Food allergy in Catalonia: Clinical manifestations and its association with airborne allergens

BACKGROUND: Food allergy affects around 6% of the European population and its prevalence worldwide has been increasing in the last decades, but studies focused on investigating food allergy epidemiology in Europe are lacking. OBJECTIVE: The Cibus project was created to register the main culprit foods and their clinical manifestations in food allergic patients in Catalonia. METHODS: A specific online database was designed. Allergists from eight different Catalan hospitals registered the new diagnoses of food allergy. RESULTS: 618 food allergic patients were included. Egg and milk were the main elicitors in the early ages, while fruits and nuts were the most frequent in patients >14 years old. Fish was more frequent in children, while seafood and Anisakis allergy were more frequent in the >14-year-old group. Overall, peach was the most prevalent food eliciting an allergic reaction (10%). Food allergy diagnosis was reached using compatible clinical history and positive skin prick test to the involved food in 98% of cases. Globally, urticaria was the most frequently reported manifestation in our population (48.2%), followed by oral allergy syndrome (25.6%) and anaphylaxis (24.8%). CONCLUSIONS: The Cibus project gives a full overview of the profile of food allergic patients in Catalonia and reinforces the predominance of plant food allergies in the Mediterranean area

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Food allergy in Catalonia: Clinical manifestations and its association with airborne allergens.

BACKGROUND: Food allergy affects around 6% of the European population and its prevalence worldwide has been increasing in the last decades, but studies focused on investigating food allergy epidemiology in Europe are lacking. OBJECTIVE: The Cibus project was created to register the main culprit foods and their clinical manifestations in food allergic patients in Catalonia. METHODS: A specific online database was designed. Allergists from eight different Catalan hospitals registered the new diagnoses of food allergy. RESULTS: 618 food allergic patients were included. Egg and milk were the main elicitors in the early ages, while fruits and nuts were the most frequent in patients >14 years old. Fish was more frequent in children, while seafood and Anisakis allergy were more frequent in the >14-year-old group. Overall, peach was the most prevalent food eliciting an allergic reaction (10%). Food allergy diagnosis was reached using compatible clinical history and positive skin prick test to the involved food in 98% of cases. Globally, urticaria was the most frequently reported manifestation in our population (48.2%), followed by oral allergy syndrome (25.6%) and anaphylaxis (24.8%). CONCLUSIONS: The Cibus project gives a full overview of the profile of food allergic patients in Catalonia and reinforces the predominance of plant food allergies in the Mediterranean area.

Reduced work/academic performance and quality of life in patients with allergic rhinitis and impact of allergen immunotherapy.

BACKGROUND: Allergic rhinitis (AR) is characterised by burdensome nasal and/or ocular symptoms. This inflammatory disease can be debilitating and thus result in considerable health-related and economic consequences. METHODS: In a cross-sectional study, adult subjects with AR (N = 683) completed three allergy-specific questionnaires that assessed the impact of AR on the work/academic performance, daily activities, health-related quality of life (HRQOL), and satisfaction with allergen immunotherapy (AIT). Regression analyses were used to examine the associations between several clinical variables and the patient-reported outcomes. RESULTS: Total loss of productivity was 21.0 and 21.2 % for employed and student patients, respectively, whereas the impairment of daily activities was 22.0 %. The mean overall HRQOL score was 1.94 ± 1.29 (on the scale of 0-6 points). Global score for satisfaction with AIT was 65.5 ± 24.8 (on a 0-100 scale). Simple regression analysis found statistically significant associations between loss of work and academic productivity, impairment of daily activities and the type and severity of AR. AIT was a protective factor. The persistent and more severe types of AR and lack of AIT contributed to the worsening of HRQOL. CONCLUSIONS: AR (the persistent and more severe form of the disease) has an impact on functional characteristics of adult patients in Spain. AIT might reduce the effect of this disease on the work/academic performance and HRQOL. Trial registration Retrospectively registered.

Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire.

OBJECTIVES: To develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations. METHODS: An initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test-retest (2-4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: The new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score. CONCLUSIONS: This new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.

Reported occupational respiratory diseases in Catalonia.

OBJECTIVES: A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system. METHODS: In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia. RESULTS: Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. CONCLUSIONS: The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.

