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Sánchez-Hernández MC, Dordal MT, Navarro AM, Dávila I, Fernández-Parra B, Colás C, Rondón C, Del Cuvillo A, Vega F, Montoro J, Lluch-Bernal M, Matheu V, Campo P, González ML, González-Pérez R, Izquierdo-Domínguez A, Puiggros A, Velasco M, Fernández-Palacín A, Valero A. Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma? Eur Ann Allergy Clin Immunol 2021; 54:277-283. [PMID: 34313088 DOI: 10.23822/eurannaci.1764-1489.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis.
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Affiliation(s)
| | - M T Dordal
- Allergy Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - A M Navarro
- Allergology UGS, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - I Dávila
- Allergy Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - B Fernández-Parra
- Department of Allergology, Hospital El Bierzo, Ponferrada, León, Spain
| | - C Colás
- Department of Allergology, Hospital Clínico Universitario, Zaragoza, Spain
| | - C Rondón
- Allergy Unit, Hospital Universitario Regional de Málaga-ARADyAL, UMA, Málaga, Spain
| | - A Del Cuvillo
- Asthma and Rhinitis Unit, Department of Otorhinolaryngology, Hospital de Jerez, Jerez, Spain
| | - F Vega
- Department of Allergology, Hospital de la Princesa, Instituto de Investigación Sanitaria (IP), Madrid, Spain
| | - J Montoro
- Allergy Unit, Faculty of Medicine, Hospital de Líria, Universidad Católica de Valencia, San Vicente Mártir, Valencia, Spain
| | - M Lluch-Bernal
- Department of Allergology, Hospital La Paz, Madrid, Spain
| | - V Matheu
- Allergy Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - P Campo
- Allergy Unit, Hospital Universitario Regional de Málaga-ARADyAL, UMA, Málaga, Spain
| | - M L González
- Department of Allergology, Hospital Clínico San Carlos, Madrid, Spain
| | - R González-Pérez
- Allergy Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - A Izquierdo-Domínguez
- Allergy Service, Allergy Unit, Consorci Sanitari de Terrassa, Clinica Diagonal, Barcelona, Spain
| | - A Puiggros
- Allergy Unit, Hospital Quirón, Barcelona, Spain
| | - M Velasco
- Allergy Unit, CCEE Araba, Vitoria, Spain
| | - A Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, Universidad de Sevilla, Spain
| | - A Valero
- Department of Pneumology and Allergy, Hospital Clínic i Universitari, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Spain
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Matito A, Escribese MM, Longo N, Mayorga C, Luengo-Sánchez O, Pérez-Gordo M, Matheu V, Labrador-Horrillo M, Pascal M, Seoane-Reula ME. Clinical Approach to Mast Cell Activation Syndromes: A Practical Overview. J Investig Allergol Clin Immunol 2021; 31:461-470. [PMID: 33541851 DOI: 10.18176/jiaci.0675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of mast cell activation syndromes (MCAS) is defined by 3 criteria: 1) typical clinical signs and symptoms of acute, recurrent (episodic) and systemic mast cell activation (MCA), 2) increase in tryptase level to plus 20 % + 2 ng/ml within a 1-4 hours after onset of the acute crisis, 3) response of MCA symptoms to antimediator therapy. Classification of MCAS requires applying highly sensitive and specific methodological approaches for assessing clonal bone marrow mast cells (BM MCs) at low frequencies. The Spanish Network on Mastocytosis (REMA) score is successfully used as predictive model for selecting MCAS candidates for BM studies based on a high probability of having an underlying clonal mast cell disorder (c-MCD). In this article, we propose a diagnostic algorithm and focus in the practical evaluation and management of patients with suspected MCAS.
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Affiliation(s)
- A Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo
| | - M M Escribese
- Department of Basic Medical Sciences, Faculty of Medicine, San Pablo CEU University, Madrid
| | - N Longo
- Allergy Department, Hospital Universitario de Araba, Osakidetza, Vitoria
| | - C Mayorga
- Allergy Research Group, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga
| | - O Luengo-Sánchez
- Allergy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), ARADyAL research network, Instituto de Salud Carlos III (ISCIII), Barcelona
| | - M Pérez-Gordo
- Basic Medical Science Department, Faculty of Medicine, CEU San Pablo University, ARADyAL, Madrid
| | - V Matheu
- IDP and Allergy Department, Hospital Universitario de Canarias, Tenerife
| | - M Labrador-Horrillo
- Allergy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), ARADyAL research network, Instituto de Salud Carlos III (ISCIII), Barcelona
| | - M Pascal
- Immunology Department, CDB, Hospital Clínic de Barcelona; IDIBAPS, Universitat de Barcelona; ARADyAL research network, Instituto de Salud Carlos III (ISCIII), Barcelona
| | - M E Seoane-Reula
- Pediatric Allergy and Immunology Unit, Hospital General Universitario Gregorio Marañón, Madrid
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3
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González-Pérez R, Sánchez-Machín I, Poza-Guedes P, Matheu V, Álava-Cruz C, Mederos Luís E. Pertinence of Telehealth in a Rush Conversion to Virtual Allergy Practice During the COVID-19 Outbreak. J Investig Allergol Clin Immunol 2020; 31:78-80. [PMID: 32508306 DOI: 10.18176/jiaci.0597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R González-Pérez
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - I Sánchez-Machín
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - P Poza-Guedes
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - V Matheu
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - C Álava-Cruz
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - E Mederos Luís
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
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4
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González-Pérez R, Pineda F, Poza-Guedes P, Castillo M, Matheu V, Sánchez-Machín I. Molecular Allergen Profiling of Dual Mite Sensitization in Severe Allergic Rhinitis. J Investig Allergol Clin Immunol 2019; 30:421-429. [PMID: 31530505 DOI: 10.18176/jiaci.0439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Mites are the most prevalent source of indoor allergens. The present study used a component-resolved diagnosis (CRD) approach to investigate the mite-specific IgE sensitization profile for Dermatophagoides pteronyssinus and Blomia tropicalis. We also assessed the performance of a commercially available CRD approach in patients with severe allergic rhinitis. METHODS We selected 63 consecutive patients with dual sensitization to D pteronyssinus and B tropicalis and persistent severe rhinitis according to the ARIA guidelines. We performed skin prick tests with standardized extracts and determined specific serum IgE to both mites, along with serum specific IgE to Der p 1, Der p 2, Der p 23, Der p 10, and Blo t 5. RESULTS Fifty-eight and 59 patients had positive sIgE to the whole extracts of D pteronyssinus and B tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE to Der p 1, Der p 2, and/or Der p 23, specific IgE to Blo t 5 (≥0.3 ISU-E) was not detected in most of the serum samples (55%). CONCLUSIONS Although the combination panel of the commercially available major allergens Der p 1, Der p 2, and Der p 23 identified more than 90% of the D pteronyssinus-allergic patients, Blo t 5 performed somewhat poorly in those sensitized to B tropicalis. Improvements in CRD and further research concerning the prevalence and clinical relevance of serodominant allergens are needed to achieve a genuine molecular diagnosis, as well as patient-centered mite allergy-specific immunotherapy.
