Systemic reactions to wasp sting: is the clinical pattern related to age, sex and atopy?

BACKGROUND: The aim of this study was to analyze the frequency of clinical features and the severity of systemic reactions to wasp stings, and to establish their relationship with mean age, sex, and atopy. METHODS: We studied 115 patients who suffered an anaphylactic reaction to wasp sting and showed specific IgE to venoms from Vespula and/or Polistes. In all patients, age, sex and personal history of atopy were registered. Cutaneous, respiratory, cardiovascular and gastrointestinal involvement during the course of the reaction was investigated. Each patient was assigned a severity grade according to a simple two-grade classification based on Müller's criteria. Bivariable analysis was performed to analyze the associations among mean age, sex and atopy and the symptoms and severity of the reaction. RESULTS: The mean age was 40.2 years. There were 60 males (52.2 %) and 55 females (47.8 %). Twenty-six patients (22.6 %) were atopic. The percentages of involved systems were as follows: skin 90.4 %, respiratory 54.8 %, cardiovascular 33.9 %, and gastrointestinal 21.7 %. Reactions were mild in 40.8 %, and severe in 59.1 %. The mean age was higher in patients without cutaneous symptoms (p < 0.05). Cardiovascular involvement was more frequent in males (p < 0.05). No other significant differences were found. CONCLUSION: The symptoms of systemic reactions to wasp venom most frequently involved the skin, while reactions without cutaneous involvement were more frequent in older patients. Cardiovascular involvement was more common in males. The clinical pattern was not determined by atopy and the variables studied were not related to severity.

Hypersensitivity to Vespula and Polistes: can we tell the primary sensitization from the clinical history?

OBJECTIVE: To study the relationship between the primary sensitization to wasp venoms and the geographical and seasonal circumstances of the anaphylaxis-induced sting. METHODS: We performed a retrospective review of 115 patients (age 10-80) who suffered a systemic reaction to a wasp sting. Season and type of locality (urban or rural) at the moment of the sting were recorded. Serum specific IgE levels to venoms from Vespula and Polistes were measured, and a primary sensitization was determined to whichever genus of wasp for which the highest class of specific IgE was observed. The primary sensitization in relation to the type of locality and the season was assessed using the chi-square test. RESULTS: Most reactions occurred in urban areas (67.8 %), and in the summer season (63.4 %). Most patients were sensitized to Vespula venom (94.8 %). Primary sensitization was to Vespula in 56.5 %, to Polistes in 10.4 %, and undetermined in 33 %. The distribution of geographical areas did not show significant differences in relation to primary sensitization (p > 0.05). Most patients with primary sensitization to Vespula suffered the anaphylaxis-induced sting after the spring season, with a statistically significant result (p < 0.05). CONCLUSION: In our population, the probability of Vespula sting is higher than Polistes sting when the reaction occurs after spring. This finding can help us to identify the responsible vespid when the diagnostic tests do not provide an accurate result.

Pharmacological stimuli in asthma/urticaria.

BACKGROUND: The use of opioids as analgesics is becoming increasingly widespread, which may have repercussions in patients with urticaria or asthma, as these agents frequently cause adverse reactions. MATERIAL AND METHODS: We present three patients who developed allergic reactions after receiving codeine: two patients who developed acute urticaria, and a third asthmatic patient receiving specific immunotherapy who developed bronchospasm. Skin prick-testing (SPT) and intradermal reaction (IDR) tests with various opioids were performed, followed by controlled oral challenge. Prick tests and IDR were also carried out in 20 controls. RESULTS: Similar SPT and IDR results were recorded in the three patients and in the controls. In the case of controlled oral challenge with codeine, patient 1 suffered bronchospasm, while patient 2 developed generalized urticaria. The test was not performed in the third patient. All of the patients tolerated tramadol 50 mg without problems. We advised the use of tramadol as analgesic and fentanyl or remifentanil as anesthetics. DISCUSSION: In these types of manifestation, the pharmacological properties of the opioids used are highly important, particularly as regards their histamine-releasing potential. Codeine, morphine and pethidine present the greatest histamine-releasing capacity, while tramadol, fentanyl and remifentanil do not release histamine and their use is thus recommended in pulmonary disease requiring opioid administration. Cutaneous symptoms are more frequently caused by opioids than by respiratory symptoms, since these drugs act on the MTC mast cell population, which is more prevalent in the skin than in the lungs. Some of this action is inhibited by naloxone. CONCLUSIONS: In most patients, these reactions are not IgE-mediated. Consequently, SPT and IDR are of little diagnostic value, and controlled oral challenging with the suspect drug or with one of the non-histamine releasing agents should be used. The patch test is useful in occupational contact dermatitis.

