RESUMO
BACKGROUND: The prevalence of asthma has increased in recent decades. Among the reasons for this increase is environmental pollution. Pollutants cause bronchial inflammation and introduce modifications in the pollen, making it more allergenic. OBJECTIVE: Assess symptoms and medication requirements of asthmatic patients with grass allergies in Madrid (high urban pollution) and Ciudad Real (low pollution), and simultaneously evaluate the in vitro effects that pollen collected in both areas has on the immune cells of patients. METHODS: During two pollen seasons, patients from both cities were included. The patients recorded their symptoms and the asthma medication they took daily. In both cities, pollen data, pollutants and meteorological variables were evaluated. The response to different cell populations from patients in both areas were analysed after "in vitro" stimulation with pollen from both cities. RESULTS: The symptoms and medication use of the patients in Madrid was 29.94% higher. The NO2 concentration in Madrid was triple that of Ciudad Real (33.4 vs. 9.1 µg/m3 of air). All other pollutants had very similar concentrations during the study period. Pollen from the high pollution area caused a significant enhancement of T-CD8+ and NK cells proliferation compared with pollen of low pollution area, independently of the patient's origin. CONCLUSION: Asthmatic patients from Madrid have a worse clinical evolution than those from Ciudad Real because of higher levels of urban pollution, and this could be driven by the higher capacity of pollen of Madrid to activate T-CD8+ and NK cells.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Alérgenos , Asma/tratamento farmacológico , Asma/epidemiologia , Asma/etiologia , Poluição Ambiental/análise , Humanos , Poaceae , Pólen , Estações do AnoRESUMO
BACKGROUND: Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. METHODS: Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and non-immediate reactions. The workup included sIgE, skin testing, and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for non-immediate ones. RESULTS: Of the 510 children included, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%). Among non-immediate reactions (11.4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6-7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities. CONCLUSIONS: There were few confirmed cases of either type of reaction. Skin testing proved less valuable in non-immediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have non-immediate reactions, while clavulanic acid selectivity was exclusive to the non-immediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation.
Assuntos
Hipersensibilidade a Drogas , Hipersensibilidade Imediata , Preparações Farmacêuticas , Antibacterianos/efeitos adversos , Criança , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Humanos , Estudos Prospectivos , Testes Cutâneos , beta-Lactamas/efeitos adversosAssuntos
Cucurbita , Globulinas , Hipersensibilidade , Albuminas , Humanos , Proteínas de Plantas , SementesAssuntos
Albuminas 2S de Plantas/imunologia , Anacardiaceae/imunologia , Antígenos de Plantas/imunologia , Reações Cruzadas/imunologia , Hipersensibilidade a Noz/diagnóstico , Hipersensibilidade a Noz/imunologia , Adolescente , Adulto , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina E/imunologia , Masculino , Adulto JovemAssuntos
Alérgenos/imunologia , Asma/diagnóstico , Conjuntivite Alérgica/diagnóstico , Hipersensibilidade Alimentar/diagnóstico , Proteínas de Plantas/imunologia , Rinite Alérgica Sazonal/diagnóstico , Rinite/diagnóstico , Adolescente , Antígenos de Plantas/imunologia , Criança , Feminino , Humanos , Masculino , Pólen/imunologia , Prunus persica/imunologia , Testes CutâneosAssuntos
Alérgenos/imunologia , Carboxipeptidases/imunologia , Quitinases/imunologia , Ouriços/imunologia , Hipersensibilidade/imunologia , Elastase Pancreática/imunologia , Adulto , Animais , Carboxipeptidases/metabolismo , Quitinases/metabolismo , Feminino , Humanos , Hipersensibilidade/diagnóstico , Elastase Pancreática/metabolismo , Adulto JovemRESUMO
BACKGROUND: Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) in children are becoming a great concern. Most studies have focused on adults, with noted discrepancies observed in the classification of hypersensitivity reactions to NSAIDs in children when compared with adults. OBJECTIVE: To phenotype a group of children with hypersensitivity reactions to NSAIDs, including paracetamol, and analyze the degree of agreement with the entities reported in adults and how they fit the proposed classifications. METHODS: The study comprised 116 children aged 0.5 to 14 years, with a clinical history indicative of hypersensitivity reactions to NSAIDs. They all underwent a single-blind oral provocation test with acetyl salicylic acid, except in those cases when this was the suspected drug, in which case the challenge was done first with ibuprofen. If