Virginia Rodríguez

Association of thromboxane A1 synthase (TBXAS1) gene polymorphism with acute urticaria induced by nonsteroidal anti-inflammatory drugs.

8. Martin L, Raison-Peyron N, N€othen MM, Cichon S, Drouet C. Hereditary angioedema with normal C1 inhibitor gene in a family with affected women and men is associated with the p.Thr328Lys mutation in the F12 gene. J Allergy Clin Immunol 2007;120:975-7. 9. Kluft C. Determination of prekallikrein in human plasma: optimal conditions for activating prekallikrein. J Lab Clin Med 1978;91:83-95. 10. Drouet C, D esormeaux A, Robillard J, Ponard D, Bouillet L, Martin L, et al. Metallopeptidase activities in hereditary angioedema: effect of androgen prophylaxis on plasma aminopeptidase P. J Allergy Clin Immunol 2008;121:429-33. 11. Duan QL, Binkley K, Rouleau GA. Genetic analysis of factor XII and bradykinin catabolic enzymes in a family with estrogen-dependent inherited angioedema. J Allergy Clin Immunol 2009;123:906-10.

Minor Interference of Cross-Reactive Carbohydrates with the Diagnosis of Respiratory Allergy in Standard Clinical Conditions

Background: Immunoglobulin E (IgE) to N-glycans from plant and invertebrate glycoproteins induces extensive in vitro cross-reactivity. This study investigates the prevalence and diagnostic relevance of IgE to these N-glycans [cross-reactive carbohydrate determinants (CCDs)] in patients with suspicion of respiratory allergy. Methods: A total of 1,025 adult subjects with symptoms of rhinitis and/or asthma from a reference allergy clinic were studied. Determinations included a structured questionnaire, skin prick tests (SPT), total IgE, a multiallergen IgE test and specific IgE (sIgE) to bromelain, MUXF (the bromelain-type N-glycan) and honeybee phospholipase-A2. Inhibition studies with CCDs were performed in selected cases. Results: The prevalence of CCD sensitization (MUXF sIgE and/or bromelain-sIgE ≧0.1 kUA/l) was 18.0%. Male sex and atopy (SPT positivity) were associated with CCD sensitization. Sensitization was more frequent in patients sensitized to pollens than in those sensitized to mites, the most common inhalant allergens in the area. A history of Hymenoptera stings was associated with CCD sensitization and multiallergen IgE test positivity. CCD sensitization was not significantly associated with age, rural residence, alcohol consumption or smoking. Only 58 patients (5.6%) showed CCD-sIgE levels ≧0.35 kUA/l. CCD-induced inhibition of pollen-sIgE or mite-sIgE in patients with respective positive SPT was minimal or absent in most cases. Conclusions: In this population of predominantly mite-allergic patients, CCD sensitization is relatively rare and CCD-sIgE levels are low. Thus, CCDs do not represent a major obstacle for the diagnosis of respiratory allergy in a specialized setting. Hymenoptera stings are associated with CCD sensitization.

Diagnosis and treatment of allergic rhinitis due to house-dust mites in Spain.

Background The prevalence of allergic rhinitis due to house-dust mites (HDMs) is high and increasing. Treatment guidelines and consensus statements are available, but few data exist on how these are followed in clinical practice in Spain. This study was designed to collect data on diagnosis and treatment of allergic rhinitis due to HDMs and adherence to guidelines in Spanish specialized clinical practice. Methods In this observational study, patients referred to specialists for a first consultation were collected. Diagnosis of allergic rhinitis due to HDMs was confirmed by skin-prick tests and measurement of specific immunoglobulin E levels. Variables included patient demographics, diagnosis, and treatment. Moreover, investigators answered a questionnaire on their attitudes to allergic rhinitis treatment. Results Two hundred forty-seven clinicians collected evaluable data from 519 patients (mean age, 24.8 years; SD, 11.9 years; 54% women) with confirmed allergic rhinitis (86.2% with moderate or severe disease and 70.5% with persistent disease; 40% with concomitant asthma) caused by Dermatophagoides. In 85.6% of patients, symptoms had not improved since diagnosis and good disease control was only being achieved in 43.4%. At the study visit, pharmacologic treatment was prescribed in 98.3% and allergen immunotherapy was prescribed in 52.2% of patients. Conclusion When patients with HDM-induced allergic rhinitis are referred to an allergy specialist in Spain, they have moderate-to-severe persistent disease and are generally not achieving good control with symptomatic treatment. Allergen immunotherapy is prescribed in approximately one-half of patients. In this representative sample of Spanish allergy specialists, the level of adherence to clinical guidelines in these patients is encouraging.

