Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery

BACKGROUND: Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. OBJECTIVES: To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. METHODS: Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. RESULTS: We studied 203 patients, with mean age 35.1 ± 17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p < 0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. CONCLUSIONS: Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids

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Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery.

BACKGROUND: Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. OBJECTIVES: To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. METHODS: Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. RESULTS: We studied 203 patients, with mean age 35.1±17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p<0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. CONCLUSIONS: Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids.

Clinical value of morphine, pholcodine and poppy seed IgE assays in drug-abusers and allergic people

Background: The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms. Methods: We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed. Results: Overall, 149 patients and 200 controls, mean age 32.9±14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<0.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy. Conclusions: Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles(AU)

Clinical significance of cross-reactivity between tobacco and latex

Background: Allergen cross-reactivity between tobacco and other species of Solanaceae family (tomato, potato, aubergine and eggplant) have been reported. We have recently studied IgE response to tobacco in asthmatic patients sensitised to Lolium perenne (Perennial rye grass pollen) and have found that 30% of the tobacco responsive patients also have latex sensitisation. Objective: The aim of our study was to investigate the possibility of cross-reactivity between tobacco and latex in asthmatic patients with IgE response to latex. Methods: A study was performed on tobacco and latex exposure in 15 patients who suffered from asthma and latex sensitisation and who were randomly chosen from our database of latex-sensitive patients. To identify tobacco and latex as possible allergens that might cause clinical specific responses, all these patients were tested with prick-tests, specific IgE to tobacco, latex and related allergens, bronchial challenge, and patch tests with tobacco, latex and nicotine. Immunological response was evaluated with immunoblotting, immunoblotting-inhibition and EAST-inhibition tests. Results: Positive prick and bronchial challenge with specific IgE>0.35kU/L to tobacco was demonstrated in 11 asthmatics who were also sensitised to rye grass. Tobacco IgE level was related with sensitisation to latex (p<0.002), but not to other vegetables belonging to the Solanaceae family. EAST-inhibition and immunoblotting-inhibition showed the existence of cross-reactivity between tobacco and latex. Conclusions: Cross-reactivity exists between latex and tobacco allergens. Smoker patients with IgE response to tobacco may be a risk population for latex sensitisation

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Comparación de tres métodos cuantitativos para la determinación de proteínas totales en orina / A comparison of three methods for quantitative determination of total urine protein

Ante la falta de un método de referencia para la cuantificación de proteínas en orina, el objetivo de este trabajo es comparar las distintas metodologías existentes en nuestro Hospital. En nuestro Hospital las muestras con petición de análisis sistemático de orina son analizadas mediante un método semi-cuantitativo de tira reactiva y, en caso de resultado positivo, se efectúa su cuantificación por turbidimetría en el Laboratorio Central y en el Laboratorio de Urgencias por una metodología de unión a colorantes. Además, la determinación de proteínas especificas (albúmina, transferrina e inmunoglobulina G) se realiza mediante nefelometría cinética. En nuestro estudio hemos determinado proteínas totales en 103 muestras de orina positivas en la tira reactiva. Para la comparación de métodos se ha considerado como el más cercano al de referencia el de unión a colorantes. Los resultados obtenidos han sido discrepantes con diferencias constantes y proporcionales y coeficientes de correlación no superiores a 0,8. El conocimiento de estas diferencias nos lleva a la necesidad de profundizar en casos clínicos (AU)

Several methodologies for determination of total urine protein are frequently used in a Clinical Chemistry Laboratory this problem, increased by the lack of an established reference method, could induce confusion in both analysts and clinicians. In this study, urine samples with a positive result for total protein by an automated test strip were analyzed by a quantitative turbidimetric method and by a quantitative dye-binding essay in routine and urgent work, respectively. By the other way, albumin, transferrin and immunoglobulin G were quantified in the same specimens using a cinetic nephelometry method. All protein determinations were performed in 103 consecutive urine sample. The Kodak 250 essay [a dye-binding based assay] was considered as 'gold standard' for method comparison. Statistical differences were found for both y-intercept and siope in regression analysis [Hitachi 917 vs Kodak 250, and Immage vs Kodak 250). The correlation coefficients [r] values were less than 0.8. The knowledge of these differences should carry out to perform alternative methodologies when discrepant/unexpected values were obtained or when further clinical study was necessary (AU)

Living in towers as risk factor of pollen allergy.