positive, cross-intolerance was established and if negative, an oral provocation test with the culprit drug was performed to establish a selective response or exclude allergy. RESULTS: Of the 26% diagnosed as hypersensitive to NSAIDs, 83% were cross-intolerant and 17% selective reactors. The highest significant differences between reactors and nonreactors were observed in the time to reaction after drug intake and the clinical entity (P < .0001), followed by drug involved and age (P < .01). CONCLUSIONS: From the total number of cases confirmed with NSAID hypersensitivity, 83% were cross-intolerant. In cross-intolerant reactions, both cutaneous and respiratory manifestations are common. Acetyl salicylic acid challenge as the first approach proved to be safe and useful to establish the diagnosis.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Acetaminofen/efeitos adversos , Administração Oral , Adolescente , Anti-Inflamatórios não Esteroides/efeitos adversos , Criança , Pré-Escolar , Hipersensibilidade a Drogas/etiologia , Feminino , Humanos , Ibuprofeno/efeitos adversos , Tolerância Imunológica , Lactente , Masculino , Método Simples-CegoRESUMO
INTRODUCTION: Different clinical and molecular patterns of food allergy have been reported in different areas of the world. The aim of the study is to evaluate differences in allergen patterns among nut-allergic patients in two different areas of Spain. MATERIAL AND METHODS: A total of 77 patients with nut allergy from two different regions of Spain (Madrid and Asturias) were evaluated. RESULTS: Hazelnut, peanut, and walnut were the three most frequent nuts eliciting allergy in both regions, but in a different order. Patients from Madrid experienced systemic reactions more often than patients from Asturias (73.5% Madrid vs. 50.0%, p < 0.05). The percentage of sensitizations to LTP (Lipid Transfer Protein) was higher than Bet v 1 (p < 0.05) in the Madrid area. The percentage of sensitizations in Asturias area was similar to LTP than Bet v 1 (Pru p 3 46.4%, Bet v 1 42.9%, ns). Bet v 1 was the predominant allergen involved among hazelnut-allergic patients (56.2%), while LTP was more common in peanut-allergic patients (61.5%). CONCLUSION: Walnut, hazelnut, and peanut were the most frequent nuts eliciting allergy in Spain. Despite this, important differences in molecular pattern were appreciated not only between both regions, but also among nut-allergic patients in Asturias. The different molecular pattern was linked to the frequency of systemic symptoms.
Assuntos
Alérgenos/análise , Hipersensibilidade a Noz/diagnóstico , Hipersensibilidade a Noz/epidemiologia , Adolescente , Adulto , Idoso , Alérgenos/imunologia , Arachis/imunologia , Proteínas de Transporte/análise , Proteínas de Transporte/imunologia , Criança , Corylus/imunologia , Feminino , Humanos , Imunoglobulina E/sangue , Juglans/imunologia , Masculino , Pessoa de Meia-Idade , Proteínas de Plantas/análise , Proteínas de Plantas/imunologia , Prevalência , Espanha/epidemiologia , Adulto JovemAssuntos
Asma/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Administração por Inalação , Corticosteroides/uso terapêutico , Adulto , Idoso , Asma/tratamento farmacológico , Betacoronavirus , COVID-19 , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Socioeconômicos , Adulto JovemAssuntos
Asma/tratamento farmacológico , Asma/epidemiologia , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Acetaminofen/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Antiasmáticos/uso terapêutico , COVID-19 , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , SARS-CoV-2 , Espanha/epidemiologiaRESUMO
SCOPE: Today, about 2-8% of the population of Western countries exhibits some type of food allergy whose impact ranges from localized symptoms confined to the oral mucosa to severe anaphylactic reactions. Consumed worldwide, lettuce is a Compositae family vegetable that can elicit allergic reactions. To date, however, only one lipid transfer protein has been described in allergic reaction to lettuce. The aim of this study was to identify potential new allergens involved in lettuce allergy. METHODS AND RESULTS: Sera from 42 Spanish lettuce-allergic patients were obtained from patients recruited at the outpatient clinic. IgE-binding proteins were detected by SDS-PAGE and immunoblotting. Molecular characterization of IgE-binding bands was performed by MS. Thaumatin was purified using the Agilent 3100 OFFGEL system. The IgE-binding bands recognized in the sera of more than 50% of patients were identified as lipid transfer protein (9 kDa), a thaumatin-like protein (26 kDa), and an aspartyl protease (35 and 45 kDa). ELISA inhibition studies were performed to confirm the IgE reactivity of the purified allergen. CONCLUSION: Two new major lettuce allergens-a thaumatin-like protein and an aspartyl protease-have been identified and characterized. These allergens may be used to improve both diagnosis and treatment of lettuce-allergic patients.