Paula Cabrera-Freitag

Can component‐based microarray replace fluorescent enzimoimmunoassay in the diagnosis of grass and cypress pollen allergy?

Background Few data on the diagnostic accuracy in pollinosis of the microarray ISAC of allergens are available.

Early skin testing is effective for diagnosis of hypersensitivity reactions occurring during anesthesia.

Allergic skin tests have to be performed 4–6 weeks after an allergic anesthetic reaction. Patients with allergic reactions during anesthesia were prospectively included (n = 44). Skin tests were performed in two stages: (i) Stage 1 (S1), 0–4 days after the reaction; and (ii) Stage 2 (S2), 4–8 weeks after. Five (11.5%) surgical procedures were suspended due to the reaction. Positive skin tests were obtained in 25/44 patients (57%). Allergic diagnosis was carried out at S1 in 15/25 (60%) and at S2 in 10/25 (40%). Three patients resulted positive only in S1. Overall agreement among S1 and S2 skin tests was 70.45%. The kappa statistic was 0.41 (P‐value = 0.002). Odds ratio of obtaining a false negative in S1 (compared with S2) was 3.33. Early allergological study is useful, could minimize false negatives, but should be considered as a complement to late skin tests.

The importance of in vitro component-resolved diagnosis in paediatric patients

In recent years, thanks to advances in molecular biology, allergological diagnosis has improved and specific IgE (sIgE) against an allergenic source has been transformed into sIgE against an allergenic protein or glycoprotein. This change, which has resulted in a more precise diagnosis of sensitisation, could explain the different dangers of certain molecular sensitisations and in many cases cross-reactivity phenomena, and could change indications for immunotherapy or clinical management. Here, we present two cases of children where the indication for immunotherapy and management of the disorder changed due to component-resolved diagnosis. However, the clinical history and skin prick tests should complement molecular in vitro diagnosis to improve routine clinical practice.

The incidence of perioperative hypersensitivity reactions: a single-center, prospective, cohort study.

BACKGROUND:The incidence of perioperative hypersensitivity reactions, which can be life-threatening, ranges from 1 in 20,000 to 1 in 1361. These reactions are usually classified as IgE or non-IgE mediated. The aim of this study was to determine the incidence of allergic reactions during general anesthesia in our hospital, to establish the incidence of the allergic reactions for each drug used, to assess the frequency of IgE-mediated reactions in even mild reactions, and to compare the degree of agreement between anesthesiologist suspicion and allergy diagnosis. METHODS:We included patients diagnosed with a clinical hypersensitivity reaction during a procedure under general anesthesia over a 30-month period (February 2008 to August 2010). Plasma histamine and serum tryptase concentrations were determined in these patients. We performed skin tests to diagnose the causative agent. Data from the hospital electronic prescribing system were collected to determine the ratio of reactions for each drug. RESULTS:During the study period, 16,946 anesthetic procedures were performed (53% involved males; mean age, 51.6 years). Forty-four perianesthetic reactions were recorded, and the ratio of reactions was 1 in 385 operations (95% confidence interval, 1/529–1/287). Twenty-five reactions (25/44; 57%) occurred during the induction of anesthesia. Twenty-one reactions (21/44; 48%) were mild, involving only skin, and 23 of 44 (52%) were anaphylactic reactions. Four of 10 patients who had only a rash experienced IgE-mediated reactions. Five surgeries (11%) were suspended because of the severity of the reactions. Fifteen reactions (15/30; 50%) were IgE mediated, and, in 2 of 30 (7%), a non-IgE agent was found (cold urticaria and nonsteroidal anti-inflammatory drug intolerance). The ratio of reactions for each drug was as follows: protamine, 1 in 468; cisatracurium, 1 in 1388; amoxicillin-clavulanate, 1 in 1968; atracurium, 1 in 2039; and dipyrone, 1 in 3159. CONCLUSIONS:Perioperative reactions are more common than previously reported. Mild hypersensitivity perioperative reactions—involving only skin—should be considered in evaluating patients because a substantial number of these reactions are IgE mediated.

Immediate allergic reaction to atropine in ophthalmic solution confirmed by basophil activation test

ACU symptoms over the course of rupatadine intake. Treatment was well tolerated and no adverse events, including somnolence, occurred. Pathogenesis of ACU is still unknown. Histamine release after cold challenge in ACU patients has been widely demonstrated, but other proinflammatory mediators, such as PAF, were found to be released (6). The clear efficacy of rupatadine in two of our patients with ACU poorly responsive to other H1-antihistamines might be due not only to the antihistamine activity of the drug, but also to its inhibitory action on PAF. In addition, we were unable to detect differences in clinical response between two different dosages of rupatadine. These findings appear to be in agreement with the results of the phase III trial of rupatadine in CIU patients which failed to disclose any significant differences in efficacy between 10 and 20 mg/day (3), although the phase II study showed a greater effect of the daily dose of 20 mg on pruritus severity as compared to the 10-mg dose (4). In conclusion, rupatadine seems an effective and safe antihistamine drug for the treatment of ACU, although controlled studies in larger patient samples are needed.

Food protein-induced enterocolitis syndrome by fish: Not necessarily a restricted diet

Food protein‐induced enterocolitis syndrome (FPIES) is a non‐IgE‐mediated gastrointestinal food hypersensitivity usually due to cow′s milk or soy. Recent researches show that fish is 1 of the most important triggers of FPIES in the Mediterranean countries. Due to the risk of multiple‐food FPIES, avoiding foods in the same category or that often occur together may be reasonable. The aim of this study was to evaluate the evolution and follow‐up of FPIES related to fish over a period of 20 years. We describe the clinical features of our population, discuss different approaches to oral food challenges, and analyze the possibility of introducing the culprit fish or other nonrelated fish to avoid unnecessary restricted diets.