ABSTRACT
Fundamento: Las pruebas cutáneas en prick son frecuentemente utilizadas para estudiar pacientes con sospecha de alergia alimentaria mediada por IgE. El presente estudio se planteó como objetivo evaluar la rentabilidad diagnóstica de las pruebas cutáneas con extractos de leguminosas frente a alimentos naturales, así como la influencia del calentamiento. Métodos: Se han realizado pruebas cutáneas en prick con alimentos naturales y extractos liofilizados de las siguientes legumbres; cacahuete, brotes de soja y productos crudos y calentados de lenteja, guisante, garbanzo, judía verde, alubia blanca y alubia pinta a 37 pacientes con hipersensibilidad clínica a alguna de las leguminosas incluidas en el estudio y 12 controles. Resultados: Las pruebas cutáneas han resultado negativas en los controles. Se ha observado una amplia variabilidad en los índices de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y eficacia entre los alimentos evaluados en los pacientes. Se ha producido globalmente una disminución de la sensibilidad y un aumento de la especificidad en los productos sometidos a calentamiento. La eficacia ha sido superior o igual para los alimentos naturales respecto a los extractos y en general, mayor en los productos hervidos. El tamaño de las pápulas fue más grande en los pacientes con respuesta clínica respecto a los que toleraban las distintas legumbres. Conclusiones: La rentabilidad diagnóstica de las pruebas cutáneas con alimentos naturales ha sido superior a la obtenida con los extractos de leguminosas y el calentamiento ha supuesto un aumento de la misma en los alimentos normalmente consumidos tras ser cocinados (AU)
Subject(s)
Adolescent , Adult , Female , Child, Preschool , Male , Child , Humans , Food Hypersensitivity/immunology , Hypersensitivity, Immediate/immunology , Fabaceae/adverse effects , Case-Control Studies , Allergens , Plant Extracts , Skin Tests/methodsABSTRACT
BACKGROUND: Although the clinical manifestations of chronic urticaria (CU) are similar in most patients, a variety of factors should be taken into consideration. In general, the cause of CU cannot be determined in most patients, and it is considered idiopathic. In the past several years, relationships between some patients with CU and hepatitis C or autoimmune thyroid diseases have been established. Similarly, other factors may also be considered as possible causes to explain certain patients with CU. Previously, some patients with CU have had their disease attributed to Helicobacter pylori (HP), but the relationship was only clinical. OBJECTIVE: None of the patients previously described included an immunological study. Thus, we studied a patient with CU, who showed marked clinical improvement after eradication of HP, to demonstrate an IgE relationship with this skin disease. METHODS: First, blood analytical parameters, roentgenograms, fecal examination for parasites, and skin tests were performed to try to establish an etiology. In addition, endoscopy with gastric biopsy confirmed HP colonization, and eradication treatment was prescribed. To investigate an immunological relationship, other tests performed included the following: HP-specific IgG, histamine release induced by HP, HP-specific IgE, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis with immunoblotting. RESULTS: The blood analytical parameters, roentgenograms, fecal examination for parasites, and skin tests were all negative. In contrast, the tests for HP-specific IgG, histamine release induced by HP, and HP-specific IgE were all positive. In addition, the sulfate-polyacrylamide gel electrophoresis with immunoblotting showed specific IgE binding to an extract of HP. CONCLUSIONS: Our results may indicate an immunological IgE relationship between HP colonization and CU in this particular patient.
Subject(s)
Urticaria/microbiology , Antibodies, Bacterial/blood , Antibody Specificity , Chronic Disease , Female , Helicobacter pylori/immunology , Humans , Immunoglobulin E/immunology , Middle AgedABSTRACT
Fundamento: La sensibilización al látex se diagnostica por pruebas cutáneas y determinación de IgE pero, a veces, es necesario utilizar una prueba de provocación para establecer una correlación entre la exposición al látex y la clínica del paciente. Se desconoce la rentabilidad de la prueba de uso con guante de látex en el diagnóstico de los pacientes que únicamente presentan síntomas rinoconjuntivales. Métodos: Se han estudiado tres pacientes con clínica de rinoconjuntivitis con la manipulación de productos de látex. Los pacientes se diagnosticaron de sensibilización al látex por medio de pruebas cutáneas y la determinación de IgE específica. Posteriormente, se realizó una prueba de uso con guante de látex, haciendo que los pacientes protegidos con guantes de vinilo manipulasen guantes de látex. Resultados: Se observó la reproducción de los síntomas rinoconjuntivales que referían los pacientes. En un caso se produjo una caída significativa e inmediata del volumen espiratorio forzado en el primer segundo (VEMS) tras la prueba. Conclusiones: El látex, a través de un mecanismo aerotransportado, era el agente responsable de la clínica de rinoconjuntivitis de los pacientes, y en un caso se puso de manifiesto una hiperreactividad bronquial latente. (AU)
Subject(s)
Adult , Female , Child , Humans , Respiratory Hypersensitivity/etiology , Latex Hypersensitivity/immunology , Conjunctivitis, Allergic/immunology , Rhinitis/immunology , Bronchial Provocation Tests/methodsSubject(s)
Amoxicillin/adverse effects , Anaphylaxis/chemically induced , Penicillins/adverse effects , Adult , Female , Humans , Skin TestsABSTRACT
We carried out a double-blind clinical trial in 30 patients who were sensitized to Bermuda grass pollen. Before and after immunotherapy we performed in vivo tests (skin tests and standardized tests of specific and nonspecific bronchial hyperreactivity), in vitro tests (histamine release), and specific IgE and IgG antibodies to BGP. We found a significant decrease (P less than .001) in specific bronchial hyperreactivity and skin sensitivity to BGP in the group of patients treated with immunotherapy, a decrease in the delayed responses (P less than .05) in histamine release (P less than .01), and an increase (P less than .001) in specific IgE and IgG antibodies to BGP. The placebo group showed no changes in these parameters.
