Allergen Profile of London Plane Tree Pollen: Clinical and Molecular Pattern in Central Spain

Background: Platanus acerifolia (London plane tree) is a deciduous tree of the Platanaceae family. Sensitization to this plant varies withgeography. Madrid, located in central Spain, has one of the highest London plane tree pollen concentration levels on the Iberian Peninsula.Objectives: We evaluated both the clinical characteristics and the molecular sensitization pattern of patients with allergy to London planetree pollen in the region of Madrid.Patients and Methods: Thirty-eight patients allergic to London plane tree pollen were selected according to their clinical symptoms andpositive results in skin prick testing and/or specific IgE determination. Serum was collected, and allergen components were evaluatedusing immunodetection techniques as well as ImmunoCAP. The IgE-binding proteins detected were identified and characterized usingmass spectrometry.Results: Analysis of serum samples from allergic patients revealed 9 IgE-binding bands in London plane tree pollen extract. Among these,the 45-kDa protein, which corresponded to Pla a 2, was detected in 76.3% of patients. However, the 18-kDa (Pla a 1) and 9-kDa (Pla a 3)bands were detected in 44.7% and 23.7% of sera, respectively. These results were confirmed using purified proteins. Characterization ofthe allergen revealed the 27-kDa protein to be glutathione-S-transferase.Conclusions: The molecular profile of patients sensitized to London plane tree pollen differs from that reported in studies from otherlocations. In the population we studied, the prevalence of Pla a 2 was higher than that of Pla a 1 and Pla a 3. In addition, the minorallergen previously referred to as Pla a 4 was characterized as glutathione-S-transferase. (AU)

Antecedentes: Platanus acerifolia es un árbol de hoja caduca de la familia Platanaceae. La sensibilización frente a esta planta varía enfunción de la zona geográfica. Madrid, ubicada en el centro de España, tiene uno de los mayores niveles de concentración de polen deeste árbol en la Península Ibérica.Objetivo: Evaluar las características clínicas y los patrones moleculares de sensibilización en pacientes con alergia al plátano de sombraen la región de Madrid.Pacientes y Métodos: Treinta y ocho pacientes alérgicos al polen del plátano de sombra fueron seleccionados de acuerdo con los síntomasclínicos, pruebas cutáneas positivas y/o IgE específica. El suero se recogió y se evaluaron los componentes alérgicos mediante técnicas deinmunodetección, así como ImmunoCAP. Las proteínas que unían IgE fueron identificadas y caracterizadas por espectrometría de masas.Resultados: El análisis de los sueros de los pacientes alérgicos reveló 9 bandas que captaban IgE en los extractos de polen de plátano desombra. Entre estas, la proteína de 45 kDa, correspondiente a Pla a 2, se detectó en el 76,3% de los pacientes. Sin embargo, las bandasde 18 kDa (Pla a 1) y 9 kDa (Pla a 3) fueron reconocidas en el 44,7% y 27,3%, respectivamente. Estos resultados se confirmaron usandoproteínas purificadas. La caracterización de los alérgenos identificó la proteína de 27 kDa como una glutatión S-transferasa.Conclusiones: El perfil molecular de los pacientes sensibilizados al polen del plátano de sombra varía respecto al descrito en estudios deotras localizaciones. Nuestra población muestra una mayor prevalencia de Pla a 2 comparado con Pla a 1 y Pla a 3. Además, el alérgenominoritario previamente denominado Pla a 4 fue caracterizado como una glutatión-S-transferasa. (AU)

Association Between the Seed Storage Proteins 2S Albumin and 11S Globulin and Severe Allergic Reaction After Flaxseed Intake

Background: Given the increased popularity of flaxseed in meals, several cases of allergy to these seeds have been reported. Little is known about the allergens implicated in hypersensitivity reactions to flaxseed. The present study aimed to identify the allergens involved in IgE-mediated reactions in 5 patients with a clinical history of severe systemic symptoms after flaxseed consumption. Methods: Proteins that were potential allergens with IgE-binding capacity were purified from flaxseed extract using chromatography and identified via MALDI-TOF mass spectrometry. Immunoassays were performed using the 5 allergic patients’ sera tested individually and as a pool. Results: Immunoblotting of the flaxseed extract revealed a low-molecular-mass protein (around 13 kDa) in 4 of the 5 patients, while a protein of approximately 55 kDa was detected in 2 patients. The proteins were identified by mass spectrometry as flaxseed 2S albumin, which is included in the WHO/IUIS allergen nomenclature as Lin u 1, and 11S globulin. Inhibition assays revealed in vitro IgE-mediated cross-reactivity between Lin u 1 and peanut and cashew nut proteins, while IgE-mediated recognition of 11S globulin by patients’ sera was partially inhibited by several plant-derived sources. Conclusions: Seed storage proteins from flaxseed were involved in the development of severe symptoms in the 5 patients studied and exhibited cross-reactivity with other allergenic sources. Besides the severity of flaxseed allergy in patients sensitized to 2S albumin, this is the first time that 11S globulin has been identified as a potential allergen. Taking these data into account should ensure a more accurate diagnosis. (AU)

