Nine cases of omeprazole allergy: cross-reactivity between proton pump inhibitors.

Although rare, anaphylactic reactions induced by proton pump inhibitors have been reported. The presence of cross-reactivity between different members of the group is not clear. We studied 9 patients with adverse reactions to omeprazole. Clinical symptoms appeared immediately in 8 patients and after 4 hours in 1. Symptoms ranged from urticaria/angioedema in 7 cases to anaphylaxis in 2 cases. Skin prick tests and oral controlled challenge tests with omeprazole, lansoprazole, and pantoprazole were performed. Skin prick or intradermal tests with omeprazole were positive in 8 patients. Four were also positive to pantoprazole. Prick tests with lansoprazole were always negative. Lansoprazole was administered to all 9 patients, with good tolerance in 8. Only 3 patients were challenged with pantoprazole and developed widespread urticaria. We present 9 patients with immunoglobulin E-mediated allergy to omeprazole. In most of our cases, lansoprazole proved to be a good alternative treatment.

Study of hypersensitivity reactions and anaphylaxis during anesthesia in Spain.

BACKGROUND: Several studies have identified neuromuscular blocking agents as the most common cause of anaphylaxis during general anesthesia. The reported frequencies vary considerably between countries. There are few reports from Spain, probably due to the low prevalence of reactions. METHODS: For 5 years (1998-2002), all the patients who presented perioperative anaphylactic-type reactions, were studied in 2 Spanish allergy departments (Santiago Apostol, Vitoria-Gasteiz and San Pedro, Logroño). The diagnostic protocol consisted of a case history (age, gender, number of previous interventions, characteristics of the reaction, reaction phase, previously administered drugs), serum tryptase measurements, skin tests, and specific immunoassays (immunoglobulin [Ig] E determination against latex, penicillin, and Echinococcus). RESULTS: Forty-eight patients were studied, with ages ranging from 7 to 86 years. The ratio of women to men was 3:2. An IgE-mediated mechanism was confirmed in 27/48 patients (56%). The etiological agents were antibiotics in 12 cases (44%) (10 betalactams, 1 vancomycin, and 1 ciprofloxacin), muscle relaxants in 10 cases (37%), pyrazolones in 2 cases, latex in 2 cases, and Echinococcus in 1 case. CONCLUSIONS: Fifty-six percent of the perianesthetic reactions studied were IgE-mediated. Antibiotics and neuromuscular blocking agents were the most frequent causal agents, as verified by skin tests, and specific IgE and/or challenge tests. It is important to keep appropriate documentation on any of the drugs used during surgery, since our results show that those drugs involved in the reaction as the etiological agent, such as antibiotics and nonsteroidal anti-inflammatory agents, can be used again outside the context of surgery.

Rosemary contact dermatitis and cross-reactivity with other labiate plants.

Rosemary, a plant belonging to the labiate family, is frequently used in the making of cosmetics and also for medicinal purposes. There are few reported cases of contact dermatitis due to this plant. Here we present 1 case and asses the existence of cross-reactivity with plants from the same family. 53-year-old man with several episodes of a pruritic and erythematous eruption that resulted in peeling of the skin, after applying rosemary alcohol, on the chest reported. Epicutaneous tests were done with the standard European series (GEIDC), with the commercial plant series (Bial-Aristegui) and with plants from the labiate family. Results were positive for 3 of 4 labiate species tested. we present a case of rosemary contact dermatitis, where we have found cross-reactivity with 3 of 4 species tested from the same family.

Immediate hypersensitivity to corticosteroids.

INTRODUCTION: In comparison with the extremely frequent use of corticosteroids in different diseases, immediate allergic reactions remain uncommon. In addition to the steroid molecule, the causative agent of these reactions can be an excipient. MATERIAL AND METHODS: We report seven cases of immediate reactions induced by different preparations of corticosteroids. Skin tests with the suspected steroid and excipients were carried out. In patients with negative skin tests, oral or parenteral challenges were performed with the drug and the excipients involved. Challenge tests with at least two other corticosteroids belonging to another or even the same group of the Coopman classification were carried out. RESULTS: Of the 7 patients, six had positive skin tests with the suspected preparation of corticoid: three cases with methylprednisolone acetate, two cases with carboxymethylcellulose and one case with the complete triamcinolone preparation. Only in one case did we have to challenge with the suspected steroid preparation to confirm the diagnosis. All challenge tests with other corticosteroids belonging to another or to the same group of the Coopman classification were negative. CONCLUSIONS: The reactions were caused by the steroid molecule (Triamcinolone or methylprednisolone succinate) in four patients, by an excipient (carboxymethylcellulose) in another two patients and we could not identify the sensitized molecule in one patient. We did not demonstrate cross-reactivity between different corticosteroids.