Subject(s)
Desensitization, Immunologic , Plant Extracts/therapeutic use , Pollen/immunology , Rhinitis, Allergic, Seasonal/therapy , Adolescent , Adult , Antibody Specificity , Bronchial Provocation Tests , Child , Clinical Trials as Topic , Desensitization, Immunologic/methods , Double-Blind Method , Humans , Immunoglobulin E/analysis , Immunoglobulin M/analysis , Middle Aged , Plant Extracts/immunology , Poaceae , Rhinitis, Allergic, Seasonal/immunologyABSTRACT
162 patients with different patterns of rhinitis were studied. In 94 a diagnosis of allergic rhinitis was made. The remaining 68 were considered as nonallergic rhinitis. In the allergic group, 64 had seasonal allergic rhinitis. 24 of them were studied during the hay fever season and 40 out of the hay fever season. Positive nasal smear eosinophilia (up to 10%) was found in 56 of 96 patients from the allergic group (59.5%), 21 of them had perenneal allergic rhinitis and 35 had seasonal allergic, of those 20 were studied during the hay fever season. In the non allergic group, 35 were diagnosed as intrinsic rhinitis and 33 as cholinergic rhinitis. Positive nasal smear eosinophilia could be demonstrated in 15 out of 35 cases of intrinsic rhinitis (42.8%), but could not be shown in patients suffering from cholinergic rhinitis. Peripheral blood eosinophilic cells were found in normal values in all patients in spite of the character of the rhinitis. These results suggest that nasal smear eosinophilic cells count is a useful orientative datum in the diagnosis of allergic and intrinsic rhinitis (59.5% and 42.8% respectively in our cases) but is not useful in the diagnosis of cholinergic rhinitis (not one out of 33 cases). Blood eosinophil cells count had no value in nasal allergy diagnosis.
Subject(s)
Eosinophilia/diagnosis , Rhinitis/diagnosis , Adolescent , Adult , Aged , Diagnosis, Differential , Eosinophils , Humans , Leukocyte Count , Middle Aged , Nasal Mucosa , Rhinitis, Allergic, Perennial/diagnosis , Rhinitis, Allergic, Seasonal/diagnosis , Rhinitis, Vasomotor/diagnosisABSTRACT
In the daily practice of allergology, one of our commonest problems concerns the prescription of nonsteroidal anti-inflammatory drugs for our patients who are intolerant of acetylsalicylic acid, whose basic clinical expression of this intolerance is primary bronchial asthma. Our problem is the high frequency with which the syndrome appears after the administration of other analgesics chemically unrelated to acetylsalicylic acid. Most authors accept that derivatives of pyrazolones and indoles, and of phenylisopropionic and anthranilic acids must be avoided. This avoidance is based on collected clinical experience and the currently accepted hypothesis concerning the pathogenesis of the syndrome (pyrazolones, indoles, etc. are inhibitors of the byosynthesis of the E series of prostaglandins, particularly PG synthetase). On the other hand there is no agreement concerning what type of analgesics, anti-inflammatory drugs and antipyretics we should prescribe for these patients. The conclusions of the protocol which we carried out are as follows. Dextropropoxyphene chlorhydrate, diviminol, tilidine chlorhydrate, salicylamide, benzidamine, pentazocine, isonixine, hyoscine bromide and ergotamine tartrate can be prescribed safely for these patients in the usual therapeutic dosage. To the list of prohibitions should be added the derivatives of glaphenine and phenylacetic acid. As regards paracetamol, our opinion is that its use should be restricted to those cases in which the previously listed drugs cannot be substituted for it, and always after administration under medical supervision in a hospital setting.
