Skin testing and drug provocation in the diagnosis of nonimmediate reactions to aminopenicillins in children.

BACKGROUND: Nonimmediate allergic reactions (NIR) to aminopenicillin include several entities, the most common of which are urticaria-like and maculopapular exanthemas. AIMS OF THE STUDY: To evaluate a group of children who developed one or more episodes of skin reactions suggestive of NIR after aminopenicillin administration. METHODS: The inclusion criteria required negative immediate skin tests and absence of specific IgE antibodies to different penicillins. Intradermal and patch tests were carried out with delayed readings and, if negative, a drug-provocation test including a full therapeutic course of the drug was given. Two different groups were compared: A) children with positive skin testing or a positive drug-provocation test and B) children with negative skin testing and good tolerance after a drug-provocation test. RESULTS: Group A was composed of 20 patients. Positive intradermal/patch tests were found in one patient and in the remaining 19, a positive response to a drug-provocation test confirmed the diagnosis. Group B (the control group) consisted of 19 patients with similar symptoms after aminopenicillin intake but good tolerance. No differences in age, dose or number of previous treatments were observed between the groups. The clinical entities were also similar in both groups. CONCLUSIONS: Reproducible nonimmediate skin reactions to aminopenicillins may occur in children in spite of negative skin testing. The value of this diagnostic procedure seems to be limited in this type of reaction, with drug-provocation tests (DPT) being a reasonable and safe alternative if the diagnosis has to be confirmed.

Reacción medicamentosa tipo enfermedad del suero / Pharmacological reaction like serum sickness

Presentamos un caso de enfermedad del suero en una paciente de 3 años de edad que, tras realizar tratamiento con amoxicilina-clavulánico durante 7 días, mostró clínica de urticaria y artralgias

We report a case of serum sickness in a 3-year-old patient who presented urticaria and arthralgias after seven days of treatment with amoxicillin-clavulanic

Uveítis por cotrimoxazol / Cotrimoxazole-induced uveitis

Niño de 10 años de edad que presenta hiperemia conjuntival bilateral, dolor ocular y visión borrosa tras la administración de trimetoprim-sulfametoxazol (TMP-SMX) por vía oral

The patient was a 10-year-old boy who developed bilateral conjunctival hyperemia, ocular pain and blurred vision following the administration of trimethoprim-sulfamethoxazole

Food-protein-induced enterocolitis syndrome caused by fish.

INTRODUCTION: Food protein-induced enterocolitis syndrome (FPIES) occurs in infants. Typical symptoms include profuse vomiting and/or diarrhea several hours after ingestion of a given food. The disorder is a non-IgE mediated food hypersensitivity. The most frequently involved foods are milk and soy, but some cases of FPIES induced by solid foods have been described. We report 14 patients with FPIES due to fish protein. MATERIAL AND METHODS: History and physical examination, skin prick test (SPT) with fish allergens and Anisakis simplex, prick-by-prick test with implicated fish and determination of specific IgE antibodies against fish were performed. In eight children atopy patch test (APT) were also performed. In nine patients an open oral food challenge with the implicated fish was carried out. RESULTS: There were six boys and eight girls, aged from 9 to 12 months at diagnosis, with between two and six reactions to the offending fish proteins before the diagnosis was established. Four patients had a previous history of atopy. Presenting symptoms included diarrhea in two patients, profuse vomiting in six patients, and recurrent vomiting and subsequent diarrhea in three patients. In addition to these symptoms, associated septic appearance, apathy and lethargy were present in the remaining three patients. Onset of symptoms occurred a few minutes after fish ingestion in two patients and from 60 minutes to 6 hours in the 12 remaining patients. SPT to fish were negative in all patients. Serum food-specific IgE antibodies were negative in all patients except one. APT was positive in three patients. Open oral challenge (OC) was performed in nine infants and was positive in all. The patients were followed-up for between 1 and 7 years after diagnosis, and follow-up OC tests were performed after fish had been eliminated from the patients' diet for 3-4 years. Four patients became clinically tolerant to the causal food. Three patients currently tolerate only one type of fish (swordfish). CONCLUSIONS: We report 14 patients with FPIES caused by fish protein. The symptoms suggest a form of cell-mediated, non-IgE mediated food hypersensitivity. The gold standard for diagnosis is OC, although caution should be exercised in infants with several reactions or a recent diagnosis. After a period of elimination of the causal food from the diet, tolerance can develop.

Non-occupational allergy caused by the pine processionary caterpillar (Thaumetopoea pityocampa).

