José María Olaguibel

Occupational asthma and immunologic responses induced by inhaled carmine among employees at a factory making natural dyes

Carmine is a natural red dye widely used as a food coloring agent and for cosmetic manufacture. It is extracted from the dried females of the insect Dactylopius coccus var. Costa (cochineal). Although it has been reported that inhalation of carmine may give rise to occupational asthma and extrinsic allergic alveolitis, there is little evidence of its immunogenic capacity. We studied nine current employees at a factory making natural dyes and one former employee who had left this plant after occupational asthma developed. A current employee had work-related symptoms of rhinitis and asthma that were confirmed by bronchial provocation tests, and another worker had rhinitis. Immunologic sensitization to carmine and cochineal was evaluated by means of skin testing and determination of serum-specific IgE and IgG subclass antibodies by RAST and ELISA, respectively. The specificity of the RAST assay was investigated by RAST inhibition with different fractions of carmine. The three workers with respiratory symptoms had positive skin prick test reactions to both carmine and cochineal. An immediate response to the bronchial provocation test with carmine and cochineal was observed in the current employee with asthma. Specific IgE antibodies against carmine and cochineal were found only in this worker. RAST inhibition studies indicated that the main allergen had a molecular weight between 10 and 30 kd. Specific IgG antibodies against carmine and cochineal, mainly the subclasses IgG1, IgG3, and IgG4, were found in the 10 subjects surveyed. These findings suggest that carmine may induce immunologic responses, most likely IgE mediated in workers with symptoms of occupational asthma.

Estudio de los mecanismos implicados en la génesis y evolución del asma (proyecto MEGA): creación y seguimiento a largo plazo de una cohorte de pacientes asmáticos

The general aim of this study is to create a cohort of asthma patients with varying grades of severity in order to gain greater insight into the mechanisms underlying the genesis and course of this disease. The specific objectives focus on various studies, including imaging, lung function, inflammation, and bronchial hyperresponsiveness, to determine the relevant events that characterize the asthma population, the long-term parameters that can determine changes in the severity of patients, and the treatments that influence disease progression. The study will also seek to identify the causes of exacerbations and how this affects the course of the disease. Patients will be contacted via the outpatient clinics of the 8 participating institutions under the auspices of the Spanish Respiratory Diseases Networking System (CIBER). In the inclusion visit, a standardized clinical history will be obtained, a clinical examination, including blood pressure, body mass index, complete respiratory function tests, and FENO will be performed, and the Asthma Control Test (ACT), Morisky-Green test, Asthma Quality of Life Questionnaire (Mini AQLQ), the Sino-Nasal Outcome Test 22 (SNOT-22), and the Hospital Anxiety and Depression scale (HADS) will be administered. A specific electronic database has been designed for data collection. Exhaled breath condensate, urine and blood samples will also be collected. Non-specific bronchial hyperresponsiveness testing with methacholine will be performed and an induced sputum sample will be collected at the beginning of the study and every 24 months. A skin prick test for airborne allergens and a chest CT will be performed at the beginning of the study and repeated every 5 years.

Debate multidisciplinar de expertos. Asma no controlada: causas, consecuencias y posibles soluciones

