Clinical trial to assess tolerability and subrogate efficacy effects of an abbreviated schedule with house dust mites mixture subcutaneous immunotherapy.

Summary: Objective. To evaluate the tolerability and efficacy of Dermatophagoides pteronyssinus/Dermatophagoides farinae mixture subcutaneous immunotherapy (SCIT). Methods. Patients received an abbreviated build-up schedule. The aims were: number, percentage, and severity of adverse reactions. Secondary outcomes included: changes in immunoglobulin titers and changes in dose-response skin prick tests. Results. Out of 289 administrations, 17% elicited any clinically relevant adverse reaction. Most of them were local reactions (LR) (9.4%) and the rest (7.6%) were systemic. Significant increases in sIgG and sIgG4 were detected in serum samples. Cutaneous reactivity decreased significantly. Conclusions. SCIT with house dust mites mixture of ROXALL Medicina España S.A. seems to have an acceptable tolerability profile, induces blocking IgG and decreases skin reactivity.

Allergy to ailanthus altissima pollen: a local allergen to consider

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Food allergy in Catalonia: Clinical manifestations and its association with airborne allergens

BACKGROUND: Food allergy affects around 6% of the European population and its prevalence worldwide has been increasing in the last decades, but studies focused on investigating food allergy epidemiology in Europe are lacking. OBJECTIVE: The Cibus project was created to register the main culprit foods and their clinical manifestations in food allergic patients in Catalonia. METHODS: A specific online database was designed. Allergists from eight different Catalan hospitals registered the new diagnoses of food allergy. RESULTS: 618 food allergic patients were included. Egg and milk were the main elicitors in the early ages, while fruits and nuts were the most frequent in patients >14 years old. Fish was more frequent in children, while seafood and Anisakis allergy were more frequent in the >14-year-old group. Overall, peach was the most prevalent food eliciting an allergic reaction (10%). Food allergy diagnosis was reached using compatible clinical history and positive skin prick test to the involved food in 98% of cases. Globally, urticaria was the most frequently reported manifestation in our population (48.2%), followed by oral allergy syndrome (25.6%) and anaphylaxis (24.8%). CONCLUSIONS: The Cibus project gives a full overview of the profile of food allergic patients in Catalonia and reinforces the predominance of plant food allergies in the Mediterranean area

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Food allergy in Catalonia: Clinical manifestations and its association with airborne allergens.

BACKGROUND: Food allergy affects around 6% of the European population and its prevalence worldwide has been increasing in the last decades, but studies focused on investigating food allergy epidemiology in Europe are lacking. OBJECTIVE: The Cibus project was created to register the main culprit foods and their clinical manifestations in food allergic patients in Catalonia. METHODS: A specific online database was designed. Allergists from eight different Catalan hospitals registered the new diagnoses of food allergy. RESULTS: 618 food allergic patients were included. Egg and milk were the main elicitors in the early ages, while fruits and nuts were the most frequent in patients >14 years old. Fish was more frequent in children, while seafood and Anisakis allergy were more frequent in the >14-year-old group. Overall, peach was the most prevalent food eliciting an allergic reaction (10%). Food allergy diagnosis was reached using compatible clinical history and positive skin prick test to the involved food in 98% of cases. Globally, urticaria was the most frequently reported manifestation in our population (48.2%), followed by oral allergy syndrome (25.6%) and anaphylaxis (24.8%). CONCLUSIONS: The Cibus project gives a full overview of the profile of food allergic patients in Catalonia and reinforces the predominance of plant food allergies in the Mediterranean area.

Latex allergy: Position Paper.

Correct management of latex allergy is essential to ensure adequate care of patients who are allergic to latex, which is ubiquitous in the health care setting. In this Position Paper, the Latex Committee of the Spanish Society of Allergology and Clinical Immunology provides guidelines for the management of latex allergy.

Molecular and antigenic characterization of rabbit hemorrhagic disease virus isolated in Cuba indicates a distinct antigenic subtype.