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Affiliation(s)
- R González-Pérez
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - F Pineda
- Diater Laboratory, Madrid, Spain
| | - P Poza-Guedes
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - V Matheu
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - I Sánchez-Machín
- Allergy Department, Hospital Universitario de Canarias, Tenerife, Spain
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Matheu V, Alonso-Larruga A, Poza-Guedes P, Barrios Y, Sanchez-Machin I. P349 Allergy whey proteins from cow's milk solved by yogurt. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Martorell A, Alonso E, Echeverría L, Escudero C, García-Rodríguez R, Blasco C, Bone J, Borja-Segade J, Bracamonte T, Claver A, Corzo JL, De la Hoz B, Del Olmo R, Dominguez O, Fuentes-Aparicio V, Guallar I, Larramona H, Martín-Muñoz F, Matheu V, Michavila A, Ojeda I, Ojeda P, Piquer M, Poza P, Reche M, Rodríguez Del Río P, Rodríguez M, Ruano F, Sánchez-García S, Terrados S, Valdesoiro L, Vazquez-Ortiz M. Oral Immunotherapy for Food Allergy: A Spanish Guideline. Immunotherapy Egg and Milk Spanish Guide (ITEMS Guide). Part I: Cow Milk and Egg Oral Immunotherapy: Introduction, Methodology, Rationale, Current State, Indications, Contraindications, and Oral Immunotherapy Build-up Phase. J Investig Allergol Clin Immunol 2017; 27:225-237. [PMID: 28731411 DOI: 10.18176/jiaci.0177] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.
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Affiliation(s)
- A Martorell
- Department of Allergology, University General Hospital, Valencia, Valencia, Spain
| | - E Alonso
- Department of Pediatric Allergy, Gregorio Marañón Hospital, Madrid, Spain
| | - L Echeverría
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - C Escudero
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - R García-Rodríguez
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - C Blasco
- Department of Pediatric Allergy, Vall d'Hebron Hospital, Barcelona, Spain
| | - J Bone
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - J Borja-Segade
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - T Bracamonte
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - A Claver
- Quirón Dexeus University Hospital, Barcelona, Spain
| | - J L Corzo
- Department of Pediatric Allergy, Carlos Haya University Hospital, Málaga, Spain
| | - B De la Hoz
- Department of Allergology, Ramón y Cajal Hospital, Madrid, Spain
| | - R Del Olmo
- Department of Pediatric Allergy, University Hospital, Móstoles, Spain
| | - O Dominguez
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | | | - I Guallar
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - H Larramona
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - F Martín-Muñoz
- Department of Allergology, La Paz Children's Hospital, Madrid, Spain
| | - V Matheu
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - A Michavila
- Department of Pediatric Allergy, General Hospital, Castellón, Spain
| | | | | | - M Piquer
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | - P Poza
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - M Reche
- Department of Allergology, Infanta Sofía Hospital, San Sebastián de los Reyes, Spain
| | - P Rodríguez Del Río
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - M Rodríguez
- Department of Allergology, Alcorcón Foundation Hospital, Alcorcón, Spain
| | - F Ruano
- Department of Allergy, Infanta Leonor Hospital, Madrid, Spain
| | - S Sánchez-García
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - S Terrados
- Department of Pediatric Allergy, Ramón y Cajal Hospital, Madrid, Spain
| | | | - M Vazquez-Ortiz
- Pediatric Allergy, Department of Medicine, Imperial College London, United Kingdom
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7
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Poza-Guedes P, Barrios Y, González Pérez R, Sánchez-Machín I, Franco A, Matheu V. Yogurt in the Treatment of β-Lactoglobulin-Induced Gastrointestinal Cow's Milk Allergy. J Investig Allergol Clin Immunol 2017; 26:327-329. [PMID: 27763864 DOI: 10.18176/jiaci.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P Poza-Guedes
- Consulta de Alergia Infantil, Unidad de Alergología-Norte, Hospital del Tórax/Ofra, San Cristóbal de La Laguna, Spain
| | - Y Barrios
- Immunology, Hospital Universitario de Canarias, La Laguna, Spain
| | - R González Pérez
- Consulta de Alergia Infantil, Unidad de Alergología-Norte, Hospital del Tórax/Ofra, San Cristóbal de La Laguna, Spain
| | - I Sánchez-Machín
- Consulta de Alergia Infantil, Unidad de Alergología-Norte, Hospital del Tórax/Ofra, San Cristóbal de La Laguna, Spain
| | - A Franco
- Immunology, Hospital Universitario de Canarias, La Laguna, Spain
| | - V Matheu
- Consulta de Alergia Infantil, Unidad de Alergología-Norte, Hospital del Tórax/Ofra, San Cristóbal de La Laguna, Spain
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8
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Martorell A, Alonso E, Echeverría L, Escudero C, García-Rodríguez R, Blasco C, Bone J, Borja-Segade J, Bracamonte T, Claver A, Corzo JL, De la Hoz B, Del Olmo R, Dominguez O, Fuentes-Aparicio V, Guallar I, Larramona H, Martín-Muñoz F, Matheu V, Michavila A, Ojeda I, Ojeda P, Piquer M, Poza P, Reche M, Rodríguez Del Río P, Rodríguez M, Ruano F, Sánchez-García S, Terrados S, Valdesoiro L, Vazquez-Ortiz M. Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase. Allergol Immunopathol (Madr) 2017; 45:393-404. [PMID: 28662773 DOI: 10.1016/j.aller.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/19/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.
