Alicia Armentia

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.

Hypersensitivity to Generic Drugs with Soybean Oil

The authors report on two women who presented with anaphylaxis a few minutes after ingesting a generic omeprazole capsule. The generic drug that each of the women took contained approved soybean oil as an excipient.

Ingesta de antioxidantes y grasas en pacientes con asma polínica

Fundamento y objetivo: El objetivo de nuestro estudio fue evaluar la ingesta deX un grupo de pacientes asmaticos. Pacientes y metodo: Se incluyo a un total de 54 pacientes. La edad media (DE) fue de 23,59 (9,6) anos. A todos los pacientes se les determino el peso corporal, la talla y el indice de masa corporal, y se les realizo una encuesta nutricional. Resultados: La media (DE) de la ingesta calorica total fue de 1.571 (433) kcal/dia. La distribucion de calorias fue un 39,7% de hidratos de carbono, un 19,4% de proteinas y un 40,9% de lipidos, con una ingesta de acidos omega 9 poliinsaturados de 34,8 (12,7) g/dia, acidos grasos poliinsaturados omega 6 de 5,7 (3,1) g/dia y de acidos grasos poliinsaturados-omega 3 de 0,85 (0,31) g/dia. Las grasas saturadas representaron un 18,4%. El cociente omega 6/omega 3 se situo en 6,63. Existio una baja ingesta de vitaminas A, D, E, tiamina y acido folico, y fue elevada la ingesta de vitaminas K, C, niacina y B12. Se detecto un aumento de la ingesta de calcio, con un claro deficit en la ingesta de magnesio, zinc, yodo y selenio. Conclusiones: Los pacientes asmaticos presentan un deficit en la ingesta de vitaminas A y E, asi como un incremento en el consumo de grasas saturadas.

Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery

BACKGROUND Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. OBJECTIVES To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. METHODS Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. RESULTS We studied 203 patients, with mean age 35.1±17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p<0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. CONCLUSIONS Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids.

Value of microarray allergen assay in the management of eosinophilic oesophagitis

BACKGROUND Eosinophilic oesophagitis (EoE) is a disorder characterised by oesophageal dysfunction and, histologically, by eosinophilic inflammation. Although treatment, which includes dilatations, oral corticosteroids and restrictive diets, is often effective, choosing the foods to be eliminated from the diet is difficult. OBJECTIVE Component resolved diagnostic by microarray allergen assay may be useful in detecting allergens that might be involved in the inflammatory process. METHODS We studied 67 patients with EoE, diagnosed clinically and histologically by endoscopic biopsy. CRD analysis with microarray technology was carried out in the 67 EoE patients, 50 patients with pollen allergy without digestive symptoms, and 50 healthy controls. RESULTS Allergies were not detected by microarray in only seven of the 67 patients with EoE. Controls with pollen allergy showed sensitisation to different groups of pollen proteins without significant differences. In EoE patients with response to some allergens, the predominant allergens were grasses group 1 and, in particular, nCyn d 1 (Cynodon dactylon) or Bermuda grass pollen in 59.5%, followed by lipid transfer proteins (LTP) of peach (19.40%), hazelnut (17.91%) and Artemisia (19.40%). CONCLUSIONS In patients with EoE, sensitisation to plant foods and pollen is important. The proteins most frequently involved are nCyn d 1 and lipid transfer proteins, hazelnuts and walnuts. After one year of an array-guided exclusion diet and pollen-specific immunotherapy in the case of high levels of response, patients with EoE showed preliminary significant improvements.

A useful method to detect opioid allergies

Department of Paediatric Allergy & Immunology, Royal Manchester Children’s Hospita1, University of Manchester, Manchester, United Kingdom Department of Immunology (Honorary Consultant), University of Manchester, Manchester, United Kingdom University of Manchester, Manchester, United Kingdom This study was funded by the Anaphylaxis Campaign, UK. Meda Pharmaceuticals Ltd, ALK-Abello, Lincoln Medical, and iMed donated the autoinjectors used in this study. Hampshire piglets were a gift of Ms M. Shah, University of Manchester. Conflicts of interest: R. S. Pumphrey is on the Clinical and Scientific Panel of the Anaphylaxis Campaign. R. S. Pumphrey, V. Sharma, and P. D. Arkwright have previously received funding to attend scientific conferences from Meda Pharmaceuticals Ltd, ALK-Abello, Lincoln Medical, and iMed. D. Diacono has received research support from the Anaphylaxis Campaign. R. S. Pumphrey has received travel grants from iMed Systems and Lincoln Medical; has received fees for a device review from Meda; has provided expert testimony for HM Coroners; and has received lecture fees from NHS Hospitals. V. Sharma has received travel grants from ALK-Abello and Meda. P. D. Arkwright has received travel grants from iMed Systems, ALK. Received for publication May 17, 2015; accepted for publication May 22, 2015. Corresponding author: Peter D. Arkwright, FRCPCH, PhD, Royal Manchester Children’s Hospital, University of Manchester, Oxford Rd, Manchester M13 0WL, United Kingdom. E-mail: peter.arkwright@nhs.net. 2213-2198 2015 American Academy of Allergy, Asthma & Immunology http://dx.doi.org/10.1016/j.jaip.2015.05.025