Phylogenetic analyses conducted on isolates of rabbit hemorrhagic disease virus (RHDV) from throughout the world have shown well-defined genogroups comprising representative strains of the virus and antigenic variants. In this work, we have isolated and characterized RHDV from the major epizootic that occurred in Cuba in 2004-2005. Sequence analysis of the capsid protein gene and antigenic characterization of this strain has allowed its inclusion as a member of the distinct RHDVa subtype. We also found that specific antibodies directed against RHDV reference strains bound to the Cuban isolate in a competition ELISA and inhibited virus hemagglutination in vitro. This is the second report on the molecular characterization of RHDVa circulating in the American region.

Epidemiology of urticaria in Spain.

BACKGROUND: In spite of the frequency of chronic urticaria there are very few epidemiological studies of its prevalence and distribution. OBJECTIVE: We wanted to approach the real prevalence of chronic urticaria in a population-based study and to depict demographic distribution and personal perception of the disease. We also wanted to describe the frequency of acute urticaria episodes in the population studied. METHODS: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a sample size for a maximum variability (conservative approach p=q=0.5). RESULTS: We found a 0.6% (95% CI: 0.4-0.8) prevalence of chronic urticaria. The prevalence is significantly higher in women than in men with a OR=3.82 (95%CI 1.56-9.37). Chronic urticaria is a self-limited disease, yet in 8.7% of cases chronic urticaria lasts from one to 5 years and in 11.3%, for more than 5 years. The average age of onset is 40 years. CONCLUSIONS: We offer large epidemiology study data on the prevalence of chronic urticaria. The prevalence of chronic urticaria has not yet been defined in an adult population-based study. With this work we offer such data to describe the prevalence and features of this disease.

Production and biochemical characterization of the recombinant Boophilus microplus Bm95 antigen from Pichia pastoris.

The new antigen Bm95 from the cattle tick Boophilus microplus was recently isolated, cloned and expressed in the methylotrophic yeast Pichia pastoris. The recombinant protein has shown to induce protection in cattle against infestations of B. microplus under controlled and production conditions. In this paper we report the production and large-scale purification of the Bm95 protein, following a simple and cost-effective process. The antigen was obtained highly aggregated, forming particles ranging from 26 to 30 nm and with purity higher than 80%. The process yield was 0.55 g of pure Bm95 protein per liter of culture. The 98% of the primary structure of the recombinant protein was verified by mass spectrometry. Three amino acid changes in comparison with the sequence deduced from cDNA were detected by LC-MS/MS. The antigen was also obtained N-glycosylated, as previously reported for heterologous protein expression in P. pastoris.

Prevalencia de alergia en la población adulta española / Allergy prevalence in adult spanish population

Introduccián: En lo últimos decenios se está registrando un aumento de las enfermedades alérgicas en todo el mundo. Sin embargo hay pocos estudios de prevalencia de alergia en la población general española. Objetivos: Establecer la prevalencia de enfermedades alérgicas en una muestra de población general adulta del estado español. Así como establecer las causas y las manifestaciones de esta alergia. Material y métodos: Se realizó un estudio observacional de tipo tranversal. El tamaño de la muestra. suponiendo un nivel máximo de indeterminación prevalencia = 50%) y aceptando un error del 1.4% y un nivel de confianza del 95%. Fue de 5.003 sujeto . La muestra e seleccionó de forma aleatoria y automática del listín de teléfono, aplicando el control de cuotas de zona. el número de habitantes, el sexo y la edad. La recogida 1:1e datos se efectuó mediante encuesta telefónica siguiendo la técnica CATI (Computer-assisted Telephone Interview technique) con oporte Omnibus Phonebus de Taylor Ne/son Sofres Market Research. Resultados: De los 4.949 sujetos incluidos en el análisis. un 21,6% (IC 95% 20,4- 22,7%) refirieron ser alérgicos. La prevalencia fue mayor en mujeres (24,6%), en el grupo de 18 a 24 años de edad (26.9%) y en poblaciones de más de 500.000 habitantes (24,3%). mientras que fue menor en los varones (18,3%), en la región norte-centro ( 17 ,8%) y en poblaciones con menos de 10.000 habitantes ( 18.7% ). o hubo diferencia significativa en relación al nivel socioeconómico. La rinoconjuntivitis fue la manifestación alérgica más frecuente (45,4%) seguida del asma bronquial (24.9% ), la urticaria (24.6% ), la dermatitis (21,5%) y el angioederna (6% ). Las tres causas más frecuente de alergia fueron con diferencia los pólenes (31,5%). los medicamento (29,4%) y los ácaros del polvo domé tico (25.3%). Mucho menos frecuentes fueron los animales (6,8%). los metales (4.9%). los alimentos (4.8%), los hongos (3%), las picadura de insecto (2.5%), la exposición al sol (1,9%) y el látex (0,8%). Conclusiones: La prevalencia de alergia en la población adulta española es del 21,6%, y es más frecuente en las mujeres y en los núcleos urbanos de más de 500.000 habitantes. La manifestación más frecuente es la rinoconjuntivitis. Las manifestaciones cutáneas de la alergia no son despreciables. Las causas más frecuentes de alergia con los aeroalérgeno (pólenes y ácaros) y lo medicamentos (AU)

