Occupational rhinoconjunctivitis from white pepper.

A 44-year-old subject developed rhinoconjunctivitis symptoms when she was exposed to white pepper while working in the food industry. A positive skin prick test for white and black pepper extracts (1:10 w/v) were obtained. Specific IgE antibodies to white and black pepper were demonstrated by ELISA. The immunoblot analysis showed two IgE-reactive protein bands able to bind to IgE from white pepper extract of 11.8 kDa and 13.6 kDa and one band from black pepper extract of 11.8 kDa. IgE binding to blotted white and black pepper extract were inhibited by preincubation of patient serum with black pepper extract. A conjunctival provocation test was positive with a white pepper extract dilution of 1:100 w/v. We describe a patient with occupational rhinoconjunctivitis caused by hypersensitivity to white pepper.

Ascitis como manifestación de la gastroenteritis eosinofílica / Ascites as manifestation of eosinophilic gastroenteritis

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Sensibilización cutánea e identificación de ácaros en las viviendas de una población de alérgicos en la provincia de Huelva / Skin sensitisation to mites and mite identification in the homes of an allergic population in the Huelva province

Fundamento y objetivos: Los ácaros domésticos suponen una de las causas de sensibilización y asma más comunes en la mayor parte del mundo. Se analiza la prevalencia de la sensibilización cutánea a las diferentes familias de ácaros y la presencia de éstos en las viviendas de una población de pacientes alérgicos a ácaros en la provincia de Huelva. Material y métodos: Se realizan pruebas cutáneas frente a 4 ácaros de la familia Pyroglyphidae y 5 de las familias Acaridae y Glyciphagidae, además de recoger muestras de polvo de las viviendas, en una muestra de pacientes con patología por sensibilización a ácaros. Resultados: De los 157 pacientes estudiados, el 74,5 por ciento entregaron una muestra de polvo de su domicilio, de las cuales en 86 (73,5 por ciento) se identificaron al menos un tipo de ácaro. Dermatophagoides pteronyssinus fue el ácaro más identificado; apareció en 80 muestras (93 por ciento de muestras positivas), de las cuales 79 correspondieron a pacientes sensibilizados a ese ácaro. Glycypaghus domesticus y Tyrophagus putrescentiae se identificaron en 37 y 21 muestras, respectivamente, pero sin encontrarse relación con la sensibilización cutánea. Ciento cuatro pacientes (66,2 por ciento) presentaban una prueba cutánea positiva al menos a uno de los ácaros de almacén, entre los que Tyrophagus putrescentiae fue el más frecuente. Existió una relación de dependencia entre los cuatro ácaros domésticos y también entre los cinco ácaros de almacén estudiados; sin embargo, esta relación desaparecía cuando se comparaba Dermatophagoides pteronyssinus con los ácaros de almacén. Conclusiones: Se evidencia una elevada sensibilización cutánea a los ácaros de la familia no Pyroglyphidae en esta región; sin embargo, la ausencia de relación entre la sensibilización cutánea y la presencia de esta familia acarina en las viviendas, nos hace pensar que la mayoría de las sensibilizaciones a estos ácaros se deben a la existencia de una reactividad cruzada con Dermatophagoides pteronyssinus, sin descartar la presencia de algunos casos de multisensibilización (AU)

Mild to moderate asthmatics and free running.

We analyzed the bronchial response to free running in 48 mild to moderate extrinsic asthmatics and 36 nonasthmatics and also studied the relation between the methacholine hyperresponsiveness (expressed as PC20) and the changes in peak flow (PEF) post-exercise in an asthmatic group. The highest bronchial response to exercise was observed in asthmatic patients 10 min after free running (17.93 +/- 13.37%) and was significantly different from the nonasthmatics (U = 156; p > 0.00001). The correlation study disclosed a high correlation (r > or = 0.6) between the PC20 values (expressed as logarithmic transformation) and the exercise response (percent drop in the PEF measured 10 and 15 min post-exercise) in asthmatic subjects. With receiver operator characteristic (ROC) curves we obtained, as an ideal point, a percentage change in PEF (PEFR) of 8% or more measured 10 min post-exercise which reached 79.1% sensitivity and 89.7% specificity. We think that this exercise challenge can be used for detection of airway hyperresponsiveness in mild to moderate asthmatics.

[An analysis of the treadmill exercise test in a population of mild and moderate extrinsic asthmatics]. / Análisis de la prueba de ejercicio de la cinta sin fin en una población de asmáticos extrínsecos leves y moderados.

The bronchial response to physical exercise on a treadmill was analyzed in 48 patients with mild to moderate extrinsic asthma diagnosed by clinical criteria and a positive methacholine test, and in 36 non-asthmatic subjects. Bronchoconstriction secondary to physical exercise was documented by measuring the percent fall in PEF in different post-exercise control times. Significant differences (p < 0.00001) were observed between bronchial response in asthmatic and non-asthmatic patients. By using ROC curves an optimal cut-off was obtained in a fall equal to or greater than 6% 10 minutes post-exercise, with a sensitivity of 0.75 and an specificity of 0.923. The bronchial challenge test with physical exercise on a treadmill, within the limits of the studied sample, can be used as a method for detecting BHR in asthmatic patients.

Absence of late responses after exercise challenges in patients with mild and moderate extrinsic asthma.

We assessed the occurrence of early bronchial response and late bronchial response after the tread mill and free running exercise tests in 46 mild and moderate extrinsic asthmatics. On the treadmill 24 asthmatic subjects (52.1%) had an early post-exercise fall in PEF greater than ten percent and they were considered to have exercise induced asthma. In the free running 30 asthmatic patients (65.2%) had exercise induced asthma no asthmatic subjects showed a fall in PEF equal to or more than 20 percent during late response period. On control day PEF levels during this time were similar 4 to 13 hours post-exercise PEF values. We reported no significant correlation between early post-exercise PEF values and PEF levels during late response period after the treadmill and free running exercise tests. This study demonstrates the absence of a late response in EIA after the treadmill and free running exercise tests, at least in young people with mild or moderate extrinsic asthma.

Toxocariasis: a cause of hyper IgE and eosinophilia.

We present a patient with elevation of total serum IgE, eosinophilia and Toxocara exoantigen specific IgG and IgE antibodies (detected by ELISA and RAST, respectively). We ruled out atopy and other parasitic diseases common in our habitat (e.g., Echinococcus granulosus, Ascaris lumbricoides, Schistosoma mansoni). The patient was asymptomatic over the four years of the study, and the levels of total serum IgE, eosinophils and Toxocara exoantigen specific IgG and IgE remained high. Although at present, immunodiagnostic tests have a high sensitivity and specificity for toxocariasis, their value is limited. This is illustrated by the fact that in our patient these techniques could not distinguish between past and present infection.