BACKGROUND: The effects of fluctuations in pollen counts have important implications for health services. Little research on the clinical implications of the vertical distribution of pollen in allergy symptoms has been carried out. METHODS: We have investigated the allergic symptoms of a population of 17 171 patients coming from our health area (Valladolid, Spain) and living in the city and villages. We compared the prevalence of sensitization to different pollens: Graminae, trees and shrub in relation with the floor of the building where they were living. RESULTS: Relative risk of pollen sensitization (confidence index, CI 95%) was higher in patients who were living at high floors than in those patients who were living in lower floors or at street level, independently of rural or urban conditions The chi-square showed a lineal trend in this relationship in the case of sensitization to grass pollen: chi(2): 1794, P > 0.00001 CONCLUSIONS: On the basis of our local investigations, natural pollen sensitization appears to increase with height where the patient lives. This paper reports clinical results on the influence of vertical pollen distribution in pollen allergy.

Enhancement of tomato allergenicity after treatment with plant hormones

Background: Practical applications to enhance the productivity of agriculture by using plants with improved resistance to pathogens are expected to increase in the near future. Although tomato has been widely investigated for breeding purposes, there have been no studies on tomato allergenicity after plant hormones treatments. Methods: Prick by prick tests were carried out with different tomato samples (fruits grown under biological conditions without addition of chemical products, and treated with ethylene and salicylic acid) in eight patients with ages between 12 and 27 years who suffered from anaphylaxis episodes after eating raw tomatoes. An immunoblot experiment with the different tomato extracts was performed using sera from these eight patients and controls. Results: The wheals obtained in prick tests were significantly higher with the extracts of tomato treated with ethylene and SAA (χ2 = 31.3, p < 0.0001) and the patients who presented higher wheal diameters in skin tests were those who had more severe episodes of anaphylaxis. Neither the protein stain nor the IgE immunodetection patterns clearly varied between the untreated and the hormone-treated samples. Conclusions: In the case of anaphylaxis induced by tomato, the treatment with plant hormones induced a higher cutaneous response than with non-treated tomato, but the "in vitro" response was similar (AU)

Información básica: Se espera que aumenten en un futuro próximo las aplicaciones prácticas para incrementar la productividad de la agricultura utilizando plantas con mayor resistencia a los patógenos. Aunque se ha investigado ampliamente el tomate para fines de producción, no se han realizado estudios sobre su alergenicidad después de tratamientos con hormonas vegetales. Métodos: Se efectuaron pruebas de prick con diferentes muestras de tomate (frutos desarrollados en condiciones biológicas sin añadir productos químicos y tratados con etileno y ácido salicílico) en siete pacientes de 12 a 27 años que habían sufrido episodios de anafilaxia después de comer tomates crudos. Se realizó una prueba de inmunotransferencia con los distintos extractos de tomate empleando sueros de estos ocho pacientes y de controles. Resultados: Los habones obtenidos en las pruebas de punción fueron significativamente mayores con los extractos de tomate tratados con etileno y SAA ( 2 = 31,3, p < 0,0001) y los pacientes que presentaron habones de mayor diámetro fueron los que habían sufrido episodios más graves de anafilaxia. Ni la tinción de proteínas ni los patrones de inmunodetección de IgE variaron con claridad entre las muestras tratadas con hormonas y las no tratadas. Conclusiones: En el caso de la anafilaxia inducida por el tomate, el tratamiento con hormonas vegetales provocó una respuesta cutánea mayor que con el tomate no tratado, pero la respuesta in vitro fue parecida (AU)

Is Lolium pollen from an urban environment more allergenic than rural pollen?