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Affiliation(s)
- A Martorell
- Department of Allergology, University General Hospital, Valencia, Spain.
| | - E Alonso
- Department of Pediatric Allergy, Gregorio Marañón Hospital, Madrid, Spain
| | - L Echeverría
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - C Escudero
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - R García-Rodríguez
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - C Blasco
- Department of Pediatric Allergy, Vall d'Hebron Hospital, Barcelona, Spain
| | - J Bone
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - J Borja-Segade
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - T Bracamonte
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - A Claver
- Quirón Dexeus University Hospital, Barcelona, Spain
| | - J L Corzo
- Department of Pediatric Allergy, Carlos Haya University Hospital, Málaga, Spain
| | - B De la Hoz
- Department of Allergology, Ramón y Cajal Hospital, Madrid, Spain
| | - R Del Olmo
- Department of Pediatric Allergy, University Hospital, Móstoles, Spain
| | - O Dominguez
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | | | - I Guallar
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - H Larramona
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - F Martín-Muñoz
- Department of Allergology, La Paz Children's Hospital, Madrid, Spain
| | - V Matheu
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - A Michavila
- Department of Pediatric Allergy, General Hospital, Castellón, Spain
| | | | | | - M Piquer
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | - P Poza
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - M Reche
- Department of Allergology, Infanta Sofía Hospital, San Sebastián de los Reyes, Spain
| | - P Rodríguez Del Río
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - M Rodríguez
- Department of Allergology, Alcorcón Foundation Hospital, Alcorcón, Spain
| | - F Ruano
- Department of Allergy, Infanta Leonor Hospital, Madrid, Spain
| | - S Sánchez-García
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - S Terrados
- Department of Pediatric Allergy, Ramón y Cajal Hospital, Madrid, Spain
| | - L Valdesoiro
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - M Vazquez-Ortiz
- Pediatric Allergy, Department of Medicine, Imperial College London, United Kingdom
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9
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Martorell A, Alonso E, Echeverría L, Escudero C, García-Rodríguez R, Blasco C, Bone J, Borja-Segade J, Bracamonte T, Claver A, Corzo JL, De la Hoz B, Del Olmo R, Dominguez O, Fuentes-Aparicio V, Guallar I, Larramona H, Martín-Muñoz F, Matheu V, Michavila A, Ojeda I, Ojeda P, Piquer M, Poza P, Reche M, Rodríguez Del Río P, Rodríguez M, Ruano F, Sánchez-García S, Terrados S, Valdesoiro L, Vazquez-Ortiz M. Oral Immunotherapy for Food Allergy: A Spanish Guideline. Egg and Milk Immunotherapy Spanish Guide (ITEMS GUIDE). Part II: Maintenance Phase of Cow Milk (CM) and Egg Oral Immunotherapy (OIT), Special Treatment Dosing Schedules. Models of Dosing Schedules of OIT With CM and Egg. J Investig Allergol Clin Immunol 2017; 27:279-290. [PMID: 28593864 DOI: 10.18176/jiaci.0178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.
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Affiliation(s)
- A Martorell
- Department of Allergology, University General Hospital, Valencia, Valencia, Spain
| | - E Alonso
- Department of Pediatric Allergy, Gregorio Marañón Hospital, Madrid, Spain
| | - L Echeverría
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - C Escudero
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - R García-Rodríguez
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - C Blasco
- Department of Pediatric Allergy, Vall d'Hebron Hospital, Barcelona, Spain
| | - J Bone
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - J Borja-Segade
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - T Bracamonte
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - A Claver
- Quirón Dexeus University Hospital, Barcelona, Spain
| | - J L Corzo
- Department of Pediatric Allergy, Carlos Haya University Hospital, Málaga, Spain
| | - B De la Hoz
- Department of Allergology, Ramón y Cajal Hospital, Madrid, Spain
| | - R Del Olmo
- Department of Pediatric Allergy, University Hospital, Móstoles, Spain
| | - O Dominguez
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | | | - I Guallar
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - H Larramona
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - F Martín-Muñoz
- Department of Allergology, La Paz Children's Hospital, Madrid, Spain
| | - V Matheu
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - A Michavila
- Department of Pediatric Allergy, General Hospital, Castellón, Spain
| | | | | | - M Piquer
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | - P Poza
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - M Reche
- Department of Allergology, Infanta Sofía Hospital, San Sebastián de los Reyes, Spain
| | - P Rodríguez Del Río
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - M Rodríguez
- Department of Allergology, Alcorcón Foundation Hospital, Alcorcón, Spain
| | - F Ruano
- Department of Allergy, Infanta Leonor Hospital, Madrid, Spain
| | - S Sánchez-García
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - S Terrados
- Department of Pediatric Allergy, Ramón y Cajal Hospital, Madrid, Spain
| | - L Valdesoiro
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - M Vazquez-Ortiz
- Pediatric Allergy, Department of Medicine, Imperial College London, United Kingdom
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10
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Colás C, Brosa M, Antón E, Montoro J, Navarro A, Dordal MT, Dávila I, Fernández-Parra B, Ibáñez MDP, Lluch-Bernal M, Matheu V, Rondón C, Sánchez MC, Valero A. Estimate of the total costs of allergic rhinitis in specialized care based on real-world data: the FERIN Study. Allergy 2017; 72:959-966. [PMID: 27886391 DOI: 10.1111/all.13099] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the socioeconomic importance of allergic rhinitis (AR), very few prospective studies have been performed under conditions of clinical practice and with a sufficiently long observation period outside the clinical trial scenario. We prospectively estimated the direct and indirect costs of AR in patients attending specialized clinics in Spain. METHODS Patients were recruited at random from allergy outpatient clinics in 101 health centers throughout Spain over 12 months. We performed a multicenter, observational, prospective study under conditions of clinical practice. We analyzed direct costs from a funder perspective (healthcare costs) and from a societal perspective (healthcare and non-healthcare costs). Indirect costs (absenteeism and presenteeism [productivity lost in the workplace]) were also calculated. The cost of treating conjunctivitis was evaluated alongside that of AR. RESULTS The total mean cost of AR per patient-year (n = 498) was €2326.70 (direct, €553.80; indirect, €1772.90). Direct costs were significantly higher in women (€600.34 vs €484.46, P = 0.02). Total costs for intermittent AR were significantly lower than for persistent AR (€1484.98 vs €2655.86, P < 0.001). Total indirect costs reached €1772.90 (presenteeism, €1682.71; absenteeism, €90.19). The direct costs of AR in patients with intermittent asthma (€507.35) were lower than in patients with mild-persistent asthma (€719.07) and moderate-persistent asthma (€798.71) (P = 0.006). CONCLUSIONS The total cost of AR for society is considerable. Greater frequency of symptoms and more severe AR are associated with higher costs. Indirect costs are almost threefold direct costs, especially in presenteeism. A reduction in presenteeism would generate considerable savings for society.
