Estudio comparativo de biocompatibilidad entre la hemodiafiltración en línea y la hemodiafiltración con reinfusión endógena / Biocompatibility comparative study between online hemodiafiltration and hemodiafiltration with endogenous reinfusion

Objetivo: Comparar la biocompatibilidad entre la hemodiafiltración en línea (HDF) y la hemodiafiltración con reinfusión endógena (HFR). Material y método: Estudio comparativo observacional en una población de 15 pacientes en hemodiálisis crónica elegidos al azar entre los pacientes de nuestra unidad. Se compararon cambios en el perfil hematológico, nivel de PCR y constantes vitales, pre y post hemodiálisis, tras someterse a ambas técnicas de hemodiafiltración. Se comparó las diferencias entre los parámetros estudiados pre y post hemodiálisis en cada técnica. Resultados: Los niveles de plaquetas descendieron más en la HDF (HDF -1,33 vs HFR -19,73 x103/mm3, p=0,005). El nivel de leucocitos disminuyó en la HDF y aumentó en la HFR (HDF -0,46 vs HFR +0,8 x103/ mm3; p=0,006). Respecto a la fórmula leucocitaria hubo resultados dispares: segmentados HDF -1,7 vs HFR +5,4%, p<0,001; linfocitos HDF +1,96 vs HFR -3,62%, p<0,001. Con la HFR disminuyeron menos los niveles de PCR (HDF -0,05 vs HFR -0,001 mg/ dl; p=NS). En lo referente a las constantes vitales, la tensión arterial sistólica descendió más en la HFR que en la HDF (HDF -9,93 vs HFR -10,33 mmHg; p<0,001), a la inversa que la diastólica (HDF -5,2 vs HFR -3 mmHg; p=0,007) y la frecuencia cardiaca (HDF -1,46 vs HFR +1,73 lpm; p=NS). La temperatura corporal aumentó más con la HDF que con la HFR (HDF +0,35 vs HFR +0,06 ºC; p=NS). Conclusiones: Según nuestros resultados la HFR parece más biocompatible que la HDF, probablemente derivado por la reinfusión exógena de la HDF (AU)

Aim: To compare biocompatibility between online hemodiafiltration (HDF) and hemodiafiltration with endogenous reinfusion. Methods: Observational comparative study in a population of 15 chronic hemodialysis patients randomly selected among the patients in our unit. We compared changes in hematological profile, CRP level and vital signs, pre and post hemodialysis, after undergoing both hemodiafiltration techniques. Comparing the differences between the parameters studied before and after each hemodialysis technique. Results: Platelet levels decreased more in the HDF (HDF -1,33 vs HFR -19,73 x103/mm3, p=0,005). Leukocyte levels decreased in the HDF and increased with HFR (HDF -0,46 vs HFR +0,8 x103/mm3; p=0,006). Regarding the leukocyte formula had mixed results: segmented HDF -1,7 vs HFR +5,4%, p<0,001; lymphocytes HDF +1,96 vs HFR -3,62%, p<0,001. With the HFR decreased CRP levels less (HDF -0,05 vs HFR -0,001 mg/dl; p= NS). Regarding vital signs, systolic blood pressure decreased more in the HFR than HDF (HDF -9,93 vs HFR -10,33 mmHg; p<0,001), conversely that the diastolic blood pressure (HDF -5,2 vs HFR -3 mmHg; p=0,007), and heart rate (HDF -1,46 vs HFR +1,73 lpm; p=NS). Body temperature increased more with the HDF that the HFR (HDF +0,35 vs HFR +0,06 ºC; p=NS). Conclusions: According to our results the HFR seems more biocompatible than the HDF, probably derived by exogenous reinfusion of HDF (AU)

Skin prick test predictive value on the outcome of a first known egg exposure in milk-allergic children.

Children with milk allergy have higher incidence of other food allergies, especially egg allergy. The objective of this study was to ascertain the accuracy of the prick test in children with IgE-mediated milk allergy for diagnosing egg allergy. Children under the age of 1 yr who came consecutively to Allergy Department 2003-05, and were diagnosed with IgE-mediated milk allergy were selected for this study. Egg introduction was completely avoided until the age of 14 months when clinical history, skin prick tests (SPT), specific-IgE antibodies determination and egg challenge test were performed. One hundred and four milk-allergic children were included. At least one positive prick test to any egg allergen was found in 65 out of the 104 (62.5%). Thirty-eight (36.5%) were allergic to egg proteins as well. Prick tests with egg white and ovomucoid (OVM) had the best diagnostic performances showing the largest areas under the receiver operating characteristic curve. The optimal diagnosis cut-off point was 6 mm for egg white and 5 mm for OVM. The positive likelihood ratios for these cut-off points were: 2.95 (95% CI: 1.74-4.99) for egg white prick test, and 20 (95% CI: 2.9-143.7) for OVM prick test. Children with specific IgE-mediated cow's milk allergy must be closely followed as a risk group for egg allergy. Early diagnosis is necessary and the SPT has shown itself to be a very useful tool for diagnosing immediate IgE reactions to egg on first known exposure.

