Respuesta de los autores: Onicomadesis en paciente adulto inmunocompetente / Author's reply: Onychomadesis in an immunocompetent adult patient

No disponible

Tratamiento endoscópico de una urticaria recidivante / Endoscopic treatment of a recurrent urticaria

No disponible

Alergias en salud laboral / Allergies in occupational health

No disponible

Una causa mortal de síncope / A mortal cause of syncope

La anafilaxia es una reacción generalizada debida a la liberación masiva de mediadores de mastocitos y otras células inflamatorias que se instaura rápidamente y puede causar la muerte. Su diagnóstico es clínico y en ocasiones los síntomas con que se presenta pueden simular enfermedades más leves como cuadros vasovagales, ansiedad o asma, por lo que a menudo resulta infradiagnosticada. Es necesario un alto índice de sospecha para su diagnóstico. Presentamos el caso de una mujer joven que acude por síncope al centro de atención primaria. A pesar de la ausencia de lesiones cutáneas, la hipotensión mantenida nos hizo sospechar una anafilaxia, permitiendo la administración precoz de tratamiento y derivación urgente al hospital. en urgencias, nuestra hipótesis se vio reforzada al hallar niveles elevados de triptasa en sangre. La ausencia de exposición a alérgenos comunes nos hizo pensar en una hidatidosis hepática complicada como causa del cuadro, lo que se confirmó mediante ecografía y tomografía computarizada (TC) (AU)

Anaphylaxis is a generalized reaction produced by the massive release of mediators from mast cells, is rapid in onset and may cause death. The diagnosis is clinical, and the initial symptoms often overlap with those of many other disorders such as, vasovagal reactions, anxiety or asthma, and is often underdiagnosed. A high index of suspicion is necessary for the diagnosis. We report the case of a young woman who presented with syncope in a Primary Care Centre. In spite of the absence of skin lesions, we suspected an anaphylaxis because of the refractory low blood pressure. Thus treatment was started she was transferred to the Hospital. In the Emergency Department, the elevated serum tryptase levels supported our diagnosis. The absence of a clear exposure to a known allergen lead us to suspect a hydatid cysts rupture. The abdominal ultrasound and CT scan confirmed this (AU)

[A mortal cause of syncope]. / Una causa mortal de síncope.

Anaphylaxis is a generalized reaction produced by the massive release of mediators from mast cells, is rapid in onset and may cause death. The diagnosis is clinical, and the initial symptoms often overlap with those of many other disorders such as, vasovagal reactions, anxiety or asthma, and is often underdiagnosed. A high index of suspicion is necessary for the diagnosis. We report the case of a young woman who presented with syncope in a Primary Care Centre. In spite of the absence of skin lesions, we suspected an anaphylaxis because of the refractory low blood pressure. Thus treatment was started she was transferred to the Hospital. In the Emergency Department, the elevated serum tryptase levels supported our diagnosis. The absence of a clear exposure to a known allergen lead us to suspect a hydatid cysts rupture. The abdominal ultrasound and CT scan confirmed this.

Anaphylaxis associated with the ingestion of Goji berries (Lycium barbarum).

Goji berry (wolfberry), a member of the Solanacea family, has been recently introduced in Western countries and its consumption has increased rapidly. The objectives of the study were to describe the cases of 2 patients who experienced allergic symptoms after Goji berry consumption, to identify the protein profile of the extract, to analyze the allergenic profile of individuals, and to determine cross-reactivity with other members of the Solanaceae family (tomato). We describe 2 cases of allergic reaction, 1 of which was an anaphylactic reaction, after Goji berry ingestion. A Goji berry extract was manufactured and immunochemically characterized. The patients were skin prick tested with a battery of common aeroallergens including mites, epithelia, and molds. Individuals were also skin prick tested with food allergens, including Goji berries. A positive skin prick test and specific immunoglobulin (Ig) E to Goji berry was detected in both cases. Serum samples recognized a 9-kDa band, probably related to lipid transfer proteins (LTPs). Cross-reactivity with tomato was analyzed by inhibition studies, which showed that the 9-kDa band was totally inhibited by the tomato extract. This study describes the first 2 cases of allergic reaction following Goji berry ingestion. LTPs seem to be involved in allergic sensitization to Goji berries, as evidenced by cross-reactivity with tomato.

Study of cross-reactivity between proton pump inhibitors.

Several studies have demonstrated different cross-reactivity patterns between proton pump inhibitors (PPIs). The aim of this study was to investigate cross-reactivity between commercially available PPIs and establish a procedure for performing cutaneous tests for verifying PPI allergy. We performed skin prick and intradermal tests with all commercially available PPIs in 5 patients with clinical allergy to omeprazole and observed positive results in all patients. We report 5 cases of immunoglobulin (Ig) E-mediated allergy to omeprazole and document cross-reactivity by skin testing between all the PPIs studied. We also found that the probability of confirming an IgE-mediated mechanism with skin tests decreases with time. Finally, we propose a hypothesis that could explain the different PPI cross-reactivity patterns reported.

