[Prospective epidemiologic study of perioperative anaphylactoid reactions occurring in Catalonia (1996-7)]. / Estudio epidemiológico prospectivo de las reacciones anafilactoides perioperatorias ocurridas en Cataluña (1996-97).

OBJECTIVES: To determine the incidence, immunological mechanisms, severity and clinical course of perioperative allergic reactions. PATIENTS AND METHODS: Prospective epidemiological study lasting 2 years (1996-97). In 20 hospitals in Catalonia (Spain), we studied patients who suffered allergic reactions equal to or greater than grade Ib according to the classification of Laxenaire. Serum and urine samples were collected during the first and sixth hours after the onset of a reaction. Complement factors, total serum and latex-specific serum IgE antibodies, hemostatic markers, serum tryptase and urinary methylhistamine were assayed. Tests for allergy to the drugs used during the perioperative period were performed on all patients who consented. RESULTS: Anesthetic procedures were performed 328,430 times in the 20 hospitals. Thirty-two allergic reactions were reported (1 case/10,263 anesthesias); the frequency was greater during general anesthesia (1 case/6,978 anesthesias). Women suffered 58.3% of the reactions, and the mean patient age was 47.8 +/- 16.5 years. Fifty-six percent of the reactions were severe (grades III-IV), and 68.7% occurred upon immediate exposure. Induction was the moment of greatest risk (50%). Treatment was required by 90.6% of the patients, but no deaths or serious sequelae occurred. Complete analyses could be carried out immediately for 25 patients. High urinary methylhistamine and/or serum tryptase levels were found for 57% of the patients with grade Ib reactions, for 80% of those with grade II reactions, and for 91.7% of those with grade III reactions (p = 0.05). High serum tryptase levels were the only findings for 53.8% of the grade III reactions (p = 0.007). Skin tests were positive for 62.5% of the patients. CONCLUSIONS: The frequency of allergic reactions in Catalonia is 1 case per 10,263 anesthesias performed, but the rate is higher in general anesthesia. Fifty-six percent of the reactions were severe. Most developed immediately and the moment of induction involved the greatest risk. Early assessment of methylhistamine and tryptase levels has been shown to be useful and positivity is linearly associated with severity of reaction. In 62.5% of the patients, positive results were seen in skin tests performed later.

Dermato-respiratory allergy induced by a marine worm (Marphysa sanguinea) used as fishing bait.

A case of rhinitis, asthma, and angioedema in a fisherman from the Mediterranean coast who used marine worm (Marphysa sanguinea) as fishing bait is described. Skin tests, nasal challenge, levels of specific IgE antibodies, and histamine release test showed that this cutaneous and respiratory response was induced by allergens of the Marphysa sanguinea.

Diagnosis of allergy to peach. A comparative study of "in vivo" and "in vitro" techniques.

In our particular Mediterranean region, extensive plantations of peach trees (prunus persica) give rise to processes of peach hypersensitivity. This datum together with the scarcity of literature and the use of disparate methods of diagnosis prompted us to select the peach as an example of hypersensitivity to a fruit, and to examine the clinical symptoms, skin tests, specific IgE antibodies (RASTR) and histamine release in a group of 25 patients with peach allergy. The results showed a good concordance between clinical history and skin tests (78%) and between RASTR (82%) and histamine release (74%) when comparison was made with the clinical history. The concordance between skin tests and RASTR histamine release was 94%. On the application of a statistical study to the different data collected, and on analysing all the concordances and possible combinations between "in vivo" and "in vitro" tests, the skin tests were not found to be superior to the RASTR (p less than 0.001) or to the histamine release test (p less than 0.001), in terms of peach allergy diagnosis. Both the RASTR and the histamine release test were found to be equally valid (p less than 0.001) in "in vitro" peach diagnosis. These findings demonstrate the perfect and complete diagnosis of peach allergy with the methodology used.

[The histamine liberation test as a diagnostic parameter and its possible modification following specific immunotherapy]. / El test de liberación de histamina como parámetro diagnóstico y su posible modificación post inmunoterapia específica.

It is generally accepted that the allergic reaction depends on the levels of specific IgE, on the concentration of blocking antibodies and on the capacity of the basophils to release mediators. The fact that in the histamine release test (HRT) all of the elements intervening in an allergic reaction (antigens, IgE, basophils and mononuclear cells of a lymphoid origin) have been found, has led some authors to consider it as the most suitable method of "in vitro" diagnosis. This is a reflection of what biologically occurs "in vivo". Furthermore, the HRT can be used as a control parameter following immunotherapy, permitting us not only to quantify the level of blocking antibodies but also to study the possible presence of a control mechanism of histamine release. Accordingly, in a group of 50 patients with extrinsic asthma we carried out a HRT, skin tests (prick test) and Rast with house dust, Dermatophagoides pteronyssinus and Dermatophagoides farinae. In another group comprising 74 subjects with extrinsic allergic asthma (45 with perennial allergic rhinitis) we performed a HRT with aeroallergens. This group was subjected to immunotherapy (dust with mites) for a year. Following this treatment another HRT was carried out with house dust, Dermatophagoides pteronyssinus and Dermatophagoides farinae. With regard to our results in the first group we obtained 80% agreement in the HRT/prick test/Rast for house dust and Dermatophagoides pteronyssinus and 78% agreement for Dermatophagoides farinae.(ABSTRACT TRUNCATED AT 250 WORDS)

T cell subsets in allergic respiratory disease using monoclonal antibodies.

Fifty patients with perennial allergic rhinitis and extrinsic allergic asthma were studied to determine the relative percentages of OKT3+, OKT4+ and OKT8+ cells as well as the OKT4+/OKT8+ ratios. The percentages of the OKT3+ cells (66 +/- 7) were reduced when compared with those of 50 healthy controls (72 +/- 6), (p less than 0.001). The mean values and deviations of the OKT4 marker produced no statistically significant differences between the patient group (44 +/- 6) and the control group (44 +/- 6). A reduction in the OKT8+ marker in the patient group was registered (20 +/- 6), (p less than 0.001). The OKT4+/OKT8+ ratio was, as a result, raised in the patient group (2.3 +/- 0.6) in relation to the control group (1.6 +/- 0.3). The reduction in the OKT3+ cells together with the imbalance in the subset inducer-helper/cytotoxic-suppressor in allergic respiratory disease could lead to non-regulation of B cells and to hyperproduction of IgE.