Gestión técnica de una unidad de inmunoterapia / Technical gestion in the immunotherapy unit

Antecedentes y objetivos: La administración de inmunoterapia (IT) por vía subcutánea es un tratamiento no exento de riesgos, por lo que su administración debe llevarse a cabo siguiendo estrictos protocolos de actuación. El objetivo del estudio es establecer los criterios de monitorización de los pacientes en una Unidad de Inmunoterapia para reducir el riesgo de aparición de reacciones adversas. Material y métodos: Un total de 378 pacientes diagnosticados de rinitis y/o asma por sensibilización a distintos aeroalergenos (ácaros, pólenes, epitelios y hongos) fueron atendidos en nuestra Unidad durante un período de 15 meses. Todos ellos fueron tratados con extractos estandarizados biológicamente. La monitorización de los enfermos se llevó a cabo con la ayuda de un programa informático (InmunoWin®). Resultados: Se administraron un total de 4.383 dosis. Aparecieron un total de 34 reacciones adversas (0,8 por ciento), de las cuales sólo una fue sistémica (0,02 por ciento). Ésta consistió en un broncoespasmo leve, que se controló inmediatamente. Conclusiones: La correcta monitorización de los pacientes, en la cual la informática juega un papel destacado, en el momento en el que se les administra una dosis de IT, reduce drásticamente el porcentaje de reacciones sistémicas y se demuestra que la IT es un tratamiento seguro cuando se administra bajo las debidas condiciones (AU)

Influence in the quality of life of the respiratory patients by environmental control and the acaricide Frontac®.

The present prospective, open, observational study assessed the effect of the use of standard environmental control measures together with the application of an acaricide-containing aerosol of esbiol/benzyl benzoate/piperonyl butoxide/2-phenylphenol (Frontac) on several clinical and environmental parameters in patients suffering from perennial allergic rhinoconjunctivitis related to house dust mites (HDM). Fifty-five patients were enrolled and studied for one year. Both symptoms and the patients' quality of life (evaluated by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)) were assessed at several clinic visits. The amount of HDM antigen was semi-quantitatively estimated using the guanine test. We found a significant decrease (p < 0.001) in most nasal symptoms scores: sneezing, runny nose, stuffy nose and itching. The overall quality of life (QoL) score also showed a significant improvement during the study period; the mean score decrease found was 0.86 (CI 95 %, 0.54-1.17) (p < 0.001). Five of the seven domains included in the questionnaire decreased significantly: non-hayfever symptoms; practical problems; nasal symptoms; eye symptoms, and emotions. These QoL score decreases were found during the first 3 months and later remained stable at lower levels than at baseline. The content of guanine in dust samples decreased significantly from 2.17 0.75 to 1.43 0.68 (p < 0.001). No toxic adverse events were recorded. In conclusion, these results show an improvement in the quality of life and a clinical benefit of the long-term use of the new chemical acaricide tested, together with environmental measures, in the home of patients suffering from allergic respiratory pathology.

Influence in the quality of life of the respiratory patients by environmental control and the acaricide Frontac®

The present prospective, open, observational study assessed the effect of the use of standard environmental control measures together with the application of an acaricide-containing aerosol of esbiol/benzyl benzoate/piperonyl butoxide/2-phenylphenol (Frontac®) on several clinical and environmental parameters in patients suffering from perennial allergic rhinoconjunctivitis related to house dust mites (HDM). Fifty-five patients were enrolled and studied for one year. Both symptoms and the patients' quality of life (evaluated by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)) were assessed at several clinic visits. The amount of HDM antigen was semi-quantitatively estimated using the guanine test. We found a significant decrease (p < 0.001) in most nasal symptoms scores: sneezing, runny nose, stuffy nose and itching. The overall quality of life (QoL) score also showed a significant improvement during the study period; the mean score decrease found was 0.86 (CI 95 %, 0.54-1.17) (p < 0.001). Five of the seven domains included in the questionnaire decreased significantly: non-hayfever symptoms; practical problems; nasal symptoms; eye symptoms, and emotions. These QoL score decreases were found during the first 3 months and later remained stable at lower levels than at baseline. The content of guanine in dust samples decreased significantly from 2.17 ± 0.75 to 1.43 ± 0.68 (p < 0.001). No toxic adverse events were recorded. In conclusion, these results show an improvement in the quality of life and a clinical benefit of the long-term use of the new chemical acaricide tested, together with environmental measures, in the home of patients suffering from allergic respiratory pathology (AU)

