Selective hypersensitivity to boiled razor shell.

Many types of seafood require cooking before ingestion and it has been demonstrated that this cooking process may affect the antigenicity and allergenicity of the food. We describe a case of anaphylaxis caused by selective sensitization to razor shell, a mollusc. In vivo and in vitro studies confirmed sensitization to boiled razor shell. Analysis of the nature of the allergen yielded results that were consistent with the findings of other authors and suggested that allergens involved in seafood allergy are commonly high molecular weight proteins that, in most cases, are heat stable.

Rhinitis and asthma due to ranitidine.

Few reports exist on allergic reactions to ranitidine. We present a case of bronchospastic reaction to ranitidine occurred during a drug challenge test. After administration of a therapeutic dose of ranitidine, the patient showed dyspnea, cough and bronchospasm in all the lung fields. Personal respiratory background was negative for respiratory disease and asthma. On reviewing the literature we found no reports of bronchospastic reaction to ranitidine. Quickness and the clinical characteristics of the adverse reaction suggest a pathogenic mechanism of immediate-type hypersensitivity.

Allergy to cloxacillin with normal tolerance to amoxicillin and cefuroxime.

BACKGROUND: Cloxacillin is a semisynthetic penicillin widely used in nonmethicillin resistant Staphylococcus aureus infections. Several hypersensitivity reactions to cloxacillin have been reported, although IgE-mediated allergic reactions to the drug are rare and there is little information about possible tolerance to other semisynthetic penicillins or cephalosporins in patients with cloxacillin allergy. We present 2 patients with demonstrated IgE-mediated allergy to cloxacillin and tolerance to amoxicillin and cefuroxime. CASE REPORTS: Case 1. A 47-year-old woman began treatment with cloxacillin due to acute cellulitis. After ingesting 500 mg of the drug, she experience generalized maculopapular eruption and facial angioedema. Case 2. A 55-year-old woman presented an episode of acute urticaria and labial angioedema 60 minutes after ingesting 500 mg of cloxacillin for a skin abscess. METHODS AND RESULTS: Skin prick tests were positive to cloxacillin in case 1 and negative in case 2. However, an intradermal test was positive to cloxacillin (2 mg/ml) in case 2. Simple-blind oral challenge tests with amoxicillin (1 g) and cefuroxime (500 mg) were well-tolerated by both patients. CONCLUSIONS: We present 2 patients allergic to cloxacillin with normal tolerance to other betalactam antibiotics, confirming that cross-reactivity among these antibiotics seems to be uncommon. Complete allergy study, including an oral challenge test, should be considered in these patients.

Sensibilización al polen de Olea europaea en las diferentes comarcas de la provincia de Zamora / Pollen sensitization to Olea europaea in the different regions of Zamora province

La sensibilización al polen de olivo en la provincia de Zamora debería ser mínima debido a que el olivo, por sus características, no se adapta bien a las condiciones climáticas y a que se ha introducido recientemente en la mayoría de las zonas de la provincia como árbol ornamental. Hemos realizado un estudio retrospectivo descriptivo que ha observado una sensibilización llamativa al polen del olivo, que aumenta en las zonas urbanas

Sensitization to olive pollen should not be important in Zamora city and province because, due to its characteristics, this tree doesn´t adapt to weather conditions in the city and because it has been recently introduced in most of the province’s areas as an ornamental tree. We have performed a retrospective descriptive study observing a significant level of sensitization to olive pollen, which is growing in urban zones

Angioedema induced by inhalation of vapours from cooked white bean in a child.

BACKGROUND: There are few references of allergic reaction to beans in childhood. We report the case of a seven years old boy who suffered from angioedema associated to inhalation of vapours from cooked white bean. METHODS: skin prick tests (SPT) were performed by prick-by-prick with cooked white bean and legumes. It was also determined total IgE and specific IgE antibodies to bean and legumes with the use of the CAP enzymo-immunoassay. Subsequently, a oral challenge test was carried out with white bean. RESULTS: The prick-by-prick with white bean was positive in our case, and negative in ten controls patients. Specific IgE in patient serum, assayed by CAP was positive for white bean and green bean. The patient developed angioedema after ingestion cooked white bean. CONCLUSION: we demonstrated a type I hypersensitivity to white bean in a seven years old child by SPT, specific IgE antibodies and challenge test.

Fluorocytometric analysis of induced sputum cells in an asthmatic population.

BACKGROUND: Bronchial mucosal inflammation is the major pathogenic process in asthma. In the latest years, induced sputum (IS) examination has become an important non-invasive method of assessing airway inflammation. Flow cytometry has been recently applied to the study of IS though it is not exempt of methodological difficulties. The aim of the present study was to further study if the fluorocytometric analysis of IS could represent a reliable tool to assess the presence of bronchial activated lymphocytes in stable mild asthmatic patients. METHODS: Induced sputa from controls and asthmatic patients were processed in isotonic 3mM dithiothreitol (DTT), a mucolytic agent required for cell dispersion. The individualized cells were then stained with monoclonal antibodies for three-colour flow-cytometric analysis. Total IgE and ECP were measured in serum and in the sputum fluid phase. RESULTS: The cellularity of asthmatic sputa is enriched in eosinophils (mean, 26.63%) with respect to controls, but not in lymphocytes. However, lymphocytes from asthmatics show increased surface expression of activation markers (CD25 in T cells, CD23 in B cells). Surprisingly, no differences were observed in the detected levels of CD54 on IS lymphocytes and eosinophils between asthmatics and non-asthmatics. Furthermore, there was a significantly higher concentration of ECP and total IgE in the sputum from the asthmatic group. CONCLUSION: Fluorocytometric analysis of induced sputum is a reliable non-invasive method for the study of bronchial immune cells. It could provide complementary information on activated cells in the bronchial mucosa even in non-smokers, mild and stable asthmatics and it is reasonable to speculate that it will be useful in monitoring the effect of the treatment in these patients.

