Pediatric allergy and immunology in Spain.

The data of the ISAAC project in Spain show a prevalence of childhood asthma ranging from 7.1% to 15.3%, with regional differences; a higher prevalence, 22.6% to 35.8%, is described for rhinitis, and atopic dermatitis is found in 4.1% to 7.6% of children. The prevalence of food allergy is 3%. All children in Spain have the right to be visited in the National Health System. The medical care at the primary level is provided by pediatricians, who have obtained their titles through a 4-yr medical residency training program. The education on pediatric allergy during that period is not compulsory and thus very variable. There are currently 112 certified European pediatric allergists in Spain, who have obtained the accreditation of the European Union of Medical Specialist for proven skills and experience in pediatric allergy. Future specialists in pediatric allergy should obtain their titles through a specific education program to be developed in one of the four accredited training units on pediatric allergy, after obtaining the title on pediatrics. The Spanish Society of Pediatric Allergy and Clinical Immunology (SEICAP) gathers over 350 pediatric allergists and pediatricians working in this field. SEICAP has a growing activity including yearly congresses, continued education courses, elaboration of technical clinical documents and protocols, education of patients, and collaboration with other scientific societies and associations of patients. The official journal of SEICAP is Allergologia et Immunophatologia, published every 2 months since 1972. The web site of SEICAP, http://www.seicap.es, open since 2004, offers information for professionals and extensive information on pediatric allergic and immunologic disorders for the lay public; the web site is receiving 750 daily visits during 2011. The pediatric allergy units are very active in clinical work, procedures as immunotherapy or induction of oral tolerance in food allergy, contribution to scientific literature, and collaboration in international projects.

Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma / External Assessment of the GEMA2009 Recommendations by a Multidisciplinary Expert Panel on Asthma

ObjetivosValorar el grado de acuerdo de un panel de expertos en asma de diferentes especialidades con las recomendaciones que propone la Guía Española para el Manejo del Asma (GEMA) 2009.Material y métodosEl estudio se efectuó en 4 fases: 1) constitución del comité científico formado por los 9 coordinadores de GEMA2009, para la selección de las recomendaciones de la Guía que conforman el cuestionario Delphi del estudio (56 ítems); 2) selección de un panel estatal multicéntrico con 74 expertos en asma de todas las especialidades implicadas en la Guía (neumólogos, alergólogos, médicos de familia, otorrinolaringólogos, y especialistas de pediatría); 3) encuesta Delphi en 2 rondas (con valoración personal de cada ítem mediante escala Likert de 5 puntos), por correo electrónico, con informe a panelistas de resultados intermedios; y 4) análisis y discusión de resultados por el comité científico del proyecto.ResultadosSe apreció un consenso de criterio en 49 de las 56 cuestiones analizadas ya en la primera ronda. Tras la interacción del panel, se lograron consensuar 53 ítems de la encuesta, en el sentido favorable al acuerdo del panel con las recomendaciones GEMA. En una de las cuestiones no consensuadas, sobre indicación de inmunoterapia en asma alérgica, se apreció una significativa disparidad de opinión entre especialidades. En otra, sobre las medidas de control ambiental en alergia a ácaros, se apreció una manifiesta oposición del panel (55%), y en la última, sobre la necesidad de cambiar de trabajo en pacientes con síndrome reactivo de disfunción de la vía aérea, se observó una ausencia significativa de criterio establecido en buena parte de los encuestados (40% expresan «ni de acuerdo, ni en desacuerdo»)(AU)

ConclusionesLa valoración externa por expertos en asma de diferentes especialidades constata un elevado nivel de acuerdo profesional con las recomendaciones formuladas en GEMA2009 (93%). Probablemente el desacuerdo evidenciado en 3 de las recomendaciones reflejan la escasez de evidencias, o su gran variabilidad, para establecer recomendaciones consistentes. Estas cuestiones podrían representar áreas susceptibles de un mayor esfuerzo investigador futuro(AU)

ObjectivesTo assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma.Materials and methodsThe study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee.ResultsSeventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts.ConclusionsThe external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5%). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research(AU)

[External assessment of the GEMA2009 recommendations by a multidisciplinary expert panel on asthma]. / Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma.

OBJECTIVES: To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma. MATERIALS AND METHODS: The study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee. RESULTS: Seventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts. CONCLUSIONS: The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5%). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research.

Efficacy of an adverse drug reaction electronic reporting system integrated into a hospital information system.

