Joaquín Quiralte

Intolerance to nonsteroidal antiinflammatory drugs: Results of controlled drug challenges in 98 patients

BACKGROUND Controlled oral challenge is the only definitive way to detect the different clinical manifestations of intolerance to nonsteroidal antiinflammatory drugs (NSAIDs). OBJECTIVE This study was carried out to describe the clinical manifestations of drug challenges in a population with histories of intolerance to NSAIDs. METHODS Two-hundred forty subjects were included in a single-blind, placebo-controlled drug challenge protocol. RESULTS Eighty patients exhibited a positive response to drug challenge: 52 had isolated periorbital angioedema, 13 had cutaneous rashes, eight had bronchial asthma (7 with associated periorbital angioedema), three had nasoocular reactions, and four had systemic anaphylaxis. In another 18 patients who were referred for treatment because of a reaction suggesting systemic anaphylaxis, the implicated drug was not given, but tolerance to other NSAIDs was found. The mean age of patients with isolated periorbital angioedema was significantly lower (p < 0.001) than that of the other groups of NSAID reactors. A significant increase (p < 0.001) in atopy was found among patients with isolated periorbital angioedema (100%) in comparison with other patients with NSAID intolerance (45.6%). NSAID cross-reactivity was a common finding, but cross-reactivity was not found in two cases of periorbital angioedema, one case of urticaria, one case of bronchial asthma, and 18 cases of systemic anaphylaxis. CONCLUSION In atopic subjects, isolated periorbital angioedema constitutes the most frequent manifestation of NSAID intolerance. Such patients are younger than other NSAID reactors and commonly have intolerance to several NSAIDs.

High Levels of Olea europaea Pollen and Relation with Clinical Findings

Background: Olea europaea pollen is an important cause of seasonal allergic rhinitis and bronchial asthma in southern Spain. For patients allergic to grass pol– len the critical concentration of airborn pollen is 50 grains/m3, but in the case of Olea pollinosis no data is available. Methods: Fifty–six seasonal allergic rhinitis patients (29 in 1994 and 27 in 1995) were included in this study, all of whom lived in Jaen. Daily symptom card were filled in and pollen counts during May and June were performed in both years. A linear regression model was used for analysis of the airborne pollen concentration and the symptom score. Results: Significant correlations among daily counts of Olea pollen and rhinitis symptoms were obtained. Most of our monosensitized patients needed a high Olea pollen concentration in the atmosphere (around 400 grains/m3) to suffer at least from mild allergic rhinitis symptoms. Conclusion: Local conditions with a wide area dedicated to olive tree cultivars result in a high concentration of this pollen in the atmosphere. Monosensitized Olea patients in our area seem to need exceptionally high levels to suffer from allergic symptoms.

Prevalence of latex allergy among greenhouse workers

ment regimens do not prevent this complication, and because it may recur, this case would not support the use of nonionic low contrast medium as a preventive measure for subsequent needed procedures. Although rare, acute pulmonary edema after administration of radiographic contrast media is potentially life-threatening. Ticeatment must be directed toward diuresis and the maintenance of adequate gas exchange. Acute pulmonary edema taust not be confused with the more typical bronchospastic ana, phylactoid reaction in order to avoid delay in starting appropriate therapy. ~ s case reinforces the need for a high index of suspicion for this problem in any patient experieneing acute dyspnea after a radiologic procedure with any of the eurrently available contrast media,

A Major Allergen from Pollen Defines a Novel Family of Plant Proteins and Shows Intra- and Interspecie Cross-Reactivity