Enfermedad alérgica en un carpintero / allergic disease in a carpenter

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Gestión técnica de una unidad de inmunoterapia / Technical gestion in the immunotherapy unit

Antecedentes y objetivos: La administración de inmunoterapia (IT) por vía subcutánea es un tratamiento no exento de riesgos, por lo que su administración debe llevarse a cabo siguiendo estrictos protocolos de actuación. El objetivo del estudio es establecer los criterios de monitorización de los pacientes en una Unidad de Inmunoterapia para reducir el riesgo de aparición de reacciones adversas. Material y métodos: Un total de 378 pacientes diagnosticados de rinitis y/o asma por sensibilización a distintos aeroalergenos (ácaros, pólenes, epitelios y hongos) fueron atendidos en nuestra Unidad durante un período de 15 meses. Todos ellos fueron tratados con extractos estandarizados biológicamente. La monitorización de los enfermos se llevó a cabo con la ayuda de un programa informático (InmunoWin®). Resultados: Se administraron un total de 4.383 dosis. Aparecieron un total de 34 reacciones adversas (0,8 por ciento), de las cuales sólo una fue sistémica (0,02 por ciento). Ésta consistió en un broncoespasmo leve, que se controló inmediatamente. Conclusiones: La correcta monitorización de los pacientes, en la cual la informática juega un papel destacado, en el momento en el que se les administra una dosis de IT, reduce drásticamente el porcentaje de reacciones sistémicas y se demuestra que la IT es un tratamiento seguro cuando se administra bajo las debidas condiciones (AU)

Asma ocupacional por polvo de espinaca / Asthma occupational to Spinach powder

Antecedentes y objetivos: Los alimentos pueden ser causa de enfermedades respiratorias como antígenos inhalados. Se presenta un caso de un varón de 45 años, panadero, sin antecedentes de atopia, que presenta síntomas de rinoconjuntivitis y asma bronquial en relación con la manipulación de polvo de espinaca deshidratada, que utiliza para el enriquecimiento de harinas integrales en la fabricación del pan integral. El paciente tolera la ingesta de espinaca, pan y bollería. Material y métodos: Se realizó prick test con extracto de polvo de espinaca deshidratada (30 mg/ml) y prueba de provocación nasal con extracto de espinaca deshidratada, así como determinación de IgE específica mediante el método HY-TEC-EIA e SDSPAGE-immunoblotting. Resultados: El prick test con extracto de polvo de espinaca deshidratada (30 mg/ml) fue positivo. La prueba de provocación nasal con el extracto de espinaca deshidratada fue positiva a una dilución 1/1000 desencadenándose de forma inmediata síntomas clínicos de rinitis; se pudo observar aumento de las resistencias y disminución en el flujo total mayor del 50 por ciento. La IgE específica fue de 1,64 kU/L y mediante la técnica SDS-PAGE immunoblotting se determinó una banda proteica fijadora de IgE de 29,6 KDa. Conclusiones: Se describe la hipersensibilidad mediada por IgE frente a polvo de espinaca en un paciente panadero que presentaba síntomas de rinitis y asma con su manipulación. El paciente se encuentra asintomático al evitar su contacto. La sensibilización a otros vegetales utilizados en la masa del pan puede ser la causa de asma ocupacional por antígenos ocultos y poco frecuentes (AU)

Asma ocupacional por polvo de acacia / Ocupational asthma by gum guar

Fundamento: Trabajador de la industria farmacéutica que refiere rinitis y asma con la manipulación de los compuestos carbonato cálcico, polvo de acacia y talco, que emplea para la realización del recubrimiento de las grageas de Mycostatin®. Los síntomas desaparecen durante los fines de semana y las vacaciones. Métodos: Se realiza pricktest con extracto de polvo de acacia (10 mg/ml) con resultado positivo. Se lleva a cabo el test de provocación nasal con extracto de polvo de acacia (10 mg/ml) a una dilución 1/10, desencadenándose de forma inmediata síntomas nasales y poniéndose de manifiesto en la rinomanometría un descenso de más del 50 por ciento en el valor del flujo total nasal e incrementándose en 10 veces la resistencia total. Se determina la IgE específica mediante método HY-TEC-EIA, obteniéndose un RAST igual a 3.1 kU/l (clase 2). Mediante la técnica de SDS-PAGE Immunoblotting se determina una banda proteica fijadora de IgE de 20 kDa. Conclusiones: Mediante el estudio realizado se demuestra la existencia de un mecanismo mediado por IgE como desencadenante de los síntomas del paciente al exponerse al polvo de acacia. Con el cambio de puesto de trabajo, el paciente se encuentra asintomático. (AU)

Anaphylactic shock after intra-articular injection of carboxymethylcellulose

Background: sodium carboxymethylcellulose (SCMC) is the sodium salt of a polycarboxymethyl ether of cellulose. SCMC is widely used in pharmaceutical and food industries. We present the case of a 47-year-old man who suffered an anaphylactic shock after an intra-articular injection of Trigon depot®. Methods and results: prick and intradermal tests with Trigon depot® and its components (triamcinolone acetonide, Tween 80, benzylalcohol, SCMC), mepivacaine 2% and latex were performed. Challenge test with mepivacaine 2% was also realized. Results showed a positive intradermal test to Trigon depot® and carboxymethylcellulose, with negative results to the rest (including challenge test to mepivcaine 2%). Conclusions: our results support the diagnosis of anaphylactic shock after intra-articular injection of carboxymethylcellulose and we consider necessary to emphasize that excipients must be taken into account as a potential source of adverse reactions to drugs (AU)

