.43; P=.009) but not with the RIα2M (r=­-0.206; P=.24). No correlation was found between oxyhemoglobin saturation and either the RIAlb (r=­-0.33; P=.19) or the RIα2M (r=­-0.12; P=.84). Conclusions: Vascular permeability is altered during asthma exacerbations and appears to be correlated with the presence of neutrophils and the degree of bronchial obstruction

[Total IgE in the sputum and serum of patients with asthma]. / IgE total en el esputo y suero de pacientes con asma.

BACKGROUND: The correlation between total IgE in induced sputum (IS) and serum is not well defined. The aim of this study was to investigate the relationship between total IgE in IS and total IgE in serum and airway inflammation. METHODS: Twenty-one patients with stable asthma and thirteen healthy controls were studied. Clinical and spirometric data were collected and a skin prick test to the 13 most common aeroallergens in our area was performed in all subjects. Total IgE in IS and serum was determined by the UNICAP immunoanalysis system (Pharmacia Uppsala, Sweden) while albumin concentration in IS and serum was determined using the Cobas Integra turbidimetric method (Roche Diagnostics, Basel, Switzerland). RESULTS: The percentage of eosinophils in EI was 8.7 (11.8) in asthmatic subjects and was 0.5 (1) in healthy controls. Total IgE (KU/L) was 43.2 (23) in asthmatics vs 25.6 (3) in healthy controls in IS, and was 329 (413) in asthmatics vs 57 (78) in controls in serum. Total IgE in IS was significantly correlated with total IgE in serum; r = 0.71 (p = 0.048), but not with the albumin relative index. No correlation was found between IgE and the number of eosinophils in IS. CONCLUSIONS: Total IgE can be measured in IS. Total IgE in IS is mildly correlated with total IgE measured in serum. The lack of correlation between total IgE and albumin in IS suggests that IgE in IS could be locally produced, at least in part.

IgE total en el esputo y suero de pacientes con asma / Total IgE in the sputum and serum of patients with asthma

Antecedentes: La IgE total en esputo inducido (EI) y su relación con la IgE total en el suero (S) no están bien definidas. El objetivo de este trabajo fue estudiar la relación entre la concentración de IgE total en EI con la concentración de IgE total en S y la inflamación de las vías aéreas. Métodos: Se estudiaron 21 pacientes con asma estable y 13 controles sanos. De cada paciente se recogieron los datos clínicos y espirométricos, y a todos se les hicieron pruebas cutáneas (prick test) con 13 aeroalergenos comunes en nuestra área. Se determinó la concentración de IgE total en EI y en S por inmuno-ensayo con el sistema UNICAP (Pharmacia-Uppsala, Suecia) y la concentración de albúmina por el método de turbidimetría Cobas Integra (Roche Diagnostics, Basel, Suiza). Resultados: El porcentaje de eosinófilos (%) en EI de asmáticos fue de 8,7 (11,8) y 0,5 (1) en sanos. La concentración de IgE (KU/L) en EI fue 43,2 (23) en asmáticos vs 25,6 (3) en sanos, y en S fue 329 (413) en asmáticos vs 57 (78) en sanos. La correlación entre IgE total en EI e IgE total en S fue de r = 0,71 (p = 0,048) pero no se relacionó con el índice relativo de albúmina. No hubo relación entre IgE en EI y número de eosinófilos en EI. Conclusiones: La IgE total puede medirse en esputo inducido y su concentración se relaciona con la IgE determinada en sangre. La ausencia de relación con la albúmina sugiere que la IgE en esputo no proviene exclusivamente de la extravasación, sino que podría intervenir una cierta producción local

Background: The correlation between total IgE in induced sputum (IS) and serum is not well defined. The aim of this study was to investigate the relationship between total IgE in IS and total IgE in serum and airway inflammation. Methods: Twenty-one patients with stable asthma and thirteen healthy controls were studied. Clinical and spirometric data were collected and a skin prick test to the 13 most common aeroallergens in our area was performed in all subjects. Total IgE in IS and serum was determined by the UNICAP immunoanalysis system (Pharmacia Uppsala, Sweden) while albumin concentration in IS and serum was determined using the Cobas Integra turbidimetric method (Roche Diagnostics, Basel, Switzerland). Results: The percentage of eosinophils in EI was 8.7 (11.8) in asthmatic subjects and was 0.5(1) in healthy controls. Total IgE (KU/L) was 43.2 (23) in asthmatics vs 25.6 (3) in healthy controls in IS, and was 329 (413) in asthmatics vs 57 (78) in controls in serum. Total IgE in IS was significantly correlated with total IgE in serum; r = 0.71 (p = 0.048), but not with the albumin relative index. No correlation was found between IgE and the number of eosinophils in IS. Conclusions: Total IgE can be measured in IS. Total IgE in IS is mildly correlated with total IgE measured in serum. The lack of correlation between total IgE and albumin in IS suggests that IgE in IS could be locally produced, at least in part

[Patient preference in the choice of dry powder inhalers]. / Preferencias de los pacientes en la elección de dispositivos de inhalación en polvo.