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Affiliation(s)
- C. Colás
- Department of Allergology; Hospital Clínico-Instituto de Investigación Sanitaria de Aragón; Zaragoza Spain
| | - M. Brosa
- Oblikue Consulting; Barcelona Spain
| | - E. Antón
- Department of Allergology; University Hospital Marqués de Valdecilla; Santander Spain
| | - J. Montoro
- Allergy Unit; Hospital Universitario Arnau de Vilanova; Facultad de Medicina; Universidad Católica de Valencia “San Vicente Mártir”; Valencia Spain
| | - A. Navarro
- UGC Intercentros Alergología de Sevilla; Hospital El Tomillar; Sevilla Spain
| | - M. T. Dordal
- Department of Allergology; Hospital Municipal; Badalona Serveis Assistencials; Badalona Spain
- Sant Pere Claver Fundació Sanitària; Barcelona Spain
| | - I. Dávila
- Department of Allergology; University Hospital of Salamanca; Instituto de Investigaciones Biosanitarias de Salamanca; IBSAL; Salamanca Spain
| | | | - M. D. P. Ibáñez
- Department of Allergology; Hospital Infantil Universitario Niño Jesús; IIS Princesa; Madrid Spain
| | | | - V. Matheu
- Department of Allergology; Hospital Universitario de Canarias; Tenerife Spain
| | - C. Rondón
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. C. Sánchez
- UGC Neumología-Alergia; Complejo Hospitalario Universitario de Huelva; Spain
| | - A. Valero
- Allergy Unit; Servei de Pneumologia i Al.lèrgia Respiratòria; Hospital Clínic; Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona; Spain
- Centro de Investigación Biomédica en red en Enfermedades Respiratorias (CIBERES); Barcelona Spain
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11
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Vega F, Panizo C, Dordal M, González M, Velázquez E, Valero A, Sánchez M, Rondón C, Montoro J, Matheu V, Lluch-Bernal M, González R, Fernández-Parra B, Del Cuvillo A, Dávila I, Colás C, Campo P, Antón E, Navarro A. Relationship between respiratory and food allergy and evaluation of preventive measures. Allergol Immunopathol (Madr) 2016; 44:263-75. [PMID: 26316421 DOI: 10.1016/j.aller.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/02/2015] [Accepted: 05/07/2015] [Indexed: 01/24/2023]
Abstract
Food allergy and respiratory allergy are two frequently associated diseases and with an increasing prevalence. Several reports show the presence of respiratory symptoms in patients with food allergy, while certain foods may be related to the development or exacerbation of allergic rhinitis and asthma. The present update focuses on this relationship, revealing a pathogenic and clinical association between food and respiratory allergy. This association is even more intense when the food hypersensitivity is persistent or starts in the early years of life. Food allergy usually precedes respiratory allergy and may be a risk factor for allergic rhinitis and asthma, becoming a relevant clinical marker for severe atopic asthma. Furthermore, the presence of co-existing asthma may enhance life-threatening symptoms occurring during a food allergic reaction. Recommendations for dietary restrictions during pregnancy and breastfeeding to prevent the development of respiratory allergy are controversial and not supported by consistent scientific data. Current recommendations from medical societies propose exclusive breastfeeding during the first four months of life, with the introduction of solid food in the fourth to the seventh month period of life. A delayed introduction of solid food after this period may increase the risk of developing subsequent allergic conditions. Further studies are encouraged to avoid unjustified recommendations involving useless dietary restrictions.
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Lluch-Bernal M, Dordal MT, Antón E, Campo P, Colás C, Dávila I, Del Cuvillo Bernal A, Fernández-Parra B, González R, González ML, Matheu V, Montoro J, Panizo C, Rondón C, Sánchez MC, Valero A, Vega F, Velázquez E, Navarro A. Nasal Hyperreactivity: Nonspecific Nasal Provocation Tests. Review by the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology. J Investig Allergol Clin Immunol 2015; 25:396-407. [PMID: 26817136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to most people. This response is caused by dysregulation of the autonomic nervous system at various levels of the nasal autonomic reflex arc. Various stimuli (methacholine, histamine, adenosine 5'-monophosphate, cold air, mannitol, rapsaicin, phentolamine, and distilled water) have been used in an attempt to find the test that most reliably differentiates between healthy individuals and patients and also between different types of rhinitis. Despite the small number of publications available, in the present review, we provide an update on current nonspecific nasal provocation techniques. The studies published to date are not comparable: the stimuli applied act through different mechanisms and are used to assess different pathways, and the methodologies differ in terms of selection of participants, concentrations used, and assessment of response (criteria for positivity). Given the limited use of nonspecific nasal provocation tests in routine clinical practice, we believe that more studies are warranted to address the research issues we present at the end of the present review, for example, the need to standardize the methodology for each test or even the clinical benefits of knowing whether or not a patient has nasal hyperreactivity.
