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 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<.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.

Allergic hypersensitivity to cannabis in patients with allergy and illicit drug users

Background: Cannabis is the illicit drug most widely used by young people in high-income countries. Allergy symptoms have only occasionally been reported as one of the adverse health effects of cannabis use. Objectives: To study IgE-mediated response to cannabis in drug users, atopic patients, and healthy controls. Methods: Asthmatic patients sensitised to pollen, and all patients sensitised to tobacco, tomato and latex, considered as cross-reacting allergens, were selected from a data base of 21,582 patients. Drug users attending a drug-rehabilitation clinic were also included. Controls were 200 non-atopic blood donors. Specific IgE determination, prick tests and specific challenge with cannabis extracts were performed in patients and controls. Results: Overall, 340 patients, mean age 26.9±10.7 years, were included. Males (61.4%) were the most sensitised to cannabis (p<0.001). All cannabis-sensitised patients were alcohol users. Eighteen (72%) of the patients allergic to tomato were sensitised to cannabis, but a positive specific challenge to cannabis was highest in patients sensitised to tobacco (13/21, 61.9%), (p<0.001). Pollen allergy was not a risk factor for cannabis sensitisation. Prick tests and IgE for cannabis had a good sensitivity (92 and 88.1%, respectively) and specificity (87.1 and 96%) for cannabis sensitisation. Conclusions: Cannabis may be an important allergen in young people. Patients previously sensitised to tobacco or tomato are at risk. Cannabis prick tests and IgE were useful in detecting sensitisation (AU)

Allergic hypersensitivity to cannabis in patients with allergy and illicit drug users.

BACKGROUND: Cannabis is the illicit drug most widely used by young people in high-income countries. Allergy symptoms have only occasionally been reported as one of the adverse health effects of cannabis use. OBJECTIVES: To study IgE-mediated response to cannabis in drug users, atopic patients, and healthy controls. METHODS: Asthmatic patients sensitised to pollen, and all patients sensitised to tobacco, tomato and latex, considered as cross-reacting allergens, were selected from a data base of 21,582 patients. Drug users attending a drug-rehabilitation clinic were also included. Controls were 200 non-atopic blood donors. Specific IgE determination, prick tests and specific challenge with cannabis extracts were performed in patients and controls. RESULTS: Overall, 340 patients, mean age 26.9±10.7 years, were included. Males (61.4%) were the most sensitised to cannabis (p<0.001). All cannabis-sensitised patients were alcohol users. Eighteen (72%) of the patients allergic to tomato were sensitised to cannabis, but a positive specific challenge to cannabis was highest in patients sensitised to tobacco (13/21, 61.9%), (p<0.001). Pollen allergy was not a risk factor for cannabis sensitisation. Prick tests and IgE for cannabis had a good sensitivity (92 and 88.1%, respectively) and specificity (87.1 and 96%) for cannabis sensitisation. CONCLUSIONS: Cannabis may be an important allergen in young people. Patients previously sensitised to tobacco or tomato are at risk. Cannabis prick tests and IgE were useful in detecting sensitisation.

[Differential health and toxicological features of drug-dependents in treatment and in active consumption]. / Características diferenciales sanitarias y toxicológicas de drogodependientes en tratamiento y consumo activo.

OBJECTIVES: To describe and compare the demographic and health characteristics and drug use patterns in a group of drug dependent individuals who were actively using drugs versus those in different types of treatment. To analyze the interventions used with the different groups. DESIGN: Descriptive study. SETTING: Users at the Association for Aid to Drug Dependent Persons (Asociación de Ayuda al Drogodependiente, ACLAD) in the city of Valladolid in northwestern Spain. PATIENTS: 1224 drug dependent persons. MEASURES: We reviewed the medical records for a 30-month period for users who were seen at a treatment center and who were participating in a damage reduction program. We recorded demographic, drug use and clinical variables and compared changes. RESULTS: We studied 1224 patients in all. One-third had human immunodeficiency virus infection, 63% had markers for previous hepatitis A infection, 48% had markers for hepatitis B, and 68.5% for hepatitis C. The Mantoux test was positive in 39.1%. We found differences in the prevalence of infections between active drug users and users in treatment, between drug dependent persons receiving different types of treatment, and between different periods of study. CONCLUSIONS: There were clear differences in demographic and health characteristics and drug use patterns between users. Those who were not in rehabilitation were in worse health, and were studied in less detail that other groups of drug users. During follow-up we noted a slight improvement in their health conditions, along with a tendency toward improved primary care interventions.

Características diferenciales sanitarias y toxicológicas de drogodependientes en tratamiento y consumo activo / Differential health and toxicological features of drug-dependents in treatment and in active consumption

Objetivo. Describir y comparar las características demográficas, toxicológicas y sanitarias de un colectivo de drogodependientes que se encuentra en consumo activo y en diferentes modalidades terapéuticas. Analizar las intervenciones realizadas con estos diferentes colectivos.Diseño. Estudio descriptivo.Emplazamiento. Usuarios que han acudido a la asociación ACLAD de Valladolid.Pacientes. Un total de 1.224 drogodependientes.Mediciones. Revisión de las historias clínicas de los usuarios atendidos en un centro de tratamiento y en un programa de reducción de daños durante un período de 30 meses.Se registran diferentes variables demográficas, toxicológicas y clínicas, se efectúa la comparación entre programas y se valora la evolución de los pacientes.Resultados. Se estudian 1.224 pacientes. Un tercio presenta infección por el virus de la inmunodeficiencia humana; el 63 por ciento, marcadores de una hepatitis A pasada, el 48 por ciento, marcadores de hepatitis B, y el 68,5 por ciento de hepatitis C. En el 39,1 por ciento es positiva la prueba de Mantoux. Se observan diferencias en la prevalencia de infecciones entre los usuarios en consumo activo y los usuarios en tratamiento, entre los drogodependientes en diferentes modalidades terapéuticas y en el período del estudio.Conclusiones. Existen claras diferencias en las características demográficas, toxicológicas y sanitarias de los usuarios incluidos en el estudio. Los usuarios que no están en tratamiento de rehabilitación son los que peores condiciones sanitarias tienen.Éstos son los menos estudiados por nuestra parte. En estos años de seguimiento se detecta una leve mejoría de estas condiciones y también una tendencia a la mejora de nuestra intervención (AU)

Brote de escabiosis en toxicómanos / No disponible

No disponible