RESUMO
The case of a woman with a serious anaphylactic pattern during menstruation is described. The patient had a clinical picture of urticaria, angioedema and shock at each menstruation for a period of 2 years until hysterectomy was performed. The studies showed no hormonal or immunological change. The only relevant finding was the extraordinarily strong vasodilating action of the menstrual fluid in the patient, and not in the controls. The results of the study suggest the possibility of two mechanisms: 1) an IgE-mediated mechanism causing hypersensitivity to some metabolic substance in the menstrual fluid and 2) an excessive pharmacological vasodilatory action produced by the prostacyclin in the fluid itself.
Assuntos
Anafilaxia/etiologia , Líquidos Corporais/imunologia , Menstruação , Adulto , Anafilaxia/imunologia , Anafilaxia/prevenção & controle , Líquidos Corporais/análise , Epoprostenol/fisiologia , Feminino , Humanos , Histerectomia , Imunoglobulina E/imunologia , Menorragia/complicações , Teste de Radioalergoadsorção , Urticária/etiologia , Urticária/imunologia , VasodilataçãoAssuntos
Aspirina/efeitos adversos , Asma/induzido quimicamente , Glafenina/uso terapêutico , Ácido Mefenâmico/uso terapêutico , Pirazóis/uso terapêutico , ortoaminobenzoatos/uso terapêutico , Aspirina/imunologia , Reações Cruzadas , Dessensibilização Imunológica , Tolerância a Medicamentos , Feminino , Glafenina/imunologia , Humanos , Masculino , Ácido Mefenâmico/imunologia , Pirazóis/imunologiaAssuntos
Imunoglobulina E/análise , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Espanha , Estatística como AssuntoRESUMO
Serum samples from eighty-one patients with suspected penicillin allergy were investigated with Phadebas RAST using the penicillin derivatives Benzylpenicilloyl-human serum albumin (PBO-HSA) and Phenoxymethylpenicilloyl-human serum albumin (PMPO-HSA) and the results were compared with skin test results and clinical data. Of the sixty-one patients who had anaphylactic shock and/or urticaria as a possible consequence of penicillin administration, reagins against PBO-HAS and PMPO-HSA could be detected in thirty-four cases (56%). Five per cent of these patients, with positive RAST results, showed negative skin tests; in the other 95% both RAST and skin tests were positive. All, except eight, of the RAST-negative patients had had their adverse reactions at least 2 years prior to the blood sampling and in some of these cases skin tests were also negative. RAST and provocation test results agreed in 80% of the cases where exposition was performed. It is concluded that the RAST technique is a valuable diagnostic tool for the detection of immediate type hypersensitivity to penicillin.
Assuntos
Imunoglobulina E/biossíntese , Penicilinas/imunologia , Anafilaxia/imunologia , Especificidade de Anticorpos , Humanos , Penicilina G/imunologia , Penicilina V/imunologia , Teste de Radioalergoadsorção , Testes Cutâneos , Urticária/imunologiaRESUMO
In a patient with a past history of allergy to penicillin and requiring treatment, skin tests with penicillin and penicilloyl-polylysine (PPL) were positive, and a penicilloyl RAST was strongly positive, although the Prausnitz-Küstner test to penicillin and PPL were negative. The haptin BPO-Flys was administered together with penicillin to try to prevent reactions. An anaphylactic reaction occurred on the fifth day, and treatment was stopped. Serum total IgE values increased markedly after the reaction and PK titres to penicillin and PPL reached values of 1/256. The skin test reaction to PPL was negative the day after the clinical reaction, but became strongly positive again a few days later. The penicilloyl RAST remained strongly positive throughout. The authors consider that there was hypersensitivity to a penicillin metabolite other than the penicilloyl group, e.g. to minor determinants, and for this reason the hapten inhibitor failed.
Assuntos
Compostos de Benzil/uso terapêutico , Hipersensibilidade a Drogas/tratamento farmacológico , Haptenos , Idoso , Feminino , Humanos , Penicilina G/efeitos adversos , Teste de Radioalergoadsorção , Testes CutâneosAssuntos
Cromolina Sódica/uso terapêutico , Hipersensibilidade Alimentar/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Criança , Ensaios Clínicos como Assunto , Cromolina Sódica/administração & dosagem , Método Duplo-Cego , Avaliação de Medicamentos , Feminino , Hipersensibilidade Alimentar/imunologia , Humanos , Imunoglobulina E/análise , Masculino , Pessoa de Meia-Idade , Placebos , Teste de Radioalergoadsorção , Testes CutâneosRESUMO
Seventeen patients with aspirin-induced asthma were studied, the majority being intolerant to more than one analgesic. In addition to asthma, eleven patients had sinusitis and eight had nasal polyps. Serum IgE levels were normal with a mean of 295 iu/ml. However, some patients had positive cutaneous and PK tests against inhalants and non-analgesic drugs. Spirometry showed the bronchial obstruction to be mild. However, all patients were hyper-reactive to acetylcholine. Oral provocation tests with aspirin alone and also with the prior administration of sodium cromoglycate (SCG) by inhalation were performed and the results assessed by spirometry and clinical examination. The results suggest that the obstruction is probably due to oedema of the bronchial mucosa together with pulmonary congestion rather than a simple spasm of the bronchi. SCG was found to prevent significantly the ventilatory obstruction induced by aspirin. It is suggested that non-immunological factors are responsible for the asthma and that SCG may have an effect on the altered receptors protecting them from the action of aspirin on kinins.
