Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputum induction and bronchial hyperreactivity assessment.

Eosinophilic asthma phenotype predicts good response to corticosteroids and associates to asthmatic exacerbations. Sputum induction by hypertonic saline (HS) inhalation is technically demanding. Bronchial hyperresponsiveness (BHR) to osmotic agents indirectly mirrors active airway inflammation. We compared the safety and ability of HS and mannitol to induce sputum and measure BHR. We evaluated the stability of inflammatory phenotypes. We studied 35 non-smoking asthmatics randomized to undergo HS and mannitol challenges on 2 days 1 week apart. Sputum was sampled for cell analysis and phenotyped as eosinophilic (≥3% eosinophils) and non-eosinophilic (<3%) asthma. Nineteen subjects had BHR to mannitol and nine of them also had BHR to HS. Drops in forced expiratory volume in 1 s were higher from HS challenge than from mannitol challenge. Adequate sputum samples were obtained from 80% subjects (68% mannitol and 71% HS). Eosinophils and macrophages from both challenges correlated. Neutrophils were higher in sputum from HS. Ninety percent samples were equally phenotyped with HS and mannitol. Fractional exhaled nitric oxide, sputum eosinophils and BHR correlated in both challenges. HS and mannitol showed similar capacity to produce valuable sputum samples. BHR to both osmotic stimuli partially resembled airway eosinophilic inflammation but mannitol was more sensitive than HS to assess BHR. Eosinophilic phenotype remained stable in most patients with both stimuli.

[Allergy to asparagus]. / Alergia al espárrago.

Asparagus (Asparagus officinalis) is a widely grown vegetable; together with garlic, the onion and the leek, it belongs to the Liliaceae family. Both delayed cell-mediated reactions and IgE-mediated reactions secondary to asparagus have been described. While the former (allergic contact dermatitis) are a fairly common cause of occupational disease, only a few case-reports of IgE-mediated reactions have been published. IgE-mediated reactions can be further grouped into food allergy and reactions due to cutaneous or respiratory exposure, which is often occupational. Anaphylaxis is the most common clinical picture of food allergy, while contact urticaria, rhinitis and asthma, appearing either isolated or associated, are clinical pictures of the latter. Sensitization to different allergens is the likely cause of the different clinical pictures due to asparagus. Their detection and early diagnosis is of prime importance due to the different prognosis and treatment. In the present article we resume our experience over the last 5 years.