Urticaria caused by antihistamines: report of 5 cases.

Antihistamines are widely used drugs. Hypersensitivity reactions with these drugs are rare and a challenge for the physician. We describe 5 outpatients who experienced urticaria after taking antihistamines. All 5 were treated at our outpatient clinic over a period of 15 years. The allergy workup included a clinical history, skin prick testing, patch testing with antihistamines, and single-blind placebo-controlled oral challenge tests. Biopsy samples were taken and serum tryptase levels were determined in 1 patient. The results of the skin prick tests and patch tests were negative in all patients but 1, in whom the prick test result was positive to some antihistamines. We confirmed all diagnoses using a single-blind challenge test. The biopsy obtained from 1 patient strongly supported urticaria. We present 5 cases of antihistamine-induced urticaria where the immunologic mechanism remains unclear. Hypersensitivity reactions should be taken into account in patients receiving antihistamines, especially in those who experience urticaria.

[Anaphylaxis after carrying out prick tests]. / Anafilaxia tras realización de pruebas cutáneas en prick.

The skin prick test (SPT) is a simple and fast method used routinely in allergology practice. Systemic reactions have been described with this technique on few occasions. We are presenting a case of anaphylaxis with hemodynamic consequences after carrying out skin prick test with a cat dander extract. A 23 years old female who suffered rhinoconjunctivitis and asthma following contact with cats. We performed skin prick test with a battery of the usual inhalants. Twenty minutes after carrying out the prick test the patient showed intense ocular irritation and reddening followed by dysphonia and a feeling of pharyngeal occupation. Although skin prick test is a safe diagnostic approach, it should be performed only in places equipped to treat anaphylaxis and for trained specialists .

[Induction of tolerance in hypersensitivity to mesalazine (5-ASA)]. / Inducción de tolerancia en la hipersensibilidad a mesalazina (5-ASA).

Mesalazine is a derivative of 5-aminosalicylic acid (5-ASA), which is useful in the treatment of intestinal inflammatory disease. Sulfasalazine is formed by two parts, sulfapyridine and 5-ASA, the latter being the active part of the molecule. The new preparatives derived from 5-ASA were developed in an attempt to avoid the traditionally associated side effects to sulfapyridine, although they are still observed and new effects appear. We present two cases. The first is a man diagnosed of inflammatory intestinal disease, with background of two previous reactions of urticaria and angioedema after acetyl salicylic acid, who presented urticaria after taking mesalazine. The second one had generalized urticaria after three months of initiating treatment with mesalazine. Given the need for treatment in both cases, a desensitization protocol to mesalazine was made. It was developed in 17 days in our service. Tolerance to that drug to therapeutic doses is reached. When faced with patients with hypersensitivity to different drugs, that are necessary to treat their disease, "desensitization" regimes, that assure good tolerance, can be made.

Positivity of patch tests in cutaneous reaction to aminocaproic acid: two case reports.

We observed two cases of maculopapular eruption occurring 12-72 h after the administration of aminocaproic acid (ACA). Patch tests performed with ACA were positive. Clinical and allergologic patterns suggest the type IV mechanism of hypersensitivity. We present what we believe are the first two cases described of hypersensitivity to this drug.

[Diagnostic procedures in primary ciliary dyskinesia. The usefulness of nasal biopsy]. / Procedimientos diagnósticos en la discinesia ciliar primaria. Utilidad de la biopsia nasal.

Eight patients are studied who are suspected to have primary ciliary dyskinesia (PCD). All cases presented from the first year of live repetitive respiratory infections, chronic cough, mucopurulent rhinorrhea, radiologic signs of sinusitis and one patient also presented situs inversus. Bronchiectasis were found in four cases, they were discarded in two cases, and in two other cases they could not be found nor discarded. The definite diagnosis was achieved by the study of the ultrastructure of the cilia by nasal biopsy. In three cases, nasal biopsy discarded the diagnosis of PCD and confirmed such diagnosis in other three cases. One case of PCD was diagnosed by a bronchial biopsy after two unsuccessful attempts to obtain a nasal sample containing ciliary epithelium. One case remains undiagnosed since after a nonvalid biopsy, we did not consider necessary to obtain another one given that the patient was asymptomatic during the last three years.