Immediate allergic reactions by polyethylene glycol 4000: two cases.

The evacuant solution (ES) is a drug that has been used to clean the colon. The most common described side effects when using this drug are abdominal symptoms; skin rash is rare. We report on two patients who presented urticaria and angioedem after the intake of an evacuant solution to make a rectoscopy. We performed allergy studies: skin prick tests with common inhalants, pure ES and the components (polyethylene glycol 4000 (PEG 4000), KCI, NaCO3, NaPO3, NaSO3, NaCI, neohesperydine, potasic acesulfam and orange flavouring), intradermic test, total serum IgE and single-blind placebo oral challenge with ES and the components. We report on the first cases of immediate allergy reactions (type1) caused by oral intake of a drug containing PEG 4000 which were demonstrated by intradermic tests and oral challenge.

Immediate allergic reactions by polyethylene glycol 4000: two cases

The evacuant solution (ES) is a drug that has been used to clean the colon. The most common described side effects when using this drug are abdominal symptoms; skin rash is rare. We report on two patients who presented urticaria and angioedem after the intake of an evacuant solution to make a rectoscopy. We performed allergy studies: skin prick tests with common inhalants, pure ES and the components (polyethylene glycol 4000 (PEG 4000), KCI, NaCO3, NaPO3, NaSO3, NaCI, neohesperydine, potasic acesulfam and orange flavouring), intradermic test, total serum IgE and single-blind placebo oral challenge with ES and the components. We report on the first cases of immediate allergy reactions (type1) caused by oral intake of a drug containing PEG 4000 which were demonstrated by intradermic tests and oral challenge

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Repercusión del grado de dependencia de los pacientes en hemodiálisis sobre la carga de trabajo de enfermería / Repercussion of the degree of dependency of haemodialysis patients on the nursing workload

El envejecimiento de la población junto con la pluripatología e inmediatez del comienzo del tratamiento sustitutivo renal supone un gran reto para la enfermería nefrológica. La mayor supervivencia ante ciertas patologías se acompaña de una mayor incapacidad de los pacientes y de una mayor necesidad de cuidados. Nuestro objetivo fue evaluar el grado de dependencia de pacientes en hemodiálisis (HD) hospitalaria y analizar las necesidades de cuidados de enfermería requeridos en función de la misma. Estudio prospectivo descriptivo en 43 pacientes en HD hospitalaria. Para la evaluación del grado de dependencia se utilizó el "Test Delta", que consta de 3 escalas: dependencia en general, deficiencia física y deficiencia psíquica. Se diseñó un registro específico en el que se recogía además: edad, sexo, enfermedad de base, tiempo en HD, Índice de Comorbilidad de Charlson (ICC). Análisis estadístico SPSS 8.0.Se estudiaron 28 hombres (65,1%) y 15 mujeres (34,9%), con una edad media de 61,86 años y un ICC medio de 5,39. Tiempo medio en HD 52,39 meses. El 67,43% presentaba algún tipo de dependencia. Cerca de un 50% de la muestra necesitaba algún tipo de ayuda en cuanto a movilización, deambulación y desplazamiento, aseo y vestido. El 35% precisaba ayuda en la administración de tratamientos y un 70% precisaba mayores cuidados de enfermería. Existe una elevada prevalencia de dependencia de os pacientes en HD hospitalaria, por lo que surge la necesidad de revisar los ratios enfermera/paciente y auxiliar de enfermería/paciente para aportar unos cuidados de mayor calidad (AU)

