Subject(s)
Allergens/metabolism , Anaphylaxis/diagnosis , Hypersensitivity/diagnosis , Plant Oils/metabolism , Skin/pathology , Administration, Topical , Adult , Angioedema , Female , Humans , Hypotension , PruritusABSTRACT
No disponible
Subject(s)
Humans , Animals , Female , Adult , Allergens/immunology , Conjunctivitis, Allergic/diagnosis , Conjunctivitis, Allergic/immunology , Pediculus/immunology , Rhinitis, Allergic/diagnosis , Rhinitis, Allergic/immunology , Serologic Tests , Skin TestsABSTRACT
BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p = 0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD
No disponible
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Anti-Inflammatory Agents/therapeutic use , Dermatitis, Atopic/drug therapy , Fluticasone/therapeutic use , Secondary Prevention/methods , Double-Blind MethodABSTRACT
BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Dermatitis, Atopic/drug therapy , Fluticasone/therapeutic use , Secondary Prevention/methods , Child , Child, Preschool , Double-Blind Method , Female , Humans , MaleSubject(s)
Anti-Allergic Agents/therapeutic use , Desensitization, Immunologic/methods , Egg Hypersensitivity/therapy , Milk Hypersensitivity/therapy , Omalizumab/therapeutic use , Allergens/immunology , Animals , Cattle , Child , Child, Preschool , Combined Modality Therapy , Egg Hypersensitivity/immunology , Egg Proteins/immunology , Female , Humans , Immunoglobulin E/blood , Male , Milk Hypersensitivity/immunology , Milk Proteins/immunology , Treatment OutcomeSubject(s)
Desensitization, Immunologic , Immune Tolerance , Milk Hypersensitivity/drug therapy , Milk Hypersensitivity/immunology , Milk/adverse effects , Animals , Cattle , Child , Child, Preschool , Cross Reactions , Female , Goats , Humans , Immunoglobulin E/immunology , Immunoglobulin E/metabolism , Male , Skin TestsABSTRACT
BACKGROUND: Leukotrienes and isoprostanes are biomarkers of airway inflammation and oxidative stress that can be detected in exhaled breath condensate (EBC). The aim of this study was to evaluate leukotriene B4 (LTB4) and 8-isoprostane levels in EBC of healthy and asthmatic children with episodic and moderate persistent asthma. METHODS: EBC was collected from 62 children aged 6 to 14 years: 22 healthy children, 30 patients with episodic asthma, and 10 patients with moderate persistent asthma, without preventive treatment at the time of enrolment. RESULTS: LTB concentrations were higher in children with asthma than in healthy controls (50.7 pg/mL vs. 13.68 pg/mL, P < .011). The same was true for children with moderate persistent asthma compared to children with episodic asthma (146.9 pg/mL vs. 18.85 pg/mL, P < .0001), children with moderate persistent asthma compared to healthy controls (146.9 pg/mL vs. 13.68 pg/mL, P < .0001), and children with episodic asthma compared to healthy controls (P, nonsignificant). EBC concentrations of 8-isoprostane were higher in asthmatic than in healthy children (18.3 pg/mL vs. 6.59 pg/mL, P < .026). They were also increased in children with moderate persistent asthma compared to those with episodic asthma (36.25 pg/mL and 12.28 pg/mL, P < .012), and in children with moderate persistent asthma and episodic asthma compared to healthy controls (36.25 pg/mL vs. 6.59 pg/mL [P < .0001] and 12.28 pg/mL versus 6.59 pg/mL [P < .0001], respectively). CONCLUSION: LTB4 and 8-isoprostane concentrations were increased in asthmatic children compared to healthy individuals, with differences detected for 2 degrees of asthma severity. Our findings suggest that EBC is a noninvasive method for airway inflammation and oxidative stress assessment.
Subject(s)
Asthma/metabolism , Dinoprost/analogs & derivatives , Leukotriene B4/metabolism , Adolescent , Asthma/immunology , Breath Tests , Child , Dinoprost/immunology , Dinoprost/metabolism , Female , Humans , Leukotriene B4/immunology , Male , Nitric Oxide/immunology , Nitric Oxide/metabolism , Oxidative Stress/immunology , Respiratory Function Tests , Statistics, NonparametricABSTRACT
OBJECTIVE: To analyze the clinical and epidemiologic characteristics of the population with atopic dermatitis (AD) consulting in Allergology services in Spain. MATERIALS AND METHODS: The study was a multi-center, observational, descriptive, cross-sectional epidemiologic study with prospective collection of data on patients consulting for the first time in Allergology services in Spain. By means of a data collection record, personal and specific variables were collected during the calendar year 2005 from a total of 4991 patients with AD. RESULTS: AD was diagnosed in 171 patients (3.4% of patients seen in Allergology services), which represented no significant change with regard to the Alergológica-1992 study. In 72% of cases, AD was associated with other allergic disorders. The mean age of the onset of clinical manifestations of AD was 1 year and 4 months. During the first consultations, the suspected diagnosis of AD was established in 83% of cases. In 58% of cases the cause was considered idiopathic and 42% were associated with sensitization to allergens. In 10% of patients with AD the triggering allergens were foods and in 26% aeroallergens. Most patients (94%) received hydrating skin and drug treatment (anti-histamines 73%, topical corticoids 49%, calcineurin inhibitors 31%). Only 10% of patients followed an exclusion diet. CONCLUSIONS: No significant increase in the demand for AD consultations was observed in comparison with Alergológica-1992. AD was frequently associated with other allergic disorders. In few cases was food involved in the etiology of the disease. In most cases nothing more than topical drug treatment was indicated.