Antecedentes: Dada la creciente popularidad de la linaza en las comidas, se han notificado varios casos de alergia a estas semillas. La información acerca de los alérgenos implicados en las reacciones de hipersensibilidad a estas semillas es escasa. El presente trabajo pretende identificar los alérgenos implicados en las reacciones mediadas por IgE en cinco pacientes con una historia clínica de síntomas sistémicos graves tras el consumo de linaza. Métodos: Las proteínas susceptibles de ser alérgenos con capacidad de unir IgE se purificaron a partir del extracto de linaza mediante técnicas cromatográficas. Su identificación se realizó mediante espectrometría de masas MALDI-TOF. Se realizaron inmunoensayos con los sueros de los cinco pacientes alérgicos, utilizados de forma individual o como mezclas. Resultados: Cuatro de los cinco pacientes reconocieron una proteína de baja masa molecular (alrededor de 13 kDa) en inmunoensayos con extracto de linaza, mientras que dos pacientes reconocieron una proteína de aproximadamente 55 kDa. Se identificaron por espectrometría de masas como albúmina 2S de linaza, incluida en la nomenclatura de alérgenos de la OMS/IUIS como Lin u 1, y globulina 11S, respectivamente. Los ensayos de inhibición in vitro revelaron la existencia de reactividad cruzada de la Lin u 1 con las proteínas del cacahuete y del anacardo, mientras que el reconocimiento por parte de la IgE de la globulina 11S por parte de los sueros de los pacientes fue parcialmente inhibido por varias fuentes vegetales. Conclusiones: Las proteínas de almacenamiento de las semillas de lino estaban implicadas en el desarrollo de síntomas graves en cinco individuos y mostraron una reactividad cruzada con otras fuentes alergénicas. Además de la gravedad de la alergia a la linaza en los pacientes sensibilizados a la albúmina 2S, es la primera vez que se identifica la globulina 11S como un alérgeno potencial.

Clinical characteristics of patients sensitized to Siberian Hamster

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Allergen characterization of Chia Seeds (Salvia hispanica), a new allergenic food

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Multicenter phase II clinical trial of operative capecitabine with concurrent radiotherapy in patients with locally advanced rectal cancer

INTRODUCTION: To assess pathologic complete response, sphincter preservation rates and toxicity profile of preoperative chemoradiation with capecitabine in resectable locally advanced rectal cancer. MATERIALS AND METHODS: Fifty-eight patients from six Spanish centers were included (March 2004 to June 2005) with histological/cytological diagnosis of locally advanced rectal cancer, age between 18 and 80 years, ECOG 0-2, adequate bone marrow, renal and hepatic functions. Prior chemotherapy/radiotherapy was not allowed. Preoperative treatment was capecitabine 825 mg/m(2) bid concomitant to radiotherapy (45 + 5.4 Gy boost over 5.5 weeks). Surgery was performed 4-8 weeks after completion of chemoradiotherapy. RESULTS: Fifty-eight patients were enrolled in this study: 60.3 % males, median age of 64.5 (30.9-78.7) years, 28.6 % with ECOG 0 and 71.4 % with ECOG 1. Median distance of tumor from the anal verge was 7 (1-12) cm. Fifty-two (89.6. %) patients completed preoperative chemoradiotherapy. Primary tumor and node downstaging occurred in 61.1 and 69.6 % of patients, respectively. Surgery was performed in 55 patients (94.8 %): 80 % had negative lymph nodes and 72.7 % underwent sphincter-preserving procedures. A pathologic complete response was observed in 10.5 % (95 % CI 2.5-18.5) of the patients. Main grade I-II toxicities were leucopenia (43.1 %), neutropenia (24.1 %), anemia (36.2 %), diarrhea (32.8 %) and skin disorders (5.1 %), from which diarrhea (6.9 %), leucopenia (1.7 %) and skin disorders (1.7 %) reached grade III. There were no grade IV toxicities. CONCLUSIONS: Preoperative capecitabine-based chemoradiation is a well-tolerated and effective neoadjuvant treatment for locally advanced rectal cancer that achieves encouraging rates of tumor downstaging (AU)