The aging of the population along with the pluri pathology and immediacy of the beginning of the renal substitute treatment supposes a great challenge for the nephrology nursing. Greater survival before certain pathologies is accompanied by a greater incapacity of the patients and by a greater necessity of cares. Our objective was to evaluate the dependency degree of patients in hospital hemodialysis (HD) and to analyze the required necessities of nursing cares based on the same one. Descriptive prospective study in 43 patients in hospital HD. Dependency degree was evaluated by the “Delta Test”, which consists of 3 scales: general dependency, physical deficiency and psychic deficiency. A specific registry was designed in which it took shelter in addition: age, sex, nephropathy, time in HD, Charlson Comorbidity Index (CCI). Statistical analysis SPSS 8.0.Twenty-eight men (65,1%) and 15 women (34,9%) were studied: mean age 61.86 years, mean CCI 5,39 points and mean time in HD 52.39 months. 67.43% presented some dependency type. Near to 50% of the sample needed some aid type as far as mobilization, de ambulation and displacement, cleanliness and dress 35% needed aid in the administration of treatments and 70% needed greater nursing cares. A high prevalence of dependency of the patients in hospital HD exists, reason why must review patient/ nurse and to patient/ nursing assistant ratios to contribute cares of greater quality (AU)

Safety of measles-mumps-rubella vaccine (MMR) in patients allergic to eggs.

INTRODUCTION: Since the measles and mumps components used in MMR vaccine are grown in cultures of fibroblast from chick embryos, for a long time there have been concerns about the presence of egg protein in the vaccine and the recommendations given to egg allergic patients. We include in this paper our clinical experience vaccinating egg allergic patients with a regular triple viral vaccine, as well as an immunological study of each vaccine available in Spain. The aim of this study was to evaluate the clinical safety of a conventional MMR vaccine in a population of egg allergic patients and to determine the presence of egg allergens in a conventional MMR vaccine and if IgE antibodies from egg allergic can recognize egg allergens in this vaccine. MATERIALS AND METHODS: Children 15 months old with a confirmed diagnosed of egg allergy were included. In all patients, a skin prick test with non diluted MMR vaccine (Priorix, GSK) was made. If negative, each patient received a single dose of measles, mumps, rubella (MMR) vaccine. If positive, a fractionated injection of the vaccine was made following SEICAP recommendations (2004). SDS-PAGE immunoblotting was performed with Priorix vaccine. RESULTS: A cumulative total of 26 patients with egg allergy have safely received MMR vaccine in a single-dose (after a negative SPT in all cases) at our department without any reaction. 5 sera of vaccinated patients and 6 control sera of egg allergic patients (positive oral challenge) were used to immunolabel the membranes. No positive bands corresponding to egg proteins were found in any of the patients. CONCLUSION: Negative results found in SPT support the absence of clinical reaction against the components and Immunological studies point that there is no detectable amount of egg protein in this vaccine to produce an IgE mediated reaction. We can conclude that MMR can be safely administrated in children allergic to egg.

Safety of measles-mumps-rubella vaccine (MMR) in patients allergic to eggs / Seguridad de la vacuna anti-sarampion-parotiditis-rubeola en pacientes alergicos al huevo

Introduction: Since the measles and mumps components used in MMR vaccine are grown in cultures of fibroblast from chick embryos, for a long time there have been concerns about the presence of egg protein in the vaccine and the recommendations given to egg allergic patients. We include in this paper our clinical experience vaccinating egg allergic patients with a regular triple viral vaccine, as well as an immunological study of each vaccine available in Spain. The aim of this study was to evaluate the clinical safety of a conventional MMR vaccine in a population of egg allergic patients and to determine the presence of egg allergens in a conventional MMR vaccine and if IgE antibodies from egg allergic can recognize egg allergens in this vaccine Materials and methods: Children 15 months old with a confirmed diagnosed of egg allergy were included. In all patients, a skin prick test with non diluted MMR vaccine (Priorix, GSK) was made. If negative, each patient received a single dose of measles, mumps, rubella (MMR) vaccine. If positive, a fractionated injection of the vaccine was made following SEICAP recommendations (2004). SDS-PAGE immunoblotting was performed with Priorix vaccine. Results: A cumulative total of 26 patients with egg allergy have safely received MMR vaccine in a single-dose (after a negative SPT in all cases) at our department without any reaction. 5 sera of vaccinated patients and 6 control sera of egg allergic patients (positive oral challenge) were used to immunolabel the membranes. No positive bands corresponding to egg proteins were found in any of the patients. Conclusion: Negative results found in SPT support the absence of clinical reaction against the components and Immunological studies point that there is no detectable amount of egg protein in this vaccine to produce an IgE mediated reaction. We can conclude that MMR can be safely administrated in children allergic to egg