Subject(s)
Dermatitis, Atopic/diagnosis , Adolescent , Adult , Aged , Breast Feeding , Child , Child, Preschool , Cross-Sectional Studies , Dermatitis, Atopic/epidemiology , Dermatitis, Atopic/etiology , Dermatitis, Atopic/therapy , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Prevalence , Quality of Life , Socioeconomic Factors , Spain/epidemiologyABSTRACT
We report the induction of tolerance in four patients with severe IgE-mediated cow's milk allergy, with an oral rush desensitization by introducing increasing daily doses of cow's milk (CM) for 5 days under clinical conditions in order to enable the patients to tolerate 200 ml of CM daily. Our results indicate that we can induce clinical tolerance in CM allergy by oral administration of progressive doses of milk. After three years of following, the four patients are taking CM with good tolerance. Specific IgE levels of casein have decreased progressively during these three years until being not detectable in three of the four patients and also a reduction has been observed in the cutaneous skin prick test reactions to CM.
Subject(s)
Desensitization, Immunologic/methods , Immune Tolerance , Milk Hypersensitivity/therapy , Milk/immunology , Animals , Child, Preschool , Female , Humans , Immunoglobulin E/blood , Immunoglobulin E/immunology , Male , Treatment OutcomeABSTRACT
We report the induction of tolerance in four patients with severe IgE-mediated cow's milk allergy, with an oral rush desensitization by introducing increasing daily doses of cow's milk (CM) for 5 days under clinical conditions in order to enable the patients to tolerate 200 ml of CM daily. Our results indicate that we can induce clinical tolerance in CM allergy by oral administration of progressive doses of milk. After three years of following, the four patients are taking CM with good tolerance. Specific IgE levels of casein have decreased progressively during these three years until being not detectable in three of the four patients and also a reduction has been observed in the cutaneous skin prick test reactions to CM
Presentamos la inducción a la tolerancia de cuatro pacientes con grave alergia a la leche de vaca mediada por IgE, mediante desensibilización oral rápida (rush), administrando diariamente dosis crecientes de leche de vaca durante 5 días, bajo vigilancia clínica, con objeto de conseguir la tolerancia de 200 ml diarios. Los resultados indican que se puede inducir la tolerancia clínica a la leche de vaca por la administración oral progresiva de la misma. Tras el seguimiento durante tres años, los cuatro pacientes toman leche de vaca con buena tolerancia. Los niveles de IgE específica a la caseína han disminuido progresivamente durante estos 3 años hasta no ser detectable en tres de los cuatro pacientes, así como se ha observado la reducción de las pruebas cutáneas realizadas con leche de vaca
Subject(s)
Animals , Male , Female , Infant , Child, Preschool , Cattle , Humans , Desensitization, Immunologic/methods , Immunoglobulin E/immunology , Milk Hypersensitivity/therapy , Administration, Oral , Double-Blind Method , Follow-Up Studies , Skin Tests , Severity of Illness IndexABSTRACT
We report a new case of rhinitis and asthma caused by sea fishing baits. The results showed exposure to Sipunculus nudus (Phylum Sipuncula; order Sipunculida: Sipunculidae) to be the main cause of the allergic symptoms. The intervention of IgE was demonstrated, with the presence of cross-reactions with allergenic extracts from other worm species used as baits, belonging to different orders of Annelida.
