Diagnostic accuracy of the atopy patch test in children with food allergy-related gastrointestinal symptoms.

BACKGROUND: Little is known about the diagnostic accuracy of atopy patch tests (APT) in the clinical practice of pediatric gastroenterology. Moreover, APTs containing purified food extracts have recently become available, but their diagnostic accuracy is largely undefined. PATIENTS AND METHODS: We evaluated the diagnostic accuracy of food challenge, skin prick test (SPT), serum specific IgE determination, and APT using fresh food and commercial food extracts in parallel in children referred for suspected food allergy-related gastrointestinal symptoms. RESULTS: Eighty-nine food challenges were performed in 60 patients (38 boys, median age 23 months, range 3-48 months): 31 tested positive for cow's milk (CM), 19 for hen's egg (HE), and two for wheat. Specific immunoglobulin E (IgE) determination, and SPT, respectively, were positive in 7/31 and 14/31 of patients with cow's milk allergy (CMA), and in 7/19 and 7/19 with HE allergy. The results of APT with fresh food vs a commercial assay were (1) CM: sensitivity: 64.5%vs 6.4%, specificity 95.8%vs 95.6%, positive predictive value (PPV) 95.2%vs 66.6% and negative predictive value (NPV) 67.6%vs 43.1%; (2) HE: sensitivity 84.2%vs 5.2%, specificity 100%vs 100%, PPV 100%vs 100% and NPV 75.0%vs 33.3%. CONCLUSIONS: Atopy patch test is a useful tool in the diagnostic work up of children with food-allergy-related gastrointestinal symptoms. The diagnostic accuracy of ATP was higher with fresh food than with commercial food extracts.

[Definition of hypertension based on a prevalence study of 1,423 young adults]. / Consideraciones sobre la definición de hipertensión arterial a partir de un estudio de prevalencia en 1423 jóvenes.

The prevalence of arterial hypertension (AH) was studied in 1423 individuals (702 males and 721 females) aged 21 years (Fig. 1, Table 1). Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) were measured three times on two different occasions separated by at least one week. Three different criteria were used to define AH (Table 3): 1) World Health Organization (WHO) [PAD > or = 95 mmHg in one casual determination]; Joint National Committee IV (JNC-4) [PAD > or = 90 mmHg on two different occasions]; and 3) Statistical [PAD > percentile 95 of the respective distribution]. BP was distributed normally in both males and females (Fig. 4). DBP decreased progressively along the six measurements (Fig. 2, Table 2), with the average of DBP determinations 4-6 being significantly lower than the average of determinations 1-3 (p < 0.05). SBP behaved in the same way (Fig. 2, Table 2), but in this case the 2nd and 3rd determinations within each occasion (2-3 and 5-6) were significantly lower than determinations 1 and 4, respectively (p < 0.05). As a result, the percentage of individuals of either sex with DBP > 90 mmHg was 14.7% based on the 1st determination (Fig. 5), but if the averages of determinations 1 to 3 or 1 to 6 were considered, these percentages decreased to 8.7% and 4% respectively (Fig. 5). With the WHO criterion (PAD > or = 160/95 mmHg based on the first determination) there were 3.3% of individuals with AH. With the statistical criterion the prevalence of AH was always 5%, but the actual value of percentile 95 was progressively lower as we took into account the 1st. determination, the average of 1-3 or the average of 1-6: 100, 95 and 90 mmHg in males and 90, 88 and 84 mmHg in females, respectively (Fig. 6). With the JNC-4 criterion there were 1.6% of individuals with AH (Fig. 5). These low figures were caused by the lack of repeatability of DBP readings in the second determination, since 79% of the individuals with DBP > or = 90 mmHg on the first occasion were normotensive on the second one, whereas more than 95% of those being initially normotensive remained in that category on the second visit (Fig. 7). The FC did not show important changes (Fig. 8), and the percentage of individuals with systolic AH was low (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Consideraciones sobre la definición de hipertensión arterial a partir de un estudio de prevalencia en 1423 jóvenes. / [Definition of hypertension based on a prevalence study of 1,423 young adults]

