Elisa Gómez

Anaphylaxis to omeprazole

BACKGROUND Omeprazole is a non-competitive inhibitor of the parietal cell enzyme H+-K--adenosine triphosphatase. To date, two cases of angioedema and urticaria and two cases of anaphylaxis from omeprazole have been published. OBJECTIVE To report a new patient with omeprazole-induced anaphylaxis demonstrated by skin tests and increased serum tryptase levels. METHODS AND RESULTS Elevated serum tryptase levels (5.1 U/L) were detected 6 hours after the onset of the anaphylaxis. Skin intradermal tests were positive with omeprazole i.v. (4 mg/mL), omeprazole capsules diluted in saline serum (20 mg/ mL), and lansoprazole (30 mg/mL). Serum specific IgE anti-omeprazole was negative. CONCLUSIONS According to the elevated serum tryptase levels and the positive skin test results, anaphylaxis was due to use of omeprazole. We think the adverse reaction to omeprazole was induced by an IgE-mediated hypersensitivity mechanism to omeprazole itself and not to a metabolite. We have also demonstrated crossreactivity, at least by skin tests, between omeprazole and lansoprazole.

Allergy to linden pollen (Tilia cordata)

. ALLERGY to linden pollen (the most common species is Tilia cordata) has not been previously documented. We present the case of a pollinic patient sensitized to linden pollen. A 21-year-old woman was diagnosed 10 years ago as having rhinoconjunctivitis and asthma caused by olive and grass pollen. After 6 years of specific immunotherapy, she experienced clinical improvement. However, every June, during the last 4 years, she reported nasal, ocular, palatine, ear, and pharynx pruritus; conjunctival hyperemia; sneezing; and night cough. She related it to the flowering of a linden tree near her house. She was asymptomatic in June when she was away from home. Her white cell count and differential blood count were normal. The total IgE (Pharmacia CAP) was 334 kUA/l. The skin prick test (SPT) to extract of T. cordata pollen (5% w/v) was positive (11317 mm). SPT was also positive to A specific linden-pollen allergen of ,50 kDa has been detected.

Mercurochrome allergy. Immediate and delayed hypersensitivity.

We describe eight patients suffering from Mercurochrome allergy. Patch and prick tests were carried out with the following organic and inorganic mercury compounds: thimerosal, Mercurochrome, phenylmercuric acetate, phenylmercuric nitrate, metallic mercury, and mercuric chloride, and with sodium fluorescein. Two patients had an anaphylactic reaction a few minutes after application of Mercurochrome. The prick tests with Mercurochrome were positive and they were negative with the other tested products. All patch tests were negative. In the other six patients, the clinical picture was local eczema, and the patch tests were all positive with Mercurochrome and the inorganic mercuric derivatives. Positive patch tests with thimerosal were found only in two patients, and only one had a positive patch test with salts of phenylmercury. In four patients, the prick test with Mercurochrome, negative in immediate reading, gave a late eczematous reaction.

A new arthropod panallergen

existence of cross-reactivity amongarthropod groups, such as mites,mosquitoes, and even crustaceans, is wellestablished, andtropomyosin, aprotein of about37 kDa, may bethe panallergenresponsible for this cross-reactivity (1–3).We detected a 25-kDa protein in a patient’sserum which showed elevated levels ofA 25-kDa allergenaccounts for muchcross-reactivity.cytokine, IFN-c, suggesting that productionof eotaxin is associated with a Th2-dominant state. Thus, both production ofeotaxin in the lesions and blood eosinophiliamay be coregulated by Th2-dominant statesunderlying the pathogenesis of AD. Incontrast, RANTES production isindependent of the Th2-dominant state.Recently, a functional mutation in thepromoter of RANTES has been reported tobe associated with AD (5). Although wehave not analyzed the promoter in ourpatients, the varied levels of RANTES in thescales may derive from this polymorphism.Acknowledgment This study was sup-ported by a Grant-in-Aid for ScientificResearch (C) (no. 12670822) from theMinistry of Education, Science, Sports, andCulture of Japan.*Department of DermatologyHiroshima UniversityFaculty of MedicineKasumi 1-2-3Minami-kuHiroshima 734-8551JapanTel. +82-257-5236Fax: +82-257-5237E-mail: emorita@hiroshima-u.ac.jp

Allergen immunotherapy decreases LPS-induced NF-κB activation in neutrophils from allergic patients

Allergen‐specific immunotherapy (IT) is widely used to treat allergic diseases. The molecular mechanisms have not been clarified yet completely. The present work was undertaken to analyze the effect of IT in the activation of NF‐κB.

Rhinoconjunctivitis and asthma caused by vine pollen: A case report

BACKGROUND The vine (Vitis vinifera) is a cultivated plant that is found in some European and American countries. Its pollen gathers in small quantities during a short pollination period in the months of May and June. Allergy to vine pollen has not been previously documented. OBJECTIVE We sought to describe a case report of allergy to vine pollen documented on the basis of anamnesis, cutaneous, provocation, and specific IgE determination tests. METHODS An allergenic extract was obtained from collected V vinifera pollens by aqueous standard procedures. Pollen counts and pollination periods of this and other common pollens in the area where the patient became symptomatic were studied. Cutaneous tests and the presence of specific IgE to the pollen extracts were performed by prick, CAP, and RAST techniques. Bronchial and conjunctival tests with the involved pollen extracts were also carried out to identify the sensitizing allergens. Five healthy subjects and 5 pollinic patients were used as control subjects and underwent the same tests. RESULTS Skin prick test responses with vine pollen at different concentrations were positive for the studied patient and negative for the control subjects. Patient serum revealed a total IgE titer of 334 IU/mL and a specific IgE value of 1.3 PRU/mL (RAST class 2) to vine pollen. Bronchial and conjunctival provocation test responses were also positive when the patient was challenged with V vinifera extract. CONCLUSION Exposure to the pollen of the vineyard plants (V vinifera) can induce immunologic sensitization and rhinoconjunctivitis/asthma.

