Ruperto González-Pérez

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.

Contact dermatitis caused by latanoprost-containing eye drops with good tolerance to bimatoprost eye drops.

The drugs most frequently used for glaucoma are topical beta blockers such as timolol and levobunolol and miotic agents such as brimonidine. Most recently, prostaglandin analogues such as latanoprost and bimatoprost have been introduced. All these drugs and some vehicles used in their formulation may be responsible for hypersensitivity symptoms (1–3). We present the case of a 48-yearold woman referred to our outpatient clinic with ocular itching, erythema, tearing, and eyelid eczema for one year. Her symptoms were mild but continuous, without seasonal variation. She did not use cosmetics. She denied respiratory symptoms. She had been diagnosed with open angle glaucoma 2 years ago, and she was having treatment with levobunolol 0.5% (Betagan ; Allergan, Santiago, Spain), brimonidine 0.2% (Alphagan ; Allergan), and latanoprost 0.005% (Xalatan ; Pfizer, Madrid, Spain). She had no other medical problems and was on no medication. Patch tests with commercial baseline antigens (True Test ; Alk Abelló, Madrid, Spain), all 3 topical drugs, bimatoprost 0.03% (Lumigan ; Allergan), and additives such as benzalkonium chloride, sulfites, and polyvinyl alcohol were performed. Non-standard antigens and drugs were tested with Curatest (Lohmann–Rauscher, Rengsdorf, Germany). Pure latanoprost was not tested because of its temperature lability. 3 patients who had no previous contact with these drugs were tested as controls. Baseline patch tests were positive only for cobalt chloride at 2 days. Brimonidine, bimatoprost, sulfites, polyvinyl alcohol, and benzalkonium chloride tests were negative. Levobunolol and latanoprost patches were positive at 2 and 4 days. Antiglaucoma treatment was stopped for one month under ophthalmologic supervision. Topical ketotifen was prescribed complete resolution of the symptoms. Levobunolol and latanoprost were reintroduced separately with a recurrence of the symptoms in 2–3 days in both cases. Later, therapy with bimatoprost and brimonidine was tolerated well. Discussion

Desensibilización frente a tolerancia clínica

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Safety of a dust mite extract in severe allergic asthma

Methods We selected 3 adult patients with a confirmed diagnosis of severe persistent allergic asthma (ATS criteria for severe asthma) for at least five years. Mean average topical steroid (inhaled) daily dose was above 1000 mcg of fluticasone propionate or 1600 mcg of budesonide. All patients included in the current trial were clinically relevant sensitized to dust mites (Dermatophagoides spp.) as shown by skin prick test and/or specific IgE. Inclusion criteria required no hospital or emergency admissions for the last 2 months with no changes in their daily medication in the last four weeks prior to the administration of immunotherapy. No pre-treatment with systemic steroids and/ or antihistaminics were used. Modified standardized specific dust mites immunotherapy extracts were subcutaneously administered according to a validated protocol to achieve a final dose of 100 DDP/ml in a two-week cluster schedule. None of the subjects in both groups have been previously treated with omalizumab. Clinical observation and lung function was strictly monitored in all subjects until the maintenance dose of immunotherapy was reached.