Fiebre y exantema tras viaje a Brasil / Fever and exanthema after a trip to Brazil

No disponible

Muerte súbita y hemocromatosis / Sudden disease and hemochromatosis

No disponible

[Prevalence of tobacco dependency and its prevention in patients with persistent asthma]. / Prevalencia del tabaquismo y prevención en pacientes con asma persistente.

OBJECTIVES: To analyse in patients with persistent bronchial asthma the prevalence of tobacco dependency and its degree; and to assess measures of prevention. DESIGN: Cross-sectional, descriptive study. SETTING: Allergy Service of the Lozano Blesa University Hospital, Zaragoza, Spain. PARTICIPANTS: A total of 121 patients, from systematic selection of asthmatics attending for consultation. MAIN MEASUREMENTS: Questionnaire filled out in the consulting room, recording social, demographic and clinical variables. RESULTS: A sample of 121 patients was obtained, 62.7% women and 37.3% men. They had 5.87 +/- 4.99 years mean evolution of asthma. 21.5% were daily smokers, 4.1% occasional smokers, 27.3% ex-smokers, and 47.1% non-smokers. The ages of starting to smoke were < 10 years old, 1.7%; 10-15, 30%; 15-20, 56.7%; 20-25, 6.7%, and > 25, 5% (P > .05). There were significant differences between gender and tobacco dependency and between age and tobacco dependency (P < .01 and P < .014, respectively). 96.8% of smokers thought that tobacco was harmful to their health. This figure was 100% in daily smokers and 80% in occasional smokers (P < .02). 83.9% of smokers had the intention of giving up. Counselling to give up was received from the specialist (41.9%), the primary care doctor (12.9%), and both (9.7% of cases). 35.5% received no counselling. CONCLUSIONS: The prevalence of tobacco dependency in patients with persistent asthma is lower than in the population as a whole; over a third receive no counselling about giving up. Interventions must be conducted in still healthy smokers and chronically ill patients in both primary and specialist care.

Prevalencia del tabaquismo y prevención en pacientes con asma persistente / Prevalence of tobacco dependency and its prevention in patients with persistent asthma

Objetivo. Analizar en pacientes con asma bronquial persistente la prevalencia de tabaquismo, el grado de éste y valorar las medidas de prevención. Diseño. Estudio descriptivo, transversal. Emplazamiento. Servicio de Alergología del Hospital Clínico Universitario Lozano Blesa de Zaragoza. Participantes. Un total de 121 pacientes, resultado de la selección sistemática de los sujetos asmáticos que acudían a consulta. Mediciones principales. Cuestionario cumplimentado en la consulta, en el que se registraba las variables sociodemográficas y clínicas. Resultados. Se obtuvo una muestra de 121 pacientes, 62,7% mujeres y 37,3% varones, con 5,87 ± 4,99 años de evolución media del asma. El 21,5% fumaba diariamente, el 4,1% era fumador ocasional, el 27,3 era ex fumador y el 47,1% no fumaba. La edad de comienzo del tabaquismo era: 25 años, 5% (p > 0,05). Hay diferencias significativas entre sexo y tabaquismo y entre edad y tabaquismo (p < 0,01 y p < 0,014, respectivamente). El 96,8% de los fumadores cree que el tabaco es perjudicial para su salud, el 100% de los que fuman diariamente y el 80% de los que lo hacen ocasionalmente (p < 0,02). El 83,9% de los que fuma tiene intención de abandonar el tabaco. El 41,9% ha recibido consejo para dejar de fumar del especialista, el 12,9% del médico de atención primaria, el 9,7% de ambos y el 35,5% no ha recibido ningún consejo. Conclusiones. La prevalencia del tabaquismo en pacientes con asma persistente es inferior a la de la población general; más de la tercera parte no recibe consejo para abandonar el tabaco. Es necesario realizar intervenciones en fumadores sanos y en pacientes con enfermedad crónica, tanto en atención primaria como en la consulta especializada

Objectives. To analyse in patients with persistent bronchial asthma the prevalence of tobacco dependency and its degree; and to assess measures of prevention. Design. Cross-sectional, descriptive study. Setting. Allergy Service of the Lozano Blesa University Hospital, Zaragoza, Spain. Participants. A total of 121 patients, from systematic selection of asthmatics attending for consultation. Main measurements. Questionnaire filled out in the consulting room, recording social, demographic and clinical variables. Results. A sample of 121 patients was obtained, 62.7% women and 37.3% men. They had 5.87±4.99 years mean evolution of asthma. 21.5% were daily smokers, 4.1% occasional smokers, 27.3% ex-smokers, and 47.1% non-smokers. The ages of starting to smoke were 25, 5% (P>.05). There were significant differences between gender and tobacco dependency and between age and tobacco dependency (P<.01 and P<.014, respectively). 96.8% of smokers thought that tobacco was harmful to their health. This figure was 100% in daily smokers and 80% in occasional smokers (P<.02). 83.9% of smokers had the intention of giving up. Counselling to give up was received from the specialist (41.9%), the primary care doctor (12.9%), and both (9.7% of cases). 35.5% received no counselling. Conclusions. The prevalence of tobacco dependency in patients with persistent asthma is lower than in the population as a whole; over a third receive no counselling about giving up. Interventions must be conducted in still healthy smokers and chronically ill patients in both primary and specialist care