Olive, grass or both? Molecular diagnosis for the allergen immunotherapy selection in polysensitized pollinic patients.

BACKGROUND: Grass and olive are the most frequently pollens that induce seasonal allergic rhinitis in Spain. Cross-reactivity due to panallergens shared by them and overlapping pollination complicates the recognition of allergy-causing agents, making it difficult to identify the most appropriate allergen immunotherapy (AIT) to use. The aim of this study was to determine the sensitization pattern to major grass and olive pollen allergens using component-resolved diagnostics in patients with seasonal allergic rhinitis (SAR) and positive skin prick test to grass and olive pollens and evaluate how knowledge of the sensitization patterns might influence AIT prescription. METHODS: After informed written consent, a total of 1263 patients were recruited. A serum determination of specific IgE levels to Ole e 1 and Phl p 1 + 5 was performed to all patients. A comparison was made before and after obtaining the specific IgE results, and differences in diagnosis were stated. RESULTS: At the 0.35 kU/l cut-off point, 71.2% of patients were positive to Ole e 1 and Phl p 1 + 5, 14% were positive only to Phl p 1 + 5 and 12% were positive only to Ole e 1. Based on available clinical data and skin prick test results, 922 (73%) patients would have been indicated for a mixture of grass and olive pollens for AIT. In 56.8% of patients, there was non-coincidence in the composition of AIT that would be selected before and after investigators received the in vitro data. CONCLUSION: The diagnostic accuracy of the recombinant allergen-specific IgE test could help to improve the selection of specific-allergen immunotherapy in polysensitized patients.

Biological standardization and maximum tolerated dose estimation of an Alternaria alternata allergenic extract.

BACKGROUND: The manufacture of allergenic extracts from the mold Alternaria alternata is influenced by factors such as strain variability, allergenic origin, culturing conditions and extraction process, which affect the reproducibility of the preparations intended for diagnostic and therapeutic use. OBJECTIVES: To select the most adequate antigenic source of A. alternata extracts and determine its maximum tolerated dose (MTD) to be used in a subsequent immunotherapy efficacy clinical trial. METHODS: Twenty-one patients monosensitized to A. alternata were involved in a biological standardization process of A. alternata extracts. Four different mold strains were cultured and used to produce extracts by three different methods, each incorporating proteins from different origins: culture filtrate, buffer extractable fraction and cellular antigens. The selected extract, characterized as in-house reference (IHR) preparation was used in a MTD finding immunotherapy study. Serum IgE, IgG, IgG1 and IgG4 specific of complete extract and purified natural and recombinant forms of Alt a 1 were determined by different EIA methods. RESULTS: Culture filtrate extract containing the allergens secreted to the spent medium was shown to be the most adequate option for establishing an IHR preparation for A. alternata extract manufacturing. A maximum dose of 1670 UBE, equivalent to 0.1 microg Alt a 1, was determined as MTD for immunotherapy. One year of administration of such a dose at monthly intervals elicited pronounced immunological changes with statistically significant decreases in IgE and increases in IgG4, both estimated with whole extract or purified Alt a 1. CONCLUSION: A high quality natural A. alternata extract has been developed and preliminarily tested to define its MTD for subsequent determination of the optimal dose in an immunotherapy efficacy clinical trial.

[Registry of occupational respiratory diseases in Navarre]. / Registro de enfermedades respiratorias de origen laboral en Navarra.

BACKGROUND: In January 2002 an occupational respiratory diseases record was established in Navarre so that the number and characteristics of the occupational respiratory pathology could be analysed. METHODS: The cases reported by doctors who collaborated in 2002, 2003 and 2004, were entered in a database for subsequently analysis. This database has several variables: gender, age, tobacco habit, hospital department and notifying doctor, diagnosis, job and causal agent. RESULTS: 125 cases were reported. 97 males (77.6%) and 28 females (22.4%). Average age was 55,4 years old. Eighty-eight were non-smokers (70.4%) and 37 were smokers (29.6%). Pneumology reported 84 cases (67.2%) and Allergology 41 (32.8%). The diagnoses were: 50 bronchial asthma (40%), 31 benign pleural disease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8 mesothelioma (6.4%), 7 bronchopulmonary cancer (5.6%), 5 acute inhalations (4%), 3 amianthinopsy (2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD (0.8%). The most reported jobs were: 13 painting and varnishing (10.4%), 12 spinning asbestos yarn (9.6%) and 8 bakery and confectionery (6.4%). The main causal agents were: 49 cases of asbestos (39.2%), 15 isocyanates (12%) and 8 silica (6.4%). CONCLUSIONS: The most frequent pathology was bronchial asthma, followed by benign pleural disease. The most reported job was painting and varnishing and secondly spinning asbestos yarn. Asbestos was the first substance involved and the second was isocyanates. Most of the patients were males and non-smokers. The Pneumology Service of the Virgen del Camino Hospital reported most of the cases. Ratio contrast analysis showed a certain tendency towards a statistical significance in rhinitis, occupational asthma and amianthinopsy.

