Cross-reactivity of Olea europaea with other Oleaceae species in allergic rhinitis and bronchial asthma.

Cross-reactivity between pollen extracts of four species of Oleaceae was studied: olive (Olea europaea), ash (Fraxinus excelsior), privet (Ligustrum vulgare), and lilac (Syringa vulgaris). Thus, 51 patients and 13 atopic controls were studied, by means of intracutaneous skin tests, histamine-release tests against the four extracts, and specific IgE to O. europaea. The proteic content of the four extracts was assessed by SDS-PAGE and immunoblotting, and similarity of all the extracts studied was observed after electrophoresis and immunodetection. Six common bands were found to be responsible for the cross-reactivity, with apparent molecular weights of 49.6, 40, 36.7, 19.7, 16.7, and 14 kDa, respectively. The cross-reactivity was also corroborated by immunoblotting inhibition and FEIA inhibition. The patients had a similar response to the four allergenic extracts used, although the response to Olea was greatest. When the patients were compared by their geographic origin (northern or southern Spain, according to the distribution of areas of olive pollen influence), there were no significant differences between the two groups in skin reactivity, but a higher histamine release was observed for the four extracts in the southern group, although it was significant only for Fraxinus and Ligustrum. This work corroborated the practicality of the diagnostic methods used and the cross-reactivity between the four species studied, as demonstrated by the different methods used. Therefore, we suggest that only O. europaea extract be used in diagnosis and immunotherapy in Oleaceae pollen allergy.

Abuse of therapy with corticosteroids in the asthmatic patient and the deficient control of suprarenal function. Indication of therapy with ACTH.

The use of corticosteroids, either oral, parenteral or as aerosol, means a great step forward in bronchial asthma treatment. Nevertheless, given the abuse of their administration, we find more and more frequently, cases of corticodependent bronchial asthma, due to a deficient control in the clinical evolution. For this reason, we performed a study with 39 patients diagnosed with corticodependent intrinsic bronchial asthma. Basal cortisol determination was performed in all, and all of them followed posttreatment with ACTH, antibiotics and mucolytics, as well as follow up of respiratory function parameters and clinical evolution. We found a mean increase in cortisol levels of 488% (basal: 2.49 +/- 0.33 micrograms/dl; posttreatment: 14.59 +/- 2.9 micrograms/dl). Regarding the respiratory function tests, FEV1 improved from 59.38 +/- 4.23% to 68.52% +/- 4.28% (15.4% increase); MEF50 went from 28.62 +/- 3.47% to 35.9 +/- 3.81% (25.4% increase) and MEF25-75 improved from 28.89 +/- 3.47% to 37.05 +/- 3.93% (28.2% increase). Clinical symptomatology and medication improved in general, going from an initial punctuation of 8.5 to a posttreatment score of 7.47. In general, 50% of the patients studied improved from the clinical point of view, only 47.2% had a discrete improvement, and only one patient got worse. Side effects with ACTH treatment appeared in 28.2% of the cases, mainly peripheral edemas, especially in the lower extremities. In conclusion, with patients undergoing lengthy corticosteroid therapy, control of their suprarenal function is absolutely necessary. If a glandular insufficiency appears with low levels of plasmatic cortisol, we advise treatment with ACTH in association with antibiotics.

International study of asthma and allergies in childhood. Results of the first phase of the I.S.A.A.C. project in Pamplona, Spain.

The international study of asthma and allergy in childhood was designed for the epidemiological investigation of asthma, by means of a standardized methodology. It was started in 1989, as a consequence of very different results obtained in previous epidemiological studies, of which none could be considered as definitive. First, a standardized survey was performed, in order to determine the prevalence of asthma in the United Kingdom, New Zealand and Australia, and subsequently several countries joined them, Spain being one of them. The first objective was to discover the prevalence and severity of bronchial asthma in children who lived in different countries, and to compare the results. Also, it was intended to obtain baseline measurements, in order to assess future trends in asthma prevalence and severity, and to facilitate a base for a subsequent phase of etiologic investigation. For this study, following a protocol previously established, a written survey and a video-survey were given to children aged 13 and 14, and a written survey to the parents of the children aged 6 and 7. All the surveys were performed during the school year 1993-1994. A total of 8,087 surveys were conducted in 53 schools from Pamplona and neighbouring towns. Among the group of children aged 13 and 14, 5.3% had a crisis in the study period, whereas 4.4% suffered from an acute attack. This prevalence was not as high in children aged 6 and 7, for whom the percentages were 3.3% and 3.2%, respectively. We found lower prevalences in the two groups in relation to other countries, and we attribute this result, on one hand to the accessibility to doctors in our area, and on the other hand, to early diagnosis of the disease by specialists, periodic control and suitable etiologic treatment.

Fruit sensitization in patients with allergy to latex.

In the last years, latex has frequently been found to be involved in immediate hypersensitivity reactions. The first case mentioned with recurrent urticaria and laryngoedema was reported by Stern (1) in 1927. Since then, latex has also been implicated in generalized urticaria, rhinoconjunctivitis, asthma and anaphylaxis. Associated sensitization to several fruits is frequently seen in latex-allergic patients with the symptoms described above. This study was performed in seven patients (six females and one male) with hypersensitivity to latex and concomitant fruit sensitization. Six of them were healthcare personnel. The age of the patients ranged from 25-39 years, with a mean of 30 years. Prick tests and intracutaneous tests with latex (10% w/v in PBS), banana, chestnut, avocado, kiwi and melon were carried out. A specific histamine release test (HRT) was performed according to the fluorometric assay. Antigen-specific IgE was also performed. Latex CAP inhibition with banana and SDS-PAGE immunoblotting were carried out in one patient. Although in latex-allergic patients multiple sensitization to fruits may be observed, banana and avocado are those most frequently involved, followed by chestnut and melon. This is likely to be due to the presence of common antigens in these fruits and latex, as demonstrated in our study only for banana and avocado. We consider that further investigation is needed on the possible sensitization to latex in sanitary personnel reporting symptoms after fruit ingestion.