Radiation oncology: future needs and equipment. Current situation in Spain

Spain's radiation oncology infrastructure has evolved in terms of both quantity and structure since the last analysis was carried out in 1999. The purpose of this paper is to describe the current facilities, basically consisting of external radiotherapeutic units, and to present a calculation model for estimating the number of irradiation units required to guarantee equitable cover for radiotherapeutic treatment. An electronic questionnaire was designed to be accessed via a link on the Spanish Association of Radiotherapy and Oncology Web page. The questionnaire provides details of the current state of Spain's radiotherapeutic facilities, and a descriptive study has been performed with analytical data. The scope of the study included all the centres providing oncology-radiotherapy in Spain. The units analysed encompassed the centres and irradiation units actively providing care in 2004. Ninety-seven centres were detected, in which 177 external radiotherapy units were registered. Forty-five of these were cobalt units and 132 were accelerators. The rate of radiotherapy use in Spain based on the best scientific evidence available and on its rate of use with cancer has been estimated at 61%. The number of external irradiation units available in 2004 (177) is clearly lower than the number desirable (266-316) (AU)

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Randomised study of single dose (8 Gy vs. 6 Gy) of analgesic radiotherapy plus zoledronic acid in patients with bone metastases

OBJECTIVE: To assess the effectiveness of a single dose of radio therapy (8 Gy vs. 6 Gy) plus zoledronic acid in cancer patients with bone metastases in treating pain; quality of life, time to onset of skeletal events and functional status. MATERIAL AND METHODS: A total of 139 patients from 22 Spanish hospitals were randomly assigned to: Group A, administered a single dose of 8 Gy+zoledronic acid (4 mg iv, in 15-min infusions), and Group B, administered a single dose of 6 Gy+zoledronic acid (4 mg iv, in 15-min infusions). The main variable was pain, which was assessed with the Visual Analogue Pain Scale (VAS) in supine, seated and standing positions. RESULTS: There was a total of 118 patients for intention to treat (n=67 in Group A and n=51 in Group B). The most frequent primary neoplasms were the lung (29.66%), prostate (22.03%) and breast (21.19%). Sixty patients were analysed per protocol, n=34 in group A and n=26 in group B. Improvements were observed in the VAS scores for pain in all three positions. The mean time to onset of the event was greater (p=0.0211) in Group A than in Group B (122 vs. 81.62 days). Functional status improved in Group A, and quality of life improved in both groups. CONCLUSION: The two groups achieved similar levels of pain control in supine, seated and standing positions. Quality of life also improved in both groups. However, the higher dose (8 Gy dose) in combination with zoledronic acid is associated with a longer period without skeletal events (AU)

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Guillain-Barre syndrome in a patient with diffuse large B-cell lymphoma, and rituximab maintenance therapy. An association beyond anecdotal evidence?

Paraneoplastic neurological syndromes constitute an unusual manifestation of cancer. The objective of this case report is to debate the association between rituximab therapy and Guillain-Barre syndrome. We present the case of a 57 years old patient, with diffuse large-B cell lymphoma in complete remission, who consulted our hospital because of symmetric lower extremity weakness, developed while being treated with a rituximab maintenance schedule. Our main conclusion is that plasma cell dysregulation due to rituximab should be clarified in future studies (AU)

La administración crónica de propiltiouracilo reduce la circulación hiperdinámica en ratas con hipertensión portal / Chronic administration of propylthiouracil ameliorates hyperdynamic circulation in portal hypertensive rats

Objetivo: evaluar el efecto del estado hipotiroideo inducido por la administración crónica de propiltiouracilo sobre los parámetros hemodinámicos esplácnicos y sistémicos en ratas con hipertensión portal secundaria a la ligadura de la vena porta. Métodos: la hipertensión portal fue inducida mediante la ligadura quirúrgica de la vena porta. El índice cardíaco y el flujo sanguíneo portal se determinaron mediante microesferas radioactivas. Las determinaciones se llevaron a cabo tras el tratamiento con propiltiouracilo (1 mg/ml) en el agua durante 5 días. Resultados: las ratas con hipertensión portal tratadas con propiltiouracilo mostraron una presión portal inferior (12,4 ± 1,9 frente a 16,3 ± 0,7 mmHg; p < 0,05) y un flujo sanguíneo portal superior (11,6 ± 0,7 frente a 3,2 ± 1,3 ml/min/100 g; p < 0,05) a los de los animales no tratados. La vasoconstricción esplácnica en los animales tratados se asoció a una resistencia vascular periférica (2,3 ± 0,4 frente a 1,8 ± 0,3 mmHg/ml/min/100 g; p < 0,05) mayor que la de los animales control. Conclusión: los resultados obtenidos indican que es posible reducir la presión portal mediante la inducción de un estado hipotiroideo a través de la administración crónica de propiltiouracilo

