María Paz García Rubio

Characterization of allergens secreted by Anisakis simplex parasite: clinical relevance in comparison with somatic allergens

Background Diagnostic methods for the study of allergic reactions to Anisakis simplex (A.s.) based on whole‐body extracts of the larva are clearly insufficient.

Missense mutation Thr309Lys in the coagulation factor XII gene in a Spanish family with hereditary angioedema type III

Background:  A new type of hereditary angioedema (type III) affecting mainly women with normal C1‐inhibitor level and function has been described. Exposition to estrogens is an important precipitating factor. Recently, a missense mutation in the gene of the blood coagulation factor XII (Hageman factor) has been reported in a few families with this type of hereditary angioedema.

Association between airborne pollen and epidemic asthma in Madrid, Spain: a case–control study

Background Despite the fact that airborne pollen is an important factor in precipitating asthma attacks, its implication in increases of epidemic asthma in usual meteorological conditions has not been reported. A study was undertaken to estimate the relationship between various types of aeroallergens and seasonal epidemic asthma in the region of Madrid, Spain. Methods A case–control study was carried out in individuals aged 4–79 years who received emergency healthcare for asthma during 2001 in a base hospital covering a population of 750 000 inhabitants of Madrid. A skin prick test was performed with grass pollen, plantain pollen, olive pollen, cypress pollen, plane tree pollen, dust mites and Alternaria and the prevalence of skin reactivity was compared between subjects with asthma requiring emergency care for asthma within (cases) and outside (controls) the seasonal epidemic period. Data were analysed using logistic regression adjusting for age and sex. Results The response rate was 61.7% for cases (n=95) and 51.6% for controls (n=146). The OR of sensitisation to grass pollen for cases compared with controls was 9.9 (95% CI 4.5 to 21.5); plantain pollen: 4.5 (95% CI 2.5 to 8.2); olive pollen: 7.3 (95% CI 3.5 to 15.2); plane tree pollen: 3.6 (95% CI 2.0 to 6.4); cypress pollen: 3.5 (95% CI 2.0 to 6.2); dust mites: 1.1 (95% CI 0.6 to 1.9); Alternaria: 0.9 (95% CI 0.5 to 1.9). The association with grasses was maintained after adjusting simultaneously for the remaining aeroallergens (OR 5.0 (95% CI 1.5 to 16.4)); this was the only one that retained statistical significance (p=0.007). Conclusions These results suggest that allergy to pollen, particularly grass pollen, is associated with the epidemic increase in asthma episodes during the months of May and June in the Madrid area of Spain.

Urticaria due to mepivacaine with tolerance to lidocaine and bupivacaine

tion) to which he had no reaction. Modified radioallergosorbent test (RAST) testing was performed with the patient’s serum to naproxen and no specific IgE was identified (Quest Diagnostics, Teterboro, NJ, USA). He was also skin-prick tested to 1/100, 1/10 and full-strength liquid naproxen (125 mg/5 ml), without wheal and flare reaction. This case demonstrated reproducible anaphylaxis to naproxen without cross reactivity to rofecoxib, aspirin or ibuprofen. Without this patient’s insistence and his professional and athletic performance requirements we would not have challenged him with naproxen, but would have challenged him with the later three drugs to provide his alternative NSAIDs. Anaphylaxis to naproxen is not rare. A recent study by van Puijenbroek (3), reported naproxen as the second leading cause of NSAID-induced anaphylaxis between 1985 and 2000 in the Netherlands. The mechanism of the reaction to naproxen is not well defined. A case report by Cisterno (4), in 1983, reported a positive intradermal skin test in a naproxen specific anaphylaxis case. This same report also demonstrated a positive basophil release assay to naproxen. To date, there have been rare reports of cross-reactions to NSAIDS in normal individuals who have anaphylaxis (1). Although we used liquid naproxen for challenge, we feel his reaction on challenge was consistent with his prior reaction and is specific for naproxen. We have been unable to demonstrate naproxenspecific IgE either by RAST or skin testing but this does not rule out the probability that an IgE-mediated reaction occurred.

Factor XII gene missense mutation Thr328Lys in an Arab family with hereditary angioedema type III.

