Latex allergy: Position Paper.

Correct management of latex allergy is essential to ensure adequate care of patients who are allergic to latex, which is ubiquitous in the health care setting. In this Position Paper, the Latex Committee of the Spanish Society of Allergology and Clinical Immunology provides guidelines for the management of latex allergy.

Immunotherapy with a Phleum pratense allergen extract induces an immune response to a grass-mix allergen extract.

BACKGROUND: Grass pollen allergy is one of the most common allergies worldwide, and patients often show sensitization to an array of phylogenetically related species. OBJECTIVE: To determine the effect of specific immunotherapy (SIT) with Phleum pratense extract on induction of the immune response to a mixture composed of 5 grass pollen extracts. METHODS: Forty-six adult patients suffering from rhinitis and sensitized to a mix of grass pollen allergen extracts were randomized 3:1 to receive a short course of SIT with P. pratense or to an open control group without SIT. At baseline and after 3-4 months, we evaluated levels of specific immunoglobulin (Ig) E and IgG4, as well as the immediate and delayed cutaneous responses to the grass mix and P. pratense. IgG4 to Lolium perenne was also determined. RESULTS: Levels of IgE and IgG4 to grass mix and P. pratense increased significantly during treatment (P<.001). However, this increase was only significantly higher in the SIT group than in the control group for IgG4 (P<.001). The levels of IgG4 to Phl p 5 and Lol p 5 were highly correlated (r=0.99, P<.001). The immediate and delayed cutaneous responses were significantly diminished to both extracts after SIT (P<.001). CONCLUSIONS: Patients with rhinoconjunctivitis diagnosed using skin prick testing with a grass mix allergen extract and treated with a short course of SIT based on a single species P. pratense allergen extract are able to develop an immune response that targets not only the immunizing species, but also the grass mix allergen extract.

Allergy workup in immediate-type local reactions to glatiramer acetate.

Local reactions to glatiramer acetate are common, but few cases of hypersensitivity reaction have been reported. We present 3 patients with multiple sclerosis who suffered immediate-type local reactions after subcutaneous injection of glatiramer acetate. Skin prick test (SPT), intradermal test (IDT), and determination of immunoglobulin (Ig) E to glatiramer acetate were performed in patients and controls (enzyme-linked immunosorbent assay). The results of SPT were all negative. Those of IDT in controls were negative at concentrations below 200 microg/mL, but positive for patients 1, 2, and 3 at 2, 20, and 200 microg/mL, respectively. Serum IgE to glatiramer acetate in patient 1 was 2.1 times higher than in the controls, whereas no differences were found between controls and patients 2 and 3. Glatiramer acetate was safely reintroduced in patients 2 and 3. The results obtained for patient 1 suggest that an IgE-mediated mechanism was probably involved. In conclusion, IDT and serum IgE determination to glatiramer acetate seem useful for identifying allergic reactions among the common local reactions induced by this drug.

Urticaria caused by antihistamines: report of 5 cases.

Antihistamines are widely used drugs. Hypersensitivity reactions with these drugs are rare and a challenge for the physician. We describe 5 outpatients who experienced urticaria after taking antihistamines. All 5 were treated at our outpatient clinic over a period of 15 years. The allergy workup included a clinical history, skin prick testing, patch testing with antihistamines, and single-blind placebo-controlled oral challenge tests. Biopsy samples were taken and serum tryptase levels were determined in 1 patient. The results of the skin prick tests and patch tests were negative in all patients but 1, in whom the prick test result was positive to some antihistamines. We confirmed all diagnoses using a single-blind challenge test. The biopsy obtained from 1 patient strongly supported urticaria. We present 5 cases of antihistamine-induced urticaria where the immunologic mechanism remains unclear. Hypersensitivity reactions should be taken into account in patients receiving antihistamines, especially in those who experience urticaria.

Interrelationship between skin sensitization, rhinitis, and asthma in patients with allergic rhinitis: a study of Spain and Portugal.

