Allergy to chironomid larvae (red migde larvae) in non professional handlers of fish food.

UNLABELLED: Chironomids are insects which inhabit wetlands. In countries such as Sudan, The United States. Egypt and Japan they are the cause of serious environmental allergy. In Europe, and particularly in Spain, allergy to Chironomids is infrequent and has only been described in patients who handle Chironomid larvae which form part of certain fish foods. MATERIALS AND METHODS: We report a case of hypersensitivity to the Chironomid Midge (Chironomus thummi thummi) in a 23-year-old patient who on two occasions, after being in contact with fishfood, suffered rash, rhinoconjunctivitis, dyspnea and dysphagia. A Prick test was carried out with the habitual pneumoallergens, Chironomid Midge extract (PBS: 1.3 mg/ml), Common Mosquito (Culex pipiens), Squid, Mussel, Prawn and Anisakis. Conjunctival provocation was also carried out with Chironomid Midge extract; detection of specific IgE for Chironomid Midge, Common Mosquito (Aedes comunis), Mussel, Squid, Shrimp, Anisakis, house dust and house mites by means of the CAP technique; detection of IgE by means of ELISA in response to Chironomid Midge, Aedes mosquito, Squid, Prawn, Mussel and Anisakis; ELISA-inhibition and Immunoblott-inhibition. RESULTS: The positive results of the cutaneous tests, the detection of specific IgE and conjunctival provocation confirmed the existence of an IgE-mediated mechanism. In our patient, the in vitro techniques demonstrated cross reactivity with the Common Mosquito. CONCLUSIONS: We report on a patient with a case history of rhinoconjunctivitis, rash, dyspnea, and dysphagia after handling fish food. The etiological agent was the Chironomid larvae. The sensitization of our patient has been demonstrated by means of in vivo and in vitro techniques.

Non-occupational allergy caused by the pine processionary caterpillar (Thaumetopoea pityocampa).

UNLABELLED: Contact with the pine processionary caterpillar induces dermatitis, usually located in exposed areas, and, less frequently, ocular lesions through a toxic-irritative mechanism. Recently, the existence of an immediate hypersensitivity mechanism has been demonstrated, mainly in occupationally exposed patients. OBJECTIVE: To present four patients who experienced allergic reactions (urticaria-angioedema and rhinitis-asthma) after non-occupational exposure to pine processionary caterpillar. PATIENTS AND METHODS: The four patients underwent allergy testing through skin prick tests (SPT), specific IgE detection and SDS-PAGE immunoblotting. One patient also underwent a specific bronchial challenge test with the pine processionary antigen. RESULTS: In all patients, both SPT with the caterpillar extract and specific IgE were positive. Western blotting showed several IgE-binding bands with molecular mass values ranging from 18 to 107 kDa. A shift in the electrophoretic mobility of some of the relevant allergens occurred under the presence of a reductive agent (beta -mercaptoethanol). The specific bronchial challenge test with pine processionary antigen performed in one of the patients also produced positive results. CONCLUSIONS: The results of this study show an immunologic IgE-mediated immediate hypersensitivity mechanism in these reactions. The processionary caterpillar's airborne urticating hairs or spicules should be considered, at least in some locations, not only as contact and occupational allergens, but also as seasonal aeroallergens.

Non-occupational allergy caused by the Pine Processionary Caterpillar (Thaumetopoea pityocampa)

Contact with the pine processionary caterpillar induces dermatitis, usually located in exposed areas, and, less frequently, ocular lesions through a toxic-irritative mechanism. Recently, the existence of an immediate hypersensitivity mechanism has been demonstrated, mainly in occupationally exposed patients. Objective: To present four patients who experienced allergic reactions (urticaria-angioedema and rhinitis-asthma) after non-occupational exposure to pine processionary caterpillar. Patients and methods: The four patients underwent allergy testing through skin prick tests (SPT), specific IgE detection and SDS-PAGE immunoblotting. One patient also underwent a specific bronchial challenge test with the pine processionary antigen. Results: In all patients, both SPT with the caterpillar extract and specific IgE were positive. Western blotting showed several IgE-binding bands with molecular mass values ranging from 18 to 107 kDa. A shift in the electrophoretic mobility of some of the relevant allergens occurred under the presence of a reductive agent (β -mercaptoethanol). The specific bronchial challenge test with pine processionary antigen performed in one of the patients also produced positive results. Conclusions: The results of this study show an immunologic IgE-mediated immediate hypersensitivity mechanism in these reactions. The processionary caterpillar's airborne urticating hairs or spicules should be considered, at least in some locations, not only as contact and occupational allergens, but also as seasonal aeroallergens (AU)