Objective: To evaluate the effect of a hypothyroid state, induced by chronic propylthiouracil administration, on splanchnic and systemic hemodynamic parameters in rats with portal hypertension due to portal vein ligation. Methods: Portal hypertension was induced by surgical stenosis of the portal vein. Cardiac index and portal blood flow were measured using radioactive microspheres. Measurements were performed after treatment with propylthiouracil (1 mg/ml in drinking water) for 5 days. Results: Propylthiouracil-treated portal hypertensive rats had a lower portal pressure (12.4 ± 1.9 versus 16.3 ± 0.7 mmHg; p < 0.05) and portal blood flow (11.6 ± 0.7 versus 13.2 ± 1.3 ml/min/100 g; p < 0.05) than non-treated animals. Splanchnic vasoconstriction in treated animals was associated with a higher peripheral vascular resistance (2.3 ± 0.4 versus 1.8 ± 0.3 mmHg/ml/min/100 g; p < 0.05) than controls. Conclusion: These results suggest that portal pressure can be lowered by inducing a hypothyroid state by chronic administration of propylthiouracil

Introducción: Monográfico Radioterapia / Introduction: Radiotherapy

Presentación a cargo del Presidente de la Asociación Española de Radioterapia y Oncología en el que hace una exposición sobre la situación actual de la Radioterapia Oncológica y una breve presentación de los artículos que conforman este monográfico (AU)

Introduction by the President of the Spanish Radiotherapy and Oncology Association, describing the situation of Radiotherapy Oncology today and offering a brief overview of the articles included in this monographic edition (AU)

Nuevos tratamientos contaminantes con radioterapia en tumoresmalignos

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La quimioterapia y la radioterapia neoadyuvante en el cáncer de recto incrementan las tasas de cirugía conservadora de esfínteres, sin aumentar la dificultad técnica de la intervención ni las complicaciones postoperatorias / Neoadjuvant chemotherapy and radiation therapy in rectal cancer increases the rate of sphincter conservation without increasing the technical difficulty of the intervention or postoperative complications

Introducción. La radioquimioterapia neoadyuvante en el cáncer de recto disminuye las recidivas locales y algunos autores comunican un aumento de la supervivencia, también se ha observado un aumento de la morbimortalidad postoperatoria. El objetivo de este estudio es analizar la dificultad operatoria y las complicaciones postoperatorias en los pacientes con radioquimioterapia preoperatoria. Pacientes y método. Se estudian 103 pacientes intervenidos de cáncer de recto entre enero de 1995 y diciembre de 1999, divididos en dos grupos: grupo A, formado por 53 pacientes sometidos a radioterapia preoperatoria con 45 Gy (1,8 Gy/día durante 25 días), junto a quimioterapia con 5-fluorouracilo y ácido folínico (la cirugía se realizó 4-6 semanas después de la finalización del tratamiento), y grupo B, compuesto por 50 pacientes con cáncer de recto a los que se practicó la cirugía tras el diagnóstico. Ambos grupos son homogéneos en los datos preoperatorios analizados. Se compara entre los dos grupos la dificultad técnica mediante datos intraoperatorios, así como la tasa de complicaciones. Resultados. No existen diferencias estadísticamente significativas entre los dos grupos en cuanto a los datos intraoperatorios ni postoperatorios evaluados. En el grupo A existen 20 complicaciones en 17 pacientes (32 por ciento), mientras que en el grupo B existen 22 complicaciones en 19 pacientes (38 por ciento). La tasa de infección de la herida perineal fue similar en los dos grupos: el 9,4 por ciento en el grupo A frente al 10 por ciento en el grupo B. El porcentaje de fugas anastomóticas fue mayor en el grupo A (5,7 por ciento) que en el grupo B (2 por ciento), diferencia sin significación estadística. En el grupo de radioquimioterapia se realizaron un mayor número de resecciones anteriores (75 por ciento) que en el grupo B (60 por ciento). Conclusión. El uso de la radioquimioterapia preoperatoria en el cáncer de recto no aumenta la incidencia de complicaciones postoperatorias y aumenta la tasa de cirugía conservadora de esfínteres (AU)