A Comprehensive Prospective Study of the Costs Associated With Evaluation of ß-Lactam Allergy.

BACKGROUND AND OBJECTIVE: Being labeled as allergic to penicillin (unverified ß-lactam allergy) can result in patients receiving broader-spectrum antibiotics than necessary that may be more toxic, less effective, and/or more expensive than alternative options. Objective: We aimed to evaluate the real costs of evaluating ß-lactam allergy. METHODS: We performed a prospective real-life observational study designed to evaluate all adult patients who consulted for suspected ß-lactam allergy over a 1-year period. Direct and indirect costs were systematically recorded. Direct health costs were calculated based on the number of visits and all additional and diagnostic tests performed, direct nonhealth costs based on the number of visits and the distance from their homes to the Allergy Department, and indirect costs based on absenteeism. RESULTS: A total of 296 patients with suspected allergy to ß-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct health care costs were €28 176.70, with a mean (SD) cost of €95.19 (37.20). Direct nonhealth costs reached €6551.73, that is, €22.13 (40.44) per patient. Indirect health costs reached €20 769.20, with a mean of €70.17 (127.40). In summary, the total cost was €55 497.63, that is, a cost per patient of €187.49 (148.14). CONCLUSIONS: When all possible costs are taken into account, the evaluation of ß-lactam allergy is not expensive and can reduce future expense arising from unnecessary use of more expensive and less effective antibiotics.

A Comprehensive Prospective Study of the Costs Associated With Evaluation of beta-Lactam Allergy

BACKGROUND: Being labeled as allergic to penicillin (unverified beta-lactam allergy) can result in patients receiving broader-spectrum antibiotics than necessary that may be more toxic, less effective, and/or more expensive than alternative options. OBJECTIVE: We aimed to evaluate the real costs of evaluating beta-lactam allergy. METHODS: We performed a prospective real-life observational study designed to evaluate all adult patients who consulted for suspected beta-lactam allergy over a 1-year period. Direct and indirect costs were systematically recorded. Direct health costs were calculated based on the number of visits and all additional and diagnostic tests performed, direct nonhealth costs based on the number of visits and the distance from their homes to the Allergy Department, and indirect costs based on absenteeism. RESULTS: A total of 296 patients with suspected allergy to beta-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct health care costs were (Euro)28 176.70, with a mean (SD) cost of (Euro)95.19 (37.20). Direct nonhealth costs reached (Euro)6551.73, that is, (Euro)22.13 (40.44) per patient. Indirect health costs reached (Euro)20 769.20, with a mean of (Euro)70.17 (127.40). In summary, the total cost was (Euro)55 497.63, that is, a cost per patient of (Euro)187.49 (148.14). CONCLUSIONS: When all possible costs are taken into account, the evaluation of beta-lactam allergy is not expensive and can reduce future expense arising from unnecessary use of more expensive and less effective antibiotics

INTRODUCCIÓN: Un diagnóstico no verificado de alergia a la penicilina o a los betalactámicos (BL) conlleva que los pacientes reciban antibióticos de amplio espectro, que pueden ser más tóxicos, menos efectivos, y/o de mayor coste. OBJETIVO: Evaluar los costes reales de un estudio de alergia a los betalactámicos. MÉTODOS: Se diseñó un estudio observacional prospectivo en condiciones de práctica clínica habitual en el que se evaluaron todos los pacientes adultos que consultaron por sospecha de alergia a BL durante un año. Los costes directos e indirectos se recogieron sistemáticamente. Los costes directos sanitarios se calcularon teniendo en cuenta el número de visitas y todas las pruebas diagnósticas realizadas; en los costes directos no sanitarios se consideraron el número de visitas y los kilómetros desde el domicilio hasta el Servicio de Alergología; en los costes indirectos se evaluó el absentismo. RESULTADOS: Se evaluaron 296 pacientes remitidos desde el 1 de junio de 2017 hasta el 31 de mayo de 2018. Los costes directos totales sanitarios fueron 28.176,70 (Euro): coste medio (desviación estándar, DS) de 95,19 (Euro) (37,20). Los costes directos no sanitarios alcanzaron, 6.551,73: coste medio 22,13 (40,44). Los costes indirectos fueron 20.769,20 (Euro): coste medio (DS) 70,17 (127,40). En resumen, la cantidad total fue de 55.497,63 (Euro), lo que supone un coste medio de 187,49 (Euro) (148,14). CONCLUSIONES: Considerando todos los costes posibles, la evaluación de la alergia a betalactámicos no es cara y puede ahorrar gastos futuros debido a una utilización innecesaria de antibióticos más caros y menos efectivos

Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital.

BACKGROUND AND OBJECTIVE: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital. METHODS: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected. RESULTS: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001). CONCLUSIONS: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions.