INTRODUCCIÓN. La vacuna triple vírica (sarampión, parotiditis y rubéola), incluida en el calendario vacunal español, se cultiva en embrión de pollo y esto ha creado controversia durante años acerca del posible presencia de proteínas de huevo y por lo tanto el riesgo de vacunar a niños alérgicos a este alimento. Incluimos en este artículo nuestra experiencia vacunando a niños alérgicos al huevo con la vacuna triple vírica convencional y un estudio inmunológico con las vacunas comercializadas en España. OBJETIVO. Evaluar la seguridad clínica de la vacuna triple vírica comercializada en España en pacientes alérgicos a proteínas de huevo. Evaluar el reconocimiento inmunológico de posibles alergenos de huevo presentes en esta vacuna por pacientes alérgicos a huevo. MATERIAL Y MÉTODOS. Se incluyeron en el estudio niños de 15 meses con diagnóstico confirmado de alergia a proteínas de huevo. En todos los casos se realizó prueba cutánea con la vacuna sin diluir (Priorix, GSK). En caso de que la prueba cutánea fuese negativa se administró la vacuna en dosis única. En caso de positividad de la prueba cutánea, la vacuna se administró de forma fraccionada. Se realizó SDS-PAGE inmunoblot con la vacuna. RESULTADOS. 26 pacientes alérgicos al huevo fueron vacunados con la vacuna triple vírica convencional sin presentar ninguna reacción. Se utilizaron sueros de 5 niños alérgicos vacunados y 6 de niños alérgicos no vacunados en el estudio inmunológico. Ninguno de ellos reconoció ninguna banda correspondiente a proteínas de huevo. CONCLUSIÓN. Los resultados negativos demuestran la ausencia de reactividad clínica frente a los componentes de la vacuna y el estudio inmunológico indica que no hay cantidades detectables de proteínas de huevo en esta vacuna para inducir una respuesta alérgica IgE mediada. Concluimos que la vacuna triple vírica se puede administrar de forma segura en niños alérgicos al huevo

Occupational rhinoconjunctivitis and asthma by exposure to Lathyrus sativus flour.

We report the case of a 42-year-old non-smoking man, who had worked as a carpenter for 6 years and who reported a history of rhinorrhea, paroxysmal sneezing, nasocular pruritus, lacrimation, wheezing and dyspnea attacks while preparing a mixture to seal the junctures between wooden panels. Allergy study consisted of skin prick testing (SPT) to inhalants, foods and Lathyrus sativus flour (LSF) extract, specific bronchial provocation test with LSF extract, cytological analysis of sputum, specific IgE antibodies against LSF, and histamine releasing test with dilutions (1:5, 1:25, 1:125, 1:625) of LSF. The results demonstrated occupational rhinoconjunctivitis and asthma due to LSF exposure. We provide a review of published reports to date.

Occupational rhinoconjunctivitys and asthma by exposure to Lathyrus sativus flour

We report the case of a 42-year-old non-smoking man, who had worked as a carpenter for 6 years and who reported a history of rhinorrhea, paroxysmal sneezing, nasocular pruritus, lacrimation, wheezing and dyspnea attacks while preparing a mixture to seal the junctures between wooden panels. Allergy study consisted of skin prick testing (SPT) to inhalants, foods and Lathyrus sativus flour (LSF) extract, specific bronchial provocation test with LSF extract, cytological analysis of sputum, specific IgE antibodies against LSF, and histamine releasing test with dilutions (1:5, 1:25, 1:125, 1:625) of LSF. The results demonstrated occupational rhinoconjunctivitis and asthma due to LSF exposure. We provide a review of published reports to date

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Contact allergy from tobramycin eyedrops.

We report a patient with allergic conjunctivitis and blepharitis as a result of tobramycin eyedrops.

Tolerance and short-term effect of a cluster schedule with pollen-extracts quantified in mass-units.

We performed a prospective, multicenter study to assess the tolerance and possible short-term effects of allergen vaccines administered according to a cluster schedule in the months immediately preceding the onset of the pollen season. The study was carried out in eight centers and included 191 patients (children and adults) with allergic respiratory disease due to sensitization to olive tree and/or grass pollen. Of these, 34 patients acted as controls and the remaining patients received immunotherapy administered in the initiation phase according to a cluster schedule of eight doses injected on four visits. After 3 months of treatment, significant differences were found between the two groups in medication consumption (antihistamines in drops and oral formulations: p = 0.045 and p = 0.001, respectively; short-acting beta2-agonist treatments: p = 0.004) and respiratory symptoms (wheezing and coughing: p = 0.035 and 0.014, respectively). The cytokine profile (interleukin [IL]-4, 5, 10 and 2, interferon [IFN-gamma], and tumor necrosis factor [TNF-alpha]) was determined before the start of treatment and at the end of follow-up (4-5 months). Levels of IL-4, 5 and 10 (Th2 profile) decreased while those of IL-2, IFN-gamma, and TNF-alpha (Th1 profile) decreased. These differences were more marked in the active group than in the control group but were not statistically significant. No severe adverse effects were recorded. This study shows that the schedule tested had an acceptable tolerance profile and produced significant changes in symptom and medication scores after a few months of treatment. A double-blind, placebo-controlled study is needed to confirm these results.

