Olga Luengo

Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients.

Background: The diagnosis of anaphylaxis is based on clinical history since no reliable biological marker is currently available to confirm the diagnosis. Objective: It was the aim of this study to determine sequential serum tryptase concentrations during anaphylaxis and to evaluate its potential as a diagnostic marker. Methods: We performed a prospective study including patients with acute anaphylaxis (according to the National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria) attending the emergency department. Demographic characteristics, anaphylactic triggers, specific risk factors, clinical characteristics and management of anaphylaxis were recorded. Serum tryptase was measured at 1–2 h (T1), 4–6 h (T2) and 12–24 h (T3) following onset of the episode and at basal conditions (TB). Results: A total of 102 patients were included (63 females, mean age 47.4 ± 19.1 years). Tryptase concentration at T1 (19.3 ± 15.4 µg/l) was significantly higher than at T2, T3 and TB (all <11.4 µg/l; p < 0.0001). Importantly, tryptase was not raised in 36.3% of cases; furthermore, in 60.6% of these patients, no changes were observed in tryptase levels comparing T1 and TB (ΔT1–TB = 0). Tryptase was more frequently elevated in more severe anaphylaxis (p < 0.0001) and positively correlated with the grades of severity (p < 0.001, r = 0.49). Anaphylaxis was more severe and tryptase concentration higher when the causative agent was a drug compared to food, both at T1 (p = 0.045) and at TB (p = 0.019). Age and coronary risk factors were associated with more severe anaphylaxis (p = 0.001). Conclusion: Tryptase is a biomarker related to the severity of anaphylaxis. However, since its concentration remains unaltered in a considerable number of patients during acute anaphylaxis, there is a need for more reliable diagnostic biological tests.

Component resolved diagnosis: when should it be used?

The knowledge on molecular allergy diagnosis is continuously evolving. It is now time for the clinician to integrate this knowledge and use it when needed to improve the accuracy of diagnosis and thus provide more precise therapeutic and avoidance measures. This review does not intend to comprehensively analyze all the available allergen molecules, but to provide some practical clues on use and interpretation of molecular allergy diagnosis. The potential role of component resolved diagnosis in circumstances such as the indication of allergen immunotherapy, pollen polysensitization, food allergy, latex allergy or anaphylaxis, is assessed. Interpreting the information provided by molecular allergy diagnosis needs a structured approach. It is necessary to evaluate single positivities and negativities, but also to appraise “the big picture” with perspective.

Allergic diseases in the elderly.

Demographic distribution of the population is progressively changing with the proportion of elderly persons increasing in most societies. This entails that there is a need to evaluate the impact of common diseases, such as asthma and other allergic conditions, in this age segment. Frailty, comorbidities and polymedication are some of the factors that condition management in geriatric patients. The objective of this review is to highlight the characteristics of allergic diseases in older age groups, from the influence of immunosenescence, to particular clinical implications and management issues, such as drug interactions or age-related side effects.

Immunotherapy in allergic rhinitis and lower airway outcomes

Allergic rhinitis and asthma constitute two clinical expressions of a single‐condition, respiratory allergy. Allergen immunotherapy (AIT) is a form of treatment specifically aimed at modifying the response to sensitizing allergens. The inherent potential benefit of AIT is the simultaneous treatment of all clinical expressions of respiratory allergy. Current data support the effectiveness of subcutaneous and sublingual immunotherapy in rhinitis. Studies also provide proof for a beneficial effect in allergic asthma. Even more, substantial evidence points to the preventive effect on the progression from rhinitis to asthma. Despite the current knowledge on the basic mechanisms underlying the immunological effect of AIT is vast, the specific mechanisms for the preventive effect of primary sensitization or new sensitizations are poorly understood. This review aimed to provide a critical overview of the current knowledge on the effectiveness of AIT and its potential role in secondary prevention of respiratory allergy progression.

Allergenicity and cross‐reactivity of Senecio pollen: identification of novel allergens using the immunoproteomics approach

Background The genus Senecio is the largest genus of the family Asteraceae (Compositae).

Spirometric Maneuvers and Inhaled Salbutamol Do Not Affect Exhaled Nitric Oxide Measurements among Patients with Allergic Asthma

Background: Exhaled nitric oxide (ENO) is used as a marker of airway inflammation. Factors such as spirometric maneuvers (SPM), β2-agonists, or tobacco smoking have been postulated to affect ENO measurements. Guidelines on measurement techniques have been published based on expert opinions. Nevertheless, there is no strong clinical evidence of many aspects because they have not been supported by research data. Objectives: The aim of this study was to evaluate the influence of performing a spirometry or receiving inhaled salbutamol on ENO readings. Methods: One hundred forty-five adults and 62 children with allergic asthma were included with a mean age of 36 ± 13 years for adults and 13 ± 2 years for children. A control group comprised 30 healthy adults and 30 children with a mean age of 37 ± 14 years and 13 ± 2 years, respectively. ENO measurements were performed with a NIOX-MINO® electrochemical device. In 179 patients ENO was measured before and after performing SPM and in 88 patients before and 15 min after SPM plus 2 puffs of salbutamol (100 µg/puff). Results: There were no significant differences in mean ENO levels before and after SPM or before and after SPM plus 2 puffs of inhaled salbutamol in adults or children (asthmatic or healthy). Conclusions: Levels of ENO are not significantly affected by SPM or salbutamol inhalation.

