Deconstructing adverse reactions to Amoxicillin-Clavulanic Acid: the importance of time of onset.

BACKGROUND: Amoxicillin-clavulanic acid (AX-CL) is the most consumed betalactam antibiotic worldwide. We aimed to establish the different phenotypes of betalactam allergy in those referring a reaction with AX-CL and to investigate the differences between immediate and non-immediate onset. METHODS: Cross-sectional retrospective study performed at Hospital Clínico San Carlos (HCSC) and Hospital Regional Universitario de Málaga (HRUM) in Spain. Patients reporting reactions with AX-CL who completed the allergy workup between 2017 and 2019 were included. Data of reported reaction and allergy workup were collected. Reactions were classified as immediate and non-immediate with 1hour cut-off point. RESULTS: We included 372 patients (HCSC 208, HRUM 164). There were 90 (24.2%) immediate, 252 (67.7%) non-immediate reactions, and 30 (8.1%) with unknown latency. Allergy to betalactams was ruled-out in 266 (71.5%) and confirmed in 106 patients (28.5%). The final main diagnosis in the overall population were allergy to aminopenicillins (7.3%), to CL (7%), to penicillin (6.5%) and to betalactams (5.9%). Allergy was confirmed in 77.2% and 14.3% of immediate and non-immediate reactions respectively, with a relative risk of 5.06 (95%CI 3.64-7.02) of an allergy diagnosis in those reporting immediate reactions. Only 2/54 patients with late-positive intradermal test (IDT) to CL were diagnosed of CL allergy. CONCLUSION: Allergy diagnosis was confirmed in a minority of the whole study population, but 5 times more frequently in those reporting immediate reactions, making this classification useful in risk stratification. Late-positive IDT for CL has no diagnostic value and its late reading could be retrieved from the diagnosis work-up.

Prevalence and clinical relevance of local allergic rhinitis.

BACKGROUND: Evidence demonstrates the existence of local allergic rhinitis (LAR) in nonatopic patients, although its prevalence in the rhinitis population remains unknown. The aim, therefore, of this study was to evaluate the prevalence, clinical characteristics, and severity of LAR in a Spanish rhinitis population, compared with patients having classical allergic rhinitis (AR) with systemic atopy or nonallergic rhinitis (NAR). METHODS: A group of 452 adult rhinitis patients were randomly selected from a total of 3860 who attended our allergy service over 1 year. A clinical questionnaire, skin prick test (SPT), spirometry, and serum total and specific IgE (sIgE) were evaluated. A nasal allergen provocation test with multiple aeroallergens (NAPT-M), including Dermatophagoides pteronyssinus, pollens, alternaria, and dog epithelia, was performed in patients with negative SPT and serum sIgE. RESULTS: A total of 428 patients completed the study; 24 were excluded because of nasal hyper-reactivity. LAR was diagnosed in 25.7%, AR in 63.1%, and NAR in 11.2%. The LAR and AR patients had a similar clinical profile: a nonsmoking woman with severe, persistent perennial rhinitis frequently associated with conjunctivitis and asthma. More than 36% of LAR patients reported rhinitis onset in childhood. NAPT-M detected aeroallergen polysensitization in 37.3% of the LAR patients. Dermatophagoides pteronyssinus was the main sensitizing aeroallergen in LAR and AR (60% vs 54%, P > 0.05). CONCLUSIONS: Local allergic rhinitis is a prevalent entity in patients evaluated with rhinitis. Persistent and severe symptoms associated with conjunctivitis and/or asthma and polysensitization were likely to be detected in LAR and AR.

Coenzyme Q content depends upon oxidative stress and dietary fat unsaturation.

The presence of Coenzyme Q (CoQ) in food, its role in cellular bioenergetics and antioxidant protection and the key role played by dietary fatty acids on membrane structure support the interest for a wide research concerning the relationship between dietary fats, CoQ content and biochemical behaviour. Several models of peroxidative stress 'in vivo' have been extensively investigated in our laboratory, with particular regards to the influence of dietary fat upon mitochondrial CoQ levels. First studies showed that the unsaturation degree of dietary fat leads to different CoQ9 and CoQ10 mitochondrial contents. The highest levels were found using polyunsaturated fat. A significant CoQ9 decrease after adriamycin peroxidative induction was found when dietary fat was polyunsaturated; on the contrary, a light increase was found in the case of monounsaturated fat. Another example of oxidative stress is that produced by food frying. The results obtained were in some cases similar to those of the previous experimental design: in fact monounsaturated dietary fats increased CoQ mitochondrial contents, whereas the polyunsaturated ones decreased CoQ levels. Finally, the combined effect of physical exercise and dietary fats on tissue and plasma CoQ levels has been studied. CoQ levels did not change during aerobic performances when dietary fat was monounsaturated whereas light increases were detected in the case of polyunsaturated fats. On the contrary, in anaerobic conditions, CoQ levels clearly increased with monounsaturated fats and no alterations were found in the case of polyunsaturated ones.