Subject(s)
Allergens/adverse effects , Asthma/etiology , Nematoda/immunology , Rhinitis, Allergic, Perennial/etiology , Allergens/immunology , Animals , Antibody Specificity , Asthma/immunology , Cross Reactions/immunology , Female , Humans , Immunoblotting , Immunoglobulin E/blood , Immunoglobulin E/immunology , Middle Aged , Nematoda/isolation & purification , Oceans and Seas , Oligochaeta/immunology , Polychaeta/immunology , Rhinitis, Allergic, Perennial/immunology , Skin TestsABSTRACT
Introducción: Los cisteinil leucotrieno: on mediadore potentes de la inflamación producidos por la 5 lipooxigenasa en el metabolismo del ácido a.raquidónico. Estos mediadores estimulan la secreción en las vías respiratorias. la migración de los eosinófilos y la inflamación en la rinitis y el asma. Los fármacos antileucotriénicos (ALT) desempeñan una función aruinflamatoria en los pacientes asmáticos al impedir los efectos de lo. leucotrieno: bien inhibiendo su síntesis o bloqueando lo receptores de los cisteinil leucotrienos. En los últimos años se han realizado estudios relacionados con la posible eficacia de los fármacos antileucotriénicos asociados o no a los antihistamínicos y los corticoides tópicos en el tratamiento de la rinitis alérgica. Objetivo: Revisar los estudios clínicos con distribución aleatorias. a doble ciego y controlados con placebo que se han realizado con fármacos antileucotriénicos en el tratamiento de la rinitis alérgica. Método: Se realiza una revisión bibliográfica hasta mayo de 2001 en Medline. IME. EMBASE. la base de datos de la Cochrane Libran· y bibliografía facilita da por la industria farmacéutica. Resultados: Se han revisado 13 estudios clínicos que cumplían los requisitos del estudio. Aunque el añadir montelukast en las dosis comercializadas a pacientes tratados con dosis terapéuticas de antihistamínico · mejoran los síntomas de la rinitis. el escaso número de estudios clínicos realizados en la rinitis alérgica utilizando ALT como monoterapia o a ociados a antihistamínico. o corticosteroides tópicos, su corta duración, el que uno de ellos esté disponible sólo en folio de resumen y el hecho de que los resultados no sean homogéneos en función del fármaco antileucotriénico utilizado hacen difícil establecer conclusiones definitivas y globales respecto a esta clase terapéutica. por lo que se precisan más estudio y de mayor duración (...) (AU)
Introduction: Cysteinil leukotrienes are potent 5lipoxygena esynthesized mediator in inflammation in metabolism of arachidonic acid. These mediators stimulate airways secretion. eosinophil migration. and inflammation in rhinitis ( ) (AU)
Subject(s)
Humans , Leukotriene Antagonists/therapeutic use , Rhinitis, Allergic, Seasonal/drug therapy , Patient Safety , Treatment Outcome , Histamine Antagonists/therapeutic use , Adrenal Cortex Hormones/therapeutic useABSTRACT
Introducción: El omalizumab es un anticuerpo monoclonal recombinante humanizado que se une específicamente al dominio C3e de la IgE, el lugar de unión al receptor de afinidad alta de la IgE. Objetivo: Realizar una revisión de lo principales estudios clínicos con distribución aleatoria, a doble ciego y controlado con placebo realizado con omalizumab en pacientes con rinitis alérgica estacional o perenne para determinar la eficacia y seguridad de este anticuerpo monoclonal. Métodos: Se realizó una búqueda bibliográfica hasta abril de 2004 en Medline, IME, EMBASE y la base de datos de Ja Cochrane Library. Resultados: Se incluyeron 8 estudio clínicos con distribución aleatoria en rinitis alérgica, que se comentan y cuyos principales resultados se exponen. Conclusiones: Los paciente con rinitis alérgica e racional y perenne tratados con omalizumab por vía subcutánea presentan un claro beneficio clínico, con poco y leves efectos adversos, lo que le convierte en un fármaco prometedor para el tratamiento de esta enfermedad alérgica (AU)
Introduction: Omalizumab is a recombinant humanized monoclonal antibody which specifically bind to the Ce3 dornain of IgE, the site of binding to the high-affinity IgE receptor. Objective: To carry out a revision of the main randomized double blind clínica] tria] , controlled with placebo that have been carried out with Omalizumab in patients with sea onal or perennial allergic rhinitis in order to determine the efficacy and safety of this monoclonal antibody. Methods: We earched until April 2004 Medline. IME. EMBASE. and Data Base of Cochrane Library. Results: Eight randomized clinical trials were included, which are commented, and their main results are exposed. Conclusions: Patients with seasonal and perennial allergic rhinitis treated subcutaneously with Omalizumab get an evident clinica1 benefit, with few and mild adverse events, what become it in a promising drug for the treatment of this allergic disease (AU)
Subject(s)
Humans , Rhinitis, Allergic, Perennial/drug therapy , Immunologic Factors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Immunoglobulin E , Hypersensitivity, Immediate/drug therapyABSTRACT
