NSAID-induced urticaria/angioedema does not evolve into chronic urticaria: a 12-year follow-up study.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent medicaments involved in drug hypersensitivity reactions, with NSAID-induced urticaria/angioedema (NIUA) being the most frequent clinical entity. The natural evolution of NIUA has been suggested to lead to chronic urticaria (CU) in an important proportion of patients, such that NIUA may therefore precede CU. Our aim was to verify whether these entities are related by following up a large cohort of patients with NIUA as well as a control group over a long period of time. METHODS: The study comprised three groups: (i) patients with a confirmed history of NIUA (more than two episodes with at least two different NSAIDs or positive drug provocation tests), (ii) patients with more than two episodes of urticaria/angioedema to a single NSAID with good tolerance to a strong COX-1 inhibitor and/or evidence by in vivo tests supporting specific IgE antibodies to the drug (single NSAID-induced urticaria/angioedema, SNIUA), and (iii) controls who tolerated NSAIDs. All cases in the three groups were followed up over a period of 12 years. RESULTS: There were 190 patients with NIUA (64.6% female; mean age 43.71 ± 15.82 years, 110 with SNIUA, and 152 controls. At the 12-year evaluation, 12 patients with NIUA (6.15%) had developed CU over a 1- to 8-year period. Similar proportions were seen in SNIUA and controls. CONCLUSIONS: Nonsteroidal anti-inflammatory drugs-induced urticaria/angioedema does not seem to precede the onset of CU over the medium term. Further research including a longer follow-up is necessary to verify this observation.

Diagnosis and management of immunodeficiencies in adults by allergologists.

Primary immunodeficiencies (PIDs) are genetic diseases that cause alterations in the immune response and occur with an increased rate of infection, allergy, autoimmune disorders, and cancer. They affect adults and children, and the diagnostic delay, morbidity, effect on quality of life, and socioeconomic impact are important. Therapy (gamma-globulin substitution in most cases) is highly effective. We examine adult PIDs and their clinical presentation and provide a sequential and directed framework for their diagnosis. Finally, we present a brief review of the most important adult PIDs, common variable immunodeficiency, including diagnosis, pathogenesis, clinical signs, and disease management.

In vitro diagnosis of immediate allergic reactions to drugs: an update.

Evaluation of allergic reactions to drugs is difficult because of the poor sensitivity of in vivo tests, which makes controlled administration of the drug necessary to confirm the diagnosis. In vitro tests are important in order to avoid the risks of in vivo testing. In the present review, we describe the different methods for detecting immunoglobulin (Ig) E antibodies that are specific to drugs involved in the development of type I (immediate) reactions. The 2 main in vitro methods are immunoassays and the basophil activation test, both of which have sufficient sensitivity and specificity for the detection of specific IgE antibodies, although with a limited number of drugs, and they have proven complementary to in vivo methods. We show the importance of the allergological workup of the patient within less than 1 year from the occurrence of the allergic reaction in order to obtain positive results in both in vivo and in vitro tests.

Guidelines on the clinical usefulness of determination of specific immunoglobulin E to foods.

The diagnostic gold standard for food allergy is challenge with the culprit food, particularly in double-blind placebo-controlled challenge. This approach involves risks and consumes both time and resources. A more efficient system would be desirable. The detection of serum specific immunoglobulin E (sIgE) against the culprit food enables us to establish sensitization, although this is not always accompanied by clinical reactivity. Age, symptoms (immediate/late reaction, local/systemic reaction), concomitant condition (eg, atopic dermatitis, pollinosis) and selection sample criteria (eg, presence of symptoms related to ingestion, positive skin prick test result) can influence the detection and concentration of IgE against foods. We analyze the clinical usefulness of sIgE determination in light of studies in which oral food challenge is used as the diagnostic method. We review clinical usefulness at diagnosis and in the decision to reintroduce the food, as well as the prognostic value of the determination of IgE to foods.

Effect of seasonal exposure to pollen on nonspecific interleukin-4, interleukin-5, and interferon-gamma in vitro release by peripheral blood mononuclear cells from subjects with pollinosis.