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Sánchez-Hernández MC, Montero J, Rondon C, Benitez del Castillo JM, Velázquez E, Herreras JM, Fernández-Parra B, Merayo-Lloves J, Del Cuvillo A, Vega F, Valero A, Panizo C, Montoro J, Matheu V, Lluch-Bernal M, González ML, González R, Dordal MT, Dávila I, Colás C, Campo P, Antón E, Navarro A. Consensus document on allergic conjunctivitis (DECA). J Investig Allergol Clin Immunol 2015; 25:94-106. [PMID: 25997302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Allergic conjunctivitis (AC) is an inflammatory disease of the conjunctiva caused mainly by an IgE-mediated mechanism. It is the most common type of ocular allergy. Despite being the most benign form of conjunctivitis, AC has a considerable effect on patient quality of life, reduces work productivity, and increases health care costs. No consensus has been reached on its classification, diagnosis, or treatment. Consequently, the literature provides little information on its natural history, epidemiological data are scarce, and it is often difficult to ascertain its true morbidity. The main objective of the Consensus Document on Allergic Conjunctivitis (Documento dE Consenso sobre Conjuntivitis Alérgica [DECA]), which was drafted by an expert panel from the Spanish Society of Allergology and Spanish Society of Ophthalmology, was to reach agreement on basic criteria that could prove useful for both specialists and primary care physicians and facilitate the diagnosis, classification, and treatment of AC. This document is the first of its kind to describe and analyze aspects of AC that could make it possible to control symptoms.
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Rondón C, Dávila I, Navarro Pulido AM, Sánchez MC, Montoro J, Matheu V, Lluch-Bernal M, Fernández-Parra B, Ibáñez MD, Dordal MT, Colás C, Antón E, Valero A. Clinical Management and Use of Health Care Resources in the Treatment of Nasal Polyposis in Spanish Allergy Centers: The POLAR Study. J Investig Allergol Clin Immunol 2015; 25:276-282. [PMID: 26310042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Nasal polyposis (NP) is a chronic inflammatory disease that constitutes a major health problem with significant comorbidities and a considerable associated socioeconomic burden. OBJECTIVE To describe the clinical features and management of patients with NP attending Spanish allergy centers, the use of health care resources, and the degree of compliance with the diagnostic and therapeutic recommendations of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). METHODS We performed a multicenter, observational, and cross-sectional epidemiologic study of 671 patients consulting for NP in 67 Spanish allergy departments. We used sociodemographic and clinical questionnaires to evaluate clinical characteristics, use of health care resources, diagnostic methods, and treatment administered. RESULTS NP was closely associated with asthma (66%), allergic rhinitis (45.9%), and hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (26%). Atopy was present in the 50% of cases, with Dermatophagoides pteronyssinus as the most frequent sensitizing allergen. Eleven percent of NP patients visited the emergency department during the previous year, and more than 58% used primary care, allergy, or otorhinolaryngology services. The most frequently used diagnostic tests were skin prick tests (93.6%) and anterior rhinoscopy (79.4%). Intranasal corticosteroids were the drug class most frequently prescribed by allergists (74.6%). Specific immunotherapy was prescribed in 21% of patients. CONCLUSIONS NP is a chronic inflammatory disease that generates considerable use of health care resources. The close association with atopy, asthma, and NSAID hypersensitivity highlights the usefulness of an allergy workup in all patients with NP. Analysis of the clinical management of NP by allergists in Spain revealed a high degree of compliance with EPOS diagnostic and therapeutic recommendations.
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Poza-Guedes P, González-Pérez R, Matheu V. Angiotensin Coverting Enzyme Inhibitors: Managing drug allergic cross-reactivity. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Franco A, Matheu V, Barrios Y, Iglesias J, Sanchez-Machin I. Follow Up of anti-IgE Therapy Using Peripheral Blood CD4+ Adenosine Triphosphate Activity. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Matheu V, Arnau M, Barrios Y. Resistance To Eosinophil Reduction In Local Response By vitamin D3 In Elder Mice. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Dordal MT, Lluch-Bernal M, Sánchez MC, Rondón C, Navarro A, Montoro J, Matheu V, Ibáñez MD, Fernández-Parra B, Dávila I, Conde J, Antón E, Colás C, Valero A. Allergen-specific nasal provocation testing: review by the rhinoconjunctivitis committee of the Spanish Society of Allergy and Clinical Immunology. J Investig Allergol Clin Immunol 2011; 21:1-12. [PMID: 21370717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Specific nasal provocation testing (NPT) consists of eliciting a response from the nasal mucosa by controlled exposure to allergens. It is indicated in the diagnostic confirmation of allergic rhinitis and when discrepancies arise or difficulties exist in the assessment of a patient's medical history and the results of skin and/or serological tests. The technique is also applied to evaluate sensitivity to the allergen, the efficacy and safety profile of treatment, and in research on the pathophysiological mechanisms of nasal response to allergens. NPT also provides information on the etiology of occupational respiratory diseases of allergic origin. Although there have been many studies and publications on the use and standardization of bronchial provocation tests with allergen, few analyze specific NPT. In this review, the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology discuss the methodology, monitoring, and assessment of allergen-specific NPT in order to provide a practical and up-to-date review of the technique.
