Pancreatitis due to codeine.

Pancreatitis is a rare adverse effect of codeine. We report the case of a 42-year-old man who suffered from epigastric pain 1 hour after taking a tablet containing amoxicillin plus clavulanic acid (500/125 mg) and another tablet containing acetaminophen plus codeine (500/30 mg) for a respiratory infection. He was admitted to the emergency room and was treated with metamizol and pantoprazole. A few minutes after receiving intravenous doses of both drugs he developed a maculopapular and itching eruption with facial angioedema. Laboratory tests showed high levels of serum amylase, GOT, GPT and total bilirubin. Serological tests for several viruses showed no evidence of recent infection. Ultrasonography was negative for biliary lithiasis and showed only cholecystectomy performed in 2000. The patient was sent to our department where skin prick and oral challenge tests were performed with negative results. For ethical reasons, oral challenge with codeine was not carried out. We believe that our patient had codeine-induced pancreatitis. The most likely underlying pathophysiological mechanism was probably codeine-induced spasm of the sphincter of Oddi combined with sphincter of Oddi dysfunction related to a previous cholecystectomy. Allergy departments should be aware of possible non-immunological adverse.

Reacciones adversas producidas por vacunas infantiles / Adverse reactions to childhood vaccines

Las vacunas han cambiado la vida de millones de personas en el mundo. Enfermedades como la viruela han sido erradicadas, la poliomielitis está en camino de serlo y otras han disminuido drásticamente. La inmunización activa consiste en estimular al organismo para producir anticuerpos, mediante la administración de una vacuna, lo que origina una respuesta similar a la infección natural pero sin riesgo para el vacunado. Este artículo examina las reacciones adversas producidas tras la vacunación y en especial las reacciones de hipersensibilidad. La incidencia de algunas de ellas se aproxima a 1:100.000 sujetos vacunados. Estas reacciones por vacunas se pueden clasificar atendiendo a la causa que las induce en: reacciones debidas a la propia vacuna, idiosincrásicas, asociadas a errores de manipulación, almacenaje o administración y reacciones coincidentes con la vacunación. Como las vacunas consisten en una mezcla del microorganismo activo, antibióticos, conservantes, proteínas del medio de cultivo y aditivos, es fácil adivinar que tras la vacunación se pueden producir reacciones de hipersensibilidad. Las vacunas incluidas en el programa de vacunación son extraordinariamente seguras y eficaces. Por tanto, los niños que presenten alguna reacción adversa al recibir las vacunas, que normalmente son combinadas, deben someterse a un estudio antes de interrumpir su calendario de vacunación, ya que los efectos adversos que producen se presentan con una frecuencia muy baja. Las nuevas técnicas de biología y genética molecular abren un campo nuevo para la elaboración de vacunas. Las áreas más prometedoras son: la tecnología del ADN recombinante, la expresión controlada de genes y la síntesis de péptidos. Estas técnicas crearán vacunas nuevas y más seguras, lo que reducirá las reacciones adversas

Use of vaccines has altered life for millions of world´s citizens. Smallpox has been eradicated. Poliomyelitis is on the way to potential eradication and other childhood diseases have been dramatically reduced. Vaccination is an attempt to replace the natural primary contact with a safer artificial contact so that natural contact first takes place in the face of heightened immunity. This report examines adverse reactions to vaccines after immunization, specially hypersensitivity reactions. The incidence of some reactions may approximate 1:100.000 individual vaccinated. These reactions can be classified according to probable cause as vaccination-induced reactions (due to an effect of the vaccine itself or an idiosyncrasia), reactions associated with faulty production, storage or administration and coincidental reactions Because vaccines consist of mixture of the active agent, antibiotics, preservatives, culture medium proteins and other additives, it is not surprising that hypersensitivity reactions occur after vaccination. Vaccines currently used for routine preventive care in children are extraordinarily safe and effective. So children should not be excluded from the normal vaccine schedule when they suffer from a reaction after receipt of such a combination. So that a logical analysis has been performed due to adverse reactions occur at a very low frequency. It seems likely that advances in vaccines will occur through the application of molecular biology and, in particular, molecular genetics. The three most promising areas are recombinant DNA technology, controlled gene expression and synthetic peptide chemistry. These techniques will create new and safer vaccines and will reduce the possibility of adverse reactions to vaccines

Barnacle hypersensitivity.