UNLABELLED: Contact with the pine processionary caterpillar induces dermatitis, usually located in exposed areas, and, less frequently, ocular lesions through a toxic-irritative mechanism. Recently, the existence of an immediate hypersensitivity mechanism has been demonstrated, mainly in occupationally exposed patients. OBJECTIVE: To present four patients who experienced allergic reactions (urticaria-angioedema and rhinitis-asthma) after non-occupational exposure to pine processionary caterpillar. PATIENTS AND METHODS: The four patients underwent allergy testing through skin prick tests (SPT), specific IgE detection and SDS-PAGE immunoblotting. One patient also underwent a specific bronchial challenge test with the pine processionary antigen. RESULTS: In all patients, both SPT with the caterpillar extract and specific IgE were positive. Western blotting showed several IgE-binding bands with molecular mass values ranging from 18 to 107 kDa. A shift in the electrophoretic mobility of some of the relevant allergens occurred under the presence of a reductive agent (beta -mercaptoethanol). The specific bronchial challenge test with pine processionary antigen performed in one of the patients also produced positive results. CONCLUSIONS: The results of this study show an immunologic IgE-mediated immediate hypersensitivity mechanism in these reactions. The processionary caterpillar's airborne urticating hairs or spicules should be considered, at least in some locations, not only as contact and occupational allergens, but also as seasonal aeroallergens.

Asthma camp. Quality of life questionnaires.

Asthma is one of the most common chronic chilhood disease. Asthmatic children need a self-management educational program, besides the medical treatment and clinical control. Camps are the ideal place to complete the educational program, to get the right control of the disease and to build the child confidence. Madrid Castilla la Mancha Allergy Society organizes every year a summer camp in a town, near Madrid. Fifty-four children stay for one week with certified allergists, fellows-in-training, nurses and cheer-leaders.Fifty-four children from 8 to 14 years old, with moderate to severe asthma participate in the camp. The camp includes educational, athletic and social activities. Campers participate daily in instructive and didactic teaching sessions. We evaluate quality of life with a questionaire filled in the camp and two months later. Results are analysed into two age groups, one between 8-10 years old and the other from 11 to 14 years old. The first group get a good management and improve their vision of the disease, quite the contrary, adolescents face up to a chronic disease with daily treatment, feeling asthma as a restriction of their autonomy. Even so, they identify crisis and learn to control them in an special risky life period. Asthma camps is a good experience for both groups and also for sanitary equipment.

[Exercise-induced anaphylaxis after apple intake]. / Anafilaxia inducida por ejercicio tras ingesta de manzana.

Exercise-induced anaphylaxis frequently is related to food ingestion, so that it receives the name of "food-dependent exercise-induced anaphylaxis". The food identification is difficult in some patients. We report two patients with apple-dependent exercise-induced anaphylaxis. STUDY: hematimetries, biochemistries, VMA and 5-HIAA in urine. Complement levels, antinuclear antibodies and viruses serology. ALLERGOLOGIC STUDY: skin prick test with a common inhalant. Skin prick test and prick by prick with different foods. Total Ig E level and specific Ig E determination by the CAP-Pharmacia System. Oral challenge test with apple, exercise test and exercise challenge test after eating an apple. Prick by prick test with fresh apple was positive. Specific Ig E determination by the CAP-Pharmacia System revealed a positive result. We get to reproduce the episode with an exercise challenge test after eating an apple in the same conditions of usual exercise in both patients.

Allergic reactions due to ibuprofen in children.

Ibuprofen is 2-(4-isobutyl-fenyl)-propionic acid, which belongs to the same group of nonsteroidal antiinflammatory drugs (NSAIDs) as naproxen and ketoprofen. We present two instances of adverse reaction to pediatric ibuprofen, an acute urticaria and a fixed drug eruption, with tolerance to acetylsalicylic acid (ASA) and acetaminophen, in what seems to be hypersensitivity to the propionic acid group. Although these reactions are very rare and ibuprofen is still very safe, we think it is important to know about the possible side effects in order to recognize and treat them when they occur.

Reacción adversa con Montelukast / No disponible

No disponible

[Round Table: Urticaria caused by arthropod bites and stings (excluding Hymenoptera)]. / Mesa Redonda: Urticarias por picaduras de artrópodos (excluidos himenópteros).

Adverse reactions to arthropod bites (hymenoptera excluded) can be faced with systemic reactions and local reaction. Among the numerous families of arthropods the species most commonly responsible are mosquitoes,. flea, horsefly and tick. In this article we explain the characteristics of reaction caused by arthropods and the mechanisms proposed. An IgE mechanism is incriminated in severe anaphylactic reactions. Various mechanisms have been proposed for local reactions. In order to know the incidence of sensitization and cross-reactivity with other arthropods, we have done a study where we have found that 31% of patients with reaction to mosquito bite had sensitization to Aedes communis and 53% of this group also had sensitization to other arthropods, probably due to a cross-reactivity.

A study of allergy to penicillin antibiotics in 1995 in the Child Allergy Department of the Gregorio Marañón University hospital.

We present 219 cases of adverse reactions to penicillin and related antibiotics during 1995 in the Child Allergy Department of Gregorio Marañón University Hospital. Amoxicillin was the most frequent cause of the reaction. The most common clinical symptom was urticaria followed by angio-edema and other characteristic exanthemas. A diagnosis of allergy to penicillin and related drugs was only made in 20 cases in which the predominant symptomatology was urticaria and the antibiotic most commonly involved was again amoxicillin. Diagnosis was confirmed by a skin test, specific IgE determination and controlled provocation. In 3 of the 20 cases diagnosis was made in the reassessment or second study, which was carried out in all cases in which more than one year had passed between the reaction and the initial allergological study.