Background: In spite of the worldwide increase in allergic diseases over the recent years, few epidemiological studies have been conducted in Spain. Objective: We wanted to establish the real prevalence of allergy in a sample of adult general population. We then wanted to describe the profile. the causes and the type of caused disease. Methods: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a simple size for a máximum undetermination level of (p = 50%). assuming a 1.4 error for global results and a 95% confidence interval (95% CI) l. Five thousands and three individual: were randomly selected from the telephone directory and matched according to sex, age and area. The phone survey was performed with each individual employing the Computer-assisted Telephone lnterview technique supported by Taylor elson Phonebus Company (Barcelona, Spain). Results: We found a 21.6% (95% CI: 20.4-22, 7%) prevalence of allergy. The prevalence was higher in wornen (24.6%) than in men (18.3%). Allergy condition was higher from 18 to 24 years old (26.9%). As it was expected. the prevalence was also higher in urban cities > 500.000 habitants (24.3%) than in rural cities with less than 10.000 habitants ( 18. 7% ). We did not find differences among economical status. The most cornrnon manifestation of allergic disease was rhinoconjunctivitis (45..+%) followed by bronchial asthrna (24.99'c), urticaria (24.6%). Dermatitis (21.5% ), and angioedema (6

A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites.

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1%) were recorded, representing 4.8% of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5% of the administered doses) and occurred in 10 patients (3.8% of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose.

[Sublingual immunotherapy in children. Immunotherapy Committee of the Spanish Society for Clinical Immunology and Pediatric Allergology]. / Inmunoterapia sublingual en niños. Comité de Inmunoterapia de la Sociedad Española de Inmunología Clínica y Alergología Pediátrica (SEICAP).

Sublingual immunotherapy is currently attracting growing interest because of its ease of administration and, according to previous studies, its infrequent and mild adverse effects. However, at least in children, the efficacy of this therapy has not been completely demonstrated. In addition, the mechanisms of action remain to be elucidated since few studies have been published and the results have been contradictory and sometimes inconclusive. For this reason, we performed a literature review through the MEDLINE database, selecting double-blind studies carried out in children. Only 10 studies meeting these requirements were retrieved. All the studies were performed by European researchers and nine were published in European journals. Efficacy was evaluated by clinical parameters and by reduction in medication use. The results on efficacy are not homogeneous, although most support the utility of this route of administration. Moreover, reports of allergens other than those used in these studies dust mites and grass pollens are lacking. In conclusion, further studies evaluating the efficacy of this therapy in children are required. Among the general population, if the efficacy of sublingual immunotherapy in the treatment of sensitization to hymenoptera venoms were demonstrated, as has been the case with subcutaneous immunotherapy, the utility of this route of administration would be definitively confirmed. Finally, sublingual immunotherapy could be used in children who have shown systemic reactions to subcutaneous immunotherapy or who refuse to undergo injections.

