Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome.

BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

Postexercise hypotension differs between white and black women.

BACKGROUND: Because data are lacking, we examined the acute effect of exercise on ambulatory blood pressure (BP) in premenopausal white women (n = 18) and black women (n = 15) with normal (n = 21) and high (n = 12) BP. METHODS: Women performed 40 minutes of control and moderate-intensity exercise. BP and hormones were measured before, during, and after the control and exercise periods. By means of RMANCOVA (repeated measures analysis of covarience), we tested whether BP and hormones differed with time and between ethnic, BP, and experimental groups. Multiple regression analysis was used to examine hormonal mediators of the postexercise BP response. RESULTS: Among white women with hypertension, average daytime systolic (S) and diastolic (D) BP decreased 11.0 +/- 3.3 mm Hg (-2.9, -19.1; P =.017) and 8.2 +/- 2.8 mm Hg (-1.2, -13.9; P =.000), from 142.6 +/- 5.8 mm Hg and 96.1 +/- 2.8 mm Hg, respectively, after exercise. Among black women with high BP, mean daytime SBP rose 12.5 +/- 5.2 mm Hg (-2.0, 27.1; P =.000) after exercise, from 121.8 +/- 6.1 mm Hg, whereas DBP was similar before and after exercise (81.4 +/- 4.3 mm Hg and 82.8 +/- 4.7 mm Hg, respectively). In white women without hypertension, daytime SBP and DBP were similar before and after exercise. In black women without hypertension, mean daytime SBP increased 6.3 +/- 2.6 mm Hg (0.4, 12.1; P =.000) after exercise from 103.6 +/- 1.4 mm Hg, and DBP did not change. In black women, hypertension (P = 0.000) and exercise-mediated insulin decreases (P =.005) explained 85.6% of the postexercise SBP response (P =.000). In white women, hypertension (P =.003) and baseline plasma renin (P =.049) accounted for 53.3% of the postexercise SBP response (P =.001). Exercise acutely reduced daytime BP in white women, but not in black women with high BP. CONCLUSION: Endurance exercise may adversely affect the BP of black women.

Exercise affects protein utilization in healthy children.

Although health initiatives promote increased physical activity in children, the physiologic outcomes have not been well characterized. This investigation examined the effects of programmed aerobic exercise on protein metabolism in children (n = 7; mean +/- SEM: 9.14 +/- 0.46 y old; weight, 32.1 +/- 1.6 kg; height, 138 +/- 2.5 cm; and body mass index, 16.21 +/- 0.36 kg/m(2) ) using (15)N-glycine methodology. Boys (n = 5) and girls (n = 2) walked (5 d/wk, 3.2-6.4 km/d) for 6 wk. Criterion measures taken at baseline (Pre) and after the exercise program (Post) included anthropometric data, dietary assessment, nitrogen balance, nitrogen flux (Q), protein synthesis (PS), protein breakdown (PB) and net protein balance [(Net) = PS - PB]. After the walking program, there were no significant changes in body weight, fat-free mass or percentage of body fat, whereas height increased (P < 0.01). Energy and protein intakes were constant throughout the study. Nitrogen balance was significantly more positive Post than Pre (P < 0.05). There was a significant decrease in Q (P < 0.0001) with corresponding decreases in PS (P < 0.001) and PB (P < 0.01). These data provide the first evidence that programmed aerobic exercise alters whole-body protein utilization in healthy, nonobese children. Longitudinal studies are required to further examine changes in protein metabolism associated with increased physical activity in this population. In addition, findings suggest a need to evaluate nutrient requirements for healthy, physically active boys and girls.

Effects of exercise combined with diet therapy on protein utilization in obese children.

PURPOSE: Hypocaloric therapy may adversely affect protein utilization in obese children given that metabolic reactions involving protein, a nutrient essential for growth, are energy-dependent. Because physical activity influences nutrient utilization and may modulate the effects of reduced energy intake, exercise combined with diet therapy may be beneficial with regard to protein metabolism. The primary purpose of this study was to evaluate changes in protein utilization in response to sequential addition of an exercise program to dietary intervention in obese children. METHODS: After a 2-wk baseline period, five subjects aged 8-10 yr reduced energy intake [-2092 to -2510 kJ.d(-1)(-500 to -600 kcal.d(-1))] for 12 wk. A walking program [5 d.wk(-1), 3.2-4.8 km.d(-1) (2-3 miles.d(-1))] was implemented during the final 6 wk of diet therapy. At baseline and after phases I (diet only) and II (exercise and diet) of intervention, 15N-glycine was used to assess protein synthesis (PS), protein breakdown (PB), net turnover (NET = PS - PB), and nitrogen flux (Q). RESULTS: Subjects lost 4.2+/-0.4 kg during the 12-wk intervention period (P < or = 0.05). With diet only, NET decreased (P < or = 0.05) due to a reduction in PS (P < or = 0.05) accompanied by no change in PB. Although PS increased with walking (P < or = 0.05), NET did not return to baseline levels due to a concurrent increase in PB (P < or = 0.05). Changes in PS and PB yielded an increase in Q (P < or = 0.05), a measure of amino acid cycling between protein and free amino acid pools. CONCLUSIONS: These results suggest that exercise offers metabolic benefits for obese children during diet-induced weight loss. Longitudinal studies are needed to assess long-term health outcomes associated with the observed changes in protein utilization.