Olive tree (Olea europaea) pollen is a main cause of allergy associated with extensive areas of Europe and North America. Ole e 10, a small (10.8 kDa) and acidic (pI 5.8) protein, has been identified as a major allergen from the olive pollen, isolated, and characterized. Circular dichroism analysis gave 17% α helix, 33% β sheet, and 21% β turn for its secondary structure. Based on amino acid sequences of tryptic peptides, the protein was cloned and sequenced. The allergen consists of a single polypeptide chain of 102 aa, with a signal peptide of 21 residues. Ole e 10 showed homology with the C-terminal domain of another olive allergen, Ole e 9 (1,3-β-glucanase, 53% identity), with deduced sequences from Arabidopsis thaliana genes (42–46% identity) and with polypeptide segments (Cys boxes) of proteins involved in yeast development (Epd1/Gas-1p/Phr2 families; 42–43% similarity). Ole e 10 showed 55% prevalence for olive-allergic patients and exhibited an IgE response dependent on its conformation. Remarkable IgE cross-reactivity was detected with Ole e 9, but no correlation was observed between the individual IgE responses to both allergens. Ole e 10 shares IgE B cell epitopes with proteins from Oleaceae, Gramineae, Betulaceae, Chenopodiaceae, Cupressaceae, Ambrosia, and Parietaria pollens, latex, and vegetable foods, such as tomato, kiwi, potato, and peach. These data indicate that Ole e 10 is a new pan-allergenic plant protein that shows notable intra- and interspecie IgE cross-reactivity and is a powerful candidate to be involved in pollen-latex-fruit syndrome.

Differences among Pollen-Allergic Patients with and without Plant Food Allergy

Background: A considerable number of pollen-allergic patients develops allergy to plant foods, which has been attributed to cross-reactivity between food and pollen allergens. The aim of this study was to analyze the differences among pollen-allergic patients with and without plant food allergy. Methods: Eight hundred and six patients were recruited from 8 different hospitals. Each clinical research group included 100 patients (50 plant food-allergic patients and 50 pollen-allergic patients). Diagnosis of pollen allergy was based on typical case history of pollen allergy and positive skin prick tests. Diagnosis of plant-food allergy was based on clear history of plant-food allergy, skin prick tests and/or plant-food challenge tests. A panel of 28 purified allergens from pollens and/or plant foods was used to quantify specific IgE (ADVIA-Centaur® platform). Results: Six hundred and sixty eight patients (83%) of the 806 evaluated had pollen allergy: 396 patients with pollen allergy alone and 272 patients with associated food and pollen allergies. A comparison of both groups showed a statistically significant increase in the food and pollen allergy subgroup in frequency of: (1) asthma (47 vs. 59%; p < 0.001); (2) positive skin test results to several pollens: Plantago,Platanus,Artemisia,Betula,Parietaria and Salsola (p < 0.001); (3) sensitization to purified allergens: Pru p 3, profilin, Pla a 1 – Pla a 2, Sal k 1, PR-10 proteins and Len c 1. Conclusion: Results showed relevant and significant differences between both groups of pollen-allergic patients depending on whether or not they suffered from plant-derived food allergy.

Association of HLA-DR11 with the anaphylactoid reaction caused by nonsteroidal anti-inflammatory drugs.

BACKGROUND Several HLA alleles have been associated with asthma induced by nonsteroidal anti-inflammatory drugs (NSAIDs). The existence of HLA markers linked to other NSAID-induced reactions, such as cutaneous and anaphylactoid reactions, has not been established. OBJECTIVE The purpose of our work was to study the HLA-DRB1 and HLA-DQB1 alleles in patients with cutaneous and anaphylactoid reactions caused by NSAIDs. METHODS We have analyzed 114 HLA DRB1 and 26 HLA-DQB1 alleles in 21 patients with anaphylactoid reactions caused by NSAIDs, 47 patients who had exclusively cutaneous reactions during single-blind, placebo-controlled oral challenges with NSAIDs, and 167 tolerant control subjects (29 of whom had also had an IgE-mediated anaphylaxis to different agents). HLA-DRB1 and HLA-DQB1 alleles were typed by the polymerase chain reaction sequence-specific primers method with genomic DNA. RESULTS The frequency of HLA-DR11 alleles was 58.8% in the anaphylactoid reaction group, compared with 15.9% in the NSAID-tolerant healthy control subjects (OR, 7:3; 95% confidence interval, 2.8-19.0; P <.02) and 6.3% in the group of the patients with a tolerance for NSAIDs and with IgE-mediated anaphylaxis (OR, 18.75; 95% confidence interval, 4.3-81.1; P <.004). No differences were observed among HLA-DR11 alleles analyzed. There were no significant HLA-DQB1 associations with NSAID-induced anaphylactoid reactions. Patients with cutaneous reactions had HLA frequencies that did not differ significantly from the tolerant control subjects. CONCLUSION The HLA-DRB1*11 alleles showed a positive association with NSAID-induced anaphylactoid reactions.