OBJECTIVE: To investigate a group of patients' preferences among 3 dry powder inhalers--Accuhaler, Easyhaler, and Turbuhaler--and to analyze the features that were most important for motivating choices. MATERIAL AND METHOD: The study enrolled 30 patients with stable asthma with a mean (SD) age of 40 (13) and who habitually used inhaled corticosteroids. The patients were shown in detail how to use each of the devices and were randomized to begin using them in different orders. After using each inhaler for a week, the patients assessed 9 different features on a scale of 0 to 10 with an independent observer. The patients were asked to put the inhalers in order of preference, and finally to demonstrate they could use them correctly. RESULTS: All patients correctly performed the inhalation maneuver at the beginning and the end of the study. The mean final scores out of 90 of the 9 features evaluated were 75 (13) for the Easyhaler, 67 (12) for the Accuhaler, and 65 (14) for the Turbuhaler. Differences were statistically significant between the first and the second device (P=0.02) and the first and the third (P=.001) but not between the Accuhaler and the Turbuhaler (P=.376). Mean rating scores were 8.6 (1.4) for the Easyhaler, 7.3 (1.9) for the Turbuhaler, and 7.1 (1.6) for the Accuhaler. The Easyhaler was the first choice for 53% of patients, the Turbuhaler for 27%, and the Accuhaler for 20%. CONCLUSIONS: The Easyhaler was rated the highest by the patients in the study. The scores were a long way from the maximum score, so research into developing an ideal inhaler must continue.

Preferencias de los pacientes en la elección de dispositivos de inhalación en polvo / Patient preference in the choice of dry powder inhalers

OBJETIVO: Conocer las preferencias de un grupo de pacientes acerca de 3 dispositivos de inhalación en polvo -Accuhaler®, Easyhaler® y Turbuhaler®- y analizar los aspectos más importantes que motivan su elección. MATERIAL Y MÉTODO: Se estudió a 30 pacientes de 40 ñ 13 años, asmáticos y estables, que se administraban habitualmente corticoides inhalados. Se les explicó detalladamente la técnica de utilización de cada uno de los dispositivos y, de forma aleatoria, se asignó el orden en que debían utilizarlos. Tras una semana de usar cada uno de los dispositivos, un observador independiente evaluó 9 aspectos distintos de los dispositivos, valorados de 0 a 10 puntos. Se pidió a los pacientes que determinaran el orden de preferencia y finalmente se evaluó la técnica de utilización. RESULTADOS: Todos los pacientes realizaron correctamente la técnica de inhalación, al principio y al final del estudio. Las puntuaciones totales de los 9 aspectos evaluados, sobre 90 puntos, fueron de 75 ñ 13 puntos para Easyhaler®, de 67 ñ 12 para Accuhaler® y de 65 ñ 14 para Turbuhaler®. Las diferencias fueron estadísticamente significativas entre el primero y el segundo (p = 0,02) y entre el primero y el tercero (p = 0,001), pero no para Accuhaler® y Turbuhaler® (p = 0,376).Las medias de los valores fueron de 8,6 ñ 1,4 para Easyhaler®, de 7,3 ñ 1,9 para Turbuhaler® y de 7,1 ñ 1,6 para Accuhaler®.El 53 por ciento de los pacientes escogió el dispositivo Easyhaler®, el 27 por ciento el Turbuhaler® y el 20 por ciento el Accuhaler®. CONCLUSIONES: El dispositivo Easyhaler® fue el mejor valorado por los pacientes evaluados. Las puntuaciones obtenidas para cada dispositivo distan de la puntuación máxima, por lo que deberá continuar investigándose para obtener el inhalador ideal (AU)

[Prospective epidemiologic study of perioperative anaphylactoid reactions occurring in Catalonia (1996-7)]. / Estudio epidemiológico prospectivo de las reacciones anafilactoides perioperatorias ocurridas en Cataluña (1996-97).

