Manuela Cuevas

Allergy to Rosaceae fruits without related pollinosis

BACKGROUND Rosaceae fruit allergy is frequently associated with birch pollinosis in Central and Northern Europe and with grass pollen allergy in Central Spain. The main cross-reactive structures involved for birch pollinosis are Bet v 1 and profilin, and for grass pollinosis they are profilin and carbohydrate determinants. Rosaceae fruit allergy can occasionally be observed in patients without pollinosis. OBJECTIVE We investigated the clinical presentation and the allergens involved in allergy to Rosaceae fruit without pollinosis. METHODS Eleven patients from Central Spain allergic to apples, peaches, and/or pears but not to pollens were compared with 22 control subjects with combined grass pollen and fruit allergy. Skin prick tests and RASTs to apple, peach, and pear were performed. Cross-allergenicity was studied by RAST inhibition. Bet v 1 was tested with an indirect RAST, and profilin was tested in skin prick tests, histamine release, and RAST. RESULTS Rosaceae fruit allergy without pollinosis is severe with 82% of patients reporting systemic symptoms, mainly anaphylaxis (73%), whereas oral symptoms are less frequent (64%). Anaphylactic shock was observed in 36% of patients. The fruit allergens involved showed cross-reactivity among Rosaceae species but were not related to profilin or Bet v 1. Ninety-one percent of patients with combined grass pollinosis and fruit allergy reported oral allergy, 45% reported systemic symptoms, 18% reported anaphylaxis, and 9% reported anaphylactic shock. CONCLUSION Allergy to Rosaceae fruits in patients without a related pollen allergy is a severe clinical entity. Profilin- and Bet v 1-related structures are not involved in Rosaceae fruit allergy without pollinosis.

Paracetamol (acetaminophen) hypersensitivity.

BACKGROUND Acetaminophen (paracetamol) is an analgesic antipyretic drug with no antiinflammatory effects and is widely used worldwide. Earlier clinical studies reported IgE-mediated adverse reactions to acetaminophen, but in vivo and in vitro tests have been inconclusive. OBJECTIVE We propose to demonstrate an IgE-mediated mechanism in four patients with adverse reactions to acetaminophen (paracetamol). Tolerance to aspirin and other nonsteroidal antiinflammatory drugs are present in all patients. METHODS We studied four patients with anaphylactic reactions to acetaminophen who tolerated aspirin and other nonsteroidal antiinflammatory drugs. Skin tests, oral challenges and immunoassay for allergen-specific IgE antibodies with acetaminophen were performed in all patients. RESULTS All patients tolerated the aspirin oral challenge without adverse effects. In contrast, the oral challenge with acetaminophen produced adverse effects in all patients. Skin tests with acetaminophen were positive in two patients (3-mm wheal and flare) and IgE antibodies acetaminophen were detected in serum from two patients. CONCLUSION We describe four patients with adverse reactions to acetaminophen but with tolerance to aspirin and other nonsteroidal antiinflammatory drugs. Skin tests, oral challenges, and serum IgE results with acetaminophen suggest that an IgE-mediated mechanism is responsible for these reactions.

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,

Asthma Caused by Ficus benjamina Latex: Evidence of Cross-Reactivity with Fig Fruit and Papain

BACKGROUND Ficus benjamina or weeping fig is a plant used increasingly for indoor decoration that can cause allergic rhinitis and asthma. OBJECTIVE We report a clinical and immunologic study in a patient with perennial asthma caused by F. benjamina latex in whom several episodes of angioedema of the oropharyngeal tract and tongue followed ingestion of figs and kiwi. METHODS Hypersensitivity to latex from F. benjamina and from Hevea brasiliensis, fig fruit, kiwi, papain, and bromelain was investigated by means of skin prick test, specific IgE determination by CAP, histamine release test, and bronchial provocation test to F. benjamina latex. CAP-inhibition assays were carried out to study possible cross-reactivity among these antigens. RESULTS Hypersensitivity to F. benjamina latex, fig, kiwi, and proteases was demonstrated by means of skin prick test, determination of specific IgE and histamine release test. Bronchial provocation test with F. benjamina latex resulted in a dual asthmatic reaction, confirming the etiologic role of this plant. A rise of eosinophil cationic protein in patients serum was observed 21 hours after bronchial challenge, suggesting activation of eosinophils. Inhibition assays showed that F. benjamina latex as liquid-phase inhibited up to 95% the CAP to fig and up to 57% the CAP to papain. Neither sensitization nor cross-allergenicity with H. brasiliensis latex was found. CONCLUSIONS Hypersensitivity to F. benjamina latex may cause IgE-mediated respiratory allergy. The association with allergy to fig and papain is likely due to the existence of cross-reactive allergen structures.

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.

Selective allergic reactions to clavulanic acid

Clavulanic acid (CL) is a [Mactam antibiotic with weak antibacterial activity, but it is a potent inhibitor of [3-1actamases. In association with amoxycillin (AX) it has great antimicrobial activity and is increasingly prescribed in daily medical practice. We present two cases of selective adverse reactions to CL with good tolerance to other [3-1actam antibiotics in which a type I immunologic mechanism is probably implicated. To the best of our knowledge, these are the first reported cases of selective allergy to CL.

Glucoamylase: another fungal enzyme associated with baker's asthma.

