Galactose-alfa-1, 3-galactose (alpha-gal) allergy: first pediatric case in a series of patients in Spain

INTRODUCTION AND OBJECTIVES: Allergy to galactose-α-1,3-galactose (alpha-gal) is a peculiar form of food allergy generally manifesting as an anaphylactic reaction hours after mammalian meat consumption, due to the presence of specific IgE against this oligosaccharide. In addition, immediate anaphylaxis may develop after exposure to other sources of alpha-gal, such as monoclonal antibody cetuximab, vaccines, plasma expanders or anti-snake venoms. Sensitization to alpha-gal has also been implicated in the rapid degeneration of biological valve implants, and recognized as a cause of occupational disease in cattle raisers. The implication of tick bites in this type of sensitization has been accepted by all the research groups dedicated to this disease. PATIENTS AND METHOD: The present study describes the clinical and sensitization characteristics of 39 patients diagnosed with alpha-gal allergy in the hospitals of our province (Lugo, Monforte de Lemos and Burela, Spain). RESULTS: Most patients were middle-age males. Of note, is the fact that the series includes the first pediatric patient reported in Spain to date. The predominant clinical manifestations were urticaria or delayed anaphylaxis after consumption of mammalian meat. Seventy-four percent of the patients reported having suffered a previous tick bite, and the clinical presentation of anaphylaxis was significantly more prevalent in those with a persistent local reaction following the bite than in those with no such reaction (p = 0.032). CONCLUSIONS: A review is also made of the disorder which, due to its variable clinical expression, is referred to as alpha-gal syndrome. The study concludes that a diagnosis of alpha-gal allergy should be considered in patients with urticaria-anaphylaxis of uncertain origin or manifesting after the administration of vaccines or products of bovine/porcine origin

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Galactose-α-1,3-galactose (alpha-gal) allergy: first pediatric case in a series of patients in Spain.

INTRODUCTION AND OBJECTIVES: Allergy to galactose-α-1,3-galactose (alpha-gal) is a peculiar form of food allergy generally manifesting as an anaphylactic reaction hours after mammalian meat consumption, due to the presence of specific IgE against this oligosaccharide. In addition, immediate anaphylaxis may develop after exposure to other sources of alpha-gal, such as monoclonal antibody cetuximab, vaccines, plasma expanders or anti-snake venoms. Sensitization to alpha-gal has also been implicated in the rapid degeneration of biological valve implants, and recognized as a cause of occupational disease in cattle raisers. The implication of tick bites in this type of sensitization has been accepted by all the research groups dedicated to this disease. PATIENTS AND METHOD: The present study describes the clinical and sensitization characteristics of 39 patients diagnosed with alpha-gal allergy in the hospitals of our province (Lugo, Monforte de Lemos and Burela, Spain). RESULTS: Most patients were middle-age males. Of note, is the fact that the series includes the first pediatric patient reported in Spain to date. The predominant clinical manifestations were urticaria or delayed anaphylaxis after consumption of mammalian meat. Seventy-four percent of the patients reported having suffered a previous tick bite, and the clinical presentation of anaphylaxis was significantly more prevalent in those with a persistent local reaction following the bite than in those with no such reaction (p = 0.032). CONCLUSIONS: A review is also made of the disorder which, due to its variable clinical expression, is referred to as alpha-gal syndrome. The study concludes that a diagnosis of alpha-gal allergy should be considered in patients with urticaria-anaphylaxis of uncertain origin or manifesting after the administration of vaccines or products of bovine/porcine origin.