Inmunoterapia sublingual en niños

En la actualidad hay un creciente interés en el uso de la inmunoterapia por vía sublingual (ITSL) por su fácil administración y, según estudios previos, los escasos y leves efectos secundarios. Sin embargo, al menos en niños, la eficacia aún no está totalmente demostrada, y por otra parte, los mecanismos de acción no están aclarados, pues los estudios son escasos, contradictorios a veces y no concluyentes. Por este motivo, se ha efectuado una revisión bibliográfica, mediante la búsqueda en MEDLINE, seleccionando trabajos efectuados en niños, doble ciego. Sólo se han localizado 10 trabajos con esas características. Todos están realizados por investigadores europeos, nueve de los cuales están publicados en revistas del continente. La eficacia se valora por parámetros clínicos y por la reducción del uso de medicación. En cuanto a la eficacia, los resultados no son homogéneos, aunque en su mayoría finalmente se acepta la utilidad de la vía de administración. Además, faltan estudios con alérgenos distintos de los usados en esos estudios, que lo han sido con ácaros y pólenes de gramíneas. En conclusión, faltan más trabajos que valoren la eficacia en niños. En población general, se considera que si se demostrase la eficacia en el tratamiento de la sensibilización a veneno de himenópteros, como está demostrado con la IT subcutánea, podría afirmarse con certeza la utilidad de esta vía de administración. Finalmente, se considera que podría utilizarse la ITSL niños que hayan tenido reacciones sistémicas con IT subcutánea, o que manifiesten algún rechazo a la administración de inyecciones (AU)

Sublingual immunotherapy is currently attracting growing interest because of its ease of administration and, according to previous studies, its infrequent and mild adverse effects. However, at least in children, the efficacy of this therapy has not been completely demonstrated. In addition, the mechanisms of action remain to be elucidated since few studies have been published and the results have been contradictory and sometimes inconclusive. For this reason, we performed a literature review through the MEDLINE database, selecting double-blind studies carried out in children. Only 10 studies meeting these requirements were retrieved. All the studies were performed by European researchers and nine were published in European journals. Efficacy was evaluated by clinical parameters and by reduction in medication use. The results on efficacy are not homogeneous, although most support the utility of this route of administration. Moreover, reports of allergens other than those used in these studies ­ dust mites and grass pollens ­ are lacking. In conclusion, further studies evaluating the efficacy of this therapy in children are required. Among the general population, if the efficacy of sublingual immunotherapy in the treatment of sensitization to hymenoptera venoms were demonstrated, as has been the case with subcutaneous immunotherapy, the utility of this route of administration would be definitively confirmed. Finally, sublingual immunotherapy could be used in children who have shown systemic reactions to subcutaneous immunotherapy or who refuse to undergo injections (AU)

Anafilaxia en el curso de una inseminación intrauterina / Anaphylaxis in the course of intrauterine insemination

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Dietary micronutrients/antioxidants and their relationship with bronchial asthma severity.

BACKGROUND: Because little is known about micronutrient/antioxidant intake and asthma severity, we investigated dietary intake and plasma/serum levels of micronutrients/antioxidants in a group of asthma patients with various degrees of severity, and compared the results with healthy subjects. METHODS: A case control study was carried out on 118 asthma patients and 121 healthy subjects. The severity of the disease was classified by division of patients into four groups. Normal dietary micronutrient/antioxidant intake was estimated from a food frequency questionnaire. Plasma/serum levels of vitamins C, E, and A, selenium, magnesium, zinc, and platelet glutathione peroxidase (GSH-Px) activity were also determined. RESULTS: No differences in daily micronutrient/antioxidant intake were seen between patients and healthy subjects. The severity of the disease showed no significant relationship with micronutrient/antioxidant intake. There were no differences in plasma/serum levels in any of the micronutrients/antioxidants between healthy subjects and asthmatics. Nor were any differences found between asthma groups in severity in the biochemical measures, except in platelet GSH-Px activity, which was significantly lower in the most severe groups. CONCLUSIONS: In this study, we found no evidence of any association between micronutrient/antioxidant intake or plasma/serum levels of micronutrients/antioxidants and asthma. Reduction of platelet GSH-Px activity in the most severe patients suggests that these patients have a diminished capacity to restore part of the antioxidant defences.

Repicaduras intrahospitalarias con himenópteros / In-hospital re-stinging with hymenoptera

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