Molecular Profile of Sensitization to Dermatophagoides pteronyssinus Dust Mite in Portugal

Objective: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas.Methods: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South.Results: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496).Conclusions: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size (AU)

Objetivo: Analizar el diagnóstico por componentes para Dermatophagoides pteronyssinus (Der p) en pacientes con alergia respiratoria ysu relación con la gravedad clínica en diferentes áreas geográficas.Métodos: Se incluyeron 217 pacientes (edad media 25,85±12,7 años; 51,16% mujeres), seleccionados de 13 centros en Portugal (5 delNorte, n = 65). Todos tenían rinitis alérgica, con o sin asma, y tenían pruebas positivas en prick a al menos un ácaro del polvo. La IgEespecífica (sIgE) para Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10 y Der p 23 se determinaronpor ImmunoCAP. El análisis estadístico (prueba U de Mann Whitney) comparó pacientes con rinitis frente a rinitis y asma; rinitis leve frentea moderada-grave; Norte frente a Sur.Resultados: La prevalencia de sensibilización fue del 98,2% para Der p, y del 72,4%, 89,4%, 9,7% y 77% para Der p 1, Der p 2, Der p 10y Der p 23, respectivamente. Las medianas de sIgE fueron de 8,56, 17,7, 0,01 y 3,95 kUA/ L. Las medianas de sIgE de todos los alérgenosfue mayor en pacientes con rinitis de moderada a grave y rinitis con asma, pero no estadísticamente significativo (NSS). El valor de Der p2 fue significativamente mayor en el Sur en comparación con el Norte (p = 0,0496).Conclusiones: La sensibilización a Der p es la más común en Portugal. Der p 2 tuvo la prevalencia más alta y los niveles medios más altos.Todos los componentes moleculares fueron mayores en pacientes más sintomáticos (NSS). El valor de Der p 2 fue mayor en el Sur, lo quepuede estar relacionado con la temperatura más cálida y/o el tamaño de muestra más grande (AU)

Role of recombinant parvalbumin Gad c 1 in the diagnosis and prognosis of fish allergy

BACKGROUND: The prevalence of fish allergy has increased in recent years. The parvalbumin Gad c 1 is a major cod allergen that is used as a follow-up marker in patients with fish allergy. OBJECTIVES: To determine the clinical and laboratory characteristics of a population of patients with fish allergy. To analyze the role of the specific IgE (sIgE) of recombinant Gad c 1 (rGad c 1) and skin prick tests (SPTs) in confirming the acquisition of tolerance to fish. METHODS: We performed a retrospective study of patients with fish allergy from July 1, 2005 to December 31, 2016. The population was characterized according to demographic data, species of fish associated with allergic reactions, and symptoms. The SPT wheal diameter and sIgE for fish and rGad c 1 were evaluated before acquisition of tolerance (T0) and afterwards (T1). RESULTS: The study population comprised 81 patients (68% male). Most reactions were triggered by hake (51%), mackerel (30%), and cod (26%). The most frequent manifestations were urticaria/angioedema (72%), gastrointestinal symptoms (35%), and eczema (33%); 42% of patients experienced anaphylaxis. At T0, the average sIgE values were as follows: cod, 32.2 kUA/L; sardine, 18.4 kUA/L; hake, 17.5 kUA/L; salmon, 13.9 kUA/L; tuna, 4.5 kUA/L; and rGad c 1, 22.9 kUA/L. In patients who acquired tolerance to at least 1 fish species (n=60; 74%), the mean value of rGad c 1 at T1 (5.1 kUA/L) was significantly lower than at T0 (16.8 kUA/L) (P=.001). Significant values were also recorded for the average diameter of the SPT wheal and the evaluations at T0 and T1 for hake (9.42 mm/3.79 mm) and salmon (7.8 mm/2.8 mm) (P=.002 and P=.026, respectively). CONCLUSION: The decrease in sIgE to rGad c 1 and the mean wheal diameter of SPT for hake and salmon can be used as markers of prognosis in the acquisition of tolerance by fish-allergic patients

