Hypersensitivity to Vespula and Polistes: can we tell the primary sensitization from the clinical history?

OBJECTIVE: To study the relationship between the primary sensitization to wasp venoms and the geographical and seasonal circumstances of the anaphylaxis-induced sting. METHODS: We performed a retrospective review of 115 patients (age 10-80) who suffered a systemic reaction to a wasp sting. Season and type of locality (urban or rural) at the moment of the sting were recorded. Serum specific IgE levels to venoms from Vespula and Polistes were measured, and a primary sensitization was determined to whichever genus of wasp for which the highest class of specific IgE was observed. The primary sensitization in relation to the type of locality and the season was assessed using the chi-square test. RESULTS: Most reactions occurred in urban areas (67.8 %), and in the summer season (63.4 %). Most patients were sensitized to Vespula venom (94.8 %). Primary sensitization was to Vespula in 56.5 %, to Polistes in 10.4 %, and undetermined in 33 %. The distribution of geographical areas did not show significant differences in relation to primary sensitization (p > 0.05). Most patients with primary sensitization to Vespula suffered the anaphylaxis-induced sting after the spring season, with a statistically significant result (p < 0.05). CONCLUSION: In our population, the probability of Vespula sting is higher than Polistes sting when the reaction occurs after spring. This finding can help us to identify the responsible vespid when the diagnostic tests do not provide an accurate result.

Hypersensitivity to Vespula and Polistes: can we tell the primary sensitization from the clinical history? / Hipersensibilidad a vespula y polistes: ¿se puede determinar la sensibilización predominante a partir de la historia clínica?

Objective: To study the relationship between theprimary sensitization to wasp venoms and the geographicaland seasonal circumstances of the anaphylaxis-induced sting.Methods: We performed a retrospective review of115 patients (age 10-80) who suffered a systemicreaction to a wasp sting. Season and type of locality(urban or rural) at the moment of the sting wererecorded. Serum specific IgE levels to venoms fromVespula and Polistes were measured, and a primarysensitization was determined to whichever genus ofwasp for which the highest class of specific IgE wasobserved. The primary sensitization in relation to thetype of locality and the season was assessed usingthe chi-square test.Results: Most reactions occurred in urban areas(67.8 %), and in the summer season (63.4 %). Mostpatients were sensitized to Vespula venom (94.8 %).Primary sensitization was to Vespula in 56.5 %, toPolistes in 10.4 %, and undetermined in 33 %. Thedistribution of geographical areas did not show significantdifferences in relation to primary sensitization(p > 0.05). Most patients with primary sensitization toVespula suffered the anaphylaxis-induced sting afterthe spring season, with a statistically significant result(p < 0.05).Conclusion: In our population, the probability ofVespula sting is higher than Polistes sting when thereaction occurs after spring. This finding can help usto identify the responsible vespid when the diagnostictests do not provide an accurate result

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Systemic reactions to wasp sting: is the clinical pattern related to age, sex and atopy?

BACKGROUND: The aim of this study was to analyze the frequency of clinical features and the severity of systemic reactions to wasp stings, and to establish their relationship with mean age, sex, and atopy. METHODS: We studied 115 patients who suffered an anaphylactic reaction to wasp sting and showed specific IgE to venoms from Vespula and/or Polistes. In all patients, age, sex and personal history of atopy were registered. Cutaneous, respiratory, cardiovascular and gastrointestinal involvement during the course of the reaction was investigated. Each patient was assigned a severity grade according to a simple two-grade classification based on Müller's criteria. Bivariable analysis was performed to analyze the associations among mean age, sex and atopy and the symptoms and severity of the reaction. RESULTS: The mean age was 40.2 years. There were 60 males (52.2 %) and 55 females (47.8 %). Twenty-six patients (22.6 %) were atopic. The percentages of involved systems were as follows: skin 90.4 %, respiratory 54.8 %, cardiovascular 33.9 %, and gastrointestinal 21.7 %. Reactions were mild in 40.8 %, and severe in 59.1 %. The mean age was higher in patients without cutaneous symptoms (p < 0.05). Cardiovascular involvement was more frequent in males (p < 0.05). No other significant differences were found. CONCLUSION: The symptoms of systemic reactions to wasp venom most frequently involved the skin, while reactions without cutaneous involvement were more frequent in older patients. Cardiovascular involvement was more common in males. The clinical pattern was not determined by atopy and the variables studied were not related to severity.

Systemic reactions to wasp sting: is the clinical pattern related to age, sex and atopy?