Background. Numerous studies conclude that about half of the asthmatic population is not well controlled. The aim of this study was to discuss causes, consequences and possible solutions of uncontrolled asthma (UCA). Methods . Discussion amongst asthma experts from the fields of Pneumology, Allergy and Primary Care, structured in three phases: 1) survey to get the opinion of participants involved in different areas of UCA; 2) expert meeting, in which the results of the survey were discussed, and the diagnosis, treatment and monitoring of UCA were presented and discussed; and, 3) with the main findings, 83 items were formulated and subjected to consensus among all participants through the Delphi method. Results . There was consensus on 86.7% of the items in the Delphi questionnaire, mostly in terms of agreement. Conclusions. The UCA analysis results show the need for future improvement in the following areas: to incorporate clinical performance protocols into asthma CPG to identify aggravating factors and comorbidities; to develop an inexpensive and easy-to-use tool to identify adherence; to establish patient phenotype; to analyse treatment side effects and to provide personalized treatment, especially assessing its efficacy and safety (symptom control and future risks). It is necessary to generate new evidence to determine additional tests to be used to monitor these patients.Background. Numerous studies conclude that about half of the asthmatic population is not well controlled. The aim of this study was to discuss causes, consequences and possible solutions of uncontrolled asthma (UCA). Methods. Discussion amongst asthma experts from the fields of Pneumology, Allergy and Primary Care, structured in three phases: 1) survey to get the opinion of participants involved in different areas of UCA; 2) expert meeting, in which the results of the survey were discussed, and the diagnosis, treatment and monitoring of UCA were presented and discussed; and, 3) with the main findings, 83 items were formulated and subjected to consensus among all participants through the Delphi method. Results. There was consensus on 86.7% of the items in the Delphi questionnaire, mostly in terms of agreement. Conclusions. The UCA analysis results show the need for future improvement in the following areas: to incorporate clinical performance protocols into asthma CPG to identify aggravating factors and comorbidities; to develop an inexpensive and easy-to-use tool to identify adherence; to establish patient phenotype; to analyse treatment side effects and to provide personalized treatment, especially assessing its efficacy and safety (symptom control and future risks). It is necessary to generate new evidence to determine additional tests to be used to monitor these patients.

Acute tryptase determinations in NSAID-induced anaphylaxis: could we avoid drug challenges?

Methods Retrospective review of patients attending the Emergency Department (2009-2013) for a NSAID induced anaphylaxis and with a tryptase determination. Patients were split into 3 groups according to the allergy workup Results Selective reactions (S) were defined by positive skin results and/or negative challenges with other NSAID; non-selective (NS) reactions were defined by the existence of symptoms with several NSAID or after positive challenge results. Those cases who did not comply with the previous conditions were non-conclusive (NC). We analysed: demographics, severity of the episode (Chi Square test), and rate of tryptase higher than 11.4 mcg/l (Chi Square test), median tryptase values and timing of sample obtention (Kruskall-Wallis).

Childhood asthma: Quantification of the bronchodilator response by impulse oscillometry system

Abstract Rationale Asthma is common among young children who rarely perform feasible forced expiratory maneuvers. The assessment of respiratory resistance by impulse oscillometry system (IOS), based on the superimposition of respiratory flows by short-time impulses, requires no patient active collaboration. We evaluated the baseline repeatability and bronchodilator response of IOS indices, and their correlation with FEV1 and sRaw. Differences between atopic and non-atopic children were evaluated. Methods Thirty-three asthma children (3-6 yrs.) underwent IOS measurements (R5rs, R20rs and X5rs) by triplicate at each, the baseline, after placebo and after salbutamol inhalation. At the baseline and post-salbutamol, spirometry (FEV1) and whole body plethysmography (sRaw) were performed. Baseline within-test (Coefficient of variation: CV%) and between test (baseline-placebo) repeatability were addressed. The SD index (change in multiples of the between-test repeatability) was used to evaluate the bronchodilator response. Results Baseline repeatability of IOS was 4.1% for R5rs, 4.0% for R20rs and 5.6% for X5rs. R5rs decreased by 2SD after salbutamol and correlated with FEV1 and sRaw at both, baseline (R=-0.51 and R=0.49) and post-salbutamol (r=−0.63 and R=0.54). A trend towards correlation between salbutamol-induced changes in R5rs and in sRaw (r=0.33) was observed. No difference between atopic and non-atopic children was detected. Conclusion IOS was well accepted by young asthma children and provided reproducible and sensitive indices of lung function. Resistance at low frequencies (R5rs) showed the best correlation with plethysmography and spirometry.