Total and honeybee venom-specific serum IgG4 and IgE in beekeepers

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Anafilaxia en la evaluación preoperatoria / Anaphylaxis in the preanesthesia evaluation

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Alergia al látex en CMA / Latex allergy in day surgery

La alergia al látex es una patología importante en el ámbito sanitario. La prevalencia en la población general está en torno al 1%, pudiendo aumentar hasta un 20% entre el personal sanitario, siendo mayor en los trabajadores de las áreas quirúrgicas. Son grupos de riesgo para desarrollar alergia al látex los pacientes multioperados y los profesionales sanitarios. La clínica varía desde rinitis hasta shock anafiláctico, pudiendo ser causa de muerte. El diagnóstico se basa en la historia clínica, test cutáneos y, si es necesario, pruebas de provocación controlada. Existen protocolos para prevenir el desarrollo de síntomas en los pacientes alérgicos cuando van a ser intervenidos quirúrgicamente. El tratamiento etiológico se basa en la inmunoterapia y en nuevas técnicas de ADN recombinante. En este artículo se describe la clínica, protocolos diagnósticos, así como protocolos de prevención y tratamientos etiológicos de la alergia al látex. La cirugía mayor ambulatoria cada vez se utiliza más frecuentemente y en procedimientos más complejos. Será importante desarrollar protocolos de detección precoz y prevención de la alergia al látex en circuitos de cirugía ambulatoria, haciendo énfasis en la educación de pacientes y trabajadores del hospital para evitar la exposición al látex (AU)

Hypersensitivity to natural rubber latex has been recognized as an important health problems. The prevalence of latex allergy among general population is concerning 1% being able to increase up to 20 % among the health staff and tends to be higher in surgical settings. Risks groups for natural rubber latex allergy included health workers and patients who have undergone multiple surgical procedures. Symptoms vary between rhinitis to anaphylaxis, even death. Diagnosis of latex allergy is based in clinical history, skin test and provocation test. Several protocols have been described to avoid symptoms in allergy patients when they undergo surgical procedures. Etiological treatment is based on specific immunotherapy and recombinant allergen techniques. The aim of this article was to review etiology, diagnosis, prevention and treatment of latex allergy. Ambulatory anesthesia is being increasingly used, and in more complex surgical procedures. It will be important to make action protocols to ensure the early detection and prevention of latex allergy in outpatient surgery, doing emphasis in the education of the heath workers and patients in order that they avoid the exposition to the latex (AU)

Omalizumab Treatment in 2 Cases of Refractory Heat Urticaria

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Serum tryptase concentrations in beekeepers with and without Hymenoptera venom allergy.

BACKGROUND: Increased tryptase concentrations are a risk marker for the severity of reactions to Hymenoptera stings or venom immunotherapy OBJECTIVE: To investigate serum tryptase concentrations in beekeepers with and without Hymenoptera venom allergy (HVA). METHODS: Serum tryptase concentrations were measured in adult patients with HVA (n = 91, 37 of whom were beekeepers), beekeepers without HVA (n = 152), and control individuals from the general adult population (n = 246). RESULTS: Multivariate analyses revealed that serum tryptase levels were positively associated with beekeeping activities (P < .001) and HVA (P < .001). Tryptase levels were also positively associated with age (P < .001) and male'sex (P = .02), and negatively associated with alcoho consumption (P = .002). CONCLUSIONS: Beekeeping and HVA are independently associated with increased concentrations of serum tryptase.

Serum Tryptase Concentrations in Beekeepers With and Without Hymenoptera Venom Allergy

Antecedentes: Los niveles séricos elevados de triptasa son un marcador de gravedad de las reacciones a las picaduras de himenópteros y de las reacciones a la inmunoterapia específica. Objetivo: Investigar los niveles séricos de triptasa en apicultores alérgicos y no alérgicos al veneno de himenópteros. Métodos: Se determinó la triptasa sérica en pacientes adultos con alergia al veneno de himenópteros (n=91, 37 de los cuales eran apicultores), apicultores sin alergia al veneno de himenópteros (n=152), y en controles de una población general adulta (n=246). Resultados: En los análisis multivariante, se observó que las concentraciones de triptasa sérica estaban positivamente asociadas con el hecho de ser apicultor (P<.001) y con el hecho de ser alérgico al veneno de himenópteros (P<.001). Los niveles de triptasa sérica también se asociaron positivamente con la edad (P<.001) y el sexo masculino (P=.02), y negativamente con el consumo de alcohol (P=.002). Conclusiones: La apicultura y la alergia al veneno de himenópteros se asocian independientemente con concentraciones elevadas de triptasa sérica (AU)