Churg-Strauss syndrome in a case of eosinophilia.

A number of allergic, infectious and idiopathic diseases are associated with an increased number of eosinophils in blood. We report the case of a woman who was referred to our outpatient clinic due to asthma that had first developed three months previously and papular rash. Laboratory investigations revealed eosinophilia (23 %; 2,162 cells/ml). An allergic cause was ruled out by anamnesis, skin prick-test and specific IgE determination. Another frequent cause of eosinophilia is infestation by parasitic helminths, but serologic studies and studies of parasites in feces were negative. Chest radiography and computed tomography scan revealed diffuse infiltrates. The diagnosis was confirmed by transbronchial and skin lesion biopsies. The patient was finally diagnosed with Churg-Strauss syndrome and was treated with oral corticosteroids. A delay in the diagnosis and treatment of this syndrome increases the risk of death from the complications of vasculitis. Because of the importance of an early diagnosis in this disease, its presence should be suspected in cases of eosinophilia after ruling out more frequent causes.

Anaphylaxis to oral furosemide.

Furosemide, one of the most used diuretic drugs, rarely induces type-1 allergic reactions It is included in the non-aromatic sulfonamides but a cross-reactivity mechanism between this group and the sulfonamides antibiotics, has not been clearly demonstrated. A 24-year-old woman, 10 minutes after the intake of one pill of Seguril 40mg experienced oral itching, generalized urticaria, facial angioedema, dyspnea and hypotension. She recovered after the administration of parental adrenaline, methyl-prednisolone and dyphenhydramine. An skin prick test with furosemide (10 mg/ml) was negative. The intradermal skin tests were positive to furosemide (1 %) as well as sulfamethoxazole (0.03 mg/ml), with 10 atopic and non-atopic negative controls. The patient rejected the performance of an oral challenge test with sulfamethoxazole. IgE-mediated reactions to furosemide are infrequent, but it could be the cause of life-threatening reactions. We have reported a case of anaphylaxis after the oral administration of furosemide with a demonstrated hypersensitivity mechanism through the positive intradermal skin test. The previous administration of the drug could probably the mechanism of sensitization, but the positive intradermal test to sulfamethoxazole would open the hypothesis of a cross-reactivity between non-aromatic and antimicrobial sulfonamides. It could be necessary an oral challenge test with furosemide in allergic patients to sulfamides.

Measurement of serum levels of eosinophil cationic protein in the diagnosis of acute gastrointestinal anisakiasis.

Thirty-two patients with abdominal pain and/or intestinal pseudo-obstruction who had consumed raw or undercooked fish in the previous 72 h, were included in a study of anisakiasis, a parasitation of the human gastrointestinal tract by third stage Anisakis simplex larvae. Skin prick test (SPT) against A. simplex were positive in all the patients. High median eosinophil cationic protein (ECP) serum concentrations (> 15 mg/L) at day 0 with normal serum levels at day 30 and a rise of median total and specific IgE against A. simplex at day 30, were observed. We conclude that a raised serum level of ECP in the first 72 h from the onset of symptoms coinciding with a positive SPT against A. simplex and high total and specific immunoglobulin (IgE) in the first month after the parasitation, could be a useful tool in the diagnosis of gastrointestinal anisakiasis, even if the parasite cannot be isolated.

[Angioedema due to sensitization to chicken meat]. / Angioedema por sensibilización a carne de gallina.

BACKGROUND: Egg is the most frequent cause of food allergy in children. The bird-egg syndrome, found in a group of patients sensitized to egg through bird proteins, was infrequent in children. We report a patient with former history of hypersensitivity to egg who developed episodes of angioedema after ingestion of hen meat. METHODS: Prick testing with egg and their different antigenic protein fractions, alpha-livetin and chicken meat was performed. Antigens of hen meat were used for the skin prick test and prick-by-prick. Serum-specific IgE was identified with use of the CAP techniques and SDS-PAGE Immunoblotting. RESULTS: Prick test was positive with egg yolk, alpha-livetin and chicken meat. A prick-by-prick test with hen meat resulted positive in our patient, but the same test in four controls patients were negative. Serum specific IgE was positive for egg yolk and hen meat. CONCLUSION: Allergy reactions to hen meat are exceptional. We report a case of children with allergy to egg proteins and hen meat that suggest an IgE mediated hypersensitivity reaction. Skin test reveal sensitivity to egg yolk and alpha-livetin, but this pattern of sensitization was infrequent in children.