[Evaluation of nasal inflammation]. / Valoración de la inflamación nasal.

In the reaction of immediate hypersensibility to alergene is joined to its specific type IgE antibody, also united to the high affinity receptors for IgE (FccI) of the effecters cells fundamentally mastocites and basophiles. The interbreeding of these molecules Fcc to RI, after the union ofpolyvalent antigenes to IgE, active these cells, producing three biologic responses: excitosis of the preformed content of its granules, synthesization of lipidic mediators and citoquine secretion. The inflammation mediators are in last term, substances responsible of the clinic symptomatology. They can be divided generally in preformed mediators (biogene amines and macromolecules of the granules) and of new synthese mediators (lipidic and citoquine mediators).

Olerance of a cluster schedule with a house dust mite extract quantified in mass units: multicentre study.

The standardisation of allergenic extracts in micrograms of the major allergen has encouraged the search for new treatment schedules, with the purpose of shortening the number of visits and doses required to reach the maintenance dose without eliciting a greater risk of adverse reactions for the patients. With this objective, a prospective multicentre pharmacovigilance study was designed that included 200 patient with allergic rhinoconjunctivitis and/or allergic asthma sensitised to mites (Dermatophagoides pteronyssinu and/or farinae). The dose increment period was carried out using a cluster schedule, where the optimal dose wa reached after 4 visits, administering two doses in each visit. The duration of the study was 5 months and a total o 1902 doses were administered. At the end of the trial, 31 adverse reactions in 23 patients were recorded. Six of these were systemic (0.3% of t administered doses) recorded in 6 patients (3% of the sample). One was an immediate reaction (grade 1) and delayed (4 mild and 1 moderate). Two were asthmatic exacerbations, 2 cutaneous reactions, 1 rhinitis and 1 an unspecific symptom (not IgE-mediated). Two appeared upon administration of the first vial and the remaining 4 after administration of the third cluster. Therefore, the schedule tested presents an adequate tolerance profile, suggesting savings (compared to th conventional schedule of 13 doses per patient) of 1800 visits and 1000 treatment doses in the whole study.

Skin tests and conjunctival and bronchial challenges with extracts of Blomia tropicalis and Dermatophagoides pteronyssinus in patients with allergic asthma and/or rhinoconjunctivitis.

BACKGROUND: Blomia tropicalis and Dermatophagoides pteronyssinus are important mite species in Tenerife, Canary Islands, Spain. Several studies have demonstrated a variable degree of allergenic cross-reactivity in vitro. However, only a few have addressed their allergenic cross-reactivity using challenge tests. OBJECTIVE: The objective of this study was to conduct conjunctival and bronchial challenge tests with B. tropicalis and D. pteronyssinus extracts in a group of 42 patients with allergic asthma and/or rhinoconjunctivitis sensitised to house dust mites (31 females, 11 males; mean age 21.7 +/- 7.02 years). METHODS: Prick tests using standardised extracts and specific IgE determinations using the CAP system were performed. Bronchial and/or conjunctival challenges were conducted using freeze-dried extracts of both mite species. A patient was considered sensitive to a mite species if she/he had a positive prick and/or CAP test result. A total of 32 conjunctival and 15 bronchial challenges were performed with both mite species. RESULTS: Prick tests were positive to B. tropicalis in 23 patients (54.7%) and to D. pteronyssinus in 41 (97.6%). One patient (2.4%) was exclusively sensitive to B. tropicalis. The CAP test was positive for B. tropicalis in 28 patients and for D. pteronyssinus in 41. Conjunctival challenges to B. tropicalis were positive in 20 patients (18 sensitised and 2 non-sensitised) and negative in 12 (5 sensitised and 7 non-sensitised patients). Conjunctival challenges with D. pteronyssinus were positive in all 31 D. pteronyssinus-sensitised patients who underwent conjunctival challenges. Bronchial challenges with B. tropicalis were positive in 9 sensitised patients and negative in 6 patients (2 sensitised and 4 non-sensitised). Bronchial challenges with D. pteronyssinus were positive in all patients except 1, who only reacted to B. tropicalis. CONCLUSIONS: Allergens of the mite species B. tropicalis induce positive conjunctival and bronchial challenges in B. tropicalis-sensitised individuals. Our results suggest that although there is a low to moderate degree of in vivo cross-reactivity between B. tropicalis and D. pteronyssinus, B. tropicalis seems to be a relevant source of allergens in areas where patients are exposed.

Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile).

Artemisia vulgaris is a common weed and an important source of allergens on the subtropical island of Tenerife, Canary Islands, Spain. It pollinates mainly from July to September, although, due to some local climatic conditions, it may flower throughout the year. Cross-reactivity with hazelnut, kiwi, birch, several Compositae (Ambrosia, Chrysanthemum, Matricaria, Solidago) and grass allergens has been suggested. Few studies have addressed the issue of in vivo cross-reactivity between A. vulgaris and Matricaria chamomilla. The objective of this study was to perform conjunctival and bronchial challenges with A. vulgaris and M. chamomilla and oral challenge with chamomile in 24 patients with asthma and/or rhinitis sensitized primarily to A. vulgaris. Skin prick tests with M. chamomilla were positive in 21 patients. Eighteen patients had a positive conjunctival provocation test with a A. vulgaris pollen extract and 13 patients had a positive conjunctival provocation test with a M. chamomilla pollen extract. Bronchial provocation tests with A. vulgaris were positive in 15 patients and with M. chamomilla pollen in another 16 individuals. Oral provocation tests, conducted with a commercial chamomile infusion were positive in 13 patients. Nine of these individuals were skin test positive to food allergens and 17 to others pollens of the Compositae family. This study confirms a high degree of in vivo cross-reactivity between A. vulgaris and M. chamomilla. Sensitization to A. vulgaris seems to be a primary risk factor for experiencing symptoms after the ingestion of chamomile infusions. Based on the results of bronchial provocation tests, M. chamomilla pollen could be a relevant inhalant allergen.

Sensitization to Blomia kulagini in a general population of a subtropical region of Spain (Canary Islands).

The Blomia genus has been described as allergenic in man. The present study aimed to assess the prevalence of B. kulagini sensitization in a large population of allergic subjects without occupational exposure in a subtropical region (Canary Islands, Spain). Secondarily, a new standardized B. kulagini extract was evaluated. The study population comprised 207 patients. RAST for B. kulagini was positive in 76.2% of patients, and 47 of them were selected for the biologic standardization. When the prick test was performed with the nonstandardized extracts, results were positive in 76.6%, whereas when the test was repeated with the standardized extract, sensitivity rose to 95.7%. The conjunctival provocation test was positive in 78.3% of 46 evaluated patients. The bronchial provocation test was positive in 18 sensitized patients and negative in five controls. In conclusion, B. kulagini is an important cause of sensitization among the occupationally unexposed population of the studied area and should be included in allergy diagnostic tests. For reliable prick tests, the use of standardized extracts is mandatory.

The natural history of Apis-specific IgG and IgG4 in beekeepers.

BACKGROUND: Most published studies on changes of specific IgG or its subclasses as a response to stimuli by allergens have been performed on patients under immunotherapy. There are few reports analysing the response to immunoglobulins in patients exposed to allergens in their natural habitats. OBJECTIVE: The aim of this work was to discover the natural history of Apis specific IgG (IgG-ap) and IgG4 (IgG4-ap) levels in beekeepers from the Canary Islands. METHODS: We studied 242 beekeepers (Bks). We used a questionnaire and measured total IgE and seric Apis specific IgE (IgE-ap), IgG-ap and IgG4-ap against Apis mellifera venom. RESULTS: All Bks had IgG-ap and IgG4-ap. IgE-ap was positive in 160 Bks (65.6%), but only 92 (37.6%) Bks were considered sensitized. IgG-ap and IgG4-ap showed significant correlation (r = 0.84); IgE did not correlate with IgG-ap or IgG4-ap. There was no seasonal variation in IgG-ap or IgG4-ap. The group of sensitized Bks had significantly lower IgG-ap and IgG4-ap levels (P < 0.05). The groups with longer beekeeping activity showed significantly higher levels of IgG-ap and IgG4-ap (P < 0.001). Bks with locals reactions had significantly higher IgG-ap and IgG4-ap than Bks who reported systemic reactions (P < 0.05). CONCLUSION: Our study showed that IgG-ap and IgG4-ap appear to increase in Bks, either according to their beekeeping experience or in subjects with local reactions after bee stings.

Hyper-IgE syndrome. Presentation of three cases.