Introducción: la carboximetilcelulosa sódica (SCMC) es la sal sódica de un éter policarboximetílico de la celulosa. SCMC es un producto ampliamente utilizado en industria alimentaria y farmacéutica.Presentamos el caso de un varón de 47 años que sufrió un shock anafiláctico tras recibir una inyección intraarticular de Trigon depot®.Métodos y resultados: se realizaron test cutáneos (prick e intradermorreacción) con Trigon depot® y sus componentes (triamcinolona acetónido, Tween 80, alcohol benzílico, SCMC), mepivacaína 2 por ciento y látex. Se realizó provocación con mepivacaína 2 por ciento.Los resultados de los tests cutáneos mostraron positividad de forma exclusiva al Trigon depot® y a la carboximetilcelulosa, con resultado negativo para el resto del estudio (incluyendo la provocación con mepivacaína 2 por ciento).Conclusiones: nuestros resultados sugieren el diagnóstico de shock anafiláctico tras la administración intraarticular de carboximetilcelulosa. Es importante destacar la importancia de tener en cuenta los excipientes como causa de reacciones adversas a fármacos. (AU)

Asma ocupacional y anafilaxia por semillas de plantago ovata / Occupational asthma and anaphylaxis due to seeds of Plantago ovata

Fundamento: Las semillas de Plantago ovata (Psyllium, Ispaghula), utilizadas en la preparación de laxantes de volumen, son conocidas como causantes de asma ocupacional y anafilaxia. Se presenta el estudio inmunológico de un trabajador de una industria farmacéutica que desarrolló asma ocupacional en relación con la exposición a semillas de Plantago ovata y una reacción anafiláctica posterior a su ingesta. Observación clínica: Varón de 31 años de edad que consultó por presentar rinitis asociada a sibilantes, en relación con la jornada laboral y la exposición a semillas de Plantago ovata. También refirió un episodio de broncospasmo, dolor abdominal, angioedema facial y urticaria generalizada posterior a la ingesta del laxante. Resultados: Las pruebas cutáneas a neumoalergenos ambientales (ácaros del polvo doméstico, epitelio de perro y gato) fueron positivas, así como las realizadas frente a extracto de Plantago ovata. La IgE específica (EIA y CAP-System) frente a Plantago ovata fue positiva y el SDS-PAGE Immnoblotting (Western blot) mostró bandas fijadoras de IgE de pesos moleculares 78, 59, 34, 25,6 y 17,6, kDa respectivamente. Una rinomanometría basal y una prueba de provocación nasal específico a Plantago ovata positivo. Conclusiones: La sensibilización a Plantago ovata es relativamente frecuente en trabajadores expuestos por vía inhalatoria (personal sanitario y de la industria farmacéutica). Existe un riesgo importante de reacciones graves anafilácticas tras su ingesta en individuos sensibilizados. (AU)

Anaphylactic shock after intra-articular injection of carboxymethylcellulose.

BACKGROUND: Sodium carboxymethylcellulose (SCMC) is the sodium salt of a polycarboxymethyl ether of cellulose. SCMC is widely used in pharmaceutical and food industries. We present the case of a 47-year-old man who suffered an anaphylactic shock after an intra-articular injection of Trigon depot. METHODS AND RESULTS: Prick and intradermal tests with Trigon depot and its components (triamcinolone acetonide, Tween 80, benzylalcohol, SCMC), mepivacaine 2% and latex were performed. Challenge test with mepivacaine 2% was also realized. RESULTS: Showed a positive intradermal test to Trigon depot and carboxymethylcellulose, with negative results to the rest (including challenge test to mepivcaine 2%). CONCLUSIONS: Our results support the diagnosis of anaphylactic shock after intra-articular injection of carboxymethylcellulose and we consider necessary to emphasize that excipients must be taken into account as a potential source of adverse reactions to drugs.

Allergy to pine nuts in children.