Occupational asthma caused by white mushroom.

The commercial growing of white mushroom (Agaricus bisporus) is a frequent activity in certain Spain regions as La Rioja. We report two cases of white mushroom workers suffering from asthma caused by hypersensitivity to basidiocarp and spores of white mushroom.

Immediate hypersensitivity to quinolones: moxifloxacin cross-reactivity.

INTRODUCTION: Immediate hypersensitivity reactions to quinolones are rare. Moxifloxacin is an quinolone chemically different from other fluoroquinolones. We report 6 patients diagnosed with hypersensitivity to different fluoroquinolones in whom the response to moxifloxacin and cross-reactivity with other quinolones was studied. MATERIAL-METHODS: An allergenic study was made by prick and intradermal test with different fluoroquinolones, in all the patients. Single blind oral challenge tests were performed with moxifloxacin in all the patients, with ciprofloxacin in five patients, with levofloxacin in three patients and with ofloxacin in one patient. RESULTS: The skin test performed with moxifloxacin was positive in five patients, and the oral challenge test was positive in all six patients. All the patients had at least one positive skin test with some of the other fluoroquinolones. CONCLUSION: The skin test with different quinolones seems to be sensitive at showing group hypersensitivity, but not at predicting specific tolerance of each drug. We found a high degree of cross-reactivity among fluoroquinolones, so we currently recommend to avoid the group. We did not find that moxifloxacin differed from other fluoroquinolones so we cannot recommend it as a valid therapeutic alternative in patients sensitized to other quinolones.

Periodate treatment of Anisakis simplex allergens.

Anaphylactic reactions after parasitized fish consumption are mediated by an IgE response. However, positive skin tests and specific IgE can also be found in many asymptomatic subjects who recognize a single medium-mol.-wt. antigen by IgE immunoblot. The study aimed to find out whether this unspecificity was due to the carbohydrate moieties of parasite antigens. Sixty-two patients with suspected parasite allergy, 51 blood donors, 18 bakers, and 38 atopic patients were studied by blotting. Parasite proteins were treated with periodate. Several selected sera were inhibited with a crude wheat extract and fungal amylase. Twelve patients (19%), eight donors (16%), six bakers (33%), and one atopic patient (3%) recognized a single medium-mol.-wt. band in blotting and should be considered false-positive. This band was periodate-sensitive, but specific IgE to this allergen could not be inhibited by a wheat extract nor by fungal amylase and was clinically irrelevant. Diagnosis of Anisakis simplex hypersensitivity by skin tests and/ or specific IgE values should always be confirmed by specific IgE immunoblotting in order to detect the presence of clinically unrelated antibodies directed to periodate-sensitive allergens. These allergens are probably not a carbohydrate moiety of a parasite glycoprotein.

Anisakis simplex, a relevant etiologic factor in acute urticaria.

Anisakis simplex, a parasite of fish and cephalopods, can induce IgE-mediated reactions. This study aimed to determine the etiologic role of A. simplex in patients affected by urticaria/angioedema (AE) or anaphylaxis. We studied 100 adult subjects suffering acute episodes of urticaria/AE, by anamnesis, prick tests with A. simplex and fish-mix extracts, and total and specific IgE to both A. simplex and cod. The following criteria of A. simplex allergy were considered: 1) urticaria/AE within 6 h after fish ingestion; 2) specific IgE to A. simplex; 3) positive prick test to A. simplex extract; 4) exclusion of other suspected causes. Double-blind, placebo-controlled food challenge was not carried out because ethical considerations forbid challenge with a parasite. Specific IgE to A. simplex (> 0.7 kU/l) was found in 22 subjects, but only eight were diagnosed as having A. simplex allergy. Other allergens were involved in 37 patients, and 55 cases were considered idiopathic. Specific IgE to fish (> 0.7 kU/l) was found in two patients, but only one was diagnosed as having fish allergy. We concluded that A. simplex is an important etiologic factor in acute urticaria. We suggest that it should be considered in cases of urticaria/AE or anaphylaxis, especially after fish ingestion.