Three cases of Hyper-IgE syndrome are herein described, corresponding to patients aged six, twelve and 4 years, who from infancy, had suffered a variety of recurrent pulmonary infections, staphylococcal cold abscesses and chronic dermatitis. IgE counts were superior to 2.000 u/ml and eosinophilia surpassed 0.6 x 10(9) cells/l in all three cases. Deficits in the mytogen and chemotaxis responses were also seen. These patients were treated with I.V. gammaglobulin, anti-biotherapy and ascorbic acid. The possible physiopathology of this syndrome and its association with different alterations to pulmonary immunity are discussed in this paper. Hyper-IgE Syndrome is characterized by recurrent dermal and pulmonary infections (pneumonia and abscesses), dominated by elevated IgE levels, and in 1974, this Syndrome was included within the "immunodeficiencies" group, and Hill and Quie described this as a process involving recurrent bacterial infections and eczemas accompanied by elevated IgE levels, together with a defect in the mobility of neutrophils. Previously, in 1966, Job described this Syndrome in fair-skinned, red-headed young girls, suffering from eczemas and recurrent cold abscesses of staphylococcal ethiology, found on the skin, in subcutaneous tissue cells and lymph nodes. Later, Dr. Buckley defined this Syndrome by an increase in serum IgE levels, chronic dermatitis and severe repetitive infections. This Syndrome today, is still an immunological mystery, defined by two clinically compatible criteria and an increase in IgE. Other analytical abnormalities, including neutrophilic mobility, the appearance of IgE antibodies anti-Candida or staphylococcus, are non-constant findings.

The capturing of pollens in the atmosphere of La Laguna City, Tenerife, Canary Islands 1990-1995.

This paper forms part of a Doctorate Thesis, carried out in the Allergy and Immunology Department of the Nuestra Señora de la Candelaria Hospital, Tenerife, entitled "Epidemiology of Pollens on the Island of Tenerife. Allergy to Pollen". This paper deals with the capturing of pollen in the atmosphere of the city of La Laguna, Tenerife, during the period 1990-1995, and demonstrates that the Occidental Islands of the Canarian Archipelago are similar to a miniature continent with a special microclimate and a large amount of vegetation, where all classes of pollen can be found given the large variety of plants and trees including native species. High concentrations of more than 50 grains of pollen per m3 can be found in the air of the Occidental Islands, above all wild grasses, cultivated grasses, weeds, Artemisa vulgaris, Parietaria officinalis and Plantago lanceolata, and in a lowe proportion, Cupressaceae, Pinaceas, Mercurialis and Rumex. We have pollen concentrations very similar to other parts of the continent.

Historical background of aeropalynology in the Canary Islands.

This paper forms part of a Doctorate Thesis, currently being completed at the Allergy and Immunology Section of the Ntra. Sra. de la Candelaria Hospital, Tenerife, regarding the Epidemiology of pollens We would like to illustrate that this island and its provinces are similar to a miniature continent, where pollens from the most important allergenic families present in the National Territory of the Iberian Peninsula can be found. We have a very high incidence of patients allergic to grass pollens (gramineas), Mugwort (Artemisia), Pellitory (Parietaria) and plantain (Plantago) pollens, with respect to the number of inhabitants and allergic subjects living on our island. In a further paper, we shall expose the graphs corresponding to an Aerobiological Study during the last five years, where we obtained more than 100 gr of pollen per m3 of air.

Epidemiology of allergic reactions in beekeepers: a lower prevalence in subjects with more than 5 years exposure.

Beekeepers (Bks) represent a high allergic risk population against Hymenoptera because of their frequent exposure to bee stings. Most published studies show different percentage of sensitization and systemic reactions with to another groups of population. With the aim to know the prevalence and type of allergic reaction in Bks from the Canary Islands, 246 subjects were studied prospectively. A questionnaire was developed and skin test and specific IgE determination against Apis mellifera, Vespula and Polistes venom were performed. One hundred and twenty eight subjects had presented at least one reaction greater than merely local. In 83.5% of these subjects subsequent stings caused reactions of lesser intensity. Specific IgE in serum for Apis mellifera was positive in 126 BKs, for Vespula in 27 and for Polistes in 9. We found that the group of BKs sensitized to Apis was significantly higher among atopics BKs (p < 0.001) and with fewest years of working experience in beekeeping (p = 0.0134). This study showed that sensitization to Hymenoptera is higher in beekeepers with less than 5 years working experience and who are sensitized to another allergens.