A modified protocol for rapid desensitization to chemotherapy agents

Desensitization protocols for chemotherapy agents (taxanes and platinum salts) have been extensively performed to safely administer these drugs to patients who have previously suffered a hypersensitivity reaction (HSR). Standardized protocols have been published using 12 or 16 steps to reach the cumulative dose in every patient. All these protocols were based on the preparation of 3 different solutions at 100-fold, 10-fold, and 1fold dilution of the final target concentration. However, from the pharmacological point of view, a reasonable doubt on the stability of diluted concentrations arises because there are no published data available. For example, concentrations higher than 0.2 and 0.1 mg/mL are known to be stable for paclitaxel and carboplatin, respectively, but no studies have been performed with lower concentrations. Docetaxel is the least stable drug. According to the Food and Drug Administration, a sodium chloride solution or 5% dextrose solution to produce a final docetaxel concentration of 0.3 to 0.74 mg/mL is stable for 4 hours under ambient room temperature and lighting conditions but there are no data for longer periods of time or lower concentrations. To address this potential problem of stability, a new protocol of desensitization with carboplatin and taxanes was developed. We present a proposed protocol that perfectly fits with the recommended published dosages for these chemotherapy agents but using the same solution during the whole procedure. Twelve patients with HSR to taxanes or platinum salts and for whom continued treatment with these drugs was considered advantageous were evaluated between July 2013 and April 2016. All patients were women with a median age of 50 years (range, 35-72 years) and had received antineoplastic treatment due to either ovarian and/or breast cancer. Eight of them had suffered at least 1 reaction with carboplatin and the remaining 4 with taxanes (2, paclitaxel and 2, docetaxel). Nine patients presented severe reactions involving the respiratory and/or the cardiovascular system. Most patients (11 of 12) presented with cutaneous symptoms (pruritus, flushing, or urticaria). During this period we have used different brands according to the availability at the hospital: docetaxel (Taxotere, Sanofi Aventis, Essex, United Kingdom; Docetaxel, Accord, Middlesex, United Kingdom; Docetaxel, Actavis, Devon, United Kingdom), carboplatin (Carboplatin, Pharmacia Nostrum, Madrid, Spain; Carboplatin, Accord, Middlesex, United Kingdom; Carboplatin, Kabi, Hampshire, United Kingdom), and paclitaxel (Taxol, Bristol Myers Squibb, Latina, Italy; Paclitaxel, Hospira, Madrid, Spain).

Food allergy to Paracentrotus lividus (sea urchin roe)

BACKGROUND Sea urchins are increasingly used as culinary products in Japanese and Korean cuisine throughout the world. OBJECTIVE To investigate a possible IgE-mediated allergy in a patient who experienced an anaphylactic reaction after eating sea urchin roe and mussels. PATIENT AND METHODS A 40-year-old man experienced generalized pruritus and urticaria, shortness of breath, and wheezing 10 minutes after eating steamed mussels and boiled sea urchin roe. Investigations included skin prick tests, serum specific IgE determinations, oral challenge tests, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunoblotting. RESULTS Results of skin prick tests with common aeroallergens were negative. Positive prick test responses were obtained with boiled and raw sea urchin extracts, boiled and raw sea urchins themselves, and boiled sea urchin water. Results of an oral challenge test with steamed mussels were negative. Five minutes after the oral mucosa contacted the boiled sea urchin extract, lip pruritus was present. Specific IgE concentrations to boiled sea urchin water and boiled and raw sea urchins surpassed the criterion for a positive result (1.1, 0.6, and 0.4 kU/L, respectively). In boiled sea urchin extract, a 118-kDa band appeared as the unique relevant IgE-binding antigen. CONCLUSION In this patient with IgE-mediated food allergy to sea urchin roe, a 118-kDa protein seemed to be the antigen responsible for the reaction.

Sensitization pattern of crustacean-allergic individuals can indicate allergy to molluscs

This study investigated the sensitization pattern of crustacean‐allergic patients according to tolerance to molluscs. Thirty‐one patients with anaphylaxis to crustaceans (14 with mollusc allergy and 17 with mollusc tolerance) were studied using skin prick tests (SPTs), specific IgEs (sIgEs) and SDS‐PAGE immunoblotting. IgE‐reactive shrimp proteins were identified by proteomic analyses. Patients with mollusc allergy presented more frequently SPTs positive to molluscs and higher sIgE titres in response to both molluscs and crustaceans. Shrimp‐sIgE and rPen a1‐sIgE values of 1.57 kUA/l and 4.38 kUA/l, respectively, showed positive likelihood ratios of 4.3 and 10.9 for the identification of mollusc allergy. Patients with mollusc allergy reacted more frequently to tropomyosin in immunoblots than did patients without it (93% vs 35%, respectively, P = 0.004). Reactivity to proteins other than tropomyosin (n = 14) was not different between the two groups. Among patients with crustacean anaphylaxis, patients with mollusc allergy and mollusc tolerance show a different pattern of sensitization, something that may help identify them.