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MESH Headings
- Administration, Intranasal
- Allergens/administration & dosage
- Allergens/immunology
- Humans
- Nasal Mucosa/immunology
- Nasal Provocation Tests/methods
- Nasal Provocation Tests/standards
- Occupational Diseases/diagnosis
- Peak Expiratory Flow Rate
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/therapy
- Rhinometry, Acoustic
- Sensitivity and Specificity
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Affiliation(s)
- M T Dordal
- Department of Allergology, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
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Affiliation(s)
- I Sánchez-Machín
- Unidad de Investigación, Hospital Universitario NS Candelaria, Tenerife, Spain
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21
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Sánchez-Machín I, Moreno C, González R, Iglesias-Souto J, Pérez E, Matheu V. Safety of a 2-visit cluster schedule of venom immunotherapy in outpatients at risk of life-threatening anaphylaxis. J Investig Allergol Clin Immunol 2010; 20:91-92. [PMID: 20232782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- I Sánchez-Machín
- Allergy Service, Hospital Universitario NS Candelaria, Santa Cruz de Tenerife, Spain
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22
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Navarro A, Colás C, Antón E, Conde J, Dávila I, Dordal MT, Fernández-Parre B, Ibáñez MD, Lluch-Bernal M, Matheu V, Montoro J, Rondón C, Sánchez MC, Valero A. Epidemiology of allergic rhinitis in allergy consultations in Spain: Alergológica-2005. J Investig Allergol Clin Immunol 2009; 19 Suppl 2:7-13. [PMID: 19530412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is considered to be the most frequent allergic disorder. OBJECTIVE To present the data from the Alergológica-2005 on the characteristics of patients with AR. METHODS An observational, descriptive, cross-sectional epidemiologic study was performed on 4991 patients consulting for the first time in Allergology services in Spain. RESULTS Fifty-five percent of patients consulting Allergology services for the first time were diagnosed with AR, of whom 65% also had conjunctivitis and 37% asthma. Two out of every three subjects with AR consulted their primary care physician twice in the previous 4 months. One third was treated by another specialist in the preceding year and one of every five required treatment in emergency departments. AR affected the quality of life (SF-12), in some cases causing time off work and school. The most frequently involved allergens were pollens (51%), followed by dust mites (42%). Polysensitization was found in 31% of cases. Antihistamines and nasal topical corticoids were the most widely used drugs. In 38% of patients, treatment with specific immunotherapy was begun. CONCLUSIONS AR was the leading cause of consultations in Alergológica-2005. Rhinitis was frequently associated with other allergic disorders in 65% of patients with conjunctivitis and 37% with asthma. The illness led to a substantial use of healthcare resources and significantly affected the quality of life of the sufferers.
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MESH Headings
- Adolescent
- Adult
- Child
- Child, Preschool
- Cross-Sectional Studies
- Delivery of Health Care/statistics & numerical data
- Female
- Humans
- Male
- Middle Aged
- Quality of Life
- Referral and Consultation
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Spain/epidemiology
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Affiliation(s)
- A Navarro
- Allergy Unit, Hospital El Tomillar, AH de Valme, Sevilla, Spain.
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Matheu V, Pérez E, González R, Poza P, de la Torre F, Sánchez-Machín I, García-Robaina JC. Assessment of a new brand of determinants for skin testing in a large group of patients with suspected beta-lactam allergy. J Investig Allergol Clin Immunol 2007; 17:257-60. [PMID: 17694698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Skin testing with major and minor determinants of benzylpenicillin is recommended standard practice for the evaluation of patients with immediate hypersensitivity reactions to beta-lactams. However, commercial reagents for this purpose were recently dropped from the European market. OBJECTIVE In the present study, we assessed a new brand of reagents for use in skin testing in patients with suspected penicillin allergy. METHODS Prick tests and intradermal tests were performed with benzylpenicilloyl polylysine (PPL) and minor determinant mixture (MDM). Penicillin G, amoxicillin, and the culprit beta-lactam were also tested. If skin tests were negative, a single-blind oral challenge test was performed with the culprit active principle or penicillin. If both skin tests and challenge tests were negative, the same procedure was repeated between 2 and 4 weeks later. RESULTS A total of 636 patients were assessed. The allergy study was positive in 69 patients. Skin tests with PPL were positive in 30 patients (46.8%) and with MDM in 28 (43.7%). Sixteen patients displayed a positive reaction to both PPL and MDM (25%), while 42 patients (65.6%) had a positive reaction to either PPL or MDM alone. Thirty-two patients had positive skin test reactions to penicillin G or another p-lactam antibiotic. Five patients in whom a negative result was obtained in skin tests had a positive reaction to oral challenge. CONCLUSIONS Our results indicate that a new brand of determinants that is commercially available in Europe is a reliable and useful tool for the diagnosis of beta-lactam allergy. The new reagents are a safe alternative to the previously available brand.
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Affiliation(s)
- V Matheu
- Drug Allergy Unit, Allergy Service, Hospital Universitario NS Candelaria, Tenerife, Spain.
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Alenmyr L, Matheu V, Uller L, Greiff L, Malm-Erjefält M, Ljunggren HG, Persson CGA, Korsgren M. Blockade of CTLA-4 promotes airway inflammation in naive mice exposed to aerosolized allergen but fails to prevent inhalation tolerance. Scand J Immunol 2006; 62:437-44. [PMID: 16305640 DOI: 10.1111/j.1365-3083.2005.01682.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In subjects not developing allergy, inhalation of nonpathogenic protein antigens causes no harm and is associated with tolerance induction. Repeated exposure to aerosolized ovalbumin (OVA) likewise does not evoke airway inflammation and induces inhalation tolerance in experimental animals. The present study explored the role of the inhibitory T-cell receptor CTLA-4, in preventing inflammation and in establishing inhalation tolerance in response to a protein antigen. Naive BALB/c mice were injected intraperitoneally with anti-CTLA-4 monoclonal antibody or control immunoglobulin G (IgG) and exposed daily to aerosolized saline or OVA over 10 or 20 consecutive days. OVA-specific IgE levels and the inflammatory response in airway tissues were assessed 2 days after last exposure. The OVA-specific IgE response was also evaluated in mice subjected to a subsequent immunogenic OVA challenge 18 days after last aerosol exposure. Additional mice were made tolerant by 10 days of OVA aerosol exposure and were then subjected to an immunogenic OVA challenge combined with CTLA-4 blockade or control IgG treatment. Repeated inhalation of aerosolized OVA alone did not cause a pulmonary inflammatory response. In contrast, 10 days of OVA exposure combined with blockade of CTLA-4 led to development of eosinophilic lung infiltrates, BAL fluid eosinophilia, goblet cell hyperplasia and increased OVA-specific IgE. By 20 days of OVA exposure and blockade of CTLA-4, the inflammatory response remained. Mice exposed to aerosolized OVA for 10 days exhibited greatly reduced OVA-specific IgE responses to subsequent immunogenic OVA challenge. Blockade of CTLA-4 during the period of OVA aerosol exposure did not prevent this suppression of the OVA-specific IgE response. Neither did blockade of CTLA-4 during immunogenic OVA challenge alter the allergen-specific IgE response. Our results indicate that in vivo blockade of CTLA-4 modulates the initial immune response to a protein antigen allowing the development of allergen-induced airway inflammation in naive mice. However, this initial exaggerated immune response is followed by the induction of inhalation tolerance, demonstrating that CTLA-4 signalling is not decisive in this process. Our findings also show that once inhalation tolerance is established it may not be disrupted by blockade of CTLA-4.