1. Kurth BM, Kamtsiuris P, Hölling H, Schlaud M, Dölle R, Ellert U et al. The challenge of comprehensively mapping children’s health in a nation-wide health survey: design of the German KiGGS Study. BMC Public Health 2008;8:196. 2. Schlaud M, Atzpodien K, Thierfelder W. Allergic diseases. Results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007;50:701– 710. 3. Gotthard Mortz C, Andersen KE, BindslevJensen C. The prevalence of peanut sensitization and the association to pollen sensitization in a cohort of unselected adolescents – The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS). Pediatr Allergy Immunol 2005;16:501–506. 4. Asarnoj A, Östblom E, Ahlstedt S, Hedlin G, Lilja G, van Hage M et al. Reported symptoms to peanut between 4 and 8 years among children sensitized to peanut and birch pollen – results from the BAMSE birth cohort. Allergy 2010;65:213–219. 5. Ben-Shoshan M, Harrington DW, Soller L, Fragapane J, Joseph L, St Pierre Y et al. A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. J Allergy Clin Immunol 2010; 125:1327–1335. 6. Asarnoj A, Movérare R, Östblom E, Poorafshar M, Lilja G, Hedlin G et al. IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds. Allergy 2010;65:1189–1195. Factor XII gene missense mutation Thr328Lys in an Arab family with hereditary angioedema type III

Double sensitization to enzymes in a baker

The enzymes alpha-amylase and lysozyme have been identified as inhalative allergens in baker’s asthma (1–4), and in egg-processing or pharmaceutical workers (5–10), respectively. We report the case of a 41-year-old man who worked in a bakery for 25 years. After 22 years of glazing rolls with fresh egg, he began to use a spraying device for the egg mixture. A few months later he began to develop rhinoconjunctivitis and asthma just minutes after this activity. He remained asymptomatic during weekends and holidays. He then worked on mixing wheat flour to make bread. Initially he was free of symptoms, but 9 months later he presented with rhinoconjunctivitis and asthma. He had no symptoms on ingestion of egg or wheat flour. At home, he had seven birds and a cat, but his symptoms did not worsen on exposure to these pets, to house dust, or pollen. Physical examination, blood cell count, biochemistry, and chest radiographs were all normal. Skin prick test (SPT) with commercially available extracts (Leti, Spain), were positive to egg white, egg yolk, ovomucoid, wheat flour, barley flour, Dermatophagoides pteronyssinus, D. farinae, G. fusca, L. destructor, T. putrescentiae, and cockroach, as well as to a lysozyme extract (Wassermann) at 10 mg/ml, and to alpha-amylase extract (1 mg/ml). SPT were negative to a battery of pollen and molds, cat and dog dander, canary and pigeon feathers, ovalbumin, and rye flour. Total serum IgE was 1142 kU/l. IgE antibodies were detected to egg white (2.07 kU/l), egg yolk (0.86), ovomucoid (2.26), wheat flour (3.21), barley flour (1.95), alpha-amylase (0.39), lysozyme (2.05), D. pteronyssinus (5.60), D. farinae (5.48), L. destructor (3.70) and T. putrescentiae (5.58) (CAP Pharmacia, Sweden). The test was negative to ovalbumin, and to canary and pigeon feathers. Spirometry revealed a forced vital capacity (FVC) of 105%, forced expiratory volume in 1s (FEV1) of 94%, FEV1/ FVC of 93%, and forced expiratory flow (FEF25)75) of 64%. Specific bronchial challenge to lysozyme (tidal breathing method) elicited an early asthmatic response (22% fall in FEV1 in 10 min). Specific bronchial challenge to alpha-amylase elicited an early asthmatic response with a 24% fall in FEV1 in 20 min. We have demonstrated IgE sensitization and clinical sensitivity to two enzymes from different sources by SPT, IgE antibody determination, and bronchial provocation test. The two enzymes are lysozyme (from egg used to decorate rolls) and fungal alpha-amylase (used to improve bread qualities). This patient was also strongly sensitized to dust mites, although no symptoms have yet been produced.

Recurrent fixed drug eruption due to metronidazole elicited by patch test with tinidazole.

A 34-year-old woman, with a personal history of FDE due to sulphonamides, had been treated 4 months ago with oral metronidazole for trichomonal vaginitis. On the 4th day of treatment, she developed pruritic erythematous and blistered lesions on interdigital areas and on the palmar side of the thumb finger of her left hand. About 3 months later, the same lesions appeared in the same locations some hours after the topical application of the first ovule of metronidazole for recurrent vaginitis, remaining as hyperpigmented macules at these locations. FDE due to metronidazole was diagnosed clinically. Patch testing with tinidazole and ornidazole 10% in dimethyl sulfoxide (DMSO) was performed on normal skin and on residual lesions. Tinidazole applied on a residual lesion was positive (Fig. 1), though negative on normal skin, while ornidazole was negative on both. The patient declined any further testing. Discussion

Non Conformity of Goods and Digital Content and its Remedies

The concept of conformity is one of the most important topics in modern Contract Law, especially concerning the sale, as well as other types of contracts of goods and services. This is also true for the CESL, where the lack of conformity constitutes a case of non-performance, which may be down to both contractual parties, although it is more often that a non-performance is the responsibility of the seller. A situation of non-performance opens up the possibility of recourse to the panoply of remedies. The analysis of the general rules laid down in the CESL for the lack of conformity and the remedies available to the buyer, is the subject of this contribution.