The immune response to environmental allergens depends on both genetic and environmental factors. Allergen exposure triggers the activation of allergen-specific Th2 cells in allergic patients, as well as increased Th2-type cytokine mRNA expression and eosinophil recruitment. Nevertheless, different patterns of release of cytokines could explain the heterogeneity of atopic response. In our study, 25 patients with pollinosis and 15 healthy donors were selected to characterize their release of Th2 (interleukin [IL]-4 and IL-5) and Th1 (interferon-gamma [IFN-gamma]) cytokines, both during and outside the pollen season. Peripheral blood mononuclear cells from patients and controls were isolated, cultured in the presence of phorbol-12-myristate-13-acetate plus ionomycine, and phytohemagglutinin (PHA), and cytokine release was assessed by titration in the supernatants. Both IL-4 and IL-5 showed higher levels during than outside the pollen season in pollinic patients (P<0.05) after nonspecific stimuli, whereas IFN-gamma levels were significantly lower during than outside the pollen season only after culture with PHA. Significant differences were not observed in the control group. Our results are consistent with the hypothesis that release of cytokines by peripheral blood mononuclear cells from patients with pollinosis depends on environmental exposure to sensitizing pollens, and that influence can be revealed by in vitro nonspecific stimulation. Nevertheless, the heterogeneity in results suggests that the use of mitogens to assess Th1/Th2 dominance may need careful evaluation.

Increased serum IgE in acute type A, B and delta hepatitis.

Serum IgE levels have been documented in patients of acute type B hepatitis. There are very few studies on serum IgE in acute type A hepatitis and, to our knowledge, there are no data on serum IgE in acute delta hepatitis patients. The purpose of this study was to measure total IgE levels in 38 patients with acute A, B and delta hepatitis and in 181 controls in order to determine the possible existence of changes in this parameter in the course of these infections. Our results showed a relevant increase in IgE levels in the three groups (hepatitis A, B and delta) with respect to the control group. Moreover, the hepatitis B group showed increased total serum IgE levels with respect to the hepatitis delta group.

Phenotypes of alpha-1-antitrypsin in intrinsic asthma and ASA-triad patients.

The frequency of presence of various phenotypes of alpha 1-antitrypsin was studied in 31 patients with intrinsic asthma and 11 with ASA-Triad, and compared to a group of 200 people representative of the general population. The MZ and SZ phenotype is more frequent in intrinsic asthmatics (p < 0.00001) and MZ in ASA-Triad (p < 0.0005) than in the control group. No differences were found between the intrinsic asthmatics and ASA-Triad. All the patients were divided into groups according to their clinical characteristics and an increase of the MZ phenotype was observed (p < 0.001) in patients with: nasal polyposis, intolerance to non-steroidal anti-inflammatories, a family history of atopy and peripheral eosinophilia (p < 0.01). Alpha-1-antitrypsin deficiency could be important in the pathogenesis of inflammatory processes and in the clinical manifestations characteristic of patients with intrinsic asthma and ASA-Triad.

Occupational rhinoconjunctivitis and asthma caused by Tetranychus urticae (red spider mite). A case report.

This paper highlights a clinical case of a patient suffering bronchial asthma and rhinoconjunctivitis due to sensitization to Tetranychus urticae (TU), commonly known as the red spider mite, which belongs to the Prostigmata sub-order of the Tetranychidae family, in relation to a work environment (a carnation nursery). Both prick and intradermal skin tests were positive, as well as specific bronchial challenge tests with TU extract. Specific IgE was demonstrated by RAST (Class 3). Unspecific bronchial provocation with methacholine was negative. Sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE) immunoblotting revealed the presence of seven main IgE binding proteins, the more intense bands being those appearing at 21, 17 and 15 kDa. This indicates a case of immediated type hypersensitivity to Tetranychus urticae with a clear correlation to occupational environment.

Connection between two peripherical markers in a group of asthmatic patients.

We have studied the goniometric value of the tda angle and the alpha 1 antitrypsin phenotypes in a group of thirty atopic patients with the following patterns: 1) they were affected with asthma, atopic dermatitis and rhinitis. 2) they presented positive prick skin tests for pneumo-allergens and had. 3) positive allergic antecedents. There exists a significant statistical value for the lower tda angle in the right hand, in the MZ phenotypes of alpha 1 antitrypsin bearers, with P less than 0.05 significance. In the left hand there are many individual values that are identical (62% of the total test effected) thus the statistical methods cannot be applied satisfactorily, bearing in mind the significant difference as the statistical group recognized. From this and other previous works, we can conclude that an individual whose right hand tda angle reaches values near 75%, and with a MZ phenotype of alpha 1 antitrypsin, has a greater possibility of pertaining to one of the groups of asthma, atopic dermatitis and rhinitis symptomatology.