Tolerance and short-term effect of a cluster schedule with pollen-extracts quantified in mass-units

We performed a prospective, multicenter study to assess the tolerance and possible short-term effects of allergen vaccines administered according to a cluster schedule in the months immediately preceding the onset of the pollen season. The study was carried out in eight centers and included 191 patients (children and adults) with allergic respiratory disease due to sensitization to olive tree and/or grass pollen. Of these, 34 patients acted as controls and the remaining patients received immunotherapy administered in the initiation phase according to a cluster schedule of eight doses injected on four visits. After 3 months of treatment, significant differences were found between the two groups in medication consumption (antihistamines in drops and oral formulations: p = 0.045 and p = 0.001, respectively; short-acting β2-agonist treatments: p = 0.004) and respiratory symptoms (wheezing and coughing: p = 0.035 and 0.014, respectively). The cytokine profile (interleukin [IL]-4, 5, 10 and 2, interferon [IFN-γ], and tumor necrosis factor [TNF-α]) was determined before the start of treatment and at the end of follow-up (4-5 months). Levels of IL-4, 5 and 10 (Th2 profile) decreased while those of IL-2, IFN-γ, and TNF-α (Th1 profile) decreased. These differences were more marked in the active group than in the control group but were not statistically significant. No severe adverse effects were recorded. This study shows that the schedule tested had an acceptable tolerance profile and produced significant changes in symptom and medication scores after a few months of treatment. A double-blind, placebo-controlled study is needed to confirm these results (AU)

Se ha llevado a cabo un estudio prospectivo y multicéntrico con el objetivo de valorar la tolerancia y posible efecto a corto plazo de las vacunas alergénicas administradas bajo pauta cluster en los meses inmediatamente anteriores al inicio de la estación polínica. El estudio se realizó en 8 centros, incluyéndose un total de 191 pacientes (niños y adultos) con enfermedad alérgica respiratoria por sensibilización a polen de olivo y/o gramíneas. De ellos, 34 actuaron como controles y a los pacientes restantes se les administró inmunoterapia bajo una pauta cluster, en la fase de iniciación, de 8 dosis administradas en 4 visitas. Tras 3 meses de tratamiento, se registraron diferencias significativas entre ambos grupos en el consumo de medicación (antihistamínicos en colirio y orales -p = 0,045 y p = 0,001 respectivamente- y ß2 de corta duración -p = 0,004-) así como en síntomas pulmonares (sibilancias y tos -p = 0,035 y 0,014 respectivamente-). Por otro lado, se determinó el perfil de citocinas (IL-4, 5, 10 y 2, IFN-gamma y TNF-a) de forma previa al inicio del tratamiento y al finalizar el seguimiento (4-5 meses). Se observaron descensos en los niveles de IL-4, 5 y 10 (perfil TH2) y aumento en los valores de IL-2, IFN-gamma y TNF-a (perfil TH1), más marcados en el grupo activo que en el control, sin alcanzar significación estadística. No se registraron efectos adversos severos. Por tanto, podemos observar que la pauta ensayada mostró un adecuado perfil de tolerancia, y tras pocos meses de tratamiento se registraron cambios significativos en la puntuación de síntomas y medicación, siendo necesaria la realización de un estudio con un diseño doble ciego frente a placebo para confirmar los resultados obtenidos (AU)

Selective allergy to sheep's and goat's milk proteins.