Objetivo: Valorar la satisfacción de los pacientes de las consultas externas de la Sección de Alergología del Hospital Universitario Virgen de la Arrixaca (Murcia) e identificar posibles mejora. Material y método: Estudio transversal, utilizando un cuestionario de satisfacción, que se entregó a todos los pacientes que acudieron a la consulta durante una semana de abril de 2004. Resultados: De los 259 pacientes citado, cuarenta y cuatro no acudieron a la consulta. La encuesta fue contestada por 113 pacientes. El 23,0 l % de los pacientes son menores de 20 años. El 67,26% conoce el nombre del alergólogo que les atiende, mientras que sólo el 10.62% conoce el del enfermero. El 6, 19% afirma que el tiempo dedicado a su consulta fue "escaso" o "muy e caso". Veintiocho paciente (24.78%) han realizado sugerencia. El grupo más numeroso corresponde a las relacionadas con la mejora del si tema de citaciones, la reducción de la Ji ta de espera y el tiempo excesivo de espera previo a la consulta. Conclusiones: El conocimiento del nombre de los profesionales sanitarios, el tiempo dedicado a consulta y la información sobre lo riesgo derivados del diagnóstico y tratamiento son aspectos muy valorados por los pacientes en las consultas de alergología y están a ociados a una mayor satisfacción global con el servicio. La espera previa a la consulta y las dificultades para la citación son las oportunidades de mejora expresadas de manera mayoritaria en el apartado de sugerencia (AU)
No disponible
Subject(s)
Humans , Allergy and Immunology/organization & administration , Hypersensitivity/epidemiology , Patient Satisfaction , Hospital Units/statistics & numerical data , Quality of Health Care/statistics & numerical data , Quality Indicators, Health Care , Ambulatory Care/statistics & numerical dataABSTRACT
Fundamento: El incumplimiento es una causa frecuente de fracaso de las actuaciones médicas, y la ausencia a los controles periódicos es una forma importante de éste. Recientemente, nuestro grupo ha publicado un estudio en el que se analiza el grado de incumplimiento de las citas concertadas de los pacientes citados en nuestra consulta de alergología (julio de 2001 a junio de 2002) y se realizaron propuestas de mejora. Objetivo: En el presente manuscrito se evalúan los resultados obtenidos en el año posterior a su puesta en marcha. Métodos: Se incluyeron los pacientes citados en consulta que acudían por primera vez o a una visita sucesiva, desde julio de 2002 a junio de 2003. Fueron objeto del estudio un total de 1.924 citaciones (441 de primera vez y 1.483 sucesivas) que no acudieron a la consulta, correspondientes a 1.762 pacientes (414 de primera visita y 1.348 sucesivas), con una media de 1,09 citas/paciente/año, 982 (55,73 por ciento) eran mujeres y 780 (44,37 por ciento) varones, con una edad media de 33,72 ñ 15,37 años. Resultados: Hubo incumplimiento en el 14,36 por ciento de las consultas. Los pacientes que incurrieron en el incumplimiento con más frecuencia fueron los varones (14,37 por ciento de los citados frente al 12,62 por ciento), los menores de 40 años (71,62 por ciento de incumplidores) y los pacientes reincidentes en el incumplimiento (8,23 frente a 91,77 por ciento). No se evidenciaron diferencias en el cumplimiento en función de la consulta, hora de citación, intervalo entre las citas o distancia desde la última consulta a demanda. No hemos encontrado un aumento significativo de las ausencias a consulta durante el período vacacional estival en ninguno de los grupos. Conclusiones: No se evidenciaron diferencias en el cumplimiento, una vez puestas en marcha las medidas propuestas a raíz de nuestro anterior estudio. Quizás, en las inasistencias jueguen cierto papel motivos de difícil control, entre los que cabe barajar la actual accesibilidad a los servicios sanitarios. Probablemente habría que estar alerta y/o tomar medidas anticipatorias en pacientes jóvenes y pacientes con incumplimientos previos. El nivel de incumplimiento es un indicador de calidad, al disminuir el rendimiento de las consultas y poner en evidencia una falta de adherencia de los ciudadanos con los equipos de atención primaria para las primeras consultas, y para la atención especializada en las consultas sucesivas. Sobre él, es difícil incidir con el fin de mejorar los índices, una vez obtenidas determinadas cuotas (AU)
Subject(s)
Humans , Outpatient Clinics, Hospital/statistics & numerical data , Outpatients/statistics & numerical data , Allergy and Immunology/statistics & numerical data , Patient Dropouts/statistics & numerical data , Appointments and Schedules , Outcome Assessment, Health Care/statistics & numerical dataSubject(s)
Anti-Allergic Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Hypersensitivity/drug therapy , Antibodies, Anti-Idiotypic , Antibodies, Monoclonal, Humanized , Asthma/drug therapy , Clinical Trials as Topic , Humans , Omalizumab , Rhinitis, Allergic, Perennial/drug therapyABSTRACT
No disponible