El contacto con la procesionaria del pino produce cuadros cutáneos, localizados generalmente en zonas expuestas, y, con menos frecuencia, oculares por un mecanismo toxico-irritativo. Recientemente, se ha demostrado un mecanismo de hipersensibilidad inmediata fundamentalmente en trabajadores expuestos ocupacionalmente. Objetivo: Presentar cuatro casos de pacientes que sufrieron reacciones alérgicas (urticaria-angioedema y rinitis-asma bronquial) tras exposición no ocupacional a procesionaria del pino.Material y métodos: En los cuatro pacientes se realizó estudio alergológico mediante pruebas cutáneas en prick, detección de IgE específica y SDSPAGE inmunotransferencia; siendo sometido, además, uno de los enfermos a prueba de provocación bronquial específica. Resultados: En todos los pacientes tanto la prueba cutánea con el extracto de oruga como la detección de IgE específica fueron positivas. En la inmunotransferencia se detectaron varias bandas fijadoras de IgE, con masas moleculares comprendidas entre 18 y 107 kDa. La movilidad electroforética de alguno de los alergenos relevantes se modifica por la presencia de un agente reductor ( Beta-mercaptoetanol). La prueba de provocación bronquial específica con Ag.de procesionaria del pino realizada en uno de los pacientes resultó, igualmente, positiva. Conclusiones: Los resultados del estudio efectuado muestran un mecanismo inmunológico de hipersensibilidad inmediata mediado por IgE en estas reacciones. Las espículas urticantes aerotransportadas de la procesionaria deberían considerarse, al menos en algunas localizaciones, como neumoalergenos estacionales y no sólo desde el punto de vista ocupacional (AU)

Evolución espirométrica en pacientes asmáticos en una consulta de alergia / Spirometric evolution of asthmatic patients in an allergy clinic

Fundamento: El asma es una enfermedad crónica caracterizada por una obstrucción bronquial reversible. En el presente estudio se pretende valorar la evolución de la obstrucción bronquial en pacientes asmáticos, tras la introducción de un tratamiento adecuado, en un período de seguimiento de cinco años. Métodos: Se seleccionaron retrospectiva y aleatoriamente un grupo de 60 pacientes con asma perenne. Se agruparon en función de la etiología del asma y del grado de obstrucción bronquial al inicio del estudio. Se compararon en cada paciente el volumen espiratorio forzado en el primer segundo (FEV1), la capacidad vital forzada (FVC) y el flujo espiratorio forzado en el 50 por ciento de la FVC (FEF50) al inicio y final del estudio. Resultados: De los 60 pacientes, 25 eran varones y 35 mujeres. El rango de edad se situó entre 16 y 83 años, con una edad media de 49,5 años. Se objetivó una mejoría estadísticamente significativa de la función pulmonar en el total de pacientes (FEV1), en los pacientes con asma intrínseca (FEV1, FEF50) y en los que presentaban una obstrucción severa al inicio del estudio (FEV1). Conclusiones: La función pulmonar de los pacientes asmáticos no empeora a lo largo de los años observados, al instaurar un tratamiento correcto. La mejoría que se objetiva en el grupo de asma intrínseca y en la obstrucción bronquial intensa puede deberse a un mejor cumplimiento del tratamiento y a un seguimiento médico más frecuente. (AU)

Skin reactions to histamine and compound 48/80 in chronic urticaria: a diagnostic tool?

Chronic urticaria is a changeable disorder with an unknown length of duration. Thus, an objective method which could differentiate affected individuals from healthy individuals and with predictive information about when treatment might be diminished or stopped would be desirable. Therefore, we have tried to achieve this by means of Multitest, a device rendering good skin reaction reproduction and reagents such as 48/80 Compound (a nonspecific mast cell degranulator) and histamine. These substances were applied on 1 to 10(3) Mol concentrations for histamine and 10 to 10(3) mg/ml as the degranulating agent. Sixteen patients and 10 controls were submitted to this test, variables such as drugs modifying wheals, time of the day, age range and skin area were controlled. In both groups a clear dose-response relationship was demonstrated by either reagent. However, an excessive individual variability appeared in each sample and significant differences could not be shown so much for sensitivity or for reactivity (responses by the lowest and the highest concentrations, respectively). We conclude that the lack of differences observed on cutaneous mast cell "releasability" and skin vessels response to histamine in chronic urticaria patients could be due to a rather outstanding role of other cells and its mediators, in mechanisms of that chronic disease.

Long-term modification on histamine-induced bronchoconstriction by disodium cromoglycate and ketotifen versus placebo.

In order to compare long-term changes induced on a wide spectrum of bronchial hyperreactivity (BH) by the antiallergic drugs disodium cromoglycate (DSCG) and ketotifen, 56 asthmatic patients (age range 15-55 years) were studied. Patients were allocated to three groups with similar age and BH level. During 2 months, 15 individuals inhaled 20 mg DSCG four times a day, 14 took ketotifen 1 mg twice a day orally and 14 one placebo (lactose) capsule twice a day. After preliminary results, an additional group of 13 patients took clemastine 1 mg orally twice a day for 1 week. Only the ketotifen and clemastine groups differed significantly from the placebo group on shifting log dose-response curves of inhaled histamine. In addition, no significant difference was seen between the ketotifen and clemastine groups. These results suggest that changes induced by ketotifen were mainly related to its powerful antihistamine action; similarly, nonspecific BH is not wholly dependent on mediator release.