BACKGROUND: Cow's milk proteins are amongst the most common causes of food allergy in infants, and caseins are probably the main allergens. The existence of a high degree of cross-reactivity between milk caseins from different animals has been reported. We describe a 2-year-old boy who experienced allergic reactions after eating and touching sheep's cheese, but who tolerated cow's milk and cow's milk dairy products. He had never ingested milk or milk derivatives from sheep or goat. METHODS: Skin prick tests were carried out using whey fractions of cow's milk, whole milk and casein from goat, sheep and cow. We also performed skin prick tests with enzymes used in cheese production. Prick-by-prick tests with cheese made from cow, sheep and goat and their corresponding whole milk were also performed. Total serum IgE and specific IgE to cow's milk proteins, whole cow's milk and sheep's milk were determined. Specific IgE against casein and whole milk from the three different species were determined by ELISA. Inhibition of IgE binding to bovine casein was tested for casein and whole milk from all three species. The proteins of three types of casein and whole milk from cow, sheep and goat were separated by SDS-PAGE and were incubated with the patient's serum. RESULTS: Skin tests were positive to sheep's milk and goat and sheep casein and were negative to all cow's milk proteins and whole cow's and goat's milk. Prick-by-prick tests were positive to goat's and sheep's cheese and were negative to cow's cheese. In ELISA-inhibition, sheep's milk and goat and sheep casein were able to inhibit > 50 % of specific IgE binding to sheep casein. The results of immunoblotting showed that the patient's circulating IgEs recognized only one band in the lanes corresponding to sheep and goat casein. CONCLUSIONS: We report a patient with allergy to sheep's and goat's milk proteins but not to cow's milk proteins. Sheep casein was probably the main allergen causing sensitization in this patient. The results suggest that sheep casein shows a high degree of cross-reactivity with goat casein but not with cow casein. Our patient presented allergic symptoms caused by sheep and goat milk and cheese proteins. However, he was able to tolerate cow's milk and cow's milk dairy products without any ill effects.

Selective allergy to sheep's and goat's milk proteins

Background: Cow's milk proteins are amongst the most common causes of food allergy in infants, and caseins are probably the main allergens. The existence of a high degree of cross-reactivity between milk caseins from different animals has been reported. We describe a 2-year-old boy who experienced allergic reactions after eating and touching sheep's cheese, but who tolerated cow's milk and cow's milk dairy products. He had never ingested milk or milk derivatives from sheep or goat. Methods: Skin prick tests were carried out using whey fractions of cow's milk, whole milk and casein from goat, sheep and cow. We also performed skin prick tests with enzymes used in cheese production. Prick-by-prick tests with cheese made from cow, sheep and goat and their corresponding whole milk were also performed. Total serum IgE and specific IgE to cow's milk proteins, whole cow's milk and sheep's milk were determined. Specific IgE against casein and whole milk from the three different species were determined by ELISA. Inhibition of IgE binding to bovine casein was tested for casein and whole milk from all three species. The proteins of three types of casein and whole milk from cow, sheep and goat were separated by SDS-PAGE and were incubated with the patient's serum. Results: Skin tests were positive to sheep's milk and goat and sheep casein and were negative to all cow's milk proteins and whole cow's and goat's milk. Prick-by-prick tests were positive to goat's and sheep's cheese and were negative to cow's cheese. In ELISA-inhibition, sheep's milk and goat and sheep casein were able to inhibit > 50 % of specific IgE binding to sheep casein. The results of immunoblotting showed that the patient's circulating IgEs recognized only one band in the lanes corresponding to sheep and goat casein. Conclusions: We report a patient with allergy to sheep's and goat's milk proteins but not to cow's milk proteins. Sheep casein was probably the main allergen causing sensitization in this patient. The results suggest that sheep casein shows a high degree of cross-reactivity with goat casein but not with cow casein. Our patient presented allergic symptoms caused by sheep and goat milk and cheese proteins. However, he was able to tolerate cow's milk and cow's milk dairy products without any ill effects (AU)

