Vasculitis during immunotherapy treatment in a patient with allergy to Cupressus arizonica.

UNLABELLED: Allergen immunotherapy dates back to 1911 and has been used successfully to treat large numbers of patients throughout the last century. CASE REPORT: a 66-year-old woman presented with symptoms of allergic rhinitis and asthma due to sensitization to Cupressus arizonica. Specific immunotherapy was prescribed as a continuous 2-year treatment with a depot preparation of standarized and characterized allergen extracts of Cupressus arizonica pollen. Forty-eight hours after one maintenance dose of 0.8 cc, the patient presented palpable violaceous purpuric lesions and pruritus on both legs. We performed skin prick and intradermal tests with Cupressus arizonica. Twenty-four hours later, the 1/1 dilution intradermal skin test was positive. Biopsy showed leukocytoclastic vasculitis. CONCLUSIONS: A middle-aged woman experienced cutaneous non-necrotizing vasculitis after 2 years of maintenance immunotherapy. The interval between injections and the first appearance of cutaneous lesions suggests a type III hypersensitivity immune reaction. Skin biopsy of the positive intradermal test also supports this hypothesis.

[Safety of rush immunotherapy with Hymenoptera venom]. / Seguridad de la inmunoterapia con una pauta rápida con veneno de himenópteros.

OBJECTIVES: To determine the incidence and nature of adverse events associated with the induction of rush Hymenoptera venom immunotherapy. MATERIAL AND METHODS: Between 1998 and 2003, we administered venom immunotherapy to 48 patients allergic to bee or wasp venom, by means of a rush immunotherapy protocol (3 days). RESULTS: We observed no severe adverse reactions in any patients. 12 patients developed only local reactions at the site of injections that did not required any pharmacological treatment. Two patients experienced mild systemic reactions consisting of diffuse urticaria on day 3. Both adverse reactions were treated with intravenous antihistamines. CONCLUSIONS: Our experience confirms that rapid venom immunotherapy is safe and should be considered in every case especially for patients during the stinging insect season when a rapid protection is required.

[Baboon syndrome]. / Síndrome de baboon.

Andersen et al described baboon syndrome in 1984. It was characterized by a clinical presentation of systemic contact dermatitis with pruritic and confluent maculopapular light-red eruption, localized in the gluteal area and the major flexures, developed several hours or days after drug or agent contact. This syndrome has a pathognomonic distribution but its cause has not been elucidated yet. Histopathology of the lesions shows non-specific features of dermatitis. Several drugs have been previously described as responsible for the Baboon syndrome origin. Mercury is the most frequent implicated agent; other agents are nickel, different antibiotics, heparine, aminophylline, pseudoephedrine, terbinafine and immunoglobulins

Síndrome de baboon / Baboon syndrome

El síndrome de baboon fue descrito por primera vez por Andersen en 1984 que lo definió como la presentación clínica de una dermatitis de contacto sistémica caracterizada por la presencia de prurito y erupción maculopapular eritematosa confluente en el área de los glúteos y de las flexuras mayores que aparece varias horas después e incluso varios días, tras el contacto con un fármaco u otro agente. La distribución de las lesiones es patognomónica aunque se desconoce la patogénesis. En la mayoría de los casos descritos, la anatomía patológica de las lesiones confirman cambios inespecíficos de dermatitis. Se han demostrado numerosos fármacos como desencadenantes de este tipo de reacciones. No obstante, el agente más frecuente es el mercurio, según numerosos casos publicados. Otros agentes causantes son: niquel, diferentes antibióticos, heparina, aminofilina, pseudoefedrina, terbinafina e inmunoglobulinas (AU)

Andersen et al described baboon syndrome in 1984. It was characterized by a clinical presentation of systemic contact dermatitis with pruritic and confluent maculopapular light-red eruption, localized in the gluteal area and the major flexures, developed several hours or days after drug or agent contact. This syndrome has a pathognomonic distribution but its cause has not been elucidated yet. Histopathology of the lesions shows non-specific features of dermatitis. Several drugs have been previously described as responsible for the Baboon syndrome origin. Mercury is the most frequent implicated agent; other agents are nickel, different antibiotics, heparine, aminophylline, pseudoephedrine, terbinafine and immunoglobulins (AU)

Auriculotemporal nerve syndrome.

INTRODUCTION: Auriculotemporal nerve syndrome is characterized by erythema, perspiration, heat and pain localized in the area supplied by the auriculotemporal nerve in response to gustatory stimuli after the ingestion of different types of food. This syndrome may be confused with food allergy. CASE REPORT: A 21-year-old woman complained of erythema, sweat and heat in the right cheek after intake of several foods such as chocolate, fruits, and nuts for the previous 8 months. She had fractured her jaw two years previously. METHODS: Skin prick tests were performed with a standard battery of common inhalant allergens and with an extensive panel of food allergens. Prick-by-prick tests were also performed with fruits, nuts, and cacao. Total and specific IgE were measured. Open oral food challenge test was performed. RESULTS: Skin prick tests were positive for grass and olive pollen. Prick-by-prick tests and specific IgE antibodies to the different foods were all negative. Open oral challenge test with apple reproduced the symptoms. CONCLUSIONS: This benign syndrome is often misdiagnosed as a food allergy.

[Exercise-induced anaphylaxis syndrome]. / Síndrome de anafilaxia inducida por ejercicio.

In the last two decades a growing incidence of a peculiar form of anaphylaxis that only occurs while carrying out physical exercise has been observed. Within the exercise-induced anaphylaxis syndrome two well differentiated clinical forms are included: systemic cholinergic urticaria and exercise-induced anaphylaxis in the strict sense which can be shown by a classic form or a variant form, more uncommon and with manifestations similar to cholinergic urticaria. Postprandial or food-dependent exercise-induced anaphylaxis is a frequently identified subtype of these last cases. It can be due to an asymptomatic food allergy manifested through physical effort, although in many occasions it is not possible to find a responsible allergen. The diagnosis is settled on the clinical history and specific tests with food allergens. It can be necessary to perform an exercise challenge test with and without previous ingestion. The treatment is preventive and it is based on avoiding the food or the food allergen some hours before the exercise. When it does not depend on foods it is used a prophylactic pharmacotherapy with antihistamines, cromones or sodium bicarbonate. The patient should be well educated on the use of epinephrine in the event of new reactions.

Anaphylactic reaction to young garlic.

BACKGROUND: Garlic is well known to cause contact dermatitis and asthma. However, it is a very rare cause of food allergy. We present the case of a 23-year-old woman with previous history of allergy to pollen and dried fruit, and food-dependent, exercise-induced anaphylaxis for which no specific food could be identified as responsible, who experienced an anaphylactic reaction after eating young garlic. METHODS: Skin prick tests and specific IgE immunoassay with several pollens and foods were performed, as well as the prick-prick test with young garlic and SDS-PAGE followed by immunoblotting IgE to young garlic and other Liliaceae species, mustard, sesame, parsley, celery, hazelnut, almond, and pollen of birch and mugwort. RESULTS: Skin prick tests and specific IgE were mainly positive for grass, plane tree, and mugwort pollen; peanut; hazelnut; walnut; almond; and mustard. Prick-prick tests with young garlic and garlic were positive. Total IgE was 113 U/ml. SDS-PAGE immunoblotting showed IgE-binding bands at 12 kDa to young garlic, garlic, onion, and leek extracts. Similar bands could also be detected with mugwort pollen and hazelnut extract. CONCLUSIONS: We describe IgE-mediated reaction to young garlic in a patient sensitized to pollen and dried fruit.