[A drink with an unexpected ending... Adverse reaction by tonic water: A case report]. / Una copa con final inesperado... Reacción adversa por agua tónica: reporte de un caso.

BACKGROUND: Quinine is an alkaloid with antipyretic and anti-infective properties, and also an ingredient in tonic waters. Adverse reactions have been reported with this product, such as photosensitivity, vasculitis, and contact dermatitis. CASE REPORT: A 31-year-old male patient who, after 3-4 hours of consuming "Schweppes®" gin with tonic water, manifested ulcers on the lips and oral cavity, and a fixed erythematous lesion on the second phalanx of the hand, 24 hours later. Skin tests with aeroallergens and food were negative, and 48-hour patch tests were positive (quinine [++] and "Schweppes®" [++]). Based on the test findings, the diagnosis of an adverse reaction to quinine, contained in the tonic water, will be established. CONCLUSIONS: Quinine can be found in other types of foods or medications, so it is important to establish an accurate diagnosis and offer adequate recommendations to the patient with the consumption of this product.

ANTECEDENTES: La quinina es un alcaloide con propiedades antipiréticas, antiinfecciosas y, además, un ingrediente del agua tónica. Se han descrito reacciones adversas con este producto, como fotosensibilidad, vasculitis y dermatitis de contacto. REPORTE DE CASO: Paciente masculino de 31 años, que luego de 3-4 horas de consumir ginebra con agua tónica "Schweppes®" manifestó úlceras en los labios y la cavidad bucal, y una lesión eritematosa fija en la segunda falange de la mano, 24 horas después. Las pruebas cutáneas con aeroalérgenos y alimentos resultaron negativas, y las pruebas epicutáneas de 48 horas positivas (quinina [++] y "Schweppes®" [++]). Con base en los hallazgos de las pruebas, se estableció el diagnóstico de reacción adversa por quinina, contenida en el agua tónica. CONCLUSIÓN: La quinina puede encontrarse en diferentes alimentos o medicamentos, por lo que es importante establecer el diagnóstico preciso y ofrecer recomendaciones adecuadas por el consumo de este producto.

[Contact dermatitis caused by diagnostic devices and surgical orthopedic treatment]. / Dermatitis de contacto causada por dispositivos de diagnóstico y tratamiento quirúrgico ortopédico.

BACKGROUND: Acrylates are plastic materials that are formed by the polymerization of monomers that are derived from acrylic or methacrylic acid; they have a wide range of applications, and they are increasingly used in medicine. CASE REPORT: We are reporting two clinical cases of contact dermatitis in the hospital environment; the first one is about a nurse (occupational exposure) and, the second one, about a patient who experienced contact dermatitis after a diagnostic procedure was performed. CONCLUSION: New sources of acrylates are identified every year due to the multiple uses of these synthetic resins; these materials are included in medical devices, both for orthopedic diagnosis or follow-up (telemetry, electrodes of electroencephalographs) and treatment (bone cement), as well as for surgery.

Antecedentes: Los acrilatos son materiales plásticos que se forman por la polimerización de monómeros derivados del ácido acrílico o metacrílico; tienen una amplia gama de aplicaciones y cada vez son más usados en el campo de la medicina. Casos clínicos: Presentamos dos casos clínicos de dermatitis de contacto en el entorno hospitalario: el primero se trata de una enfermera (exposición ocupacional) y el segundo, de un paciente a quien se le realizó un procedimiento diagnóstico. Conclusión: Cada año se identifican nuevas fuentes de acrilatos debido a las múltiples utilidades de estas resinas sintéticas; estos materiales se incluyen en dispositivos médicos, tanto para el diagnóstico o seguimiento (telemetría, electrodos de electroencefalógrafos) como para el tratamiento (cemento óseo) y cirugía ortopédica.

Occupational Allergic Respiratory Disease and Eosinophilic Esophagitis by Wheat Flour in a Baker / Enfermedad respiratoria alérgica ocupacional y esofagitis eosinófila por harina de trigo en un panadero

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Provocation Tests in Nonimmediate Hypersensitivity Reactions to ß-Lactam Antibiotics in Children: Are Extended Challenges Needed?

BACKGROUND: ß-Lactam antibiotics are the most common trigger of reactions in children with most of them being nonimmediate (85.5%), but proven allergy after the allergological workup is between 7% and 10%. There is no agreement on how to perform the provocation tests in these types of hypersensitivity reactions. OBJECTIVE: To determine whether or not repeated doses of the ß-lactams are required to reproduce a nonimmediate reaction in children. METHODS: This is a retrospective observational study. We included children under 14 years who were referred for a nonimmediate reaction to ß-lactams. All patients underwent a 1-day hospital provocation and were kept under observation at home during the following days for at least the time elapsed between the first dose and the symptoms of the index reaction. If no reaction was triggered, the patient resumed the provocation at home with 2 daily therapeutic doses for an equal of interval time. RESULTS: Ninety-seven patients were included in the study. A positive reaction was recorded in 14 of them (14.4%). The short hospital provocation triggered 3 immediate reactions and 8 delayed reactions. The home rechallenge developed 1 immediate reaction and 2 delayed reactions. CONCLUSIONS: Nonimmediate reactions to ß-lactams in children may be triggered with a 1-day provocation test. We suggest to perform a 1-day provocation test followed by an observational period of at least the time interval of the index reaction. If this challenge is negative, an extended home provocation could subsequently be carried out.