Introducción: La alergia a proteínas de la leche de vaca es una de las causas más frecuentes de alergia alimentaria en la infancia y las caseínas son probablemente los principales alergenos implicados. Ya ha sido descrita con anterioridad la existencia de alto grado de reactividad cruzada entre las caseínas de distintos animales. Describimos un niño de 2 años que presentó reacciones alérgicas tras la ingesta y el contacto con queso de oveja, pero que toleraba el consumo de leche de vaca y derivados. Nunca había tomado previamente leche o derivados de oveja o cabra. Métodos: Se realizaron tests cutáneos mediante prick con leche y caseína de vaca, oveja y cabra así como con las fracciones de la leche de vaca. También se realizaron tests cutáneos con enzimas empleadas en la elaboración de queso. Se llevaron a cabo prickprick con leche entera y queso de vaca, oveja y cabra.Se determinó IgE total y específica frente a leche de vaca y sus fracciones y leche de oveja. También se determinó mediante ELISA la IgE específica frente a caseina y leche entera de las tres especies. Asimismo se calculó mediante ELISA-inhibición el porcentaje de inhibición de la caseína bovina frente a caseína y leche entera de las tres especies. Se separaron las proteínas de la leche y caseína de vaca, oveja y cabra mediante SDS-PAGE y posteriormente fueron incubadas con el suero del paciente. Resultados: Los tests cutáneos resultaron positivos frente a leche de oveja y caseína de oveja y cabra, y negativos frente a las proteínas séricas de vaca, así como frente a leche entera de vaca y cabra. Los prick-prick fueron positivos frente a queso de oveja y cabra, siendo negativos frente a queso de vaca. En el ELISA-inhibición, la leche de oveja y la caseína de oveja y cabra fueron capaces de inhibir más del 50 por ciento de los sitios de unión de la IgE a la caseína de oveja. Los resultados del immunoblot mostraron que los anticuerpos IgE del paciente reconocían solo una banda en las calles correspondientes a las caseínas de oveja y cabra. Conclusiones: Presentamos un paciente con alergia a proteínas de la leche de oveja y cabra pero no a las proteínas de la leche de vaca. La caseína de la oveja es probablemente el principal alergeno causante de la sensibilización de este sujeto. Los resultados sugieren que la caseína de oveja muestra un elevado grado de reactividad cruzada con la caseína de cabra, pero no con la de vaca. Nuestro paciente presentaba síntomas alérgicos causados por la exposición frente a las proteínas de la leche y queso de oveja y cabra, pero es capaz de tolerar el consumo de leche y derivados de vaca sin ningún efecto adverso (AU)

Tacrolimus como tratamiento de la dermatitis atópica: estudio piloto observacional en la práctica clínica / Tacrolimus, a new treatment to atopic dermatitis: an observational pilot study in routine clinical practice

Antecedentes: Los antinflamatorios no esteroideos (AINE) como el ácido acetilsalicílico, diclofenaco o las pirazolonas se encuentran entre las causas más comunes de reacciones adversas a los fármacos. Durante los últimos años han surgido nuevos antiinflamatorios con una acción selectiva preferente por la vía dela cicloxigenasa 2. Se han realizado multitud de ensayos clínicos. Especialmente con nimesulida que se ha retirado del mercado y rofecoxib que indican que son bien tolerados por los pacientes intolerantes a Al E. Pero se han realizado pocos en ayos clínicos sobre la tolerancia a meloxicam. Material y métodos: Hemos seleccionado 20 pacientes con una anamnesis urgente de intolerancia a diversos AI E y. tras obtener su consentimiento informado, les hemos expuesto a dosis cada vez mayores de meloxicam hasta alcanzar una dosis acumulada de 22,5 mg. en la misma sesión. Resultados: Los veinte pacientes han tolerado meloxicam sin problemas. Conclusiones: En los pacientes estudiados meloxicam parece ser una alternativa terapéutica eficaz y segura al resto de los Al E. Creemos necesario realizar estudios más amplios con grupos grandes de pacientes sano intolerantes a Al E. asmáticos con intolerancia a AINES y pacientes con urticaria crónica que no toleran los antinflamatorios para confirmarlo (AU)

Background: Nonsteroidal antiinflamatories ( SAIDs), such as acetyl salicylic acid, diclofenac. metamizol are one of the most common cause of adverse reactions to drugs. Last years, new elective ciclooxigenase Il antiinflamatories have appeared. Several clinic a say have been performed, fir t with nimesulide, actually retired, and larger with rofecoxib, that indicate good tolerance to them in intolerance patients to NSAJDs. There are few studies with meloxicam. Methods: We have included 20 patient with clinical hi tory of intolerance to at least two different NSAIDs. After obtained their informed consent patients (…) (AU)

Tolerance of a cluster schedule on the treatment of seasonal allergic respiratory disease with pollen extracts quantified in mass units.