ANTECEDENTES: La prevalencia de alergia al pescado ha aumentado en los últimos años. Gad c 1 es una parvalbúmina y un importante alérgeno del bacalao, utilizado como marcador de seguimiento en pacientes con alergia a pescado. OBJETIVOS: Caracterización clínica y de laboratorio de una población de pacientes con alergia a pescados. Analizar la contribución de la IgE específica (sIgE) a parvalbúmina recombinante (rGad c 1) y las pruebas cutáneas (SPT) para confirmar la aparición de tolerancia al pescado. MÉTODOS: Estudio retrospectivo de pacientes con alergia a pescados, desde julio de 2005 hasta diciembre de 2016. Se recogieron datos demográficos, reacciones alérgicas y síntomas con los pescados; el diámetro total de la SPT y el valor de la IgE a rGad c 1 antes (T0) y después de la adquisición de tolerancia (T1). RESULTADOS: Se evaluaron 81 pacientes (68% hombres). La merluza (51%), caballa (30%) y bacalao (26%) desencadenaron la mayoría de las reacciones. Las manifestaciones más frecuentes fueron urticaria/angioedema (72%), síntomas gastrointestinales (35%) eccema (33%) y el 42% de los pacientes tuvieron anafilaxia. En (T0), los valores medios de sIgE fueron: bacalao (32,2 kUA/L), sardina (18,4 kUA/L), merluza (17,5 kUA/L), salmón (13,9 kUA/L), atún (4,5 kUA/L) y rGad c 1 (22,9 kUA/L). En pacientes que adquirieron tolerancia a al menos una especie de pescado (n= 60; 74%), el valor medio de rGad c 1 en T1 (5,1 kUA/L) fue significativamente más bajo que T0 (16,8 kUA/L) (p= 0,001). Los valores del diámetro medio de la SPT en T0 y T1 para merluza (9,42 mm/3,79 mm) y salmón (7,8 mm/2,8 mm) también fueron significativos p= 0,002 y p= 0,026, respectivamente. CONCLUSIÓN: La disminución de la sIgE a rGad c 1 y el diámetro medio de la SPT para merluza y salmón se pueden utilizar como marcadores de pronóstico en la adquisición de tolerancia de alergia a pescados

Salmon roe as an emerging allergen in western countries

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Anaphylaxis to long-acting release exenatide

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The role of TLR2 in the acute inflammatory response induced by Bothrops atrox snake venom

Envenomation by snakes of the species Bothrops atrox induces local and systemic effects. Local effects include drastic tissue damage and a marked inflammatory response as a result of the synthesis and release of a variety of protein and lipid mediators. Toll-like receptor (TLR) signaling pathways can play an important role in this response, leading to synthesis of these inflammatory mediators. This study investigated the influence of TLR2 on the acute inflammatory response induced by Bothrops atrox venom. Wild-type C57BL/6 mice (WT) and TLR2 gene knockout mice (TLR2(-/-)) were injected with Bothrops atrox venom (BaV), and the following responses to the venom were assessed in peritoneal exudate: leukocyte accumulation; release of mediators, including CCL-2, IL-10, IL-1 beta, IL-6 and LTB4; protein expression of COX-1 and COX-2; and quantification of their products PGE(2) and TXA(2). After injection with BaV, the TLR2(-/-) mice (TLR2(Bav)(-/-)) had higher levels of IL-6 and CCL-2 than WT animals kept under the same conditions (WTBav), together with an accumulation of polymorphonuclear leukocytes (PMNs), inhibition of IL-1 beta and LTB4 and reduced mononuclear leukocyte influx. However, no significant differences in COX 2 protein expression or PGE(2), TXA(2) and IL-10 production between the TLR2(Bav)(-/-) and WTBav animals were observed. Together, these results indicate that the signaling pathway activated by TLR2 acts by modulating the induced inflammatory response to BaV through the direct action of venom-associated molecular patterns (VAMPs) or indirectly by forming damage-associated molecular patterns (DAMPs) and that this may have important therapeutic implications. (C) 2016 Elsevier Ltd. All rights reserved.