Anafilaxia tras realización de pruebas cutáneas en prick / Anaphylaxis after carrying out prick tests

Las pruebas cutáneas en prick (SPT) son un método sencillo y muy útil en la práctica alergológica diaria. Se han descrito reacciones sistémicas con este método diagnóstico en contadas ocasiones. Presentamos un caso de anafilaxia tras la realización de SPT con epitelio de gato. Se trataba de una mujer de 23 años que presentaba rinoconjuntivitis y asma bronquial al contacto con gato. Realizamos SPT con bateria de aeroalérgenos habituales, presentando cuadro de irritación ocular, disfonía y sensación de ocupación faríngea a los 20 minutos. Aunque el riesgo de reacción sistémica tras SPT es escaso, recomendamos la realización de esta prueba diagnóstica en lugares preparados para tratar reacciones anafilácticas y por personal experto

The skin prick test (SPT) is a simple and fast method used routinely in allergology practice. Systemic reactions have been described with this technique on few occasions. We are presenting a case of anaphylaxis with hemodynamic consequences after carrying out skin prick test with a cat dander extract. A 23 years old female who suffered rhinoconjunctivitis and asthma following contact with cats. We performed skin prick test with a battery of the usual inhalants. Twenty minutes after carrying out the prick test the patient showed intense ocular irritation and reddening followed by dysphonia and a feeling of pharyngeal occupation. Although skin prick test is a safe diagnostic approach, it should be performed only in places equipped to treat anaphylaxis and for trained specialists

Inducción de tolerancia en la hipersensibilidad a mesalazina (5-ASA) / Inductionof tolerance in hypersensitivity to mesalazine (5-ASA)

La mesalazina es un derivado del ácido 5-aminosalicílico (5-ASA, el cual es útil en el tratamiento de la enfermedad inflamatoria intestinal. La sulfasalazina está formada por dos partes, la sulfapiridina y el 5-ASA, siendo ésta última la parte activa de la molécula. Los nuevos preparados derivados del 5-ASA se desarrollaron tratando de evitar los efectos secundarios tradicionalmente asociados a la sulfapiridina, aunque se siguen observando y aparecen nuevos efectos. Presentamos dos casos, el primero es un varón diagnosticado de enfermedad inflamatoria intestinal, con antecedentes de dos reacciones previas de urticaria y angioedema tras ácido acetilsalicílico, que presenta urticaria tras la toma de mesalazina. El segundo presenta urticaria generalizada tras tres meses de iniciar tratamiento con mesalazina. Dada la necesidad de tratamiento en ambos casos, se realiza el protocolo de desensibilización a mesalazina desarrollado en 17 días en nuestro servicio, con el que se llega a la tolerancia de dicho fármaco hasta dosis terapéuticas. Ante pacientes con hipersensibilidad a distintos fármacos, que sean necesarios para el tratamiento de su patología, pueden realizarse pautas de “desensibilización”, que aseguren una buena tolerancia

Mesalazine is a derivative of 5-aminosalicylic acid (5-ASA), which is useful in the treatment of intestinal inflammatory disease. Sulfasalazine is formed by two parts, sulfapyridine and 5-ASA, the latter being the active part of the molecule. The new preparatives derived from 5-ASA were developed in an attempt to avoid the traditionally associated side effects to sulfapyridine, although they are still observed and new effects appear. We present two cases. The first is a man diagnosed of inflammatory intestinal disease, with background of two previous reactions of urticaria and angioedema after acetyl salicylic acid, who presented urticaria after taking mesalazine. The second one had generalized urticaria after three months of initiating treatment with mesalazine. Given the need for treatment in both cases, a desensitization protocol to mesalazine was made. It was developed in 17 days in our service. Tolerance to that drug to therapeutic doses is reached. When faced with patients with hypersensitivity to different drugs, that are necessary to treat their disease, “desensitization” regimes, that assure good tolerance, can be made