Epidemiological, Clinical, and Allergic Profile of Psoriatic Patients. Evaluation of the Spanish Registry of Contact Dermatitis and Cutaneous Allergy (REIDAC). / Perfil epidemiológico, clínico y alérgico en pacientes con psoriasis. Evaluación del Registro Español de Dermatitis de Contacto (REIDAC).

BACKGROUND: Psoriasis is a chronic inflammatory dermatosis whose clinical and topographic distribution requires differential diagnosis, or the possible association with allergic contact dermatitis (ACD), requiring patch testing (PT) as part of the diagnostic procedure. OBJECTIVES: To describe the epidemiological, clinical, and allergic profile of patients with a primary or secondary diagnosis of psoriasis undergoing PT and compare them with patients with a diagnosis of ACD at the end of the diagnostic process. METHODS: Cross-sectional study with data from REIDAC from 2018 through 2023 of selected patients with a diagnosis of psoriasis and/or ACD. RESULTS: A total of 11 502 patients were included, 513 of whom had been diagnosed with primary or secondary psoriasis, 3640 with ACD, and 108 with both diseases. Men were more predominant in the groups of patients with psoriasis, psoriasis+ACD, and lesions were more predominantly seen in the hands with little association with atopic factors vs the ACD group. The rate of positivity in PT to the 2022 Spanish battery of allergens was lower in the group with psoriasis only in 27% of the patients. The most common allergens found in the psoriasis group were also the most common ones found in the overall ACD population. CONCLUSIONS: Overall, 36.2% of psoriatic patients tested positive in PT to the 2022 Spanish battery of allergens, which proved that this association is not uncommon. Overall, psoriatic patients had a higher mean age, were more predominantly men, and showed more hand involvement.

Kounys syndrome after rocuronium administration. / Síndrome de Kounis tras administración de rocuronio.

Kounis syndrome encompasses concepts including angina and allergic infarction described in relation to exposure to different allergens. The aim of this article is to describe a case of Kounis Syndrome type II after exposure to rocuronium as well as the patholophysiology and the treatment of this syndrome.

Effect of cigarette smoke on counts of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa in young patients with perennial allergic rhinitis / Efeito do tabagismo nas contagens de células imunorreativas a eotaxina-1 e eosinófilos na mucosa nasal em pacientes jovens com rinite alérgica perene

Abstract Introduction: In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective: To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods: In a cross-sectional study, forty-four patients were evaluated (aged 7-19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results: Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions: Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.

Resumo Introdução: Em adolescentes com rinite alérgica perene, a exposição à fumaça do cigarro de tabaco aumenta a contagem de eosinófilos na mucosa nasal. O recrutamento de eosinófilos surge da ação combinada de alguns sinais celulares e moleculares, inclusive a eotaxina. Objetivo: Avaliar o efeito da exposição à fumaça do cigarro de tabaco na contagem de células imunorreativas a eotaxina-1 e eosinófilos na mucosa nasal de crianças e adolescentes com rinite alérgica perene. Método: Em um estudo transversal, 44 pacientes foram avaliados (entre sete e 19 anos): 22 com e 22 sem exposição à fumaça do cigarro de tabaco. Depois de responder a dois questionários validados, sobre asma e alergias na infância e sobre a gravidade dos sintomas nasais, as amostras de mucosa nasal foram obtidas por meio de raspagem do terço médio das conchas inferiores. Em seguida, as contagens de células imunorreativas para eotaxina-1 e eosinófilos foram avaliadas por imuno-histoquímica. Resultados: Os pacientes com exposição à fumaça do cigarro de tabaco apresentaram contagens de células mais elevadas tanto para eotaxina-1 como para eosinófilos em comparação com os pacientes sem exposição à fumaça, sem correlação entre as duas variáveis. No entanto, ambas as contagens, de eotaxina-1 e eosinófilos foram relacionadas com a razão cotinina/creatinina. Conclusões: A exposição à fumaça do cigarro de tabaco pode aumentar a eotaxina-1 e a contagem de eosinófilos na mucosa nasal de pacientes jovens com rinite alérgica perene.

Effect of cigarette smoke on counts of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa in young patients with perennial allergic rhinitis.

INTRODUCTION: In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. OBJECTIVE: To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. METHODS: In a cross-sectional study, forty-four patients were evaluated (aged 7-19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. RESULTS: Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. CONCLUSIONS: Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.

Allergic contact dermatitis caused by cosmetic products.

Contact dermatitis due to cosmetic products is a common dermatologic complaint that considerably affects the patient's quality of life. Diagnosis, treatment, and preventive strategies represent a substantial cost. This condition accounts for 2% to 4% of all visits to the dermatologist, and approximately 60% of cases are allergic in origin. Most cases are caused by skin hygiene and moisturizing products, followed by cosmetic hair and nail products. Fragrances are the most common cause of allergy to cosmetics, followed by preservatives and hair dyes; however, all components, including natural ingredients, should be considered potential sensitizers. We provide relevant information on the most frequent allergens in cosmetic products, namely, fragrances, preservatives, antioxidants, excipients, surfactants, humectants, emulsifiers, natural ingredients, hair dyes, sunscreens, and nail cosmetics.

