Rodolfo Castillo

Intolerance to nonsteroidal antiinflammatory drugs: Results of controlled drug challenges in 98 patients

BACKGROUND Controlled oral challenge is the only definitive way to detect the different clinical manifestations of intolerance to nonsteroidal antiinflammatory drugs (NSAIDs). OBJECTIVE This study was carried out to describe the clinical manifestations of drug challenges in a population with histories of intolerance to NSAIDs. METHODS Two-hundred forty subjects were included in a single-blind, placebo-controlled drug challenge protocol. RESULTS Eighty patients exhibited a positive response to drug challenge: 52 had isolated periorbital angioedema, 13 had cutaneous rashes, eight had bronchial asthma (7 with associated periorbital angioedema), three had nasoocular reactions, and four had systemic anaphylaxis. In another 18 patients who were referred for treatment because of a reaction suggesting systemic anaphylaxis, the implicated drug was not given, but tolerance to other NSAIDs was found. The mean age of patients with isolated periorbital angioedema was significantly lower (p < 0.001) than that of the other groups of NSAID reactors. A significant increase (p < 0.001) in atopy was found among patients with isolated periorbital angioedema (100%) in comparison with other patients with NSAID intolerance (45.6%). NSAID cross-reactivity was a common finding, but cross-reactivity was not found in two cases of periorbital angioedema, one case of urticaria, one case of bronchial asthma, and 18 cases of systemic anaphylaxis. CONCLUSION In atopic subjects, isolated periorbital angioedema constitutes the most frequent manifestation of NSAID intolerance. Such patients are younger than other NSAID reactors and commonly have intolerance to several NSAIDs.

Mustard allergy confirmed by double‐blind placebo‐controlled food challenges: clinical features and cross‐reactivity with mugwort pollen and plant‐derived foods

Background:  Mustard IgE‐mediated allergy is supposed to be a rare cause of food allergy, and its clinical features and cross‐reactivities have not been fully elucidated.

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,

Association of HLA-DR11 with the anaphylactoid reaction caused by nonsteroidal anti-inflammatory drugs.

BACKGROUND Several HLA alleles have been associated with asthma induced by nonsteroidal anti-inflammatory drugs (NSAIDs). The existence of HLA markers linked to other NSAID-induced reactions, such as cutaneous and anaphylactoid reactions, has not been established. OBJECTIVE The purpose of our work was to study the HLA-DRB1 and HLA-DQB1 alleles in patients with cutaneous and anaphylactoid reactions caused by NSAIDs. METHODS We have analyzed 114 HLA DRB1 and 26 HLA-DQB1 alleles in 21 patients with anaphylactoid reactions caused by NSAIDs, 47 patients who had exclusively cutaneous reactions during single-blind, placebo-controlled oral challenges with NSAIDs, and 167 tolerant control subjects (29 of whom had also had an IgE-mediated anaphylaxis to different agents). HLA-DRB1 and HLA-DQB1 alleles were typed by the polymerase chain reaction sequence-specific primers method with genomic DNA. RESULTS The frequency of HLA-DR11 alleles was 58.8% in the anaphylactoid reaction group, compared with 15.9% in the NSAID-tolerant healthy control subjects (OR, 7:3; 95% confidence interval, 2.8-19.0; P <.02) and 6.3% in the group of the patients with a tolerance for NSAIDs and with IgE-mediated anaphylaxis (OR, 18.75; 95% confidence interval, 4.3-81.1; P <.004). No differences were observed among HLA-DR11 alleles analyzed. There were no significant HLA-DQB1 associations with NSAID-induced anaphylactoid reactions. Patients with cutaneous reactions had HLA frequencies that did not differ significantly from the tolerant control subjects. CONCLUSION The HLA-DRB1*11 alleles showed a positive association with NSAID-induced anaphylactoid reactions.

Tobacco allergy: demonstration of cross- reactivity with other members of Solanaceae family and mugwort pollen

BACKGROUND Tobacco is a plant belonging to the Solanaceae family. This plant is usually used as a contact insecticide for several infestations in some areas, such as the Canary Islands. Allergy induced by inhalation of this plant is unusual. Identification of the potential allergen in growing areas is essential. OBJECTIVE We report a patient with occupational sensitivity to an aqueous solution of cut tobacco whose clinical manifestations were rhinoconjunctivitis and urticaria. Past medical history was significant for seasonal allergic rhinoconjunctivitis to mugwort pollen and oral allergy syndrome with avocado. METHODS Green tobacco and cured tobacco leaf extracts were prepared, skin prick tests were performed with green tobacco, cured tobacco leaf extracts, and certain aeroallergens. Conjunctival challenge test was carried out with green tobacco and cured tobacco leaf extract. Serum-specific IgE against tobacco leaf was performed by commercial CAP. CAP inhibition experiments were carried out with tobacco and Artemisia vulgaris. RESULTS Skin prick tests and conjunctival challenge tests with green tobacco and cured tobacco leaf extracts were positive, as well as serum-specific IgE by CAP, indicating an IgE-mediated sensitization. CAP inhibition experiments were carried out and it was found that tobacco, mugwort pollen, and tomato extracts inhibited the binding of the patients serum to solid-phase tobacco leaf. No inhibition was observed when Alternaria, D. pteronyssinus, and potato were used as control inhibitors. Inhibition of immunoCAP to mugwort was obtained with mugwort and tobacco extracts and no cross-reactivity to D. pteronyssinus was shown. CONCLUSION The results suggest that tobacco can induce IgE-mediated reactions that are mediated by the existence of common antigenic epitopes between tobacco and mugwort pollen. This allergy can be a hazard of employment in the agricultural areas.