The inhibitory potential of the condensed-tannin-rich fraction of Plathymenia reticulata Benth. (Fabaceae) against Bothrops atrox envenomation

Ethnopharmacological relevance: Ethnobotanical studies have shown that Plathymenia reticulata Benth. (Fabaceae) has been widely used in cases of snake envenomation, particularly in Northern Brazil. In light of this, the aim of this study was to evaluate the inhibitory potential of the condensed-tannin-rich fraction obtained from the bark of P. reticulata against the main biological activities induced by Bothrops atrox venom (BaV). Materials and methods: The chemical composition of the aqueous extract of P. reticulata (AEPr) was first investigated by thin-layer chromatography (TLC) and the extract was then fractionated by column chromatography on Sephadex LH-20. This yielded five main fractions (Pr1, Pr2, Pr3, Pr4 and Pr5), which were analyzed by colorimetry to determine their concentrations of total phenolics, total tannins and condensed tannins and to assess their potential for blocking the phospholipase activity of Bay. The Pr5 fraction was defined as the fraction rich in condensed tannins (CTPr), and its inhibitory potential against the activities of the venom was evaluated. CTPr was evaluated in different in vivo and in vitro experimental protocols. The in vivo protocols consisted of (1) pre-incubation (venom:CTPr, w/w), (2) pretreatment (orally administered) and (3) post-treatment (orally administered) to evaluate the effect on the hemorrhagic and edematogenic activities of Bay; in the in vitro protocol the effect on phospholipase and coagulant activity using pre-incubation in both tests was evaluated. Results: There was statistically significant inhibition (p < 0.05) of hemorrhagic activity by CTPr when the pre-incubation protocol was used [55% (1:5, w/w) and 74% (1:10, w/w)] and when pre-treatment with doses of 50 and 100 mg/kg was used (19% and 13%, respectively). However, for the concentrations tested, there was no statistically significant inhibition in the group subjected to post-treatment administered orally. CTPr blocked 100% of phospholipase activity and 63.3% (1:10, w/w) of coagulant activity when it was pre-incubated with BaV. There was a statistically significant reduction (p < 0.05) in edema induced by BaV in the oral protocols. Maximum inhibition was 95% (pre-treatment). Conclusion: Our findings indicate that CTPr could be a good source of natural inhibitors of the components of snake venom responsible for inducing local inflammation. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Tempo de destilação e perfil volátil do óleo essencial de aroeira da praia (Schinus terebinthifolius) em Sergipe / Distillation time and volatile profile of the essential oil of Brazilian pepper (Schinus terebinthifolius) in Sergipe, Brazil

Aos frutos e óleos essenciais da aroeira da praia (Schinus terebinthifolius) atribui-se atividade antimicrobiana sobre bactérias gram positivas além de ação anti-inflamatória. O óleo essencial da aroeira é utilizado no tratamento de micoses, sendo a sua atividade antifúngica atribuída à alta concentração de monoterpenos. Este estudo teve como objetivo determinar o melhor rendimento de destilação de óleo essencial de sementes e folhas da aroeira e os componentes químicos do óleo essencial nos diversos períodos de destilação. Cem gramas de cada material foram destilados em aparato de Clevenger durante 2,5h, 4,0h, 5,5h e 7,0h. O material destilado foi analisado por cromatografia a gás acoplada a espectrofotômetro de massas, onde foi obtido o perfil cromatográfico do material. As sementes de aroeira apresentaram maiores quantidades de óleo essencial, quando comparadas com as folhas em todos os períodos de destilação. O óleo essencial de aroeira mostrou perfil volátil formado principalmente por mono e sesquiterpenos.

The fruits and essential oils of Brazilian pepper (Schinus terebinthifolius) have antimicrobial activity against gram-positive bacteria, as well as anti-inflammatory action. The essential oil of Brazilian pepper is used to treat fungal infections, and its antifungal activity is attributed to the high concentration of monoterpenes. This study aimed to determine the best yield of distillation of the essential oil of seeds and leaves of Brazilian pepper and the chemical components of the essential oil in different periods of distillation. One hundred grams of each material were distilled in Clevenger apparatus for 2.5 h, 4.0 h, 5.5 h and 7.0 h. The distilled material was analyzed by gas chromatography coupled to mass spectrometer, where the chromatographic profile of the material was obtained. Seeds of Brazilian pepper showed higher amounts of essential oils when compared with the leaves in all the periods of distillation. The essential oil of Brazilian pepper showed a profile consisting mainly of volatile mono- and sesquiterpenes.