Background: The aim of this study was to analyze the frequency of clinical features and the severity of systemic reactions to wasp stings, and to establish their relationship with mean age, sex, and atopy. Methods: We studied 115 patients who suffered an anaphylactic reaction to wasp sting and showed specific IgE to venoms from Vespula and/or Polistes. In all patients, age, sex and personal history of atopy were registered. Cutaneous, respiratory, cardiovascular and gastrointestinal involvement during the course of the reaction was investigated. Each patient was assigned a severity grade according to a simple two-grade classification based on Müller's criteria. Bivariable analysis was performed to analyze the associations among mean age, sex and atopy and the symptoms and severity of the reaction. Results: The mean age was 40.2 years. There were 60 males (52.2 %) and 55 females (47.8 %). Twenty-six patients (22.6 %) were atopic. The percentages of involved systems were as follows: skin 90.4 %, respiratory 54.8 %, cardiovascular 33.9 %, and gastrointestinal 21.7 %. Reactions were mild in 40.8 %, and severe in 59.1 %. The mean age was higher in patients without cutaneous symptoms (p < 0.05). Cardiovascular involvement was more frequent in males (p < 0.05). No other significant differences were found. Conclusion: The symptoms of systemic reactions to wasp venom most frequently involved the skin, while reactions without cutaneous involvement were more frequent in older patients. Cardiovascular involvement was more common in males. The clinical pattern was not determined by atopy and the variables studied were not related to severity

Fundamento: El propósito de este estudio es analizar la frecuencia de manifestaciones clínicas y la gravedad de las reacciones sistémicas a picadura de avispa, así como establecer su relación con la edad media, el sexo y la atopia. Métodos: Estudiamos 115 pacientes que han sufrido una reacción anafiláctica a picadura de avispa y que muestran IgE específica frente a venenos de Vespula y/o Polistes. En cada caso re registra la edad, el sexo y los antecedentes personales de atopia. Se investigó la presencia de afectación cutánea, respiratoria, cardiovascular y gastrointestinal en el curso de la reacción, y se asignó un grado de severidad mediante un sistema de clasificación en dos grados a partir de los criterios de Müller. Se realizó un análisis bivariante para relacionar la edad, el sexo y la atopia con los síntomas y la gravedad de la reacción. Resultados: La edad media fue de 40,2 años. Los varones eran 60 (52,2%) y las mujeres 55 (47,8%). Veintiséis pacientes (22,6%) eran atópicos. El porcentaje de afectación por sistemas fue como sigue: cutánea 90,4%; respiratoria 54,8%; cardiovascular 33,9%; gastrointestinal 21,7%. Las reacciones fueron leves en un 40,8% y graves en un 59,1%. La edad media fue superior en pacientes sin síntomas cutáneos (p>0,05) y la afectación cardiovascular resultó mas frecuente en varones (p>0,05). No se observaron otros hallazgos significativos. Conclusión: Se concluye que los síntomas más frecuentes de las reacciones sistémicas a veneno de avispa son los cutáneos, siendo las reacciones sin afectación cutánea más típicas de personas de edad avanzada. La presencia de síntomas cardiovasculares es más común en varones. La atopia no determina el cuadro clínico y la gravedad no se relaciona con las variables estudiadas

Pharmacological stimuli in asthma/urticaria.

BACKGROUND: The use of opioids as analgesics is becoming increasingly widespread, which may have repercussions in patients with urticaria or asthma, as these agents frequently cause adverse reactions. MATERIAL AND METHODS: We present three patients who developed allergic reactions after receiving codeine: two patients who developed acute urticaria, and a third asthmatic patient receiving specific immunotherapy who developed bronchospasm. Skin prick-testing (SPT) and intradermal reaction (IDR) tests with various opioids were performed, followed by controlled oral challenge. Prick tests and IDR were also carried out in 20 controls. RESULTS: Similar SPT and IDR results were recorded in the three patients and in the controls. In the case of controlled oral challenge with codeine, patient 1 suffered bronchospasm, while patient 2 developed generalized urticaria. The test was not performed in the third patient. All of the patients tolerated tramadol 50 mg without problems. We advised the use of tramadol as analgesic and fentanyl or remifentanil as anesthetics. DISCUSSION: In these types of manifestation, the pharmacological properties of the opioids used are highly important, particularly as regards their histamine-releasing potential. Codeine, morphine and pethidine present the greatest histamine-releasing capacity, while tramadol, fentanyl and remifentanil do not release histamine and their use is thus recommended in pulmonary disease requiring opioid administration. Cutaneous symptoms are more frequently caused by opioids than by respiratory symptoms, since these drugs act on the MTC mast cell population, which is more prevalent in the skin than in the lungs. Some of this action is inhibited by naloxone. CONCLUSIONS: In most patients, these reactions are not IgE-mediated. Consequently, SPT and IDR are of little diagnostic value, and controlled oral challenging with the suspect drug or with one of the non-histamine releasing agents should be used. The patch test is useful in occupational contact dermatitis.