BACKGROUND: the aim of the present study is to investigate the responsible mechanism of different adverse reactions suffered by five patients, aged between six and thirty years-old, after consumption of barnacle. The symptoms were angioedema, dyspnea, generalized urticaria, conjunctivitis and one of them suffered from anaphylactic reaction. Four patients had personal atopic history. METHODS: the allergic study included prick by prick test with raw and boiled barnacle and prick-test with a standardized battery of shellfish and neumoallergens, specific-IgE determination to barnacle, crustacean and house-dust-mite and SDS-PAGE immunoblotting to barnacle. Even though an oral challenge was proposed to three of the patients, they were reluctant to do the test and eventually the challenges were not carried out. RESULTS: prick to prick tests were positive to barnacle for all of them. Specific-IgE was found in four patients. The western blotting results showed an IgE-binding band whose apparent molecular mass ranged between 58 and 68 kDa. CONCLUSIONS: barnacle could induce IgE-mediated adverse reaction. Our study has demonstrated the presence of an IgE-binding protein in barnacle extracts ranged between 58 and 68 kDa of molecular mass. It has not been previously described a crustacean allergen with the same molecular mass, so it could be a specific allergen from barnacle. We believe that further study will confirm this is the case.

Baker's asthma in a child

Background: baker's asthma is a well-known occupational lung disease which usually develops in adults. We report the case of a two years old boy who suffered from asthma, urticaria and atopic dermatitis for twelve months, whose symptoms were associated to visits to his grandfather's bakery. Methods and results: skin prick tests (SPT) were made to dust mites, moulds, flours, alfa-amylase and egg. It was also determinated total IgE and specific IgE antibodies to alfa-amylase and flours. Subsequently, a challenge test was carried out with wheat flour. The SPTs were positive to flours, alfa-amylase and egg. The determination of specific IgE antibodies showed 2.64 kU/L to wheat, 0.79 kU/L to glyadin and 2.98 kU/L to alfa-amylase. The patient developed asthma and rhinitis after manipulating wheat flour for 10 min. Conclusions: we demonstrated a type I hypersensitivity to wheat flour and alfa-amylase in a two years old child by SPT, specific IgE antibodies and challenge test. This case in the childhood equivalent of occupational baker's asthma (AU)

Caso clínico: paciente varón que consultó a los 2 años de edad por cuadros de asma y dificultad respiratoria que los padres relacionaban con visitas a la panadería propiedad de los abuelos y en la que la madre trabaja habitualmente. El niño presenta desde los 4 meses de vida dermatitis atópica y urticaria tras ingestión de huevo desde su introducción en la dieta. El paciente tolera sin problemas harinas cocinadas en forma de pan, bollería y pastas. Los 15 primeros meses de vida el niño permaneció diariamente el cuidado de su madre en una habitación próxima al horno de pan. Material y métodos: se realizaron pruebas subcutáneas en prick test y se midió IgE total y específica por método CAP para harinas de trigo y otros cereales, alfa-amilasa, ácaros, hongos ambientales y alimentos. Se procedió a realizar provocación controlada en la consulta mediante exposición a harinas que el paciente manipuló durante unos minutos. Los prick tests resultaron positivos para harinas, alfa-amilasa y huevo y negativos para el resto de los inhalantes y alimentos. La IgE total fue de 244 kU/L, el CAP para trigo de 2,64 kU/L, para gliadina de 0,79 kU/L y para alfa-amilasa de 2,98 kU/L. Tras manipular una pequeña cantidad de harina el paciente presentó a los 10 min tos, leve disnea con sibilancias, rinitis con estornudos y rinorrea que cedieron espontáneamente tras retirar al paciente y tras el lavado de manos y cara. Se recomendó al paciente la evitación de contacto con harinas y se aconsejó no acudir a la panadería. El cuadro clínico ha mejorado con la excepción de urticaria y disnea por manipulación de harina en el curso de actividades escolares y alguna crisis ocasional tras visitar la casa de los abuelos situada sobre la panadería. Conclusiones: se ha demostrado por historia clínica, pruebas in vivo e in vitro y provocación por manipulación la existencia de una sensibilización medida por IgE a la harina y alfa-amilasa. Este cuadro constituye en la infancia el equivalente al asma ocupacional del panadero (AU)