Anaphylactoid Reactions due to Nonsteroidal Antiinflammatory Drugs: Clinical and Cross-Reactivity Studies

BACKGROUND Anaphylactoid reactions due to nonsteroidal antiinflammatory drugs have been described. OBJECTIVE To study the clinical characteristics of 21 patients with anaphylactoid reactions due to nonsteroidal antiinflammatory drugs and to determine the cross-reactivity to non-steroidal antiinflammatory drugs not involved in the previous reactions nor structurally related by means of single-blind, placebo-controlled drug challenges. PATIENTS AND METHODS Twenty-one patients who exhibited clinical evidence of anaphylactoid reactions after nonsteroidal antiinflammatory drugs were recruited for the study at the time of admission in Emergency Unit of our Hospital, Single-blind, placebo controlled oral challenges with nonsteroidal antiinflammatory drugs (except those reported by the patient as being responsible for the previous reaction), were performed in all patients. RESULTS Fifteen patients were woman and six man, with a mean age of 35.7 years (range 18 to 62 years). Thirteen patients (60%) were normal subjects without concomitant diseases. No increase in frequency of atopy in comparison to the general population was observed. Pyrazole derivatives were the most common nonsteroidal antiinflammatory drugs involved (71.3%). A tolerance to drugs included in drug challenge protocol was noted in all patients. CONCLUSION In our population, pyrazole derivatives were the most common nonsteroidal antiinflammatory drugs involved in anaphylactoid reactions. Most patients appeared to be otherwise normal subjects without concomitant disease and no cross-reactivity with other non-steroidal antiinflammatory drugs not involved in the anaphylactoid reaction nor structurally related was found.

Safety of selective cyclooxygenase-2 inhibitor rofecoxib in patients with NSAID-induced cutaneous reactions

BACKGROUND Controlled oral challenge with nonsteroidal anti-inflammatory drugs (NSAIDs) is the only definite way to diagnose the different clinical manifestations of NSAID sensitivity. OBJECTIVE To evaluate the safety of selective cyclooxygenase-2 inhibitor rofecoxib in a patient population with NSAID-induced skin reactions. METHODS We prospectively conducted single-blind, placebo-controlled, oral challenges (SBPCOCs) with rofecoxib in 15 patients with challenge-proven NSAID-induced cutaneous reactions. RESULTS Fifteen patients (9 men and 6 women, ranging in age from 14 to 60 years) had positive SBPCOC response to at least one of the following NSAIDs: aspirin (in 46.7% of cases), nimesulide (in 40% of cases), and diclofenac (in the remaining 13.3% of cases). During controlled challenges, 8 patients (53.3%) had urticaria (1 of them with associated angioedema); 6 (40%) had facial angioedema; and 1 (6.6%) had nonurticarial rash. Controlled oral challenge with rofecoxib were well tolerated in all patients. CONCLUSION Rofecoxib did not cross-react with aspirin and other NSAIDs in patient with NSAID-induced skin reactions. A tolerance observed to this drug during SBPCOCs will indicate a safe alternative in this patient-group.

A comparative analysis of the cross‐reactivity in the polcalcin family including Syr v 3, a new member from lilac pollen

Background:  Polcalcins are pollen‐specific allergens with two EF‐hand calcium‐binding sites that exhibit strong cross‐reactivity. Our objective was to isolate and express the cDNA coding of the EF‐hand calcium‐binding allergen from lilac pollen and to study cross‐reactivity with other polcalcins from related and nonrelated pollen sources with different specific antibodies and sera from two different populations.

Ole e 2 and Ole e 10 : new clinical aspects and genetic restrictions in olive pollen allergy

Background:  The clinical characteristics in olive pollen allergy are dependent on the antigenic load, the allergens profile, and the genetic restrictions. Our objective was to determine specific response pattern in Ole e 2 and Ole e 10 sensitization at those levels.