Hiperqueratosis palmoplantar en lactante / Palmoplantar hyperkeratosis in an infant

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Demanda derivada a Dermatología: peso de la patología banal / Referrals to Dermatology: Proportion of Banal Disorders

Introducción: Las enfermedades dermatológicas ocupan un lugar importante en las consultas de Atención Primaria (AP). Nuestro objetivo fue conocer las características y costes de la demanda derivada a Dermatología desde AP. Material y método: Estudio descriptivo transversal de los pacientes remitidos a Dermatología por un centro de salud de AP, realizado en una consulta de Dermatología ubicada en el propio centro de salud y atendida por un dermatólogo del Complejo Hospitalario Universitario de Albacete durante 10 días aleatorios desde el 21 de abril de 2009 al 26 de junio de 2009. Se recogieron los datos de edad, sexo, aplicación o no de crioterapia y grupo diagnóstico. En función de esta última variable se dividieron los pacientes en 4 categorías: A) patología degenerativa benigna o entidades banales, cuyo tratamiento podría no ser apropiado en el Sistema Nacional de Salud ;B) enfermedades resueltas en una visita única realizada por el dermatólogo en el centro de AP;C) enfermedades derivadas a la consulta externa de Dermatología; y D) Entidades que precisan tratamiento quirúrgico y son derivadas a quirófano. Resultados: Se recogieron los datos de 257 pacientes, con una media de edad de 41,18 años y ligero predominio femenino. El grupo diagnóstico más frecuente fue el B (53,7%), seguido del grupo A (19,1%), C (19,1%) y D (8,2%). El coste total estimado de las 257 consultas fue de 29.750,32 euros, de los que 5.672,24 euros representarían el gasto en entidades cutáneas banales. Conclusiones: La actual saturación de las consultas de Dermatología por motivos banales hace necesario un mayor control de la demanda derivada desde AP (AU)

Background and objective: Skin diseases account for a large number of consultations in primary care. The objective of this study was to determine the characteristics and cost of referrals from primary care to a dermatology clinic. Material and methods: Descriptive cross-sectional study of referrals from a primary care health center to a dermatology clinic. The dermatology clinic was situated in the same health center and was attended by a dermatologist from Complejo Hospitalario Universitario in Albacete, Spain. The study was performed on 10 days selected at random between April 21, 2009, and June 26, 2009. The data gathered included age, sex, use of cryotherapy, and diagnostic group. Patients were divided into 4 diagnostic groups: A) benign degenerative disease or trivial disorders whose treatment may not merit involvement of the national health service, B) diseases resolved with a single dermatology consultation at the health center, C) diseases requiring evaluation in hospital-based dermatology outpatients, and D) diseases referred for surgical treatment. Results: Data were gathered on 257 patients with a mean age was 41.18 years and there was a slight female predominance. The majority of patients were in diagnostic group B (53.7%),followed by groups A (19.1%), C (19.1%), and D (8.2%). The total estimated cost of these257 visits was D 29 750.32, of which D 5672.24 was for trivial disorders. Conclusions: The current high prevalence of trivial disorders in the caseload of dermatology clinics by trivial disorders makes it necessary to control referrals from primary care more strictly (AU)

Anaphylaxis to pine nut: cross-reactivity to Artemisia vulgaris?

The use of pine nuts, the seeds of Pinus pinea, is on the increasing in the modern Mediterranean diet. Little more than 20 cases of allergy to this tree nut have been published, and cross-reactivity with pine pollen, peanut and almond has already been reported. We describe the case of a young boy with several episodes of anaphylaxis after pine nut ingestion. Specific IgE to pine nut and Artemisia vulgaris was demonstrated by skin prick tests and in vitro determination of specific IgE, although no IgE to pine pollen or other nuts was detected. Immunoblotting of Artemisia vulgaris and pine nut revealed two matching diffuse bands, just below 14 kDa and 30 kDa. The ImmunoCAP® inhibition assays showed complete inhibition of pine nut specific IgE after serum incubation with Artemisia vulgaris extract. As far as we know, this is the first reported case of documented cross-reactivity between pine nut and Artemisia vulgaris

