Paloma Poza-Guedes

Different patterns of cross‐reactivity in non‐immediate hypersensitivity to heparins: from localized to systemic reactions

Female, 62 years old; following an osteosynthesis procedure she received prophylactically enoxaparin (ClexaneA) 40 mg a day, and 2 weeks later itchy infiltrated plaques appeared on the lower abdomen, persisting for 7 days. Heparin was interrupted on the 8th day due to an itchy rash spreading over the whole abdomen. Informed consent was obtained from all patients. Patch tests were carried out on their backs with undiluted preparations of 3 types of LMWH and UH (1000 IU/mL), with readings at 30 min [day (D)0], 48 and 96 h (D2 and D4). After a week, prick and intradermal (ID) tests were performed on their volar forearms (1/10–1/1 dilutions). 10 controls were included for all skin testing. Negative

The nose as a target organ in the diagnosis of severe aspirin-exacerbated respiratory disease.

Background The nasal provocation test (NPT) with lysine aspirin is a useful tool in the diagnosis of aspirin-exacerbated respiratory disease (AERD), previously reffered to as Samters disease. The aim of the present study focuses on methodological interventions to show the usefulness of the NPT with lysine aspirin in differentiating AERD patients from aspirin-tolerant asthma (ATA) patients to improve the diagnostic efficacy and minimize the risk for adverse reactions compared with the gold standard. Methods Thirty AERD patients comprised the active study group while the control group consisted of 25 ATA patients. A combination of objective nasal aerodynamic response (i.e., nasal inspiratory flow and nasal inspiratory resistance) was evaluated by active anterior rhinomanometry and the subjective clinical nasal and extranasal symptoms (including forced expiratory volume) were monitored throughout the challenge. Results Fifty-five NPTs were successfully completed: sensitivity, 87%; specificity, 100%; positive predictive value, 100%; negative predictive value, 86%; global efficacy, 92.72%. No severe adverse reactions were recorded. Conclusion The present NPT with lysine aspirin proved to be a safe, efficient, and a timesaving method in the diagnosis of patients with AERD, even in those with severe rhinitis–rhinosinusitis and/or recurrent nasal polyposis.