OBJECTIVE: Allergic rhinitis can determine the presence and type of asthma. The main aim of this study was to evaluate the link between allergic rhinitis, asthma, and skin test sensitization in patients with allergic rhinitis. METHODS: Patients with allergic rhinitis, aged 10 to 50 years, were consecutively enrolled at different allergy centers in Spain and Portugal. All the patients underwent skin prick tests with a panel of 20 biologically standardized aeroallergens. Allergic rhinitis was classified according to etiology and the Allergic Rhinitis and its Impact on Asthma guidelines and asthma was classified according to the Global Initiative for Asthma guidelines. RESULTS: A total of 3225 patients, with a mean age of 27 years, were evaluated. House dust mites and grass and olive tree pollens were the most common aeroallergens. The mean (SD) number of positive skin tests per patient was 6.5 (4), the mean wheal size was 42.3 (28) mm2, and the mean atopy index was 6.5 (2). Forty-nine percent of the patients had concomitant asthma. Asthma severity was associated with a longer time since onset (P < .04) and allergic rhinitis severity (P < .001). Patients with concomitant asthma had a significantly higher number of aeroallergens and sensitization intensity than those without asthma (P < .001). CONCLUSIONS: In this broad population sample, the presence and type of asthma was influenced by skin sensitization and both time since onset and severity of allergic rhinitis.

Reproducibility of delayed-type reactions to betalactams.

BACKGROUND: Delayed reactions with betalactam antibiotics are a very common reason for consultation and a matter of numerous publications. OBJECTIVE: To demonstrate that delayed reactions occurring during treatment with betalactam antibiotics are not reproduced in a high percentage of the patients, when making drug challenge. To analyse the characteristics of people showing this type of reaction. METHODS: We included in our study all the patients who came to our Allergy Department during one year (2004), with a clinical history of delayed reaction (> 72h) to betalactams. Skin prick tests (SPT), intradermal tests (IT) and patch tests were carried out, followed by simple blind placebo controlled drug challenge (SBPCDC) at hospital and home treatment with betalactams. RESULTS: We studied 23 patients (12 men and 11 women), average age 23.4 years old. SPT and patch test were negative in all patients. Only one patient showed positive IT tests, and allergic reaction was only reproduced in two patients; 76 % tolerated the drug involved in supposed allergy. CONCLUSIONS: Simple blind oral challenge with implicated drug followed by home treatment is required for a conclusive diagnosis of allergy in patients with delayed reactions to betalactams.

[Tolerance to celecoxib and meloxicam in patients with intolerance to nonsteroidal anti-inflammatory drugs]. / Tolerancia a celecoxib y meloxicam en pacientes con intolerancia a analgésicos no esteroideos.

INTRODUCTION: Hypersensitive reactions to analgesics in the general population are less than 1%. Previous studies have demonstrated that cyclooxigenase 2 (COX-2) inhibitors are an efficient alternative in patients with non-steroidal anti-inflammatory drugs (NSAIDs) intolerance. The aim of our study is to test the tolerance to celecoxib and meloxicam in patients with NSAIDs intolerance, upto dosages higher than those used in previous studies. MATERIAL AND METHODS: The subjects of the study were 38 NSAID-sensitive patients from September 2004 to June 2005. The diagnosis of intolerance to NSAIDs was carried out by means of single-blind placebo-controlled oral challenge with aspirin. We performed single-blind placebo controlled oral challenge tests with celecoxib (accumulated dose of 400 mg) and meloxicam (accumulated dose of 15 mg). RESULTS: There was only one reaction with celecoxib (97.3%) which was generalised urticaria after the dose of 400 mg accumulated, it should be pointed out that this patient tolerated perfectly the dose of 200 mg. For meloxicam, we found 100% tolerance at a dosage of 15 mg, including the patient who showed a reaction to the celecoxib. CONCLUSION: We consider that there are patients with tolerance to low dosages of COX-2 inhibitors who show a reaction on increasing the administered dosage, which means that their tolerance should be taken into account and checked in the long term.