The use of IgE immunoblotting as a diagnostic tool in Anisakis simplex allergy.

BACKGROUND: The fish parasite Anisakis simplex is the etiologic agent of anisakiasis and induces IgE-mediated reactions. Skin prick tests (SPTs) and the measurement of specific IgE to A. simplex were, in our experience, not valid tools with which to discriminate between allergic and nonallergic patients because many control subjects also had positive results. OBJECTIVE: The study was carried out to assess the usefulness of IgE immunoblotting in the diagnosis of allergy to A. simplex. METHODS: We have studied 61 patients with acute symptoms of urticaria, angioedema, or anaphylaxis and positive specific IgE to A. simplex. According to the anamnesis, time interval between ingestion of fish and clinical onset of symptoms, and exclusion of other causes of allergy, three different groups of patients were established: group A (allergic), group NA (non-allergic), and group D (doubtful). Fifty-one healthy donors were included as control subjects (group C). IgE immunoblotting with A. simplex whole-body extract was performed in all patients and control subjects. RESULTS: Four patterns of immunoblotting were observed: type 1, with a group of several bands of medium molecular weight and others of low molecular weight; type 2, two or more bands of medium molecular weight; type 3, only one band of medium molecular weight; type 4, without any band. There was a significant predominance of blotting type 1 in group A and type 4 in group C. CONCLUSION: These data suggest that IgE immunoblotting is the most useful approach to A. simplex allergy diagnosis.

Anisakis simplex induces not only anisakiasis: report on 28 cases of allergy caused by this nematode.

Anisakis simplex R., parasitizes several sea-fish and cephalopods. This parasite induces not only anisakiasis but also anaphylactic reactions, as has recently been confirmed. We present 28 patients with immediate hypersensitivity to Anisakis simplex, developed after parasitized fish ingestion. Each case was diagnosed by suggestive anamnesis, skin prick tests with an A. simplex extract, specific IgE detection in serum (CAP System), and histamine release test. The clinical manifestations were urticaria/angioedema in all 28 patients and respiratory arrest in one. Paradoxically, the patients reported tolerance to ingestion of the same kind of fish between and after the allergic episodes. Type 1 hypersensitivity to A. simplex was demonstrated by a positive skin-prick test reaction, specific IgE detection in all cases and positive histamine release in a representative case. Sensitization to the proteins of the fish themselves was ruled out by negative reactions of the same tests in all cases. It was also proven that the allergen/s involved may be resistant to cooking and deep freezing. Hence, anaphylactic reactions may result either from infection or, more frequently, from mere exposure to the allergen. The results confirm that A. simplex can develop IgE-mediated anaphylactic reactions, the clinical severity of which was pronounced in the patients examined. Physicians must take into account that the consumption of parasitized fish may cause severe reactions, even if fish of the same kind is subsequently tolerated. A higher frequency of reactions of this type can be expected in countries where fish is a staple diet.

Laboratory determinations in Anisakis simplex allergy.

BACKGROUND: Anaphylactic reactions caused by the fish nematode, Anisakis simplex, after ingestion of parasitized fish, have been described. OBJECTIVE: This study was undertaken to confirm, by histamine release tests, that A. simplex is able to trigger IgE-mediated reactions and to describe the serologic profiles in this sensitization. METHODS: Twelve patients who had anaphylactic symptoms after ingestion of cooked fish and positive prick test results and determinations of IgE to A. simplex were studied by indirect IgG ELISA and IgG and IgE immunoblotting. Sera from subjects parasitized with other nematodes, patients with fish allergy, and healthy donors were included as controls. A histamine release test was performed in a representative case. RESULTS: IgE immunoblotting was a specific test to detect A. simplex allergy. IgE-reacting bands were found in serum samples from 11 of our patients. Specific IgG antibodies were found by ELISA and immunoblotting, but this response was less specific. Histamine release was positive with A. simplex extract and negative with fish. CONCLUSION: A specific and intense immune response to an A. simplex extract was found in our patients. A. simplex is able to elicit anaphylactic reactions, and A. simplex allergy should be suspected in patients with allergic symptoms after ingestion of fish. A positive prick test response to A. simplex and a negative response to fish is a good indication for a diagnosis of A. simplex allergy.