[Treatment strategies in rhinoconjunctivitis and asthma during pregnancy]. / Estrategias de tratamiento de la rinoconjuntivitis y el asma durante el embarazo.

BACKGROUND: The incidence of asthma is high, especially in young people, a population group that includes women of reproductive age. We reviewed recent publications on asthma control during pregnancy to avoid undesired effects on both the mother and fetus. The prevalence of rhinoconjunctivitis is also high, although this disease is often under-treated by physicians. The use of beta2-agonists, corticoids (systemic/inhaled/nebulized), epinephrine and specific allergen immunotherapy is discussed. METHODS: We reviewed recent publications on asthma during pregnancy as well as other articles of interest. Articles providing data on drug therapy, overall strategies and patient education were selected. Sufficient drugs are available for the management of this disease and under-treatment cannot be justified. CONCLUSIONS: Pregnancy is not a disease, but constitutes a period when special care must be taken with underlying diseases. The aim of asthma treatment during pregnancy is to prevent fetal complications due to the effects of medication and asthma crises by keeping the mother symptom free and preventing possible exacerbations. Almost all authors agree that asthma crises in pregnant women should be treated no differently from those in non-pregnant women. Treatment of rhinoconjunctivitis should not be stopped during pregnancy since a wide variety of FDA category B drugs is available. Specific allergen immunotherapy should not be suspended during pregnancy as it is not contraindicated. However, this therapy should not be initiated during pregnancy.

Systemic reactions to wasp sting: is the clinical pattern related to age, sex and atopy?

Background: The aim of this study was to analyze the frequency of clinical features and the severity of systemic reactions to wasp stings, and to establish their relationship with mean age, sex, and atopy. Methods: We studied 115 patients who suffered an anaphylactic reaction to wasp sting and showed specific IgE to venoms from Vespula and/or Polistes. In all patients, age, sex and personal history of atopy were registered. Cutaneous, respiratory, cardiovascular and gastrointestinal involvement during the course of the reaction was investigated. Each patient was assigned a severity grade according to a simple two-grade classification based on Müller's criteria. Bivariable analysis was performed to analyze the associations among mean age, sex and atopy and the symptoms and severity of the reaction. Results: The mean age was 40.2 years. There were 60 males (52.2 %) and 55 females (47.8 %). Twenty-six patients (22.6 %) were atopic. The percentages of involved systems were as follows: skin 90.4 %, respiratory 54.8 %, cardiovascular 33.9 %, and gastrointestinal 21.7 %. Reactions were mild in 40.8 %, and severe in 59.1 %. The mean age was higher in patients without cutaneous symptoms (p < 0.05). Cardiovascular involvement was more frequent in males (p < 0.05). No other significant differences were found. Conclusion: The symptoms of systemic reactions to wasp venom most frequently involved the skin, while reactions without cutaneous involvement were more frequent in older patients. Cardiovascular involvement was more common in males. The clinical pattern was not determined by atopy and the variables studied were not related to severity

Fundamento: El propósito de este estudio es analizar la frecuencia de manifestaciones clínicas y la gravedad de las reacciones sistémicas a picadura de avispa, así como establecer su relación con la edad media, el sexo y la atopia. Métodos: Estudiamos 115 pacientes que han sufrido una reacción anafiláctica a picadura de avispa y que muestran IgE específica frente a venenos de Vespula y/o Polistes. En cada caso re registra la edad, el sexo y los antecedentes personales de atopia. Se investigó la presencia de afectación cutánea, respiratoria, cardiovascular y gastrointestinal en el curso de la reacción, y se asignó un grado de severidad mediante un sistema de clasificación en dos grados a partir de los criterios de Müller. Se realizó un análisis bivariante para relacionar la edad, el sexo y la atopia con los síntomas y la gravedad de la reacción. Resultados: La edad media fue de 40,2 años. Los varones eran 60 (52,2%) y las mujeres 55 (47,8%). Veintiséis pacientes (22,6%) eran atópicos. El porcentaje de afectación por sistemas fue como sigue: cutánea 90,4%; respiratoria 54,8%; cardiovascular 33,9%; gastrointestinal 21,7%. Las reacciones fueron leves en un 40,8% y graves en un 59,1%. La edad media fue superior en pacientes sin síntomas cutáneos (p>0,05) y la afectación cardiovascular resultó mas frecuente en varones (p>0,05). No se observaron otros hallazgos significativos. Conclusión: Se concluye que los síntomas más frecuentes de las reacciones sistémicas a veneno de avispa son los cutáneos, siendo las reacciones sin afectación cutánea más típicas de personas de edad avanzada. La presencia de síntomas cardiovasculares es más común en varones. La atopia no determina el cuadro clínico y la gravedad no se relaciona con las variables estudiadas