Peroxidative extent and coenzyme Q levels in the rat: influence of physical training and dietary fats.

Sport practice is widely recognized as capable of producing peroxidative damages, even of severe intensity. Dietary manipulations can also modify membrane susceptibility to peroxidation. In previous experiments we found that, while dietary virgin olive oil successfully protects mitochondrial and microsomal membranes from endogenous, xenobiotics-induced peroxidation, dietary polyunsaturated oils lead to increased peroxidative levels. In the latter conditions, cell machinery tries to counteract the structural and functional changes which have occurred, by modulating enzyme activities and concentrations, by increasing biosynthesis of coenzyme Q and by mobilizing cholesterol. In the present study we hypothesized that combining these two aspects could give useful information on the membrane response to peroxidation phenomena that daily occur throughout the lifespan. Rats fed different dietary oils as only fat source underwent a carefully designed training program and were killed at different times following acute or chronic exercise. Results show that peroxidation related to chronic training and to an acute bout of exercise sum up with peroxidative effects induced by dietary factors. The above mentioned phenomena occurred simultaneously with increased tissue levels of coenzyme Q, possibly triggered within a physiological reactive antioxidant strategy.

Lipid peroxidation and antioxidants in newborns.

The aim of this investigation was to elucidate a possible correlation between lipid peroxidation, antioxidant concentrations and erythrocyte membrane fluidity in plasma from newborns. Ten healthy newborns were recruited. Venous blood samples were collected at birth, and thereafter at 3 and 72 h postnatal age. The following parameters were assessed: hydroperoxides, Coenzyme Q10 and alpha-tocopherol both in plasma and in erythrocyte membranes, and fluorescence polarization (as a tool for assessing membrane fluidity). Hydroperoxides were shown to be high in erythrocyte membranes at birth and significantly decreased at 3 and 72 h after birth. In the erythrocyte membranes, coenzyme Q10 content showed an opposite behaviour with respect to the plasma compartment. Membrane fluidity appeared unchanged even in the presence of the above mentioned modifications.

Plasticidad cognitiva en personas con la enfermedad de Alzheimer que reciben programas de estimulación cognitiva / Cognitive plasticity in Alzheimer’s disease patients receiving cognitive stimulation programs

El objetivo de este estudio es el de investigar potenciales cambios en plasticidad cognitiva tras entrenamientos de psicoestimulación en enfermos de Alzheimer en fase leve. Participaron en el estudio 26 pacientes diagnosticados de enfermedad de Alzheimer en fase leve, 17 de los cuales seguían un programa de estimulación cognitiva durante 6 meses y los otros 9 fueron asignados al grupo control. Con el objetivo de evaluar la plasticidad cognitiva, todos los participantes fueron evaluados antes y después del tratamiento con tres subtests de la Batería de Evaluación del Potencial de Aprendizaje (BEPAD). Los sujetos tratados incrementaron su rendimiento en todas las pruebas de evaluación de potencial de aprendizaje con respecto al nivel previo al entrenamiento: memoria viso-espacial, audio-verbal y fluidez verbal. Sin embargo, los pacientes del grupo control disminuyeron su rendimiento en todas las pruebas. Los resultados de este estudio ponen de manifiesto que el entrenamiento cognitivo realizado puede eficazmente incrementar la plasticidad cognitiva, en pacientes con enfermedad de Alzheimer en fase leve, en tareas de memoria viso-espacial, audio-verbal y en fluidez verbal, y que los pacientes que no son tratados declinan en su plasticidad cognitiva (AU)

The main purpose of this article is to examine whether cognitive plasticity increases after cognitive training in Alzheimer’s disease patients. Twenty six patients participated in this study, all of them diagnosed with mild Alzheimer’s disease , 17 of them received a cognitive training program during 6 months, and the other 9 were assigned to the control group. Participants were assigned to experimental or control conditions for clinical reasons. In order to assess cognitive plasticity, all patients were assessed before and after treatment with three subtests from the «Bateria de Evaluación de Potencial de Aprendizaje en Demencias» [Assessment Battery of Learning Potential in Dementia] (BEPAD). After treatment, Alzheimer’s disease patients improved their performance in all the tasks assessing cognitive plasticity: viso-spatial memory, audio-verbal memory and verbal fluency. However, the cognitive plasticity scores of the patients in the control group decreased. In conclusion, this study showed that cognitive stimulation programs can improve cognitive functioning in mildly demented patients, and patients who do not receive any cognitive interventions may reduce their cognitive functioning (AU)