Pocket 4 in the HLA-DRB1 antigen-binding groove : an association with atopy

Background: Many studies have attempted to identify an association between HLA genes and atopy, given the role of HLA molecules in the regulation of the immune response. In the case of house‐dust mites, it is difficult to find an association with a particular HLA allele, due to the complexity of the allergen. The objective was to investigate whether HLA‐DRB1 functional groups are better correlated with the atopic disease in our population than DRB1 alleles.

Linkage of house dust mite allergy with the HLA region.

BACKGROUND Atopy is a multifactorial disease, the pathogenesis of which is influenced by both genetic and environmental conditions. Genes in the HLA region have been involved in the control of the IgE response. OBJECTIVE In order to investigate whether allergy to house dust mite is associated with HLA in our population, we performed sib-pair analysis in 18 families and a case/control study of 161 non-related individuals. METHODS Levels of total and specific IgE were determined, skin-prick tests were carried out and clinical history was reviewed for every subject in the study. HLA class II typing was performed by the polymerase chain reaction with sequence specific primers. RESULTS We observed a significant difference from expected values in haplotypes shared by affected sibs; however, the case/control study did not reveal any association with any particular allele. CONCLUSION These results suggest that any particular HLA-DRB1/DQA1/DQB1 allele is responsible for the development of allergy to house dust mite in the Spanish population. Some other locus in or close to the HLA region might be involved, e.g., the tumour necrosis factor gene, a possibility that would explain the significant difference from expected values in the segregation of HLA haplotypes.

Carica papaya Pollen Allergy

BACKGROUND Carica papaya (CP) trees are widely cultivated in tropical and subtropical areas; however, CP pollen allergy has not been previously described. OBJECTIVE To study patients with CP pollen hypersensitivity. METHODS A CP pollen extract was elaborated. Skin prick tests (SPTs) with this extract, as well as with commercial papaya fruit and papain extracts, were performed. Specific IgE levels to CP pollen, papaya fruit, and papain were determined. Specific conjunctival challenge tests to the CP pollen extract were also performed. RAST inhibition studies among CP pollen, papaya fruit, and papain were carried out. Twenty atopic patients were used as a control group for in vivo and in vitro tests. RESULTS Six patients with clinical histories of seasonal rhinoconjunctivitis or bronchial asthma in relation to CP trees exposure, suggestive of IgE-mediated respiratory allergy, were studied. Commercial SPT and specific serum IgE to papaya fruit and papain were positive in our patients. An IgE-mediated hypersensitivity to a CP pollen extract was demonstrated in all patients, by means of SPTs, specific serum IgE determinations, and conjunctival challenge tests. Control atopic subjects showed negative SPTs, specific IgE, and conjunctival challenge tests to the CP pollen extract. On RAST inhibition studies using CP pollen extract in solid phase, a significant crossreactivity was found among CP pollen, papaya fruit, and papain. CONCLUSIONS Our study suggests that papaya flower pollen is able to induce respiratory IgE-mediated allergy. The existence of common allergens among papaya flower pollen, papaya fruit, and papain has been demonstrated by RAST inhibition.

IL4‐R1 (5q31–q33) and FcεRI‐βca (11q13) markers and atopy: a case/control study in a Spanish population

Background: Rhinoconjunctivitis and bronchial asthma are atopic diseases with a high prevalence in the Canary Islands (Spain). Given that the most prevalent allergen is the house‐dust mite Dermatophagoides pteronyssinus, early detection of genetically susceptible subjects would allow the application of preventive measures. The objective was to investigate the possible association of IL4‐R1 (chromosome 5q31–q33) and FcεRI‐βca (chromosome 11q13) markers with the atopic disease in our population.

Oral iron cutaneous adverse reaction and successful desensitization

BACKGROUND The oral administering of iron preparations sometimes produces adverse gastrointestinal effects. In contrast, cutaneous reactions are extremely rare. OBJECTIVE We report a patient with several episodes of generalized pruritus and erythematous maculopapular eruption after receiving oral compounds of iron and on whom desensitization with oral iron was attempted. METHODS We studied a female with microcytic anemia due to gynecologic blood loss who presented several episodes of cutaneous eruption after receiving oral compounds of iron. Skin prick-test and two simple-blind, placebo-controlled oral challenges were performed with various iron compounds, and finally desensitization with oral iron was carried out. RESULTS Skin prick-test and patch-test with iron preparations were negative. Two simple-blind, placebo-controlled oral challenges were performed and the patient began experiencing similar cutaneous symptoms. We started a slow desensitization protocol using increasing doses until the target amount of the drug was tolerated without adverse effects. The chronic administration of oral iron therapy once a day for 9 months sustained the desensitized state and the anemia disappeared. CONCLUSION We present methods to effectively manage iron supply for a microcytic anemia patient with cutaneous reactions due to oral iron compounds, to avoid repeated transfusions, slow desensitization with oral iron was successfully attempted.