¿Asma profesional o agravada por el trabajo? / Occupational asthma or work-exacerbated asthma?

En los últimos años se viene observando un aumento de la prevalencia de asma siendo la exposición laboral uno de los factores condicionantes. Se llama asma laboral al que es inducido por la exposición a una sustancia en el lugar de trabajo y asma agravada por el trabajo a la que existe previamente y se exacerba en el trabajo. Para realizar un diagnóstico correcto es necesario una alta sospecha y relacionar temporalmente los síntomas y el trabajo. Un diagnóstico incorrecto produce consecuencias socio-económicas para el paciente. En el Real Decreto 1299/2006 de 10 noviembre (modificado el 4 de mayo de 2018) se establecen criterios para su clasificación y registro. Ante un proceso alérgico debe contemplarse la etiología laboral y los médicos del trabajo de los servicios de prevención de riesgos laborales hospitalarios pueden actuar como consultores para orientar y manejar estos casos. En este caso que se presenta se estableció una asociación entre la exposición laboral y el asma sufrido por la paciente, lo cual llevó, mediante una serie de procesos, a establecer su patología como enfermedad profesional

Currently there is an increase in the prevalence of asthma and it seems that occupational exposure is one of the factors contributing to this increase. "Occupational asthma" refers to new onset asthma induced by exposure to a substance in the workplace, whereas "work-aggravated asthma" refers to pre-existing asthma that is then exacerbated in the workplace. A correct diagnosis requires a high index of suspicion and establishing a temporal relationship between symptoms and work. An in-correct diagnosis can lead to important socioeconomic consequences for the worker. In Spain, Royal Order 1299/2006 on 10 November (amended on May 4, 2018) establishes the criteria for its classification and official recognition. In the context of an allergic process, an occupational etiology should be considered and occupational physicians in an occupational health service can serve as consultants to guide and manage these cases. In this case report we established an association between an occupational exposure and asthma in a worker which led to a series of steps resulting in its acceptance as an occupational disease

[Occupational Asthma or Work-exacerbated asthma?] / ¿Asma profesional o agravada por el trabajo?

Currently there is an increase in the prevalence of asthma and it seems that occupational exposure is one of the factors contributing to this increase. "Occupational asthma" refers to new onset asthma induced by exposure to a substance in the workplace, whereas "workaggravated asthma" refers to pre-existing asthma that is then exacerbated in the workplace. A correct diagnosis requires a high index of suspicion and establishing a temporal relationship between symptoms and work. An incorrect diagnosis can lead to important socioeconomic consequences for the worker. In Spain, Royal Order 1299/2006 on 10 November (amended on May 4, 2018) establishes the criteria for its classification and official recognition. In the context of an allergic process, an occupational etiology should be considered and occupational physicians in an occupational healht service can serve as consultants to guide and manage these cases. In this case report we established an association between an occupational exposure and asthma in a worker which led to a series of steps resulting in its acceptance as an occupational disease.

En los últimos años se viene observando un aumento de la prevalencia de asma siendo la exposición laboral uno de los factores condicionantes. Se llama asma laboral al que es inducido por la exposición a una sustancia en el lugar de trabajo y asma agravada por el trabajo a la que existe previamente y se exacerba en el trabajo. Para realizar un diagnóstico correcto es necesario una alta sospecha y relacionar temporalmente los síntomas y el trabajo. Un diagnóstico incorrecto produce consecuencias socio-económicas para el paciente. En el Real Decreto 1299/2006 de 10 noviembre (modificado el 4 de mayo de 2018) se establecen criterios para su clasificación y registro. Ante un proceso alérgico debe contemplarse la etiología laboral y los médicos del trabajo de los servicios de prevención de riesgos laborales hospitalarios pueden actuar como consultores para orientar y manejar estos casos. En este caso que se presenta se estableció una asociación entre la exposición laboral y el asma sufrido por la paciente, lo cual llevó, mediante una serie de procesos, a establecer su patología como enfermedad profesional.

[Anaphylaxis to hymenoptera sting: study of 113 patients]. / Anafilaxia por picadura de himenóptero: estudio de 113 casos.

BACKGROUND AND OBJECTIVE: The purpose of this study was to describe the clinical and epidemiological features of anaphylactic reactions to hymenoptera stings, with a case-history analysis according to severity. PATIENTS AND METHOD: We conducted an observational descriptive study of patients aged between 10 and 80 years who suffered a systemic reaction after hymenoptera sting. All of them showed specific serum IgE to venoms from Apis, Vespula and/or Polistes. A questionnaire including history of atopy, past reactions and characteristics of the reaction, was performed by individual interview. Anaphylactic reactions were classified into two levels of severity according to Müller's classification. An analysis of independence was carried out in order to relate each level with several factors: age, gender, atopy, type of previous reactions, area of sting and time sequence. RESULTS: 113 patients were included (63 male; mean age [standard deviation]: 40.1 [15.9] years). Reactions were accounted for bee venom in 10.6% of patients, and wasp in 89.4%. Specific IgE was positive to Vespula in 91.9% of subjects, Polistes in 71.4%, and Apis in 28.7%. Furthermore, 50.4% were sensitive to both Vespula and Polistes. Personal history of atopy was found in 20.3%. Among the 106 patients who reminded previous stings, local large reactions were referred by 35.9% and systemic reactions by 16.5%. Upper limb was the most frequent area of sting (38.9%). Most common symptoms were: pruritus (77.8%), hives (57.5%), edema (54.8%), erythema (52.2%), dizziness (51.3%) and dyspnea (49.5%). Severe reactions occurred in 65.5% of patients. Age, gender, atopy, type of previous reactions, area of sting and restoration time were not significantly associated with severity. Time elapsed to first symptom was proportionally shorter in severe cases (p < 0.05). CONCLUSIONS: There is a high frequency of hypersensitivity to wasp venom (Vespula) in the studied population. Except for immediacy, severity-associated data could not be established.