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Affiliation(s)
- L Alenmyr
- Department of Clinical and Experimental Pharmacology, Lund University Hospital, Lund, Sweden.
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Matheu V, Perez-Rodriguez E, Sanchez-Machin I, Garcia-Robaina JC, de la Torre Morin F. Importance of repeat testing in the diagnosis of penicillin allergy. Br J Dermatol 2005; 154:198. [PMID: 16403125 DOI: 10.1111/j.1365-2133.2005.07027.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baeza ML, Rodríguez A, Matheu V, Rubio M, Tornero P, de Barrio M, Herrero T, Santaolalla M, Zubeldia JM. Characterization of allergens secreted by Anisakis simplex parasite: clinical relevance in comparison with somatic allergens. Clin Exp Allergy 2004; 34:296-302. [PMID: 14987311 DOI: 10.1111/j.1365-2222.2004.01883.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diagnostic methods for the study of allergic reactions to Anisakis simplex (A.s.) based on whole-body extracts of the larva are clearly insufficient. OBJECTIVES To study the allergenicity of the proteins secreted by the parasite. Comparison with somatic antigens and determination of their clinical importance in allergic patients were also addressed. METHODS An excretory/secretory (E/S) extract was produced by culturing third-stage A.s. larvae. It was used to perform immediate skin tests and to determine specific IgE in 10 patients diagnosed with allergy to A.s. Both tests were compared with the results obtained with the whole-body extract (somatic (S)). The molecular weight (MW) of their allergens was determined by immunoblotting, and a single-blind placebo-controlled oral challenge with E/S proteins was performed. Finally, allergens' resistance to gastric pepsin and acid pH was explored. RESULTS A.s. larvae secreted allergens more potent than those present in the S extract. The skin prick test wheal area produced by E/S molecules and the absorbance obtained in the determination of specific IgE with these allergens (ELISA) were 5.8 times bigger than those obtained with S extract. MW allergens of 72 and 56 kDa in E/S extracts and those of 56, 48 and 43 kDa in S extract were recognized by more than 50% of the patients. Partial cross-reactivity between them was revealed by immunoblotting inhibition studies. Oral challenge with E/S extract (up to 479 microg) was negative in all the patients. Treatment of E/S proteins with gastric pepsin inhibited the binding of the E/S allergens for specific IgE. The acid pH did not affect the overall binding of IgE to E/S extract. It decreased by 15.23% and 19.96% at pH 4 and 2, but the difference was not statistically significant. CONCLUSION A.s. secretes allergens more potent than somatic antigens and should be used in the diagnostic procedures. These allergens are inactivated by the pepsin, which supports the theory that live larva is necessary to induce an allergic reaction in most of the patients.
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Affiliation(s)
- M L Baeza
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Matheu V, Treschow A, Teige I, Barrios Y, Issazadeh-Navikas S. Role of IFN-beta gene in the immune response after CpG motifs treatment in an allergy murine model. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)81162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trujillo MJ, Rodríguez A, Gracia Bara MT, Matheu V, Herrero T, Rubio M, Zubeldia JM, Baeza ML. Dietary recommendations for patients allergic to Anisakis simplex. Allergol Immunopathol (Madr) 2002; 30:311-4. [PMID: 12464163 DOI: 10.1016/s0301-0546(02)79145-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anisakis simplex, a fish parasite, causes allergic urticaria, angioedema and anaphylactic shock through an IgE-mediated hypersensitivity mechanism. Consensus on the dietary recommendations that should be given to allergic patients is lacking. Our objective was to evaluate the usefulness of different types of diets in preventing further reactions in patients allergic to A. simplex. METHODS Twenty-eight adult patients, who had suffered an allergic episode caused by A. simplex were asked to follow one of the following three diets for a mean period of 13.16 months: a fish-free diet (diet 1; n = 19), a diet including fish frozen for more than 48 hours (diet 2; n = 9) and a diet with fresh fish (diet 3; n = 12). In all patients raw fish was excluded. Relapse rates and changes in total serum IgE and specific IgE to A. simplex were studied during the follow up. RESULTS During the 13-month follow-up none of the patients developed anaphylaxis. Urticaria symptoms were present in 5.8 %, 11.1 % (n.s) and 33.3 % (p = 0.016) of patients following diets 1, 2 and 3, respectively. Total IgE decreased by 64 % (p < 0.05), 48 % (p < 0.05) and 39.4 % (p < 0.05), respectively. Specific IgE to A. simplex decreased by 50.7 % (p < 0.05), 54.1 % (p < 0.05) and 23.6 % (p < 0.05) after diets 1, 2 and 3, respectively. No statistically significant differences were found among the groups in variations in total and specific IgE. CONCLUSIONS Patients allergic to A. simplex can eat fish that has been frozen at -20 C for 48 hours without risk of a severe allergic reaction. Long term decreases in specific and total IgE may not be good markers of eventual contact with A. simplex.
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Affiliation(s)
- M J Trujillo
- Hospital General Universitario Gregorio Marañón. Servicio Alergia. Madrid. Spain.