The prevalence of arterial hypertension (AH) was studied in 1423 individuals (702 males and 721 females) aged 21 years (Fig. 1, Table 1). Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) were measured three times on two different occasions separated by at least one week. Three different criteria were used to define AH (Table 3): 1) World Health Organization (WHO) [PAD > or = 95 mmHg in one casual determination]; Joint National Committee IV (JNC-4) [PAD > or = 90 mmHg on two different occasions]; and 3) Statistical [PAD > percentile 95 of the respective distribution]. BP was distributed normally in both males and females (Fig. 4). DBP decreased progressively along the six measurements (Fig. 2, Table 2), with the average of DBP determinations 4-6 being significantly lower than the average of determinations 1-3 (p < 0.05). SBP behaved in the same way (Fig. 2, Table 2), but in this case the 2nd and 3rd determinations within each occasion (2-3 and 5-6) were significantly lower than determinations 1 and 4, respectively (p < 0.05). As a result, the percentage of individuals of either sex with DBP > 90 mmHg was 14.7

based on the 1st determination (Fig. 5), but if the averages of determinations 1 to 3 or 1 to 6 were considered, these percentages decreased to 8.7

and 4

respectively (Fig. 5). With the WHO criterion (PAD > or = 160/95 mmHg based on the first determination) there were 3.3

of individuals with AH. With the statistical criterion the prevalence of AH was always 5

, but the actual value of percentile 95 was progressively lower as we took into account the 1st. determination, the average of 1-3 or the average of 1-6: 100, 95 and 90 mmHg in males and 90, 88 and 84 mmHg in females, respectively (Fig. 6). With the JNC-4 criterion there were 1.6

of individuals with AH (Fig. 5). These low figures were caused by the lack of repeatability of DBP readings in the second determination, since 79

of the individuals with DBP > or = 90 mmHg on the first occasion were normotensive on the second one, whereas more than 95

of those being initially normotensive remained in that category on the second visit (Fig. 7). The FC did not show important changes (Fig. 8), and the percentage of individuals with systolic AH was low (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Consideraciones sobre la definición de hipertensión arterial a partir de un estudio de prevalencia en 1423 jóvenes. / [Definition of hypertension based on a prevalence study of 1,423 young adults]

The prevalence of arterial hypertension (AH) was studied in 1423 individuals (702 males and 721 females) aged 21 years (Fig. 1, Table 1). Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) were measured three times on two different occasions separated by at least one week. Three different criteria were used to define AH (Table 3): 1) World Health Organization (WHO) [PAD > or = 95 mmHg in one casual determination]; Joint National Committee IV (JNC-4) [PAD > or = 90 mmHg on two different occasions]; and 3) Statistical [PAD > percentile 95 of the respective distribution]. BP was distributed normally in both males and females (Fig. 4). DBP decreased progressively along the six measurements (Fig. 2, Table 2), with the average of DBP determinations 4-6 being significantly lower than the average of determinations 1-3 (p < 0.05). SBP behaved in the same way (Fig. 2, Table 2), but in this case the 2nd and 3rd determinations within each occasion (2-3 and 5-6) were significantly lower than determinations 1 and 4, respectively (p < 0.05). As a result, the percentage of individuals of either sex with DBP > 90 mmHg was 14.7

based on the 1st determination (Fig. 5), but if the averages of determinations 1 to 3 or 1 to 6 were considered, these percentages decreased to 8.7

and 4

respectively (Fig. 5). With the WHO criterion (PAD > or = 160/95 mmHg based on the first determination) there were 3.3

of individuals with AH. With the statistical criterion the prevalence of AH was always 5

, but the actual value of percentile 95 was progressively lower as we took into account the 1st. determination, the average of 1-3 or the average of 1-6: 100, 95 and 90 mmHg in males and 90, 88 and 84 mmHg in females, respectively (Fig. 6). With the JNC-4 criterion there were 1.6

of individuals with AH (Fig. 5). These low figures were caused by the lack of repeatability of DBP readings in the second determination, since 79

of the individuals with DBP > or = 90 mmHg on the first occasion were normotensive on the second one, whereas more than 95

of those being initially normotensive remained in that category on the second visit (Fig. 7). The FC did not show important changes (Fig. 8), and the percentage of individuals with systolic AH was low (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of nifedipine on cardiac chronotropism in conscious dogs]. / Acción de la nifedipina sobre el cronotropismo cardíaco en perros conscientes.