Adherence to anaphylaxis guidelines: real-world data from the emergency department of a tertiary hospital

Background: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital. Methods: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001). Conclusion: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions

Antecedentes: Pocos estudios han evaluado el cumplimiento de las recomendaciones de las guías clínicas de anafilaxia en los servicios de urgencias. Objetivo: El objetivo de este estudio fue conocer el cumplimiento de las guías de anafilaxia en el servicio de urgencias (SU) de un hospital terciario. Métodos: Se revisaron los informes de los pacientes atendidos en el SU del Hospital Universitario de Salamanca durante un año y se seleccionaron los que cumplían los criterios de anafilaxia propuestos por el NIAID/FAAN. Resultados: Se identificaron 89 pacientes, 74 adultos y 15 niños. El 65% de los adultos presentó una reacción moderada, el 34% grave y el 1% muy grave; en todos los niños la gravedad fue moderada. Menos de la mitad de los pacientes (42%) fueron tratados con adrenalina, solo el 19% por vía intramuscular. El 65% de las reacciones moderadas y el 42% de las graves no recibieron adrenalina. Al alta, se recomendó un auto-inyector de adrenalina al 5,6% de los pacientes, se remitió al Servicio de Alergia al 52% (57% adultos frente a 27% niños, p=0,047), se dieron indicaciones para evitar posibles desencadenantes al 29% (31% adultos frente a 20% niños, p=.5) e instrucciones para reconocer los signos de alarma de una reacción anafiláctica al 51% (41% adultos frente a 100% niños, P<0,001). Conclusión: Los resultados del estudio muestran importantes discrepancias entre las recomendaciones de las guías clínicas y el manejo de la anafilaxia en un SU hospitalario. Es necesario un mayor esfuerzo en educación para mejorar el tratamiento de los pacientes con anafilaxia

Urticaria crónica en Pediatría / No disponible

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Sibilancias en el lactante / No disponible

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Asma en el primer año de vida / Asthma in the first year of life

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Exploración funcional pulmonar en pediatría / Pulmonary function tests in pediatrics

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Genética del asma / Genetics of asthma

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Novedades en el diagnóstico y tratamiento de la alergia a losmedicamentos en los niños / Novelties in the diagnosis and treatment of drug allergies in children

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Analysis of 927T > C CYSLTR1 and -444A > C LTC4S polymorphisms in children with asthma.

INTRODUCTION: The cysteinyl leukotrienes (Cys-LTs) are potent inflammatory mediators in asthma. It has been suggested that the different response of patients to Cys-LTs inhibitors could be due to the presence of polymorphisms in the genes implicated in this pathway. METHODS: In this study, polymorphisms 927T > C CYSLTR1 and -444A > C LTC4S were analysed in a Spanish population of 188 individuals (109 asthmatic children and 79 controls). Standardised history, skin prick tests and lung function measurements were performed in all patients. Genotypes were determined by sequencing after PCR amplification. RESULTS: Differences were observed in 927T > C CYSLTR1, regarding the severity of asthma in males. A greater presence of allele C in the population with persistent asthma versus the control group (Fisher's p-value = 0.001; Monte Carlo p-value = 0.003; OR: 12.35; 95 %CI: 2.18-70.00) was observed. Differences were also detected in the combined study of both polymorphisms, among controls and asthmatic patients (Monte Carlo p-value = 0.0002). In the group of males with asthma, an increase of AC variant (-444A LTC4S and 927C CYSLTR1) and a reduction in the AT genetic combination were detected. CONCLUSIONS: The combined study of polymorphisms in genes of the leukotriene pathway could explain the differences observed in the studies reported on polymorphism -444A < C LTC4S individually analysed.

Hernia de Morgagni izquierda con contenido hepático / Left Morgagni hernia with hepatic content

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Analysis of 927T > C CYSLTR1 and –444A > C LTC4S polymorphisms in children with asthma

Introduction: The cysteinyl leukotrienes (Cys-LTs) are potent inflammatory mediators in asthma. It has been suggested that the different response of patients to Cys-LTs inhibitors could be due to the presence of polymorphisms in the genes implicated in this pathway. Methods: In this study, polymorphisms 927T > CCYSLTR1 and –444A > C LTC4S were analysed in a Spanish population of 188 individuals (109 asthmatic children and 79 controls). Standardised history, skinprick tests and lung function measurements were performed in all patients. Genotypes were determined by sequencing after PCR amplification. Results: Differences were observed in 927T > CCYSLTR1, regarding the severity of asthma in males. A greater presence of allele C in the population with persistent asthma versus the control group (Fisher’sp-value = 0.001; Monte Carlo p-value = 0.003; OR:12.35; 95 %CI: 2.18-70.00) was observed. Differences were also detected in the combined study of both polymorphisms, among controls and asthmatic patients (Monte Carlo p-value = 0.0002). In the group of males with asthma, an increase of AC variant (–444A LTC4S and 927C CYSLTR1) and a reduction in the AT genetic combination were detected. Conclusions: The combined study of polymorphisms in genes of the leukotriene pathway could explain the differences observed in the studies reported on polymorphism –444A < C LTC4S individually analysed

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Steinert neonatal: un caso inesperado / Neonatal Steinert´s disease: an unexpected case

La distrofia miotónica congénita (DMC) está causada por una mutación genética consistente en el aumento de repeticiones del trinucleótido CTG en el cromosoma 19 q13.3. En el periodo neonatal se presenta con hipotonía, decaimiento global, problemas respiratorios y dificultad en la alimentación. Los niños afectados suelen tener una madre con distrofia miotónica, que puede estar asintomática. Los que sobreviven al periodo neonatal suelen mejorar su función muscular, para posteriormente desarrollar una distrofia miotónica y una miopatía progresiva(AU)

Congenital myotonic dystrophy is caused by a mutation involving an expansion of the CTG trinucleotide repeat on chromosome19q13.3. During the neonatal period, it presents with hypotonia, overall despondency, respiratory problems and failure to thrive. The mother of the affected child usually has myotonic dystrophy also, even if she does not manifest overt symptoms and signs. Children who survive the neonatal period often show improvement in muscle function but, later in life, develop myotonic dystrophy and progressive myopathy(AU)