Background: Increased tryptase concentrations are a risk marker for the severity of reactions to Hymenoptera stings or venom immunotherapy. Objective: To investigate serum tryptase concentrations in beekeepers with and without Hymenoptera venom allergy (HVA). Methods: Serum tryptase concentrations were measured in adult patients with HVA (n=91, 37 of whom were beekeepers), beekeepers without HVA (n=152), and control individuals from the general adult population (n=246). Results: Multivariate analyses revealed that serum tryptase levels were positively associated with beekeeping activities (P<.001) and HVA (P<.001). Tryptase levels were also positively associated with age (P<.001) and male sex (P=.02), and negatively associated with alcohol consumption (P=.002). Conclusions: Beekeeping and HVA are independently associated with increased concentrations of serum tryptase (AU)

Two flushing-like reaction cases from calcium pidolate who tolerated calcium carbonate

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Profilin as an aeroallergen by means of conjunctival allergen challenge with purified date palm profilin.

BACKGROUND: The role of profilin as a food allergen is well established, but little research has been done about its ability to elicit respiratory disease. Profilin is considered more of a confounding allergen on skin testing with whole pollen extracts than other airborne allergens. Our aim was to find out whether or not profilin can cause symptoms in sensitized individuals, which would be compatible with its role as an airborne allergen. METHODS: We performed conjunctival allergen challenges with date palm profilin in a series of consecutive pollen-allergic patients with rhino-conjunctivitis, divided in two groups: profilin sensitized (n = 17) and not sensitized (n = 14), who served as controls. We investigated the possible association between profilin sensitization and profilin allergy in these groups of patients. RESULTS: None of the patients from the not profilin-sensitized group had a positive result in conjunctival allergen challenges. In contrast, 65% of profilin sensitized patients had a positive conjunctival allergen challenge and were considered allergic to profilin. We found a significant statistical association between being profilin allergic and being profilin sensitized (χ(2) = 10.39, p < 0.005). CONCLUSIONS: Profilin seems to work as an aeroallergen in a significant proportion of profilin-sensitized patients. This might explain the uselessness of conjunctival challenges with whole pollen extracts to disclose genuine sensitization. In the future, the possibility of quantifying this allergen in pollen immunotherapy vaccines should be considered.

Postmarketing study for assessment of tolerability of a grass allergen immunotherapy tablet (GRAZAX) in patients with rhinitis or rhinoconjunctivitis.

BACKGROUND AND OBJECTIVE: Many patients with grass pollen allergy in Spain have concomitant sensitization to other allergens such as profilin. Since this type of sensitization is more common in Mediterranean countries than in countries where most patients were enrolled in clinical trials on GRAZAX (Phleum pratense 75,000 SQ-T/2, 800 BAU, ALK), the aim of this study was to analyze tolerability to GRAZAX under clinical practice conditions in patients with grass pollen allergy. METHODS: A total of 155 patients were enrolled consecutively in a prospective, open-label, observational study. Adverse reactions were recorded during the first month of treatment at 3 different timepoints: after the first dose, when patients were kept under observation for 30 minutes, and on days 15 and 30 after starting treatment RESULTS: With the first dose, 117 adverse reactions were recorded in 63 patients (40.7%). The commonest reactions (>10% patients) were oral pruritus (25.2%) and throat irritation (24.5%). Ear pruritus was recorded in 7.7%. All reactions but 1 occurred within 30 minutes of administration and all were mild-to-moderate. At the end of treatment, the percentage of patients with adverse reactions had decreased significantly (21.3%). Most adverse reactions (95.2%) were mild-to-moderate and only 3 (1.4%) were severe. No serious adverse reactions were recorded. CONCLUSION: GRAZAX seems to be well tolerated, and most reactions were mild-to-moderate. Many of these reactions occur with the first dose. Therefore, according to the Summary of Product Characteristics, the first dose has to be administered under medical supervision.