El estudio se realizó de manera prospectiva, abierta y observacional para valorar el efecto de las normas habituales de control ambiental de forma conjunta con la aplicación de un acaricida en aerosol de esbiol/bencil benzoato/piperonil/butóxido/2-fenilfenol (Frontac®) en pacientes afectos de rinoconjuntivitis perenne relacionada con sensibilización a ácaros del polvo doméstico. Cincuenta y cinco pacientes fueron incluidos y estudiados durante un año. Se procedió a tabular la calidad de vida de los pacientes mediante el cuestionario de calidad de vida para pacientes con rinoconjuntivitis. Los niveles de ácaros domésticos fueron evaluados de forma semicuantitiva mediante el test de guanina. Encontramos un significativo descenso (p < 0,001) en la mayoría de los registros de los síntomas nasales: estornudos, rinorrea, prurito nasal y obstrucción nasal. El registro del cuestionario de la calidad de vida también constató una significativa mejoría durante dicho periodo, siendo el descenso de la media del registro del 0,86 (IC 95 %, 0,54-1,17) (p < 0,001). Cinco de los siete ítems incluidos en el registro disminuyeron significativamente (síntomas respiratorios, problemas sociales, síntomas nasales, síntomas conjuntivales y síntomas afectivos). El registro del cuestionario descendió durante los primeros tres meses y se mantuvo con posterioridad por debajo de los valores basales de forma estable. El contenido de guanina de las muestras del polvo del habitat de los pacientes disminuyó significativamente de 2,17 ± 0,75 a 1,43 ± 0,68 (p < 0,001). No se detectaron reacciones tóxicas adversas. En conclusión, estos resultados demuestran una mejoría de la calidad de vida y mejoría clínica utilizando a largo plazo la aplicación del nuevo acaricida testado de forma conjunta con la aplicación de medidas ambientales del habitat de los pacientes que sufren enfermedad respiratoria alérgica (AU)

Inmunoterapia sublingual con un extracto de Dermatophagoides pteronyssinus valorado en unidades de masa: evaluación del grado de cumplimiento, seguridad y mejoría clínica / Sublingual immunotherapy with a Dermatophagoides pteronyssinus extract in mass units: assessment of efficacy, safety and degree of compliance

Fundamento: El uso de vacunas alergénica administradas por vía sublingual (SLIT) e cada vez mayor. y con numerosos los estudios en los que e demuestra su eficacia y seguridad. El objetivo del presente estudio era establecer, en dos grupos de pacientes (niños y adultos) con enfermedad alérgica respiratoria por sensibilización a Dermatophagoides pteronyssinus, además de los dos parámetros anteriores, el grado de cumplimiento de los pacientes hacia el tratamiento. Métodos: Se analizó la evolución clínica de los pacientes tras 1 año de tratamiento, mediante puntuación de síntomas y medicación. El grado de cumplimiento e valoró correlacionando el cumplimiento del estudio con un cuestionario que contenía un juicio crítico del paciente respecto a SLIT. Resultados: El 84% de los pacientes e encontró mejor o mucho mejor al finalizar el año de tratamiento: se encontraron diferencias estadísticamente significativas en lo síntomas nasales, oculares. Síntomas totales y puntuación del conjunto de Síntomas y medicación. El porcentaje de reacciones sistémicas por do i fue de 0,3. El grado de cumplimiento del protocolo fue bueno o muy bueno en el 72% de los paciente; en estos paciente la correlación entre este parámetro y la existencia de un juicio crítico positivo fue significativa. Conclusión: Las vacunas alergénicas administradas por vía sublingual han demostrado ser un tratamiento seguro y eficaz. Se ha objetivado en lo paciente un alto grado de cumplimiento hacia esta forma de inmunoterapia (AU)

Background: Allergenic vaccines administered by sublingual route (SLIT) are being increase ingly ued in clinical practice, being their efficacy and safety well documented. The aim of this study was lo assess both parameters in two groups of parients, adults and children, unitized to a perennial allergen (D. pteronyssinus), and to establi h the degree of compliance of treatment. Methods: Syrnptorns and medication score was measured before end after 1 year of treatment. The degree of cornpliance was evaluared through correlarion between the compliance of protocol and a questionnaire based on the critica! opinion towards SLIT. Results: Most of patients (84C/t) were better or much better after J year of treatment. Statistical differences were found in ocular.na al and total symptoms score, a well as in total (symptoms plus medication) score. The percentage of systemic reactions was 0.3. The degree of protocol compliance was good or very good in 72% of patients. existing in these patients a significant correlation between this parameter and a positive opinion towards SLIT. Conclusion: SLIT is an effective and well tolerated treatment, showing the patients a high degree of compliance (AU)

Occupational allergy caused by cow dander: detection and identification of the allergenic fractions.