BACKGROUND: Allergy to nuts is a common and well-known disease. Despite the fact that pine nut is a widely eaten food, only nine cases have been described in literature. OBJECTIVE: To describe four paediatric patients suffering from allergy reaction on ingestion of pine nuts and compare them with cases described in literature, taking into account clinical symptoms, epidemiological and diagnostic methods. METHODS: The immuno-allergic study was carried out with skin tests (prick tests) using a commercial and native extract, and specific IgE serum test. An oral provocation test was performed in one case. RESULTS: Ages ranged from 12 months to 6 years. All patients had a personal history of atopy. Symptoms on ingesting pine nut were severe systemic reactions in three cases. Two of the children had allergic reactions to other nuts. In all cases, both the skin test and the specific IgE serum test were positive. The oral provocation was positive in the case for which it was performed. CONCLUSIONS: A typical clinical reaction of immediate hypersensitivity to this nut took place in all four children. The skin tests and in vitro studies confirm an IgE-mediated response. We currently have a commercial prick test for pine nut for the diagnosis, which has proven its sensitivity and specificity. In our region, due to the large consumption, the rate of allergic reactions to pine nuts would probably be greater and earlier on in life than in other areas.

Blood sample processing effect on eosinophil cationic protein concentration.

BACKGROUND: Asthma is considered to be an inflammatory disease. The most important cell involved in the inflammation is the eosinophil. These cells and their mediators, such as eosinophil cationic protein (ECP), are potential markers of the inflammation's severity. Eosinophil cationic protein may be used for monitoring antiasthma treatment. It is well known that sample processing conditions can affect the ECP blood levels. OBJECTIVE: The aim of this work is to study the effect of temperature, time, and anticoagulants on ECP levels. METHODS: We studied five asthmatic patients and five healthy controls. We obtained three different blood samples from each subject, one with heparin, one with EDTA, and one without anticoagulant. To evaluate the effect of temperature, serum samples were clotted for an hour, one at 0 degree C, one at room temperature, and the other at 37 degrees C. Plasma (heparin and EDTA) samples were treated as follows: one was immediately centrifuged, and two were stored for an hour, one at 0 degree C, and the other at room temperature. Eosinophil cationic protein levels were measured by fluoroimmunoassay (CAP-System ECP FEIA Pharmacia). RESULTS: A higher temperature during blood clotting resulted in a higher ECP concentration. There were no differences between ECP determination in serum samples and plasma samples with heparin, under the same conditions of time and temperature; so clotting may not be necessary for ECP release in vitro. Eosinophil cationic protein was not released in plasma samples with EDTA, neither at 0 degree C nor room temperature. CONCLUSIONS: More studies must be done to clarify the mechanism of the ECP release in vitro.

Effect of conditions in obtaining blood samples for ECP testing in children.

Eosinophil Cationic Protein (ECP) is a basic protein found in eosinophil granules. This cell and its mediators are currently considered to be potential indicators of the severity of inflammation in the organism. ECP concentration can be reliably tested using several RIA or ELISA methods. It is well known that the conditions of sample obtention can affect the ECP values in blood. The aim of this study is to establish which parameters affect ECP testing during regular blood sample collection and how they affect it. Blood samples taken for the routine study of five children attended in our department were analysed: four were asthmatic and one child had atopic dermatitis. In the results we observed that ECP was not detected in the blood samples taken with EDTA tripotassium. In both the plasma samples taken with heparin as well as with serum, more ECP was released at a higher temperature. In the release of ECP obtained by coagulation, samples at 37 degrees showed values of between 4 and 20 higher than those obtained for an hour at 0 degrees. There is a considerable variability in the testing of ECP depending on the blood test extraction conditions, the range is bigger in the samples with eosinophils. These results imply the need to define a stricter protocol for obtaining samples than that suggested at present.

[Anaphylaxis caused by royal jelly]. / Anafilaxia por jalea real.

Royal jelly is the food on which are fed and which causes them to develop into queen bees. It is claimed to have rejuvenating virtues for human beings. This report describes a 15-year-old atopic woman who presented, 15 minutes after the intake of royal jelly, local angioedema, generalised urticaria, dysphonia and bronchospasm. She was given antihistaminics and corticoesteroids and responded well. The ingested product contains royal jelly, lactose and potassium sorbate. No anaphylactic reactions to lactose and sorbates have been described previously. Prick test to common food allergens hymenoptera venoms and pollens were negative. RAST to meletin was also negative. Blood eosinophils were 600 and total IgE 465. Non-commercial prepared specific IgE to royal jelly was positive (0.8 KU/l). Prick by prick was positive to 1/10 dilution, being negative in controls (undiluted). No oral provocation test was performed due to the risk of anaphylaxis. No reported cases of royal jelly allergy were founded in a review of the medical literature. Concluding, it is the first described case of IgE anaphylactic reaction due to royal jelly.

[Anaphylaxis caused by human seminal fluid]. / Anafilaxia por fluido seminal humano.

Anaphylaxis to human seminal fluid (HSF) is rare. We present an atopic woman with postcoital cutaneous and respiratory symptoms. Prick by prick to HSF was positive. CAP to FSH was also positive (4 KU/l). The clinical findings, differential diagnosis and different treatments are discussed.