OBJECTIVES: To determine the incidence, immunological mechanisms, severity and clinical course of perioperative allergic reactions. PATIENTS AND METHODS: Prospective epidemiological study lasting 2 years (1996-97). In 20 hospitals in Catalonia (Spain), we studied patients who suffered allergic reactions equal to or greater than grade Ib according to the classification of Laxenaire. Serum and urine samples were collected during the first and sixth hours after the onset of a reaction. Complement factors, total serum and latex-specific serum IgE antibodies, hemostatic markers, serum tryptase and urinary methylhistamine were assayed. Tests for allergy to the drugs used during the perioperative period were performed on all patients who consented. RESULTS: Anesthetic procedures were performed 328,430 times in the 20 hospitals. Thirty-two allergic reactions were reported (1 case/10,263 anesthesias); the frequency was greater during general anesthesia (1 case/6,978 anesthesias). Women suffered 58.3% of the reactions, and the mean patient age was 47.8 +/- 16.5 years. Fifty-six percent of the reactions were severe (grades III-IV), and 68.7% occurred upon immediate exposure. Induction was the moment of greatest risk (50%). Treatment was required by 90.6% of the patients, but no deaths or serious sequelae occurred. Complete analyses could be carried out immediately for 25 patients. High urinary methylhistamine and/or serum tryptase levels were found for 57% of the patients with grade Ib reactions, for 80% of those with grade II reactions, and for 91.7% of those with grade III reactions (p = 0.05). High serum tryptase levels were the only findings for 53.8% of the grade III reactions (p = 0.007). Skin tests were positive for 62.5% of the patients. CONCLUSIONS: The frequency of allergic reactions in Catalonia is 1 case per 10,263 anesthesias performed, but the rate is higher in general anesthesia. Fifty-six percent of the reactions were severe. Most developed immediately and the moment of induction involved the greatest risk. Early assessment of methylhistamine and tryptase levels has been shown to be useful and positivity is linearly associated with severity of reaction. In 62.5% of the patients, positive results were seen in skin tests performed later.

Reaccion de hipersensibilidad inmediata al látex peroperatoria / Inmediate reaction of hypersensibility to latex

No disponible

Repicaduras intrahospitalarias con himenópteros / In-hospital re-stinging with hymenoptera

No disponible

Plantain allergy (Plantago lanceolata): assessment of diagnostic tests.

A study was made of 55 patients with skin prick test results for Plantago lanceolata of 3 mm2 or more. They were evaluated in relation to the response elicited by 10 mg/ml of histamine HCl. Patients with a response to Plantago less intense than the response to histamine were considered as having a "negative" response, whereas those whose response to Plantago was more intense than the response to histamine were considered as having a "positive" response. In 35 cases a radioallergosorbent test (RAST) was performed and in 22, nasal provocative testing (NPT). The frequency of positive response was 0.63 for skin tests, 0.11 for RAST and 0.72 for NPT. Among the patients with positive NPT, the frequencies of positive response to skin tests and RAST were 0.71 and 0.6 (p < 0.05), respectively. Results are discussed and study methods are proposed.

Allergy to Alternaria. II. Diagnostic comparison of skin-tests and RAST.

The diagnosis of Alternaria allergy is difficult and tests in vivo and in vitro usually do not give results as satisfactory as those obtained with other allergens. We studied 33 patients with a cutaneous response of 2 mm2 or more to skin-prick tests for Alternaria (extract containing 104 micrograms/ml of Alt-1). Results were compared with those of RAST. Skin tests were positive in 75.8% of cases (the resulting papule was the same size as or larger than that elicited by 10 mg/ml histamine) and negative in 24.2% of cases. RAST was positive in 75% of cases and negative in 25%. There was no significant difference in the frequencies. RAST was positive four times more often in males than in females; when these figures were corrected for population data, the ratio was 2:1. The coefficient of correlation between the intensity of skin-test and RAST results was r = 0.51 (p < 0.05). These findings are evaluated and results are discussed.

Diagnosis of allergy to cat epithelium in clinical practice. I. Value of skin tests.

Seventy atopic patients were studied. Pin-prick skin tests with cat epithelium extract (Ifidesa-Aríste-gui) were made. The results were compared by dividing the patients into a group with clinical manifestations of contact with cats and a group without clinical manifestations of contact with cats. Our results show that skin tests for cat epithelium, such as those carried out routinely in clinical practice, are not very sensitive or specific, and, therefore, are not suitable for diagnosis or prevalence studies.

Allergy to Alternaria. I. Clinical aspects.

We studied 66 patients allergic to mould Alternaria. 53% males and 47% females, with 60% diagnosed as having asthma versus 40% rhinitis, only 29% had allergy to Alternaria without any other cutaneous reactivity while 71% were polisensitized, more frequently to D. pteronyssinus, grass pollen, Cladosporium and cat epithelium. We compared the patients allergic to Alternaria with those allergic to grass pollen and D. pteronyssinus.

Studies of nonsedative antihistamines. II. Assessment of its antihistaminic potency.

An analysis is made of the effectiveness of terfenadine at dosages of 60 and 120 mg, of cetirizine at a dose of 10 mg, and of loratadine and ebastine at a dose of 10 mg in inhibiting the papule induced by 20 mcg of intradermal histamine. Although all produced significant inhibition, cetirizine and terfenadine 120 mg showed a significantly greater inhibition coefficient than loratadine.