BACKGROUND Aspergillus-derived enzymes are widely used as dough additives in the baking industry. These enzymes may give rise to immunoglobulin (Ig)E-mediated sensitization and occupational asthma. Glucoamylase (or amyloglucosidase) is an important industrial enzyme obtained from Aspergillus niger and used to provide fermentable sugars for yeast to improve loaf volume and texture. OBJECTIVE The aim of our study was to investigate the potential allergenic role of glucoamylase in bakers asthma. METHODS We report four subjects with work-related allergic respiratory symptoms who were exposed to glucoamylase and other starch-cleaving enzymes used as baking additives. The causative role of glucoamylase in work-related asthma was investigated by immunologic tests and specific inhalation challenges (SIC). Glucoamylase allergenic components were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting. RESULTS Skin prick tests to glucoamylase (10 mg/mL) gave a positive response in all patients. Further, a positive skin prick test to alpha-amylase was obtained in the four patients and to hemicellulase in two of them. SIC to glucoamylase elicited isolated early asthmatic responses in the three patients tested, and SIC to alpha-amylase elicited early asthmatic responses in two patients and a dual asthmatic response in another patient. Immunoblotting with glucoamylase showed several IgE-binding bands with molecular masses between 33 and 96 kD. IgE-inhibition assays showed scarce to moderate allergenic cross-reactivity between glucoamylase and alpha-amylase. CONCLUSIONS These bakers had developed IgE-mediated occupational asthma to glucoamylase and alpha-amylase. Fungal glucoamylase is widely used as a baking additive and this enzyme may give rise to allergic respiratory reactions among exposed workers.

Reverse enzyme immunoassay for the determination of Dermatophagoides pteronyssinus IgE antibodies.

Sera from patients with suspected mite sensitivity were assayed using both the radioallergosorbent test (RAST) and a reverse enzyme immunoassay for IgE antibodies (REIA). Of the 133 sera studied, the RAST gave positive results in 48 cases and the REIA in 59. Negative results for both assays were obtained in 72 of the sera. The immunoenzymatic assay described here, using micro-plates as solid phase, has proven to be IgE- and antigen-specific. The allergen conjugate has a prolonged shelf life and the method is easy to perform. The sensitivity of the REIA for Dermatophagoides pteronyssinus IgE antibodies is limited by the small amount of IgE bound by the well surface (less than 100 ng). However, we think that the method offers a reliable alternative for the diagnosis of D. pteronyssinus-allergic patients.

Aspergillus fumigatus and Candida albicans in Cystic Fibrosis: Clinical Significance and Specific Immune Response Involving Serum Immunoglobulins G, A, and M

OBJECTIVE The aim of this study was to analyze the clinical significance of Aspergillus fumigatus and Candida albicans in respiratory secretions from patients with cystic fibrosis and to assess the immune response to these fungi in serum. PATIENTS AND METHODS The study included 66 patients with cystic fibrosis (34 men; mean age, 16.2 years). Sera from 15 healthy individuals were used as controls. RESULTS The serum concentrations of immunoglobulin (Ig) G, IgA, and IgM against A fumigatus and C albicans were higher in patients than in the control group. There was no correlation between the presence of A fumigatus in respiratory secretions and the immune response to the fungus measured in serum. In contrast, the presence of C albicans in respiratory secretions was correlated with the immune response to that fungus. The likelihood of obtaining A fumigatus cultures from respiratory secretions increased with age. The presence of these fungi in respiratory samples was not a risk factor for greater respiratory impairment. CONCLUSIONS In response to increased colonization of the lower respiratory tract by A fumigatus and C albicans, patients with cystic fibrosis have elevated serum levels of IgG, IgA, and IgM against those fungi. In patients with cystic fibrosis, culture of sputum and oropharyngeal secretions is adequate for the assessment of lower respiratory tract colonization by C albicans but not A fumigatus. Fungal colonization of the lower respiratory tract is not a risk factor for greater respiratory impairment in patients with cystic fibrosis.

Allergic bronchopulmonary aspergillosis with low serum IgE levels in a child with cystic fibrosis

A five-year-old girl was diagnosed with cystic fibrosis (CF) at age 8 months on the basis of failure to thrive, steatorrhea, and a positive sweat chloride determination of 95 mEq/L. She was seen in our outpatient clinic four times per year. During the last 4 years she remained well with mild pulmonary symptoms and no evidence of asthma. She had experienced a few episodes of infectious bronchitis without wheezing, which improved with oral antibiotic therapy. There was no history of production of brown sputum plugs, and she had never been treated with bronchodilators or oral or inhaled corticosteroids. At age 1 year, Staphylococcus aureus was cultured from her sputum. At age 2 years, Pseudomonas aeruginosa grew on her sputum culture without pulmonary involvement, and a 3-week course of intravenous antibiotic was given. Over the next three years, S. aureus, and sometimes P. aeruginosa, were cultured from her sputum. AspergiUus fumigatus (Aft only grew twice at age 2 and 3 years. Her routine chest roentgenogram showed minor changes, such as increased lung markings and mild hyperinflation, without acute changes. On routine clinical examination, clear lung fields were heard. Routine laboratory evaluation always showed a peripheral eosinophil count less than 300 cells/mm 3. Since June 1995, as part of the Allergic Bronchopulmonary Aspergillosis (ABPA) screening study, the patient was evaluated every 4 months with total serum IgE and IgE against Af (IgE-Af) by CAP ftuoroenzymeimmunoassay (Pharmacia, Uppsala, Sweden); precipitins against Af by means of the Ouchterlony technique; IgG, IgA, and IgM antibodies against Af (IgG-Af, IgA-Af, IgM-Af) assessed by ELISA; peripheral eosinophil count; and immediate skin testing with Af. In February 1996, when the patient was free of symptoms laboratory data showed a blood eosinophil count of 300 cells/ram 3, a total serum IgE of 41 kU/L (normal value <84 kU/L) and a negative IgE-Af (<0.35 kU/L). In August 1996 a left upper lobe infiltrate was seen on a routine chest roentgenogram. She had no symptoms, and clinical examination was normal. Sputum