Recommendations for the use of propofol in egg-allergic patients

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Heterogeneity in allergy to mollusks: a clinical-immunological study in a population from the North of Spain

Background: Allergy to mollusks has been the focus of fewer studies than allergy to crustaceans. Furthermore, allergy to mollusks is less well characterized. Objectives: To describe the clinical characteristics of mollusk-allergic patients, to identify the responsible allergens, and to assess crossreactivity. Methods: We performed a prospective multicenter study including 45 patients with mollusk allergy, which was diagnosed based on a suggestive clinical history and a positive skin test result with the agent involved. Fractions were identified using SDS-PAGE and immunoblotting. The proteins responsible were subsequently identified using mass spectrometry. ELISA inhibition studies were performed with mollusks, dust mites, and crustaceans. Results: We found that 25 patients (55%) were allergic to cephalopods, 14 (31%) to bivalves, and 11 (24%) to gastropods. Limpet was the third most frequent cause of allergy (15% of cases). In 31 patients (69%), the manifestation was systemic; 10 (22%) exhibited oral allergy syndrome, and 7 (15%) experienced contact urticaria. Most major allergens were found between 27 kDa and 47 kDa. ELISA inhibition assays revealed a high degree of inhibition of cephalopods and bivalves from all the groups of mollusks, mites, and crustaceans. Mass spectrometry identified tropomyosin, actin, and myosin as the major allergens. Conclusions: Cephalopods, especially squid, are the mollusks that most frequently trigger allergic symptoms. The very frequent occurrence of allergy to limpets is striking, given their low consumption in our area. It is worth highlighting the heterogeneity observed, exemplified by the gastropods. Tropomyosin appears to be responsible for the high cross-reactivity found between mollusks, mites, and crustaceans. Three new mollusk allergens were also identified, namely, actin, enolase, and a putative C1q domain-containing protein (AU)

Introducción: La alergia a moluscos ha sido menos estudiada y está peor caracterizada que la alergia a crustáceos. Objetivo: Describir las características clínicas de pacientes alérgicos a moluscos, identificar los alérgenos responsables y estudiar la reactividad cruzada entre ellos. Métodos: Estudio multicéntrico, prospectivo. Se incluyen 45 pacientes con alergia a moluscos, definida como una clínica sugestiva y prueba cutánea positiva con el molusco sospechoso. Se identificaron las bandas alergénicas mediante SDS-PAGE e inmunodetección. Las proteínas responsables se identificaron utilizando espectrometría de masas. Se realizaron ensayos de inhibición de ELISA entre moluscos, ácaros y crustáceos. Resultados: Veinticinco (55%) de los pacientes eran alérgicos a cefalópodos, 14 (31%) a bivalvos y 11 (24%) a gasterópodos. La lapa resultó ser la tercera causa de alergia (15% de los casos). Los síntomas fueron sistémicos en 31 pacientes (69%), diez (22%) tuvieron síndrome de alergia oral y siete (15%) urticaria de contacto. La mayoría de las bandas alergénicas estaban entre 27 y 47 kDa. Los ensayos de inhibición de ELISA mostraron un alto grado de inhibición de cefalópodos y bivalvos por parte de moluscos, ácaros y crustáceos. Mediante espectometría de masas se identificaron tropomiosina, actina y miosina como los alérgenos mayoritarios. Conclusiones: Los moluscos que con más frecuencia provocan reacciones alérgicas son los cefalópodos, especialmente el calamar. Llama la atención la elevada frecuencia de alergia a la lapa, a pesar de su bajo consumo. También hay que resaltar la heterogeneidad observada, por ejemplo en los gasterópodos. La tropomiosina parece ser responsable de la elevada reactividad cruzada encontrada entre moluscos, ácaros y crustáceos. Se han identificado tres nuevos alérgenos en los moluscos: actina, enolasa y putative C1q domain-containing protein (AU)

Repicaduras intrahospitalarias con himenópteros / In-hospital re-stinging with hymenoptera

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Anaphylactic reactions to suxamethonium (succinylcholine).

We present the case of a woman who had two severe anaphylactic episodes with hypotension and bradycardia in relation to the administration of general anesthesia. In the allergy evaluation, IgE antibodies to suxamethonium, a muscle relaxant which was used in both procedures, were detected by skin prick tests. No cross-reaction was found to other muscle relaxants derived from quaternary ammonium. The patient was able to be operated on, and did not present any adverse reactions to the use of local anesthesia or to general anesthesia using pancuronium as a muscle relaxant.

Adverse reactions to food in adults.

This study was carried out to assess the occurrence of food hypersensitivity (type I) in adults. The diagnosis of food allergy, based on suggestive history and positive skin prick test and/or RAST, was established in 30 (0.98%) of 3034 patients over 14 years of age who were attended between June 1992 and March 1993. The foods implicated were as follows: fruit (46.8%), dried fruits (19.1%), seafood (14.9%), vegetables (12.8%), fish (4.2%) and chicken eggs (2.1%). This study confirmed the low occurrence of food allergy in adulthood. The differences found with regard to the sensitizing foods (cow's milk and eggs were infrequent; fruit, seafood and vegetables were common) may be attributed to dietary habits in our geographical region.

Systemic anaphylaxis due to hepatic hydatid disease.

Hydatidosis can be a cause of anaphylaxis; it has been clearly established that the accidental rupture of a cyst during surgery can provoke severe anaphylactic reactions. Spontaneous anaphylaxis secondary to hydatid disease is much less frequent. We report three patients who presented with spontaneous anaphylaxis without apparent cause. Serological and ultrasonographic studies showed hepatic hydatid disease. Two years after surgical resection of cysts, no new episodes of anaphylaxis have occurred. Hydatidosis is a cause of apparently spontaneous anaphylaxis and this is likely due to an IgE-mediated mechanism.

Systemic anaphylaxis following parenteral orgotein administration.

We present a patient displaying a systemic anaphylactic reaction after local infiltration of orgotein. An IgE-mediated mechanism was demonstrated with skin tests and specific IgE measurement. It is concluded that orgotein can rarely cause IgE-mediated anaphylaxis.

Bronchial asthma due to sensitization to chloramine T.

Chloramine T, an organic, highly reactive derivative of chlorine with potent bactericidal properties, is used as a disinfectant in the food industry. Described as an occupational sensitizer in 1945 for the first time, it produces late or dual asthma, occasionally accompanied by fever and leukocytosis, which is mediated by IgE. We present the case of a male dairy worker who, after 4 years of exposure to the product, developed rhinitis and asthma. Skin tests with chloramine T were positive at a concentration of 10 mg/ml, while all other allergens tested negative. RAST detected specific IgE at 12 PRU and bronchial provocation induced immediate and late bronchoconstriction.