Background: Allergy to grass pollen is a highly prevalent allergic disease. Hay fever is more predominant in urban than in rural areas, despite the increasingly smaller areas of surrounding grassland. The effect of vehicle exhaust pollutants, mainly diesel particles, and other industrial sources of atmospheric pollution leading to plant damage has been implicated in this phenomenon. Objective: This study compared the in vivo and in vitro allergenicity of pooled samples of Lolium perenne grass pollen harvested from 10 different urban areas with that of samples of the same pollen from 10 neighboring rural areas. Methods: Lolium perenne pollen from different parts of a city and from a nearby rural area was harvested in 1999 and 2000 during the peak pollination period. Protein composition was compared by SDS-PAGE and in vivo and in vitro IgE-binding capacity was compared by skin-prick tests, RAST-inhibition and measurement of the major allergen, Lol p 5. Results: In the two years under study, urban samples contained approximately twice the protein content of the rural samples. Biological activity and Lol p 5 content was higher in urban pollen than in rural pollen and showed differences in the two years under study. Conclusions: The protein content and allergenicity of Lolium perenne pollen was higher in urban areas than in rural areas. These differences might explain why allergy to grass pollen is more prevalent in urban areas. This finding should be taken into account in diagnosis, preventive measures and specific immunotherapy (AU)

Antecedentes: Los pólenes son una causa muy importante de enfermedades alérgicas. La polinosis es mas prevalente en zonas urbanas que en rurales, a pesar de que cada vez hay menos zonas verdes en las ciudades. Se ha valorado el efecto de las partículas diesel y otras fuentes de contaminantes urbanos sobre los pólenes para tratar de explicar este fenómeno. Objetivo: Este estudio compara la alergenicidad de muestras de Lolium perenne recolectado en diferentes zonas de la ciudad de Valladolid con pólenes de la misma especie recogidos en zonas rurales vecinas. Métodos: Se recolectaron pólenes de Lolium perenne de diferentes partes de la ciudad y de zonas rurales circundantes durante su pico de polinización en los años 1999 y 2000. Se mide su reactividad "in vivo" mediante prick tests e "in vitro" por SDS-PAGE, RAST inhibición y medición de su alérgeno principal Lol p 5, y se comparan los resultados obtenidos por todas la técnicas. Resultados: Demostramos una mayor concentración proteica y alergenicidad de los pólenes de Lolium perenne de zonas urbanas comparadas con las rurales cercanas. Conclusión: Sugerimos que esta diferencia en concentración proteica y actividad biológica del polen según el lugar de procedencia debería ser tenida en cuenta para el diagnóstico, medidas de prevención e inmunoterapia específica (AU)

Aportación al estudio de la otosclerosis y del síndrome de Van der Hoeve / Otosclerosis and Van der Hoeve's syndrome: a contribution

Hemos realizado un estudio ultraestructural y microanalítico de estribos procedentes de pacientes otosclerosos, sanos y afectos por el síndrome de Van der Hoeve a fin de determinar los cambios en la composición mineral de los mismos. Para ello hemos utilizado métodos no destructivos microscopía electrónica de barrido asociado a espectroscopia por dispersión de energía de rayos X (EDAX)- y otros destructivos (espectrografía con infrarrojos mediante transformada de Fourier). Utilizando la relación Ca/P hemos determinado que la composición mineral de los estribos es distinta en individuos normales, otosclerosos y afectos por el síndrome de Van der Hoeve. En esta última entidad hemos detectado una composición mineral inusual en huesos sanos: la brushita (AU)

Morphological and microchemical changes that effect to the otosclerotic stape in the Van der Hoeve's syndrome were examined with a scanning electron microscope equipped with an energy dispersive X-ray fluorescence. Using the Ca/P ratio as criterion--measured by the characteristic x-ray fluorescence--it was shown that the Van der Hoeve stape had a higher Ca/P ratio (2.6:1) as compared to the normal stape (2:1). The Van der Hoeve's syndrome lesions as poorly mineralized, with low calcium salt and apparent increase of phosphates. This finding indicates a possible change from hydroxyapatite (or apatite) to brushite, which imply an acidification of bone (AU)