We describe two cases involving cow farmers, both males, one aged 28 and the other 45, who attended our center because his presented symptoms of rhinoconjunctivitis and asthma with 18 months and 4 year of evolution respectively, related to this laboral environment. The study included the following tests: skin tests (prick tests) to inhalant allergens (mites, pollens, moulds, dog and cat epithelium), foods, cow epithelium-dander, cow serum, beef and milk proteins. We determined the total seric IgE, specific IgE (RAST-CAP System) to cow meat and cow dander. Nasal provocation test with freeze-dried biological standardized extract of cow epithelium-dander were carried out. We observed the symptoms and realized control with a previous active computerized rhinomanometry. Cow dander proteins used for the provocation test were separated by means of SDS-PAGE or isoelectric focusing (IEF). The allergenic component were identified by immunoblotting with the patients' serum. The skin tests were positive to cow dander, and negative to the other allergens tested, including cow serum, cow milk and beef. The seric IgE were 383 and 477 kU/L, and the RAST was positive to cow dander, 20.10 and 36.4 kU/L (class 4). The provocation test were positive with a concentration of 500 SBU. We observed that the IgE of the two patients reacted with the same allergens: 3 major bands were identified with MW of 11, 15, 62.3 kDa. All these bands correspond to protein with acid pl.

[Sensitivity and specificity of the determination of IgE using chemiluminescence (CLA allergy test)]. / Estudio de la especificidad y sensibilidad de la determinación de la IgE mediante quimioluminiscencia (CLA allergy test).

We studied 80 patients. All patients underwent a thorough clinical evaluation, including a comprehensive study and physical examination of the ear, nose, throat and chest. Each patient underwent prick testing and a nasal provocation test. In addition, blood was drawn for the allergen-specific IgE test (RAST) and total serum IgE levels. We selected 11 allergens for this study: grass (Dactylis glomerata-orchard grass, Phelum pratense-Timothy grass, Lolium-raygrass), weeds (Chenipodium, Parietaria), tree (European olive), dog, cat, mites (D. pteronyssinus, D. farinae) and mould (Alternaria). To evaluate the efficiency, specificity and sensitivity of this method, test results obtained in our centre were compared to the clinical standard. Sensitivity is related to the lowest concentration of specific IgE detected by test method. Specificity is related to the antibody test's ability to detect the specific substance being measured without interference from related molecules. Chemiluminescent assay system (CLA) demonstrated a good balance between sensitivity and specificity and was consistent for the following allergens: D. pteronyssinus, D. farinae, Parietaria pollen and Gramineae pollena.

Dried fruit hypersensitivity and its correlation with pollen allergy.

A group of 102 patients (children and adults) with hypersensitivity to dried fruits and dermo-respiratory pathology underwent "in vivo" tests (skin tests) and "in vitro" tests (histamine release test, specific IgE) using a battery of foods and neumoallergens. We assessed immunoglobulin (IgG, IgA, IgM, IgE) levels as well as the complement (CH50), its components (C3, C4) and the possible presence of circulating immune complexes. Of the dried fruits the almond was the most sensitizing (89%, 87% and 68% of correlation between the clinical history and "in vivo" tests--skin tests--and "in vitro" tests--histamine release test and RAST--, respectively). As regards the other sensitizations, a hypersensitivity to peach was detected in 47% of the cases. As for the association between food allergy and pollen hypersensitivity, the highest percentages were for tree pollen (51%) followed by weeds (27%) and grasses (25%). The complement values did not show significant differences when they were compared with the control population. The statistical study correlating the clinical history with the results of the diagnostic methods--agreements between two or three tests--was positive (p greater than 0.05) for almond and peanut whereas it was negative (p less than 0.005) for hazelnut.

Evaluation of immune parameters (including specific IgG4) during immunotherapy.

A group of 26 patients with allergic asthma and rhinitis, exclusively sensitized to house dust and mites, underwent immunotherapy with an extract of Dermatophagoides pteronyssinus (Allpyral) for a period of 36 months. Every 6 months we carried out a clinical examination and assessed IgE levels, specific IgE to house dust and mites, histamine release curve to house dust and mites, CD3+ CD4+ CD8+ lymphocyte subpopulations, anti-Dermatophagoides pteronyssinus specific IgG and anti-Dermatophagoides pteronyssinus specific IgG4. The results did not show any significant differences in the IgE levels pre therapy and those monitored every 6 months. However, the anti-Dermatophagoides pteronys-sinus specific IgE generally registered a decrease during hyposensitization when compared with the levels obtained before the therapy. The histamine release curve to house dust and mites registered superior histamine release percentages pre immunotherapy to those obtained after 36 months of treatment. The T subpopulations did not show any statistically significant differences at any of the times they were monitored. The assessment of anti-Dermatophagoides pteronyssinus specific IgG did not yield any significant differences in the levels pre, during or at the end of the hyposensitizing period. The study of the levels of anti-Dermatophagoides pteronyssinus specific IgG4 showed a mean overall increase between 6 and 24 months of immunotherapy. When separately comparing these increases in specific IgG, with the clinical course no relationship was found between the increase in these antibodies and levels of the "in vivo" assessment scale.(ABSTRACT TRUNCATED AT 250 WORDS)