Component-resolved diagnostics in vernal conjunctivitis

BACKGROUND Conventional diagnostic tests in allergy are insufficient to clarify the origin of vernal conjunctivitis (VC). OBJECTIVES To evaluate IgE-mediated hypersensitivity by component-resolved diagnosis (CRD) in tears and serum from patients with VC and to evaluate how to treat patients with identified triggering allergens by specific immunotherapy. METHODS Patients were divided into 3 groups: (1) patients with VC (25 patients), (2) patients allergic to grass pollen with seasonal allergic conjunctivitis (AC) (50 patients), and (3) healthy blood donors (50 patients). If triggering allergens were detected, specific conventional immunotherapy was administered for 1 year. RESULTS Twenty-five patients with VC were evaluated. The identified triggering allergens were n Lol p 1 (11 patients), n Cyn d 1 (8 patients), group 4 and 6 grasses (6 patients), and group 5 grasses (5 patients). Prick test and pollen IgE test results were positive in one patient. Clinical improvement was observed in 13 of the 25 patients with VC after 1 year of specific immunotherapy. CONCLUSION CRD seems to be a more sensitive diagnostic tool compared with prick test and IgE detection. Specific CRD-led immunotherapy may achieve clinical improvements in patients with VC.

Clinical significance of cross-reactivity between tobacco and latex.

BACKGROUND Allergen cross-reactivity between tobacco and other species of Solanaceae family (tomato, potato, aubergine and egg plant) have been reported. We have recently studied IgE response to tobacco in asthmatic patients sensitised to Lolium perenne (Perennial rye grass pollen) and have found that 30% of the tobacco responsive patients also have latex sensitisation. OBJECTIVE The aim of our study was to investigate the possibility of cross-reactivity between tobacco and latex in asthmatic patients with IgE response to latex. METHODS A study was performed on tobacco and latex exposure in 15 patients who suffered from asthma and latex sensitisation and who were randomly chosen from our database of latex-sensitive patients. To identify tobacco and latex as possible allergens that might cause clinical specific responses, all these patients were tested with prick-tests, specific IgE to tobacco, latex and related allergens, bronchial challenge, and patch tests with tobacco, latex and nicotine. Immunological response was evaluated with immunoblotting, immunoblotting-inhibition and EAST-inhibition tests. RESULTS Positive prick and bronchial challenge with specific IgE>0.35 kU/L to tobacco was demonstrated in 11 asthmatics who were also sensitised to rye grass. Tobacco IgE level was related with sensitisation to latex (p<0.002), but not to other vegetables belonging to the Solanaceae family. EAST-inhibition and immunoblotting-inhibition showed the existence of cross-reactivity between tobacco and latex. CONCLUSIONS Cross-reactivity exists between latex and tobacco allergens. Smoker patients with IgE response to tobacco may be a risk population for latex sensitisation.

Estudio de la influencia del consumo de lácteos fermentados en una población de pacientes alérgicos

Fundamento: La prevalencia de enfermedades alergicas ha aumentado en las ultimas decadas en los paises desarrollados, por lo que se estan ensayando nuevas alternativas terapeuticas. Los efectos beneficiosos de los probioticos han sido descritos en algunas patologias, especialmente en las diarreas, ciertos tumores y la sintomatologia de la alergia, por lo que estan adquiriendo una gran importancia por las aplicaciones en el manejo preventivo y terapeutico de esta patologia. El objetivo de nuestro estudio fue describir la situacion nutricional y la influencia de la ingesta de productos lacteos fermentados en una poblacion de pacientes alergicos. Pacientes y metodos: Se seleccionaron 44 pacientes alergicos, se les tomo los siguientes datos: edad, sexo, lugar de residencia; se les realizo una valoracion antropometlica y una encuesta nutricional de 7 dias, asi como la determinacion de variables aiergicas (rash cutaneo, niveles sericos de IgE y numero de crisis al ano). Resultados: Dieciocho pacientes (40,9%) eran mujeres y 26 (59,1%) varones con una media de edad de 24,5 (10,3) anos. La mayoria de los pacientes (20,5%) se encuentra en el P25-50 tanto para el pliegue tricipital, como circunferencia del brazo y circunferencia muscular del brazo lo que indica que mantienen dentro de la normalidad los compartimentos graso y proteico muscular. Con respecto al consumo de lacteos fermentados, 16 pacientes consumian estos productos habitualmente (27,1%), con una media de tomas a la semana de 1,79 (3,16) y una cantidad total a la semana de (mg-ml) (593,4 (461,9). Con respecto a las variables alergicas, el numero de crisis/ano fue de 1,44 (1,8), los valores medios de IgE sericos fueron de 35,68 (3 1,93) UI/L y con un valor medio del rash cutaneo de 10,09 (2,8) mm. Los pacientes que consumian mas de 593 mg/semana de lacteos fermentados presentaban menor diametro en el rash cutaneo [10,12 (0,8) mm vs 8,85 (1,1) mm; p < 0,05], sin encontrar diferencias en el resto de variables alergicas. Conclusion: El consumo de lacteos fermentados en pacientes alergicos puede ser beneficioso, disminuyendo determinados marcadores alergicos. No obstante, son necesarios estudios con mayor numero de pacientes y de intervencion para evaluar esta influencia sobre variables clinicas de mayor relevancia.

Cocaine Allergy in Drug-Dependent Patients and Allergic People

BACKGROUND Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine. OBJECTIVE To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation. METHODS We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard. RESULTS After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy. CONCLUSIONS Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.