Hypersensitivity to Vespula and Polistes: can we tell the primary sensitization from the clinical history? / Hipersensibilidad a vespula y polistes: ¿se puede determinar la sensibilización predominante a partir de la historia clínica?

Objective: To study the relationship between theprimary sensitization to wasp venoms and the geographicaland seasonal circumstances of the anaphylaxis-induced sting.Methods: We performed a retrospective review of115 patients (age 10-80) who suffered a systemicreaction to a wasp sting. Season and type of locality(urban or rural) at the moment of the sting wererecorded. Serum specific IgE levels to venoms fromVespula and Polistes were measured, and a primarysensitization was determined to whichever genus ofwasp for which the highest class of specific IgE wasobserved. The primary sensitization in relation to thetype of locality and the season was assessed usingthe chi-square test.Results: Most reactions occurred in urban areas(67.8 %), and in the summer season (63.4 %). Mostpatients were sensitized to Vespula venom (94.8 %).Primary sensitization was to Vespula in 56.5 %, toPolistes in 10.4 %, and undetermined in 33 %. Thedistribution of geographical areas did not show significantdifferences in relation to primary sensitization(p > 0.05). Most patients with primary sensitization toVespula suffered the anaphylaxis-induced sting afterthe spring season, with a statistically significant result(p < 0.05).Conclusion: In our population, the probability ofVespula sting is higher than Polistes sting when thereaction occurs after spring. This finding can help usto identify the responsible vespid when the diagnostictests do not provide an accurate result

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Pharmacological stimuli in asthma/urticaria / Estimulos farmacológicos en el asma/urticaria

Background: The use of opioids as analgesics is becoming increasingly widespread, which may have repercussions in patients with urticaria or asthma, as these agents frequently cause adverse reactions. Material and methods: We present three patients who developed allergic reactions after receiving codeine: two patients who developed acute urticaria, and a third asthmatic patient receiving specific immunotherapy who developed bronchospasm. Skin prick-testing (SPT) and intradermal reaction (IDR) tests with various opioids were performed, followed by controlled oral challenge. Prick tests and IDR were also carried out in 20 controls. Results: Similar SPT and IDR results were recorded in the three patients and in the controls. In the case of controlled oral challenge with codeine, patient 1 suffered bronchospasm, while patient 2 developed generalized urticaria. The test was not performed in the third patient. All of the patients tolerated tramadol 50 mg without problems. We advised the use of tramadol as analgesic and fentanyl or remifentanil as anesthetics. Discussion: In these types of manifestation, the pharmacological properties of the opioids used are highly important, particularly as regards their histamine-releasing potential. Codeine, morphine and pethidine present the greatest histamine-releasing capacity, while tramadol, fentanyl and remifentanil do not release histamine and their use is thus recommended in pulmonary disease requiring opioid administration. Cutaneous symptoms are more frequently caused by opioids than by respiratory symptoms, since these drugs act on the MTC mast cell population, which is more prevalent in the skin than in the lungs. Some of this action is inhibited by naloxone. Conclusions: In most patients, these reactions are not IgE-mediated. Consequently, SPT and IDR are of little diagnostic value, and controlled oral challenging with the suspect drug or with one of the non-histamine releasing agents should be used. The patch test is useful in occupational contact dermatitis