The effect of nifedipine (NIF) was studied in intact conscious dogs with and without autonomic blockade. Maximal decrease of systolic arterial pressure (delta P, in mmHg), maximal increase of heart rate (delta F, in beats/min), the ratio delta F/delta P, and the time elapsed between delta F and delta P (delta t) were measured after the acute administration of the drug. Two intravenous doses of NIF (50 and 150 micrograms/kg) were administered either alone or after sympathetic and parasympathetic blockade. Group Ia: 50 micrograms/kg of NIF alone. The delta F/delta P and delta T were 3.8 +/- 0.4 and 11.3 +/- 2.2 sec respectively. Group Ib: 150 micrograms/kg of NIF alone. The delta F/delta P and delta T were 2.4 +/- 0.2 and 15 +/- 3 sec respectively. Group IIa: 2 mg/kg of propranolol + 150 micrograms/kg of NIF. The delta F/delta P and delta T were 0.84 +/- 0.4 and 16 +/- 5 sec respectively. Group IIIa: 0.2 mg/kg of atropine + 2 mg/kg of propranolol + 50 micrograms/kg of NIF. In this group left systolic ventricular pressure decreased about 14 mmHg, but the heart rate (HR) was not modified. Group IIIb: 0.2 mg/kg of atropine + 2 mg/kg of propranolol + 150 micrograms/kg of NIF. In this group, left systolic ventricular pressure decreased about 18 mmHg but the HR was not modified. We conclude that acute administration of NIF decreases systolic ventricular pressure and increases HR. The reflex tachycardia is partially abolished by 2 mg/kg of propranolol, and completely abolished by sympathetic and parasympathetic blockade.(ABSTRACT TRUNCATED AT 250 WORDS)

Acción de la nifedipina sobre el cronotropismo cardíaco en perros conscientes. / [Effect of nifedipine on cardiac chronotropism in conscious dogs]

The effect of nifedipine (NIF) was studied in intact conscious dogs with and without autonomic blockade. Maximal decrease of systolic arterial pressure (delta P, in mmHg), maximal increase of heart rate (delta F, in beats/min), the ratio delta F/delta P, and the time elapsed between delta F and delta P (delta t) were measured after the acute administration of the drug. Two intravenous doses of NIF (50 and 150 micrograms/kg) were administered either alone or after sympathetic and parasympathetic blockade. Group Ia: 50 micrograms/kg of NIF alone. The delta F/delta P and delta T were 3.8 +/- 0.4 and 11.3 +/- 2.2 sec respectively. Group Ib: 150 micrograms/kg of NIF alone. The delta F/delta P and delta T were 2.4 +/- 0.2 and 15 +/- 3 sec respectively. Group IIa: 2 mg/kg of propranolol + 150 micrograms/kg of NIF. The delta F/delta P and delta T were 0.84 +/- 0.4 and 16 +/- 5 sec respectively. Group IIIa: 0.2 mg/kg of atropine + 2 mg/kg of propranolol + 50 micrograms/kg of NIF. In this group left systolic ventricular pressure decreased about 14 mmHg, but the heart rate (HR) was not modified. Group IIIb: 0.2 mg/kg of atropine + 2 mg/kg of propranolol + 150 micrograms/kg of NIF. In this group, left systolic ventricular pressure decreased about 18 mmHg but the HR was not modified. We conclude that acute administration of NIF decreases systolic ventricular pressure and increases HR. The reflex tachycardia is partially abolished by 2 mg/kg of propranolol, and completely abolished by sympathetic and parasympathetic blockade.(ABSTRACT TRUNCATED AT 250 WORDS)