BACKGROUND: Adverse drug reaction (ADR) spontaneous reporting is the primary method of postmarketing drug surveillance; although it is an important part of postmarketing drug surveillance, it is underused. Before 2004, almost no ADRs were reported in our 400-bed hospital. As an electronic hospital information system was available in our hospital, we developed a tool (ADR-RS-IHIS) for ADR reporting integrated into the hospital information system to facilitate reporting through easy use, automatic input of certain information, increased accessibility, real-time review, and intervention. OBJECTIVE: To analyze the efficacy of the ADR-RS-IHIS in increasing ADR reporting to the national drug surveillance system, propose and implement improvements to increase ADR reporting, and evaluate the impact of these improvements. METHODS: Every ADR reported through the ADR-RS-IHIS was evaluated retrospectively. Two study phases for evaluating ADR-RS-IHIS efficacy were identified. Phase I took place April 2004-August 2006; in April 2006, an interim analysis was performed to propose improvements. Phase II took place September 2006-April 2007 for evaluation of the impact made by the proposed improvements. Efficacy in the phase I and improvement impact on phase II were measured as the number of ADRs reported to the national drug surveillance system. RESULTS: The rate of ADRs reported per month to the national system increased from 0 before 2004 to 0.91 in phase I and 1.62 in phase II (2.25 if delayed reporting was considered). Improvement measures included: allowing nurses to report ADRs in the same way as physicians and pharmacists, automatic form filling of certain information from the electronic hospital information system, easier ADR report analysis, and automatic notification to the allergy department regarding suspected allergies. CONCLUSIONS: An ADR reporting system integrated into the electronic hospital information system is effective for increasing the number of ADRs reported to the national drug surveillance system. Allowing nurses to report ADRs in a manner similar to that of physicians and pharmacists, as well as automatic entry of certain data into the form, contributes to the improvement of the system.

Eosinophilic esophagitis.

BACKGROUND: Esophagitis is an increasingly diagnosed disease. Patients with gastroesophagic reflux, dysphagia, vomiting or abdominal pain, with a torpid response to the treatment, could be suffering from it. MATERIAL AND METHODS: A 37 year-old male patient with background of gastroesophagic reflux and dysphagia for solids since 2002, self-limited diarrhea episodes and intolerance to alcoholic drinks due to epigastric pain. Skin prick tests, specific IgE, histamine release test and basophil activation test were carried out. RESULTS: Skin prick test to the usual allergens with negative result; prick-prick tests to egg white and yolk, milk and apple with positive result to egg white; total serum IgE within normal levels, specific IgE to egg white with positive result; histamine release test (HRT) and basophil activation test (BAT) with positive result to egg white and yolk. CONCLUSION: The patient was diagnosed eosinophilic esophagitis. The commercial food extracts have a great variability in their allergenic composition, which could result in false negative results in the prick test. Prick-prick with the natural food is a more sensitive technique than prick in the diagnosis of food allergy. There are other useful in vitro techniques, apart from specific IgE, in the diagnosis of food allergy. In our case, an exclusion diet of the involved food was more effective than other treatments for remission of the symptoms.

Eosinophilic esophagitis / Esofagitis eosinofílica

Background: Esophagitis is an increasingly diagnosed disease. Patients with gastroesophagic reflux, dysphagia, vomiting or abdominal pain, with a torpid response to the treatment, could be suffering from it. Material and methods: A 37 year-old male patient with background of gastroesophagic reflux and dysphagia for solids since 2002, self-limited diarrhea episodes and intolerance to alcoholic drinks due to epigastric pain. Skin prick tests, specific IgE, histamine release test and basophil activation test were carried out. Results: Skin prick test to the usual allergens with negative result; prick-prick tests to egg white and yolk, milk and apple with positive result to egg white; total serum IgE within normal levels, specific IgE to egg white with positive result; histamine release test (HRT) and basophil activation test (BAT) with positive result to egg white and yolk. Conclusion: The patient was diagnosed eosinophilic esophagitis. The commercial food extracts have a great variability in their allergenic composition, which could result in false negative results in the prick test. Prick-prick with the natural food is a more sensitive technique than prick in the diagnosis of food allergy. There are other useful in vitro techniques, apart from specific IgE, in the diagnosis of food allergy. In our case, an exclusion diet of the involved food was more effective than other treatments for remission of the symptoms

Introducción: La esofagitis eosinofílica es una entidad cada vez más diagnosticada. Pacientes que presentan síntomas de reflujo gastroesofágico, disfagia, vómitos o dolor abdominal con mala respuesta al tratamiento, pueden tener esta enfermedad. Presentamos el caso de un paciente varón de 37 años con antecedente de reflujo gastroesofágico y disfagia para sólidos desde 2002, episodios diarreicos autolimitados e intolerancia al alcohol por dolor epigástrico, que fue diagnosticado de esofagitis eosinofílica. Material y métodos: En el estudio alergológico realizado se efectuaron pruebas cutáneas (Prick) a los alergenos habituales con resultado negativo; pruebas cutáneas (Prick-Prick) frente a clara y yema de huevo, leche y manzana con resultado positivo frente a clara; IgE sérica total que resultó dentro de la normalidad, IgE específica frente a clara de huevo con resultado positivo; Test de Liberación de Histamina (TLH) y Test de Activación de Basófilos (TAB) con resultado positivo frente a clara y yema. Conclusion: Los extractos comerciales a alimentos presentan gran variabilidad en su composición alergénica, lo que puede dar resultados falsamente negativos en el prick. El prick-prick con el alimento en estado natural es una técnica más sensible y que ha demostrado una rentabilidad diagnóstica mayor que el prick en el diagnóstico de alergia a alimentos. Existen otras técnicas in vitro además de la IgE específica que sirven para el diagnóstico de la alergia alimentaria. En nuestro caso, una dieta de exclusión del alimento implicado resultó ser más determinante que otros tratamientos para la resolución de los síntomas