Evaluación perioperatoria de una paciente con un angioedema grave para una cirugía de coordinación

RESUMEN Introducción: el angioedema es una enfermedad caracterizada por episodios de edema subcutáneo o submucoso, recurrente y autolimitado, pudiendo comprometer la vía aérea de forma grave y en diferentes momentos de la intervención. El diagnóstico de su etiología es esencial para el tratamiento y la prevención. Objetivos: presentar la evaluación preoperatoria de una paciente con diagnóstico de angioedema que será sometida a una cirugía de coordinación, centrado en la valoración etiológica y perioperatorio. Caso clínico: paciente de sexo femenino, 32 años, coordinada para colecistectomía con exploración radiológica de vía biliar principal. Angioedema diagnosticado en 2009, caracterizado por episodios recurrentes de edema de extremidades, cara, labios, lengua y úvula, asociado a dificultad respiratoria, sintomatología abdominal, con múltiples consultas, tratada con corticoides, antihistamínicos y adrenalina inhalatoria, con buena respuesta. No existen antecedentes familiares de angioedema. Se descartaron enfermedades autoinmunes (lupus y artiris reumatoidea). Fibrogastroscopía con biopsia, negativa para Helicobacter pylori. Prick tests positivos para ácaros, polvo y variados alimentos. Discusión: C1 inhibidor y C4 fueron normales, descartándose en primer lugar déficit de C1 inhibidor hereditario y adquirido, así como causas autoinmunes, e infección por Helycobacter pylori. Se descartan causas farmacológicas. Dado su terreno atópico y prick test positivos el planteo diagnóstico es de angioedema alérgico o pseudoalérgico. Se plantea la siguiente profilaxis preoperatoria: anthistamínicos 5 a 7 días y corticoides 2 a 3 días vía oral. Conclusiones: se presenta un caso clínico de muy baja frecuencia donde el uso de un algoritmo diagnóstico es fundamental para la profilaxis de complicaciones anestésicas graves.

SUMMARY Introduction: angioedema is a disease characterized by recurrent, self-limited episodes of subcutaneous or submucosal edema, that may seriously affect the airway during different stages of the surgery. The diagnosis of its etiology is essential for treatment and prevention. Objectives: to present the preoperative evaluation of a patient diagnosed with angioedema who will be subject to a scheduled surgery, with a focus on the etiologic assessment and the preoperative period. Clinical case: female patient, 32 years of age, with scheduled surgery for cholecystectomy with radiological exploration of main biliary tract, diagnosed with angioedema in 2009, characterized by recurrent episodes of edema in extremities, face, lips, tongue and uvula, associated to respiratory distress, abdominal symptoms; she consulted in several occasions, and was treated with corticosteroids, antihistamines and adrenaline by inhalation, with good response. There is no family history of angioedema. Autoimmune diseases were discarded (lupus and rheumatoid arthritis). Fibrogastroscopy with negative biopsy for Helicobacter pylori. Prick tests positive for mite, dust and different types food. Discussion: C4 and C1 inhibitor were normal, therefore, hereditary and acquired C1 inhibitor deficiency was discarded in the first place, as well as autoimmune diseases and Helicobacter pylori infection. Pharmacological causes were discarded. Due to the atopic field and positive prick tests, the diagnosis presented was allergic or pseudoallergic angioedema. Planned preoperative prophylaxis: antihistamines 5 to 7 days and corticosteroids 2 to 3 days, orally. Conclusions: we present a clinical case with very low frequency where the use of a diagnostic algorithm is fundamental for the prophylaxis of severe anesthetic complications.

RESUMO Introdução: o angioedema é uma doença caracterizada por episódios de edema subcutâneo ou submucoso, recorrente e autolimitado, podendo comprometer a via aérea de forma grave em diferentes momentos da intervenção cirúrgica. O diagnostico de sua etiologia é essencial para o tratamento e a prevenção. Objetivos: apresentar a avaliação pré-operatória de uma paciente com diagnostico de angioedema que será submetida a uma cirurgia eletiva, centrado na avaliação etiológica e perioperatoria. Caso clinico: paciente do sexo feminino, 32 anos, marcada para realização de uma colecistectomia com exploração radiológica da via biliar principal. Angioedema diagnosticado em 2009, caracterizado por episódios recorrentes de edema de extremidades, face, lábios, língua e úvula , associada a dificuldade respiratória, sintomatologia abdominal, com múltiplas consultas, tratada com corticóides, antihistaminicos e adrenalina inalatoria, com boa resposta. Não existem antecedentes familiares de angioedema. Descarta-se doenças autoimunes (lúpus e artrite reumatoide). Fibrogastroscopia com biopsia, negativa para Helicobacter pylori. Prick test positivo para ácaros, pó e varios alimentos. Discussão: C1 inibidor e C 4 foram normais , descartando-se em primeiro lugar déficit de C1 inibidor hereditário e adquirido, assim como causas autoimunes,ou infecção por Helycobacter pylori. Descartam-se causas farmacológicas. Pelos seus antecedentes e prick teste positivo foi cogitado o diagnostico de angioedema alérgico ou pseudoalergico. Foi planejada a seguinte profilaxia pré-operatória: antihistaminicos 5 a 7 dias e corticóides 2 a 3 dias via oral. Conclusões: apresenta-se um caso clinico de baixa frequência onde a utilização de um algorritmo diagnostico é fundamental para a profilaxia de complicações anestésicas graves.