Tolerancia a celecoxib y meloxicam en pacientes con intolerancia a analgésicos no esteroideos / Tolerance to celecoxib and meloxicam in patients with intolerance to nonsteroidal anti-inflammatory drugs

Introducción: Las reacciones de hipersensibilidad a analgésicos en la población general son menores del 1%. En estudios previos se ha comprobado que los inhibidores de la ciclo-oxigenasa 2 (COX-2) son una alternativa eficaz en pacientes con intolerancia a antiinflamatorios no esteroideos (AINES). El objetivo de nuestro estudio es comprobar la tolerancia en pacientes diagnosticados de intolerancia a AINES a celecoxib y meloxicam, hasta dosis superiores a las utilizadas en estudios previos. Material y métodos: Los sujetos del estudio son 38 pacientes diagnosticados en nuestro Servicio de Alergia del Hospital Clínico San Carlos de intolerancia a AINES desde el mes de septiembre de 2004 a junio de 2005. El diagnóstico de intolerancia a AINES se había realizado mediante POSCCP (provocación oral simple ciego controlada con placebo) con AAS según protocolo de nuestro servicio. Se llevaron a cabo POSCCP con celecoxib hasta una dosis acumulada de 400 mg y meloxicam hasta una dosis acumulada de 15 mg. Resultados: Sólo se presentó una reacción con celecoxib que consistió en urticaria generalizada tras la toma de 400 mg acumulados. Este paciente había tolerado previamente una dosis de 200 mg. Con respecto al meloxicam, encontramos una tolerancia del 100%, incluyendo el paciente que presentó reacción con celecoxib. Conclusiones: Consideramos que al existir pacientes con tolerancia a dosis bajas de los inhibidores de la COX-2 que presentan reacción al elevar la dosis administrada, se debería comprobar la tolerancia de estos fármacos a largo plazo

Introduction: Hypersensitive reactions to analgesics in the general population are less than 1%. Previous studies have demonstrated that cyclooxigenase 2 (COX-2) inhibitors are an efficient alternative in patients with non-steroidal anti-inflammatory drugs (NSAIDs) intolerance.The aim of our study is to test the tolerance to celecoxib andmeloxicam in patients with NSAIDs intolerance, upto dosages higherthan those used in previous studies. Material and methods: The subjects of the study were 38 NSAID-sensitive patients from September 2004 to June 2005. The diagnosis of intolerance to NSAIDs was carried out by means of single-blind placebo-controlled oral challenge with aspirin. We performed single-blind placebo controlled oral challenge tests with celecoxib (accumulated dose of 400 mg) and meloxicam (accumulated dose of 15 mg). Results: There was only one reaction with celecoxib (97.3%) which was generalised urticaria after the dose of 400 mg accumulated, it should be pointed out that this patient tolerated perfectly the dose of 200 mg. For meloxicam, we found 100% tolerance at a dosage of 15 mg, including the patient who showed a reaction to the celecoxib. Conclusion: We consider that there are patients with tolerance to low dosages of COX-2 inhibitors who show a reaction on increasing the administered dosage, which means that their tolerance should be taken into account and checked in the long term

[Anaphylaxis after carrying out prick tests]. / Anafilaxia tras realización de pruebas cutáneas en prick.

The skin prick test (SPT) is a simple and fast method used routinely in allergology practice. Systemic reactions have been described with this technique on few occasions. We are presenting a case of anaphylaxis with hemodynamic consequences after carrying out skin prick test with a cat dander extract. A 23 years old female who suffered rhinoconjunctivitis and asthma following contact with cats. We performed skin prick test with a battery of the usual inhalants. Twenty minutes after carrying out the prick test the patient showed intense ocular irritation and reddening followed by dysphonia and a feeling of pharyngeal occupation. Although skin prick test is a safe diagnostic approach, it should be performed only in places equipped to treat anaphylaxis and for trained specialists .

Fixed exanthema from systemic tobramycin.

Eye drops contain several ophthalmic medications which can produce allergic reactions. We report the case of a patient with contact dermatitis from neomycin and a probable fixed exanthema after parenteral administration of tobramycin who tolerated topical tobramycin and other aminoglycosides.