Anaphylaxis from Brazil nut

. We describe the case of an 11-month-old girl who had had a cough since the age of 3 months. The cough progressively increased in severity and became more nagging during the night, causing frequent awakenings. She was treated without bene®t by her family doctor with antitussives, antibiotics, and ®nally homeopathic remedies. The past clinical history revealed the presence of seborrheic dermatitis on the scalp and diaper dermatitis. No recurrent vomiting or regurgitation was recorded. From birth, she had used a rubber paci®er, especially during sleep. Her mother suffered from seasonal allergic rhinitis due to Gramineae. Skin prick tests (SPT) in the infant with the common aeroallergens and foods were negative. SPT to natural rubber latex (NRL) with a commercial allergen (Lofarma S.p.A., Milan, Italy) produced a wheal twice the diameter of the histamine wheal. The total IgE (PRIST, Pharmacia, Uppsala, Sweden) was 18.4 kU/l. Speci®c IgE (CAP-RAST, Pharmacia) was positive for NRL (0.48 kU/l, class 1). Speci®c IgE for foods such as banana, apple, chestnut, kiwi, and avocado, which may cross-react with NRL, was absent. When the rubber paci®er was replaced with a silicon one, the cough disappeared. When the infant 6. Hershey GKK, Friedrich MF, Esswein LA, Thomas ML, Chatila TA. The association of atopy with a gain-of-function mutation in the a subunit of the interleukin-4 receptor. N Engl J Med 1997;337:1720±1725. 7. Nogichi E, Shibasaki M, Arinami T. et al. Lack of association of atopy/asthma and the interleukin-4 receptor a gene in Japanese. Clin Exp Allergy 1999;29:228±233. was assessed 3 months later, she was well without any treatment. The clinical history, SPT, and RAST led us to the diagnosis of NRL allergy with upper respiratory tract involvement. Wrangsjo et al. (1) found two adults, with SPT and RAST positive for Hevea brasiliensis, who reacted to extracts of rubber teats or paci®ers, and asked whether their use may represent a NRL sensitization risk for infants. In a series of 326 allergic outpatient children, Novembre et al. (2) found 10 children with NRL-positive SPT. Among them, the frequency of use of rubber teats or paci®ers was comparable to that of atopic latex-SPTnegative children or nonatopic children. They concluded that their use does not affect sensitization to latex. Recently, Niggemann et al. (3) made a retrospective analysis of the risk of latex allergy development in a population of 5-year-old children. Among 149 atopic children, sensitization to latex (cutoff: speci®c IgE .0.35 kU/l) was found in 20 (13.4%). The researchers were unable to discover relevant lifestyle factors inducing sensitization such as cross-reacting foods, the composition of mattresses, and the use of paci®ers. Retrospective study of the sera of 13/ 20 sensitized children showed that none of them had detectable speci®c IgE at the age of 1 year. Sensitization started around the second year of life, but most of the children appeared to be sensitized when between 3 and 5 years of age. Even in a population of 21 children affected by spina bi®da, the youngest patient in whom sensitization was demonstrable was 14 months old (4). Our case shows that very early latex sensitization with associated symptoms is possible and that rubber dummies or paci®ers may provoke it. Finally, we would recommend the assessment of eventual NRL sensitization in infants with persistent cough if they use rubber teats or paci®ers.

Occupational rhinoconjunctivitis and asthma in a wool worker caused by Dermestidae spp.

Background: The family Dermestidae belongs to the order Coleoptera. Occupational allergy has been described in museum personnel. A 31‐year‐old male wool worker presenting rhinoconjunctivitis and asthma episodes probably linked to exposure to Dermestidae‐infected wool was investigated.

Decompensation of pollen-induced asthma in two towns with different pollution levels in La Mancha, Spain.

Background Allergic diseases have increased in industrialized countries and this increase is associated not only with genetic factors but also with lifestyle and environmental factors such as air pollution. Our hypothesis was that asthma in pollen‐allergic patients from two towns with very different pollution levels in La Mancha (Spain) could be affected to a very different degree.

Delayed skin reactions to metamizol

1. Allergic reactions, usually anaphylaxis and urticaria/angioedema, probably due to an IgE-mediated mechanism. In these cases, patients tolerate different nonsteroidal antiinflammatory drugs (NSAIDs). 2. Nonallergic NSAID hypersensitivity (3) (NSAID intolerance), probably via cyclooxygenase inhibition, leading to an overproduction of leukotrienes. NSAIDs can precipitate asthma attacks and/or urticaria or angioedema. 3. Severe skin and/or mucosal reactions, such as Stevens–Johnson syndrome, toxic epidermal necrolysis, fixed drug eruption, and contact dermatitis. Probably a cell-mediated mechanism is implicated. 4. Other clinical syndromes, such as agranulocytosis, thrombocytopenia, and vasculitis whose mechanism is unknown.