Registro de enfermedades respiratorias de origen laboral en Navarra / Registry of occupational respiratory diseases in Navarre

Fundamento. Con objeto de analizar la incidenciay características de la patología respiratoria ocupacionalen Navarra, se implantó en enero de 2002 el Registrode Enfermedades Respiratorias de Origen Laboral.Métodos. Los casos notificados por los médicoscolaboradores durante los años 2002, 2003 y 2004, seintrodujeron en una base de datos diseñada para suanálisis posterior, que constaba de distintas variables:sexo, edad, tabaco, servicio y médico declarante, diagnóstico,profesión y agente causal.Resultados. Se notificaron 125 casos. 97 varones(77,6%) y 28 mujeres (22,4%). La media de edad fue 55,4años. Ochenta y ocho pacientes no fumaban (70,4%) y37 eran fumadores (29,6%). Neumología declaró 84casos (67,2%) y Alergología 41 (32,8%). Los diagnósticosfueron: 50 casos de asma bronquial (40%), 31 deenfermedad pleural benigna (24,8%), 8 alveolitis alérgicaextrínseca (6,4%), 8 mesotelioma (6,4%), 7 cáncerbroncopulmonar (5,6%), 5 inhalaciones agudas (4%), 3asbestosis (2,4%), 2 rinitis (1,6%), 1 RADS (0,8%) y 1EPOC (0,8%). Las profesiones más declaradas: 13 pintura/barnizado (10,4%), 12 hilado de ovillos de amianto(9,6%) y 8 panadería/pastelería (6,4%). Como agentescausales principales: 49 casos de asbesto (39,2%),15 isocianatos (12%) y 8 sílice (6,4%).Conclusiones. La patología más frecuente fue elasma bronquial, seguida de la enfermedad pleuralbenigna. La profesión más notificada era pintura/barnizadoy en segundo lugar hilado de ovillos. El asbestofue la primera sustancia implicada seguida de los isocianatos.La mayoría de pacientes eran varones y nofumadores. El Servicio de Neumología del Hospital Virgendel Camino notificó el mayor número de casos. Elanálisis de contraste de proporciones mostró ciertatendencia a la significación en rinitis, asma bronquial yasbestosis

Background. In January 2002 an occupationalrespiratory diseases record was established in Navarreso that the number and characteristics of theoccupational respiratory pathology could be analysed.Methods. The cases reported by doctors whocollaborated in 2002, 2003 and 2004, were entered in adatabase for subsequently analysis. This database hasseveral variables: gender, age, tobacco habit, hospitaldepartment and notifying doctor, diagnosis, job andcausal agent.Results. 125 cases were reported. 97 males (77.6%)and 28 females (22.4%). Average age was 55,4 years old.Eighty-eight were non-smokers (70.4%) and 37 weresmokers (29.6%). Pneumology reported 84 cases(67.2%) and Allergology 41 (32.8%). The diagnoseswere: 50 bronchial asthma (40%), 31 benign pleuraldisease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8mesothelioma (6.4%), 7 bronchopulmonary cancer(5.6%), 5 acute inhalations (4%), 3 amianthinopsy(2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD(0.8%). The most reported jobs were: 13 painting andvarnishing (10.4%), 12 spinning asbestos yarn (9.6%)and 8 bakery and confectionery (6.4%). The maincausal agents were: 49 cases of asbestos (39.2%), 15isocyanates (12%) and 8 silica (6.4%).Conclusions. The most frequent pathology wasbronchial asthma, followed by benign pleural disease.The most reported job was painting and varnishing andsecondly spinning asbestos yarn. Asbestos was thefirst substance involved and the second wasisocyanates. Most of the patients were males and nonsmokers.The Pneumology Service of the Virgen delCamino Hospital reported most of the cases. Ratiocontrast analysis showed a certain tendency towards astatistical significance in rhinitis, occupational asthmaand amianthinopsy

Síndrome del nervio auriculotemporal. Diagnóstico diferencial con alergia alimentaria / Auriculotemporal nerve syndrome. Differential diagnosis to food allergy

Fundamento: El síndrome del nervio auriculotemporal se caracteriza por la aparición de eritema, sudoración, calor y dolor, localizados en el área de distribución cutánea del nervio auriculotemporal, como respuesta a estímulos gustatorios y es consecuencia del daño de las fibras parasimpáticas de dicho nervio. Pacientes y métodos: Se presentan tres niños de 6 meses, 4 y 11 años, en los que aparecía eritema facial coincidiendo con la ingesta de múltiples alimentos en el caso de los dos de mayor edad y al comer papilla de frutas en el lactante. Todos tenían el antecedente de parto asistido con forceps. Se realizó pricktest con el grupo de alimentos estándar, cereales, pescados, frutas y leche y en los dos de más edad prickprick con gominolas y cebolleta encurtida. Se determinó la IgE sérica específica frente a algunos de los alimentos implicados y se llevó a cabo una prueba de provocación abierta, masticando gominolas en los dos mayores e ingiriendo papilla de frutas en el lactante. Resultados: En los tres pacientes los test in vivo con los alimentos mencionados fueron negativos. No se detectó IgE sérica específica frente a ningún alimento. La prueba de provocación fue positiva, con reproducción de los síntomas. Conclusiones: El síndrome de Frey en la infancia coincide con la introducción de los alimentos sólidos en la dieta, y plantean el diagnóstico diferencial con alergia alimentaria. La mayoría de casos descritos en niños son consecuencia de un traumatismo durante el parto asistido con forceps. En la edad pediátrica se trata de un proceso benigno y no requiere tratamiento, por lo que un diagnóstico correcto evita dietas inadecuadas de exclusión alimentaria. (AU)