Iberian study of aeroallergens sensitisation in allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a prevalent allergic disease in Iberian countries, but there are no recent epidemiological studies that characterize this pathology according to clinical classification and aeroallergens sensitisation. This is a clinical study, representative of each country METHODS: Descriptive, observational cross-sectional, population-based study carried-out in Portugal and Spain. 3397 consecutive patients (5 regions in Spain and 3 regions in Portugal) were selected for clinical observation and skin prick tests were carried out using the same panel of standardized aeroallergens. RESULTS: 3225 patients (aged 10-50 years old) completed the study (IC 95%, SE 15). Intermittent rhinitis makes up 36% of the entire sample. Of them, intermittent AR mild forms represented 82% in Spain and 92% in Portugal that is, 87% for Iberian countries. Persistent types of rhinitis showed exactly the same rate of severity in Portugal and Spain, 44% mild and 56% moderate/severe. Seasonal forms represent 37% while 63% were perennial. BA was present in 49% of AR patients. There were significant differences between aeroallergens according to the different regions considered. Mites and grass pollens are the most relevant aeroallergens in Spanish and Portuguese AR patients, while Alternaria showed higher positive rates among 10-20 year old patients. CONCLUSIONS: This study characterizes the AR patients in Iberian countries according to the ARIA classification. No correlation was observed between this classification and the conventional (seasonal/perennial). Our results also characterize the allergic cutaneous pattern of aeroallergen sensitisation using the same panel of standardized allergens and show differences between the different regions analysed.

Occupational asthma due to acrylates in a graphic arts worker.

BACKGROUND: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. MATERIAL AND METHODS: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. RESULTS: The PEF improved on weekends and sick leave. The challenge test provoked a late asthmatic response and the non-specific bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount.

Occupational asthma due to acrylates in a graphic arts worker / Asma ocupacional por acrilatos en un trabajador de artes gráficas

Background: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. Material and methods: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. Results: The PEF improved on weekends and sick leave. The challenge test provoked a late astmatic response and the non-specifc bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount

Antecedentes: Los acrilatos se usan en una amplia variedad de productos, como solventes, adhesivos, pinturas, tinta de imprenta, lentes de contacto blandas y uñas de porcelana, mientras que los metacrilatos los usan dentistas y ortopedas. Hay varios tipos de compuestos acrílicos: acrilatos, cianoacrilatos (como adhesivos de tejidos y pegamentos de uso doméstico), así como de metacrilatos usados en prótesis dentales y rellenos ortopédicos. Los mecanismos de sensibilización se desconocen, pero se piensa que la reacción alérgica no está mediada por IgE, ya que la reacción asmática se produce tardíamente. Hay publicados varios casos de asma inducida por acrilato, especialmente en dentistas y personas que usan colas o pinturas que contienen esas sustancias. Material y métodos: Se presenta el caso de un varón de 52 años de edad que había trabajado en artes gráficas en los últimos 7 años. En los dos últimos años había presentado tos persistente con sensación de ahogo, disnea que aumentaba con el ejercicio moderado y obstrucción nasal, a pesar del tratamiento continuado. Los síntomas aparecieron primero tras un episodio agudo de dificultad respiratoria asociada con pérdida de peso, infiltrados pulmonares y eosinofilia. El flujo espiratorio punta (PEF) se midió durante el trabajo y los días de baja laboral. Se llevó a cabo prueba de provocación con acrilatos en cámara bronquial. Resultados: El PEF mejoró en los fines de semana y los días de baja laboral. El test de provocación dio lugar a una crisis de asma tardía. Después de la prueba, aumentó la hiperreactividad bronquial no específica. Al mismo tiempo, en las muestras de esputo se constató un aumento del contenido en eosinófilos

Inducción de tolerancia en la hipersensibilidad a mesalazina (5-ASA) / Inductionof tolerance in hypersensitivity to mesalazine (5-ASA)