Effects of reduced energy intake on protein utilization in obese children.

Dietary treatment of pediatric obesity is a challenge given the need for adequate nutrients to support the maintenance of lean tissue and growth. The primary purpose of this investigation was to assess the effects of reduced energy intake on protein turnover in obese children aged 8 to 10 years. Following a 2-week baseline period, 16 subjects reduced energy intake during a 6-week intervention period. At baseline and following the intervention, 15N-glycine methodology was used to measure nitrogen flux (Q), protein synthesis (PS), protein breakdown (PB), and net turnover ([NET] PS - PB). Other criterion measures included resting metabolic rate (RMR), fat mass (FM), fat-free mass (FFM), urinary creatinine to height ratio (Cr:Ht), and nitrogen balance (NB). On average, subjects lost 2.2 +/- 0.3 kg, of which greater than 85% was FM. Decreased Q (P = .03) indicated downregulation of protein turnover in response to diet-induced weight loss. While PB did not change, NET declined slightly (P = .06) as a consequence of reduced PS (P = .03). Reductions in FFM (P = .09), Cr:Ht (P = .02), and NB (P = .03) accompanied alterations in protein turnover, but there was no change in the RMR. In conclusion, while short-term therapy promoted the loss of FM and did not compromise RMR, practitioners must be cautious when prescribing diets, given the observed changes in protein utilization and somatic protein status. Longitudinal studies are needed to further characterize the metabolic responses of obese children to long-term diet therapy.

Subclinical and clinical eating disorders in IDDM negatively affect metabolic control.

OBJECTIVE: To characterize the relationship of subclinical and clinical eating disorders to HbA1c values in women with IDDM. RESEARCH DESIGN AND METHODS: Ninety women with IDDM (18-46 years of age) were recruited from diabetes clinics throughout Connecticut and Massachusetts. Subjects were categorized into one of three groups according to the Diagnostic Statistical Manual of Mental Disorders (DSM-III-R) criteria for eating disorders as follows: the clinical group (n = 14), the subclinical group (partially fulfilling the diagnostic criteria; n = 13), and the control group (n = 63). Group differences in the degree of dietary restraint, binge eating, and bulimic behaviors and weight, shape, and eating concerns were assessed with the Eating Disorder Examination (EDE) and the Bulimia Test Revised (BULIT-R). RESULTS: Women with subclinical and clinical eating disorders had clinically elevated HbA1c results and more diabetes-related complications, compared with the control subjects. The severity of bulimic behaviors, weight concerns, reduced BMI, and decreased frequency of blood glucose monitoring were associated with elevated HbA1c. CONCLUSIONS: HbA1c may have clinical utility in the identification of eating disorder behavior in females with IDDM. Health care professionals should be aware of the potent effect of subclinical and clinical eating behaviors including insulin misuse in weight-conscious women with IDDM who have poor glycemic control.

Effects of acute metabolic acidosis and alkalosis on leucine metabolism in conscious dogs.

To determine the effects of acute metabolic acidosis and alkalosis on leucine metabolism in vivo, mongrel dogs were infused with [1-14C]leucine for 8 h, along with NaCl, HCI, or NaHCO3 over the last 4 h. Arterial pH did not change from the basal value during NaCl infusion but decreased (P less than .01) and increased (P less than .01) during HCl and NaHCO3 infusions, respectively. Total leucine carbon entry did not change from the basal value during saline infusion but increased (P less than .01) with acidosis and decreased (P less than .05) with alkalosis. Compared with saline controls, acidosis increased (P less than .01) leucine oxidation. During alkalosis decreased (P less than .01) leucine oxidation. During acidosis, total plasma essential and nonessential amino acid concentrations increased (P less than .05), whereas during alkalosis, total plasma essential and nonessential amino acid concentrations decreased (P less than .05). These studies suggest that acute alterations in arterial pH may affect the regulation of protein metabolism in vivo and must be considered in the interpretation of results from experiments in which alterations of acid-base homeostasis may have occurred.

Glucogenic and hormonal responses to abomasal casein and ruminal volatile fatty acid infusions in lactating goats.

To determine responses to abomasal protein infusion and ruminal acetate: propionate ratios, four lactating Toggenburg goats fed hourly a 70% roughage and 30% concentrate diet were used in a Latin-square design with a factorial arrangement of treatments. Either acetate or propionate was infused ruminally and casein or saline infused abomasally. Estimated net energy and volume of the infusates were similar for all treatments. To examine the effects of treatments on glucose metabolism, 2-carbon-14 propionate was infused ruminally and 6-hydrogen-3 glucose was infused intravenously for 9 and 5 h, respectively. Although glucose concentration in plasma was higher and propionate turnover greater with propionate treatment, percentage of glucose derived from propionate, amount of propionate coverted to glucose, and glucose turnover remained unchanged. No differences in glucose metabolism due to the abomasal casein infusion were evident. To determine the effects of treatment on insulin, glucagon, growth hormone, and prolactin in plasma, samples were collected at 10-min intervals for 3 h at 0400 and 1600 h. No diurnal variation or consistent peaks were observed for any of the hormones nor were treatment effects on plasma concentrations of insulin, growth hormone, or prolactin evident. Glucagon concentration was higher with casein treatment; however, no relationship existed between glucagon in plasma and glucogenic parameters measured.