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Efficacy and safety of specific immunotherapy with a modified mite extract

Background: In specific immunotherapy (SIT), modified extracts have been used to allow safe administration of higher allergen doses. Schedules reaching maintenance doses in approximately 1 month, which may have greater efficacy, have even been proposed. Aims: To assess the safety and efficacy of SIT with modified (depigmented and polymerized) Dermatophagoides pteronyssinus extract in the treatment of allergic rhinitis. Material and methods: Fifty patients with moderate-to-severe persistent allergic rhinitis and who were monosensitized to Dermatophagoides were included in this controlled, pragmatic, 1-year open study. The patients were randomly allocated to receive treatment with a Dermatophagoides pteronyssinus 100% modified allergen vaccine (active group, n = 25) or pharmacological treatment only (control group, n = 25). All SIT-related adverse reactions were recorded. Efficacy was assessed primarily through the results of nasal allergen challenges, through visual analog scale (VAS) and symptom scores. Results: In SIT-treated patients, significant improvements were found in symptom scores (mean reduction > 40%), VAS scores (mean improvement > 20%) and nasal challenges (mean increase in allergen concentration threshold > 500%). For symptom and VAS scores, statistically significant differences between control and SIT-treated patients were recorded at 12 months. In nasal challenges statistically significant differences were observed as early as at 6 months. Control patients showed no significant differences during the study period. Local reactions were observed in 28% of SIT-treated patients (total 24 reactions). There was only one immediate grade I systemic reaction, which was successfully treated with an antihistamine. Conclusions: SIT with this modified extract appears to be a relatively safe treatment, which can rapidly improve nasal allergenic tolerance, reducesymptom scores and improve subjective self-evaluation measured through VAS, reflecting a general improvement in patients’ well-being

Antecedentes: En inmunoterapia específica (ITE) los extractos modificados han sido utilizados para permitir una mayor seguridad en la administración de dosis alergénicas más altas. Incluso, con tales extractos han sido propuestas pautas de inmunoterapia que llegan a dosis de mantenimiento en un mes y que se propone que tengan una mayor y más rápida eficacia. Objetivo: Evaluación de la eficacia y seguridad de ITE con extracto modificado (despigmentado y polimerizado) de Dermatophagoides pteronyssinus en el tratamiento de pacientes con rinitis alérgica. Material y métodos: Incluimos a 50 pacientes con rinitis alérgica persistente moderada a grave, monosensibilizados a Dermatophagoides, en un estudio abierto, pragmático, controlado y paralelo con duración de un año. Se les distribuyó de forma aleatoria para recibir tratamiento con una vacuna de alergeno modificado 100% Dermatophagoides pteronyssinus (grupo activo; n = 25) o sólo un tratamiento farmacológico (grupo control; n = 25). Se registraran todas las reacciones adversas asociadas con las inyecciones de la vacuna y se evaluó la eficacia por pruebas de provocación nasal, escala visual analógica (EVA) y puntuación de síntomas. Resultados: En los enfermos tratados con inmunoterapia se observó mejoría en la puntuación de síntomas (reducción media > 40%), en EVA (mejoría media > 20%) y en prueba de provocación nasal (aumento medio de concentración alergénica tolerada > 500%). En la puntuación de síntomas y EVA a los 12 meses se observaron diferencias estadísticamente significativas entre pacientes control y los tratados. En la prueba de provocación nasal ya existían diferencias significativas a los 6 meses de tratamiento. En el grupo control no se han observado diferencias significativas. Se registró un total de 24 reacciones locales (en 28% de pacientes tratados) y sólo una reacción inmediata sistémica de grado I, que fue tratada solamente con un antihistamínico. Conclusiones: Inmunoterapia específica con este extracto modificado parece ser un tratamiento relativamente seguro que puede rápidamente conseguir mejoría en la tolerancia alergénica nasal, en puntuación de síntomas y en la auto-evaluación sujetiva por EVA, lo que traduce una mejoría general en el bienestar de los pacientes alérgicos