La mesalazina es un derivado del ácido 5-aminosalicílico (5-ASA, el cual es útil en el tratamiento de la enfermedad inflamatoria intestinal. La sulfasalazina está formada por dos partes, la sulfapiridina y el 5-ASA, siendo ésta última la parte activa de la molécula. Los nuevos preparados derivados del 5-ASA se desarrollaron tratando de evitar los efectos secundarios tradicionalmente asociados a la sulfapiridina, aunque se siguen observando y aparecen nuevos efectos. Presentamos dos casos, el primero es un varón diagnosticado de enfermedad inflamatoria intestinal, con antecedentes de dos reacciones previas de urticaria y angioedema tras ácido acetilsalicílico, que presenta urticaria tras la toma de mesalazina. El segundo presenta urticaria generalizada tras tres meses de iniciar tratamiento con mesalazina. Dada la necesidad de tratamiento en ambos casos, se realiza el protocolo de desensibilización a mesalazina desarrollado en 17 días en nuestro servicio, con el que se llega a la tolerancia de dicho fármaco hasta dosis terapéuticas. Ante pacientes con hipersensibilidad a distintos fármacos, que sean necesarios para el tratamiento de su patología, pueden realizarse pautas de “desensibilización”, que aseguren una buena tolerancia

Mesalazine is a derivative of 5-aminosalicylic acid (5-ASA), which is useful in the treatment of intestinal inflammatory disease. Sulfasalazine is formed by two parts, sulfapyridine and 5-ASA, the latter being the active part of the molecule. The new preparatives derived from 5-ASA were developed in an attempt to avoid the traditionally associated side effects to sulfapyridine, although they are still observed and new effects appear. We present two cases. The first is a man diagnosed of inflammatory intestinal disease, with background of two previous reactions of urticaria and angioedema after acetyl salicylic acid, who presented urticaria after taking mesalazine. The second one had generalized urticaria after three months of initiating treatment with mesalazine. Given the need for treatment in both cases, a desensitization protocol to mesalazine was made. It was developed in 17 days in our service. Tolerance to that drug to therapeutic doses is reached. When faced with patients with hypersensitivity to different drugs, that are necessary to treat their disease, “desensitization” regimes, that assure good tolerance, can be made

Rupatadine 10 mg and cetirizine 10 mg in seasonal allergic rhinitis: a randomised, double-blind parallel study.

This randomised, double-blind, parallel-group, multicentre clinical trial evaluated the efficacy and safety of rupatadine, a new antihistamine with antiplatelet-activating factor (PAF) activity, and cetirizine in the treatment of patients with seasonal allergic rhinitis (SAR). A total 249 patients were randomised to receive rupatadine 10 mg once daily (127 patients) or cetirizine 10 mg (122 patients) for two weeks. The main efficacy variable was the mean total daily symptom score (mTDSS) and was based on the daily subjective assessment of the severity of each rhinitis symptom--nasal (runny nose, sneezing, nasal itching and nasal obstruction) and non-nasal (conjunctival itching, tearing, and pharyngeal itching)--recorded by patients in their diaries. The mTDSS was 0.7 for both treatment groups (intention to treat analysis). In the investigator's global evaluation of efficacy at the seventh day, 93.3% and 83.7% patients in the rupatadine and cetirizine groups, respectively, showed some or great improvement (p = 0.022). In the per protocol analysis (n = 181), runny nose at the seventh day of treatment was absent or mild in 81.1% of patients in the rupatadine group and in 68.6% of patients in the cetirizine group (p = 0.029). In any case statistical significance was not maintained at the second week. Overall, all treatments were well tolerated. Adverse events (AEs) were similar in both treatment groups, i.e. headache, somnolence and fatigue/asthenia as the most often reported. Somnolence was reported in 9.6% and 8.5% of patients treated with rupatadine or cetirizine, respectively. The most reported AEs (67%) were mild in intensity. Our results suggest that rupatadine 10 mg may be a valuable and safe alternative for the symptomatic treatment of SAR.

Probióticos: ¿fantasía o realidad? / Probiotics: fantasy or reality?

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