Anafilaxia por picadura de himenóptero: estudio de 113 casos / Anaphylaxis to hymenoptera sting: study of 113 patients

Fundamento y objetivo: El propósito de este trabajo es la descripción de las características clinicoepidemiológicas de las reacciones anafilácticas a picaduras de himenópteros, analizando los casos en función de la gravedad. Pacientes y método: Se ha realizado un estudio observacional descriptivo de pacientes con edades comprendidas entre 10 y 80 años que, tras experimentar una reacción sistémica consecutiva a picadura de himenóptero, presentan inmunoglobulina E específica frente a venenos de Apis, Vespula y/o Polistes. Se realizó una encuesta dirigida a conocer los antecedentes y las características de la reacción, y se establecieron 2 niveles de gravedad a partir de la clasificación de Müller. Se efectuó un análisis de relación de cada nivel con diversos factores: edad, sexo, atopia, tipo de reacciones previas, zona de picadura y evolución del cuadro. Resultados: Se incluyó a 113 pacientes (63 varones), con una edad media (desviación estándar) de 40,1 (15,9) años. Se identificó reacción a veneno de abeja en el 10,6% y de avispa en el 89,4%. La inmunoglobulina E fue positiva a Vespula en el 91,9%, a Polistes en el 71,4% y a Apis en el 28,7%. Un 50,4% de casos mostró sensibilización conjunta a Vespula y a Polistes. Presentaba antecedentes de atopia el 20,3%. Entre los 106 pacientes que recordaban picaduras previas, el 35,9% refería reacciones locales aumentadas y el 16,5% reacciones sistémicas. La zona de picadura más frecuente fue la extremidad superior (38,9%). Los síntomas más comunes fueron: prurito (77,8%), habones (57,5%), edema (54,8%), eritema (52,2%), mareo (51,3%) y disnea (49,5%). Presentó reacciones graves el 65,5% de los pacientes. La edad, el sexo, la atopia, el tipo de reacciones previas, la zona de picadura y el tiempo de resolución no se relacionaron de forma significativa con la gravedad. El tiempo de aparición del primer síntoma fue proporcionalmente menor en los casos graves (p < 0,05). Conclusiones: En la población estudiada se objetiva una elevada frecuencia de hipersensibilidad a veneno de avispa (género Vespula). Excepto por la inmediatez del cuadro, no han podido establecerse a priori otros datos asociados al grado de presentación

Background and objective: The purpose of this study was to describe the clinical and epidemiological features of anaphylactic reactions to hymenoptera stings, with a case-history analysis according to severity. Patients and method: We conducted an observational descriptive study of patients aged between 10 and 80 years who suffered a systemic reaction after hymenoptera sting. All of them showed specific serum IgE to venoms from Apis, Vespula and/or Polistes. A questionnaire including history of atopy, past reactions and characteristics of the reaction, was performed by individual interview. Anaphylactic reactions were classified into two levels of severity according to Müller's classification. An analysis of independence was carried out in order to relate each level with several factors: age, gender, atopy, type of previous reactions, area of sting and time sequence. Results: 113 patients were included (63 male; mean age [standard deviation]: 40.1 [15.9] years). Reactions were accounted for bee venom in 10.6% of patients, and wasp in 89.4%. Specific IgE was positive to Vespula in 91.9% of subjects, Polistes in 71.4%, and Apis in 28.7%. Furthermore, 50.4% were sensitive to both Vespula and Polistes. Personal history of atopy was found in 20.3%. Among the 106 patients who reminded previous stings, local large reactions were referred by 35.9% and systemic reactions by 16.5%. Upper limb was the most frequent area of sting (38.9%). Most common symptoms were: pruritus (77.8%), hives (57.5%), edema (54.8%), erythema (52.2%), dizziness (51.3%) and dyspnea (49.5%). Severe reactions occurred in 65.5% of patients. Age, gender, atopy, type of previous reactions, area of sting and restoration time were not significantly associated with severity. Time elapsed to first symptom was proportionally shorter in severe cases (p < 0.05). Conclusions: There is a high frequency of hypersensitivity to wasp venom (Vespula) in the studied population. Except for immediacy, severity-associated data could not be established