Alergia a alimentos

La alergia a alimentos es un problema sanitario de creciente interes. Su prevalencia ha aumentado de forma exponencial en los ultimos anos hasta situarse en torno al 4-5% de la poblacion general. Los profesionales sanitarios deberan responder cada vez con mas frecuencia a las demandas de atencion de estos pacientes. Solo un pequeno porcentaje de la variedad de alimentos consumidos causa la mayoria de las reacciones alergicas. En Espana, los alimentos que producen alergia con mas frecuencia en ninos son la leche, el huevo y el pescado, mientras que en adultos son las frutas y los frutos secos, seguidos por el pescado y el marisco. Las manifestaciones clinicas varian desde reacciones cutaneas leves hasta reacciones anafilacticas, de potencial riesgo vital. Por ello es necesario un diagnostico preciso del alergeno implicado, asi como un correcto tratamiento de las reacciones. Es mas, es imprescindible la educacion del paciente con alergia para evitar el alimento que la provoca y para la autoadministracion de medicacion en caso de una ingesta accidental.

The Mast Cell, Contact, and Coagulation System Connection in Anaphylaxis

Anaphylaxis is the most severe form of allergic reaction, resulting from the effect of mediators and chemotactic substances released by activated cells. Mast cells and basophils are considered key players in IgE-mediated human anaphylaxis. Beyond IgE-mediated activation of mast cells/basophils, further mechanisms are involved in the occurrence of anaphylaxis. New insights into the potential relevance of pathways other than mast cell and basophil degranulation have been unraveled, such as the activation of the contact and the coagulation systems. Mast cell heparin released upon activation provides negatively charged surfaces for factor XII (FXII) binding and auto-activation. Activated FXII, the initiating serine protease in both the contact and the intrinsic coagulation system, activates factor XI and prekallikrein, respectively. FXII-mediated bradykinin (BK) formation has been proven in the human plasma of anaphylactic patients as well as in experimental models of anaphylaxis. Moreover, the severity of anaphylaxis is correlated with the increase in plasma heparin, BK formation and the intensity of contact system activation. FXII also activates plasminogen in the fibrinolysis system. Mast cell tryptase has been shown to participate in fibrinolysis through plasmin activation and by facilitating the degradation of fibrinogen. Some usual clinical manifestations in anaphylaxis, such as angioedema or hypotension, or other less common, such as metrorrhagia, may be explained by the direct effect of the activation of the coagulation and contact system driven by mast cell mediators.

Generalised delayed desquamative exanthema after intradermal testing with betalactam antibiotics.

teins were assayed with the patient’s serum, but none of the proteins were recognized. The basophil activation test (BAT) was performed following Flow2CAST (Bühlmann, Schönenbuch, Switzerland) manufacturer’s procedure. The stimuli used were lipoproteins from olive, sesame, and hazelnut in DMSO. The test was positive for olive fruit (30.5%), hazelnut (41.1%), and sesame extract (8.4%). The BAT was performed in parallel with two nonallergic individuals obtaining a negative result with the stimuli tested (Fig. 1B). In summary, the clinical information and the allergologic study have shown that the patient presents a food allergy because of his sensitization to peachand hazelnut-lipid transfer proteins (Pru p 3 and Cor a 8, respectively), which could explain some of the reactions suffered. However, the more relevant information of this case is that the patient also presents a sensitization toward lipoproteins, which could explain the anaphylactic reaction caused by olive ingestion and also could contribute to nut allergy. Lipoproteins are recognized by patient’s IgE antibodies. So the lipoproteins of olives (and of the other nuts and fruits tested) have allergenic properties, which are relevant as hydrosoluble proteins. Therefore, we state that the liposoluble protein fraction could be used for diagnostic purposes, especially in those patients with negative results to standard extracts in prick tests and specific IgE measurements. In this way, should we make a careful study about the role of lipid derivatives as allergens? Most of allergens are obtained through hydrosoluble methods that remove the lipid derivatives from the allergenic extract.

Técnicas de diagnóstico no validadas en alergia alimentaria: declaración de postura de la Societat Catalana d'Al·lèrgia i Immunologia Clínica

Resumen La alergia alimentaria es una reaccion adversa mediada por mecanismos inmunologicos que puede diagnosticarse mediante metodos cientificamente establecidos. En el presente trabajo de revision, se enumeran una serie de procedimientos, in vitro e in vivo, «complementarios» y «alternativos», no validados cientificamente. En este sentido, una aproximacion diagnostica equivocada conlleva un retraso en la aplicacion de un tratamiento adecuado.