In order to evaluate the tolerance of a cluster schedule on specific immunotherapy (SIT), 306 patients were included in a multicenter study. The patients were suffering from rhinoconjunctivitis with/without asthma, caused by sensitization to olive and/or grass pollen. SIT was administered subcutaneously according to a cluster schedule in which the maintenance dose is reached after four visits (3 weeks). The extracts were biologically standardized with major allergens quantified in mass units. Local reactions appeared in 7.2% of the patients and 1.3% of the doses. Systemic reactions (SR) were recorded in 1.2% of the doses administered to 9.5% of the patients. No anaphylactic shock was registered, and all the SR responded fully and rapidly to treatment. There was no difference in SR according to diagnosis or allergen extract used. The majority of SR occurred with the administration of vial of higher concentration (Vial 2: 7 SR (22%), Vial 3: 32 SR (78%), p < 0.05). Of the 32 SR recorded with Vial 3, 13 (41%) were immediate, with no existing association between dose administered and appearance of SR. However, of the 18 delayed SR (56%), 14 occurred after the administration of the first two doses of Vial 3 and four occurred after administration of the second two doses (78% vs 22%, p < 0.05). On the other hand, this regime realized an important saving in cost and time compared to the conventional schedule (1581 fewer doses and 2754 fewer visits were necessary to reach the optimal dose). Considering all these factors, the clinical profile of the proposed regime may be qualified as good. However, future studies are necessary in order to better adjust the schedule to avoid the delayed SR that occurred after the administration of the first two doses of Vial 3.

Estudio de tolerancia a cefpodoxima proxetil en pacientes con hipersensibilidad a betalactámicos / Study of tolerance to cefpodoxime proxetil in patients allergic to beta-lactam antibiotics

Objetivos: Se seleccionó de forma aleatoria a un grupo de 30 pacientes (< 65 años) diagnosticados de hipersensibilidad a betalactámicos mediante pruebas cutáneas o provocación controlada para estudiar su tolerancia a cefpodoxima proxetil, una cefalosporina de tercera generación que se administra por vía oral. Material y metodos: Se realizaron pruebas cutáneas con penicilina G, amoxicilina, ampicilina, cefpodoxima proxetil, cefalexina, ceftazidima y cefotaxima; simultáneamente se extrajo sangre para la realización de una prueba de liberación de histamina con penicilina G, amoxicilina, ampicilina y cefpodoxima. Se realizó una prueba de tolerancia oral con dosis terapéuticas (200 mg) de cefpodoxima proxetil (Otreon) a simple ciego a 26 pacientes.Se volvió a administrar el fármaco 15 días después. Se solicitó consentimiento informado por escrito a todos los pacientes. Se utilizaron como controles 36 pacientes que habían tolerado betalactámicos en los 6 meses previos. Resultados: Todos los pacientes toleraron con normalidad la administración de dosis terapéuticas de cefpodoxima proxetil. En el estudio se analizan los resultados de las distintas pruebas realizadas tanto in vivo como in vitro. Conclusiones: La tolerancia a cefpodoxima proxetil, una cefalosporina de tercera generación que se administra por vía oral, ha sido buena en pacientes con hipersensibilidad a betalactámicos. Con nuestro estudio apoyamos los datos existentes en la actualidad de que la reactividad cruzada clínica con cefalosporinas en pacientes con hipersensibilidad constatada a betalactámicos es muy escasa. Antes de recomendar su uso es necesario realizar más estudios (AU)

Pruebas cutáneas con leguminosas: comparación de resultados con alimentos naturales frente a extractos y efectos del calentamiento / Skin test with pulses: a comparison of the results with natural and extracts, and the effects of heating

Fundamento: Las pruebas cutáneas en prick son frecuentemente utilizadas para estudiar pacientes con sospecha de alergia alimentaria mediada por IgE. El presente estudio se planteó como objetivo evaluar la rentabilidad diagnóstica de las pruebas cutáneas con extractos de leguminosas frente a alimentos naturales, así como la influencia del calentamiento. Métodos: Se han realizado pruebas cutáneas en prick con alimentos naturales y extractos liofilizados de las siguientes legumbres; cacahuete, brotes de soja y productos crudos y calentados de lenteja, guisante, garbanzo, judía verde, alubia blanca y alubia pinta a 37 pacientes con hipersensibilidad clínica a alguna de las leguminosas incluidas en el estudio y 12 controles. Resultados: Las pruebas cutáneas han resultado negativas en los controles. Se ha observado una amplia variabilidad en los índices de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y eficacia entre los alimentos evaluados en los pacientes. Se ha producido globalmente una disminución de la sensibilidad y un aumento de la especificidad en los productos sometidos a calentamiento. La eficacia ha sido superior o igual para los alimentos naturales respecto a los extractos y en general, mayor en los productos hervidos. El tamaño de las pápulas fue más grande en los pacientes con respuesta clínica respecto a los que toleraban las distintas legumbres. Conclusiones: La rentabilidad diagnóstica de las pruebas cutáneas con alimentos naturales ha sido superior a la obtenida con los extractos de leguminosas y el calentamiento ha supuesto un aumento de la misma en los alimentos normalmente consumidos tras ser cocinados (AU)