Introducción: Como fármacos analgésicos, cada vez está más extendido el uso de opiáceos y éstos pueden tener repercusiones sobre pacientes con urticaria o asma. La mayoría de las veces la causa es un efecto secundario. Material y Métodos: Presentamos dos pacientes que han tenido una urticaria tras la toma de codeína y otra paciente asmática que está recibiendo inmunoterapia y tiene crisis de broncoespasmo tras la toma de éste fármaco. Se realizan prick-test e IDR con varios opiáceos, y tras esto se realiza exposición oral controlada. También se realizan pricks e IDR a 20 controles. Resultados: En los tres casos y en los controles se obtienen resultados similares de los pricks y de las IDR. En la exposición oral controlada con codeína, la paciente 1 sufre un broncoespasmo, la 2 una urticaria generalizada y la 3 no se realiza. Las tres toleran tramadol 50mg sin problemas. Se recomienda el uso de tramadol como analgésico y fentanilo o remifentanilo como anestésicos. Discusión: En este tipo de cuadros las propiedades farmacológicas de los opiáceos son muy importantes, puesto que van a venir marcados por la potencia de liberación de histamina. La codeína, la morfina y la petidina, son los mayores liberadores y por el contrario, el tramadol, el fentanilo y el remifentanilo no lo son y están recomendados en patología pulmonar que necesiten opiáceos. Los opiáceos suelen producir en mayor número de ocasiones cuadros cutáneos por que actúan sobre todo sobre los MTC que son más numerosos en la piel que en el pulmón. La Naloxona inhibe en parte ésta acción. Conclusiones: La mayoría de reacciones de este tipo no son IgE mediadas, por lo que los pricks e IDR no tienen ningún valor, y se debe de recurrir a la exposición controlada con el fármaco implicado o con uno de los no liberadores de histamina. Las pruebas del parche si que tienen utilidad en las dermatitis de contacto ocupacionales

Estrategias de tratamiento de la rinoconjuntivitis y el asma durante el embarazo / Treatment strategies in rhinoconjunctivitis and asthma during pregnancy

Introducción: El asma es una enfermedad con alta incidencia sobre todo en gente joven, grupo de población al que pertenecen las mujeres en edad fértil. Hemos revisado los últimos artículos sobre el tema para poder mantener el asma bien controlada y así evitar efectos no deseados tanto en la madre como en el feto. Igualmente se aborda el control de la rino-conjuntivitis, tan incapacitante para multitud de personas y tan olvidada e infratratada por muchos profesionales. Intentamos dar una perspectiva que nos parece razonable para el uso de medicación como β -adrenérgicos, corticoides (sistémicos/inhalados/nebulizados), epinefrina e inmunoterapia específica con alergenos inhalantes. Material y métodos: Hemos revisado los últimos artículos sobre el tema y los que nos han parecido más relevantes. Además no sólo nos hemos centrado en el aspecto farmacológico, sino que hemos tratado de buscar aquellos textos donde se da también una estrategia de tratamiento global, sin descuidar la educación en el manejo de su enfermedad. En esta revisión se comprueba que existe medicación suficiente para el control de estas enfermedades por lo que no hay motivo para infratratar. Conclusiones: El embarazo no es una enfermedad, sino un momento en la vida de una mujer en el que hay que tener mayor control del habitual sobre su patología de base. El objetivo del tratamiento del asma en el embarazo es que la paciente esté libre de síntomas y prevenir las posibles exacerbaciones, para así evitar un mayor daño fetal, tanto por la medicación que se necesita, como por los efectos de la crisis sobre el feto. Es importante destacar que casi todos los autores coinciden en que una crisis asmática en una mujer embarazada se trata igual que en una paciente no embarazada. No hay que dejar de tratar la rino-conjuntivitis por parecer una patología menor ya que se dispone de un importante arsenal terapéutico catalogado como de categoría B por la FDA. La inmunoterapia específica con alergenos no está contraindicada en el embarazo, ni hay que suspenderla, pero no está recomendado iniciarlo durante el mismo

Background: The incidence of asthma is high, especially in young people, a population group that includes women of reproductive age. We reviewed recent publications on asthma control during pregnancy to avoid undesired effects on both the mother and fetus. The prevalence of rhinoconjunctivitis is also high, although this disease is often under-treated by physicians. The use of β2-agonists, corticoids (systemic/inhaled/nebulized), epinephrine and specific allergen immunotherapy is discussed. Methods: We reviewed recent publications on asthma during pregnancy as well as other articles of interest. Articles providing data on drug therapy, overall strategies and patient education were selected. Sufficient drugs are available for the management of this disease and under-treatment cannot be justified. Conclusions: Pregnancy is not a disease, but constitutes a period when special care must be taken with underlying diseases. The aim of asthma treatment during pregnancy is to prevent fetal complications due to the effects of medication and asthma crises by keeping the mother symptom free and preventing possible exacerbations. Almost all authors agree that asthma crises in pregnant women should be treated no differently from those in non-pregnant women. Treatment of rhinoconjunctivitis should not be stopped during pregnancy since a wide variety of FDA category B drugs is available. Specific allergen immunotherapy should not be suspended during pregnancy as it is not contraindicated. However, this therapy should not be initiated during pregnancy