Assessment of short-term changes induced by a Dermatophagoides pteronyssinus extract on asthmatic patients. Randomised, double-blind, placebo-controlled trial.

BACKGROUND Once the optimal dose is reached, subcutaneous immunotherapy [SCIT] with mite extract is capable of reducing symptoms and the need for rescue medication. OBJECTIVE To assess the capacity of a subcutaneous extract of mites [D. pteronyssinus] to bring about a reduction in concomitant medication as well as in vivo and in vitro changes in just 2-3 months of treatment in patients with allergic asthma. METHODS A total of 45 patients with persistent mild-moderate allergic asthma due to sensitisation to D. pteronyssinus were included in a multi-centre, double-blind, placebo-controlled trial. Length of treatment was 4 months. After a period for adjusting medication in order to classify asthma severity appropriately, patients were commenced on treatment of 400 or 800 g/day of budesonide as concomitant medication. RESULTS After 4 months of treatment there were no significant changes in the budesonide dose between the active group and the placebo group. In the active group there was a significant difference between active and placebo group in sIgG4 [p=.0003], as well as a significant increase in the cutaneous tolerance index [2.81, CI 95%: 1.29 - 7.48, which was significant with a Confidence Interval of 95%]. These changes were not observed in the placebo group. CONCLUSION After just 4 months of treatment, SCIT was capable of inducing in vivo and in vitro changes, but these changes were not reflected in improved clinical outcome within the first 4 months of therapy.

Anaphylaxis to Hippobosca equina (louse fly)

BACKGROUND IgE-mediated allergy to insects different from Hymenoptera species is seldom reported. OBJECTIVE To describe and study the case of a previously nonatopic man with an anaphylactic reaction (grade III, Müeller) caused by a bite from a louse fly (Hippobosca equina). METHODS In vivo (skin prick tests) and in vitro (enzyme-linked immunosorbent assay and sodium dodecyl sulfatepolyacrylamide gel electrophoresis immunoblotting) tests were used for diagnosis. Cross-reactivity between H. equina and different insects was investigated. RESULTS Results of skin prick tests and serum specific IgE were positive to H. equina. Immunoblot inhibition studies identified common bands in H. equina, Apis mellífera, and Musca domestica, but this cross-reactivity did not affect a band of 16 or 15 kDa. This molecular weight is similar to that of phospholipase A2 in A mellifera venom. CONCLUSION We describe a case of IgE-mediated allergy to H. equina in which specific molecular band proteins seemed to be responsible for the reaction.

Anaphylaxis to Cyphomandra betacea Sendth (tamarillo) in an obeche wood (Triplochiton scleroxylon)—allergic patient

BACKGROUND Anaphylaxis after the first exposure to a food allergen is uncommon unless a cross-reaction is present. OBJECTIVE To investigate a possible relationship between the fruit Cyphomandra betacea Sendth (commonly known as tamarillo) and the wood of Triplochiton scleroxylon (obeche) in a patient with allergic occupational bronchial asthma due to obeche wood who began to experience anaphylaxis episodes after eating tamarillo. METHODS A 33-year-old carpenter exposed to obeche wood in his occupation was initially seen with rhinitis and bronchial asthma. The causal relationship of these symptoms to obeche wood exposure was investigated by means of peak flow monitoring and bronchial inhalation testing. Furthermore, the patient had 2 acute episodes of anaphylaxis a few minutes after eating salad containing tamarillo. He had never tasted tamarillo before. The allergologic study included skin prick tests, serum specific IgE determinations, bronchial challenges, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunoblotting. RESULTS Results of skin prick tests with common aeroallergens were negative. Strong skin prick test responses were obtained with obeche and tamarillo. Results of bronchial challenge testing with obeche extract were positive. In tamarillo extract, a 28-kDa band appeared as the most relevant IgE-binding antigen. A similar band of 28 kDa happens to be frequently detected in obeche-allergic patients. CONCLUSION To our knowledge, this is the first reported case of anaphylaxis to tamarillo presented in a patient allergic to obeche, which raises the question of a new cross-reactivity antigen.