Pharmacological stimuli in asthma/urticaria / Estimulos farmacológicos en el asma/urticaria

Background: The use of opioids as analgesics is becoming increasingly widespread, which may have repercussions in patients with urticaria or asthma, as these agents frequently cause adverse reactions. Material and methods: We present three patients who developed allergic reactions after receiving codeine: two patients who developed acute urticaria, and a third asthmatic patient receiving specific immunotherapy who developed bronchospasm. Skin prick-testing (SPT) and intradermal reaction (IDR) tests with various opioids were performed, followed by controlled oral challenge. Prick tests and IDR were also carried out in 20 controls. Results: Similar SPT and IDR results were recorded in the three patients and in the controls. In the case of controlled oral challenge with codeine, patient 1 suffered bronchospasm, while patient 2 developed generalized urticaria. The test was not performed in the third patient. All of the patients tolerated tramadol 50 mg without problems. We advised the use of tramadol as analgesic and fentanyl or remifentanil as anesthetics. Discussion: In these types of manifestation, the pharmacological properties of the opioids used are highly important, particularly as regards their histamine-releasing potential. Codeine, morphine and pethidine present the greatest histamine-releasing capacity, while tramadol, fentanyl and remifentanil do not release histamine and their use is thus recommended in pulmonary disease requiring opioid administration. Cutaneous symptoms are more frequently caused by opioids than by respiratory symptoms, since these drugs act on the MTC mast cell population, which is more prevalent in the skin than in the lungs. Some of this action is inhibited by naloxone. Conclusions: In most patients, these reactions are not IgE-mediated. Consequently, SPT and IDR are of little diagnostic value, and controlled oral challenging with the suspect drug or with one of the non-histamine releasing agents should be used. The patch test is useful in occupational contact dermatitis

Introducción: Como fármacos analgésicos, cada vez está más extendido el uso de opiáceos y éstos pueden tener repercusiones sobre pacientes con urticaria o asma. La mayoría de las veces la causa es un efecto secundario. Material y Métodos: Presentamos dos pacientes que han tenido una urticaria tras la toma de codeína y otra paciente asmática que está recibiendo inmunoterapia y tiene crisis de broncoespasmo tras la toma de éste fármaco. Se realizan prick-test e IDR con varios opiáceos, y tras esto se realiza exposición oral controlada. También se realizan pricks e IDR a 20 controles. Resultados: En los tres casos y en los controles se obtienen resultados similares de los pricks y de las IDR. En la exposición oral controlada con codeína, la paciente 1 sufre un broncoespasmo, la 2 una urticaria generalizada y la 3 no se realiza. Las tres toleran tramadol 50mg sin problemas. Se recomienda el uso de tramadol como analgésico y fentanilo o remifentanilo como anestésicos. Discusión: En este tipo de cuadros las propiedades farmacológicas de los opiáceos son muy importantes, puesto que van a venir marcados por la potencia de liberación de histamina. La codeína, la morfina y la petidina, son los mayores liberadores y por el contrario, el tramadol, el fentanilo y el remifentanilo no lo son y están recomendados en patología pulmonar que necesiten opiáceos. Los opiáceos suelen producir en mayor número de ocasiones cuadros cutáneos por que actúan sobre todo sobre los MTC que son más numerosos en la piel que en el pulmón. La Naloxona inhibe en parte ésta acción. Conclusiones: La mayoría de reacciones de este tipo no son IgE mediadas, por lo que los pricks e IDR no tienen ningún valor, y se debe de recurrir a la exposición controlada con el fármaco implicado o con uno de los no liberadores de histamina. Las pruebas del parche si que tienen utilidad en las dermatitis de contacto ocupacionales

Comisión Nacional de Alergología / No disponible

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Asma bronquial / Bronchial asthma

La obstruccion reversible de las vias aereas como consecuencia de estimulos diversos exige tratamiento inmediato y un profundo y concienzudo estudio de su etiologia, patogenia y factores agravantes, para poder conducir adecuadamente una terapia que mejore el pronostico a largo plazo y la calidad de vida del paciente

Urticaria y angioedema / Urticaria and angioedema

Urticaria y angioedema son un problema clinico muy frecuente, cuyos mecanismos patogenicos pueden ser o no inmunologicos y precisan de un diagnostico cuidadoso para identificar las causas desencadenantes.