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de Barrio M, Matheu V, Baeza ML, Tornero P, Rubio M, Zubeldia JM. Bezafibrate-induced anaphylactic shock: unusual clinical presentation. J Investig Allergol Clin Immunol 2002; 11:53-5. [PMID: 11436973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
We report a case of a patient who suffered generalized urticaria, chest tightness, wheezing, nausea, vomiting, hypotension, and loss of consciousness. Two hours earlier she had taken Eulitop Retard following lunch. She had tolerated all the implicated food after the reaction. Allergy evaluation revealed intense positive responses to intradermal tests with bezafibrate active component and Eulitop Retard (skin tests in control subjects were negative). Specific IgE tests (RAST) to Eulitop Retard were negative. An IgE mechanism is suggested to be responsible for this adverse reaction on the basis of the positive skin tets. The delayed onset (two hours) of this anaphylactic shock is unusual. Although infrequent, it may be caused by the specific pharmacokinetic characteristics of this drug, which is a slow releasing agent, mainly absorbed in the gut. The drug was taken just after lunch, and this concomitant food ingestion could also have produced a delay in gastric drainage and a retarded drug absorption. An IgE-mediated accelerated type reaction could also explain this delay. Apparently the patient reacted after the first contact to the drug, and the absence of a sensitization period is not usual in this type of immune reponse. Finally, we recommend the performance of prick and intradermal skin tests prior to any systemic challenge when allergic reactions to fibric acid derivatives are suspected.
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Affiliation(s)
- M de Barrio
- Servicio de Alergia, Hospital General Gregorio Marañón, Madrid, Spain.
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Abstract
We report a case of a 5-year-old child who suffered an oral allergy syndrome and lip angiedema after eating grapes. We obtained a positive prick test with commercial grape extract and a positive prick-by-prick test with pulp and peel of fresh white grape (Moscatel variety) and pulp and peel of blue grape. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis followed by immunoblotting revealed specific immunoglobulin E (IgE) antibodies in the patient's serum against a 94,000 molecular-weight antigenic band. Lip open challenge was positive.
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Affiliation(s)
- A Rodríguez
- Servicio de Alergia, Sección de Alergia Infantil Hospital, General Universitario Gregorio Marañón, Madrid, Spain.
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Gracia-Bara MT, Matheu V, Zubeldia JM, Rubio M, Ordoqui E, López-Sáez MP, Sierra Z, Tornero P, Baeza ML. Anisakis simplex-sensitized patients: should fish be excluded from their diet? Ann Allergy Asthma Immunol 2001; 86:679-85. [PMID: 11428742 DOI: 10.1016/s1081-1206(10)62298-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anisakis simplex (A.s.) allergy is an emerging disease. The third-stage larvae of this nematode are a source of hidden allergens in fish. There are no clear guidelines concerning dietary restrictions for patients with serum-specific IgE to this parasite. OBJECTIVE To follow up the clinical data and immunological parameters of patients sensitized to A.s. during 6 to 23 months. METHODS The clinical symptoms and serologic status of 17 patients with specific IgE and positive skin prick test results to A.s. were studied prospectively. Six of these had anaphylaxis (ANA) attributed to A.s. and 11 patients experienced concomitant chronic urticaria (CU). All patients were advised not to eat fish for 6 months. RESULTS Four patients from the ANA group excluded fish, and ANA did not recur. Two other patients with ANA refused to exclude fish; one remained free of symptoms and the other experienced several urticarial episodes. During this 6-month period total IgE levels decreased in all six ANA patients; specific IgE for A.s. decreased in four patients and increased in two. Two patients from the CU group did not exclude fish, and symptoms persisted in these two patients. Clinical improvement was observed in 78% of the patients with CU who excluded fish. Total and specific IgE levels decreased in all the patients with CU. CONCLUSIONS Because ANA symptoms are very severe, patients should always be advised to exclude fish until specific food allergens are identified. However, in patients with CU and specific IgE to A.s., only the clinical response to fish ingestion will determine the need for strict fish avoidance.
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Affiliation(s)
- M T Gracia-Bara
- Sección de Alergia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Matheu V, Zapatero L, Alcázar M, Martínez-Molero MI, Baeza ML. IgE-mediated reaction to a banana-flavored drug additive. J Allergy Clin Immunol 2000; 106:1202-3. [PMID: 11112910 DOI: 10.1067/mai.2000.111239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
The case is presented of a child who developed rhinoconjunctivitis, angioedema and asthma by sensitization to Sapelli wood, which was used in his father's carpentry. Positive skin-prick test, high levels of specific immunoglobulin E by ELISA and a positive conjunctival challenge test suggest a type I hypersensitivity mechanism to this wood. This is the first case report of sensitization to Sapelli wood and it confirms that occupational allergen exposure as Sapelli wood may also cause sensitization in a child.
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Affiliation(s)
- V Matheu
- Child Allergy Section, Gregorio Marañón University General Hospital, Madrid, Spain.
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Abstract
BACKGROUND Legumes are one of the most common foods causing allergic reactions in children and adults. Cross-reacting antibodies are frequently demonstrated in this family but the real clinical cross-reactivity is uncommon. OBJECTIVE To report a case of lupine-induced anaphylaxis and to elucidate in vivo and in vitro cross-reactivity with some legumes. METHODS Skin prick test (SPT) with some legumes were performed. Cap-IgE, ELISA-IgE, and immunoblotting were carried out. Open oral challenges with some legumes were performed. Cross-reactivity was studied by ELISA and immunoblotting inhibition. RESULTS The results demonstrated type-I hypersensitivity reactions with lupine and some other legumes. Cap-IgE with peanut was positive but the SPT and ELISA-IgE were negative and the patient tolerated a peanut challenge. ELISA inhibition revealed a partial inhibition (62%) using lupine as the solid phase. Partial inhibition was demonstrated by immunoblotting inhibition. Open oral challenge with peanut and green bean were negative but positive with pea. CONCLUSION We present a lupine sensitized patient with positive SPT and in vitro cross-reactivity with other legumes. Clinical cross-reactivity progressively developed over a 5-year period. Discrepancies were found between the clinical aspect and in vitro study of peanut allergy. Factors determining the wide variability in cross-reactivity among individuals are still obscure.
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Affiliation(s)
- V Matheu
- Allergy Section, Gregorio Marañón University General Hospital, Madrid, Spain.
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Affiliation(s)
- V Matheu
- Sección de Alergia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Affiliation(s)
- V Matheu
- Sección de Alergia Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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De Barrio M, Tornero P, Zubeldia JM, Sierra Z, Matheu V, Herrero T. Fixed drug eruption induced by indapamide. Cross-reactivity with sulfonamides. J Investig Allergol Clin Immunol 1998; 8:253-5. [PMID: 9777542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Indapamide is a nontiazidic sulfonamide diuretic which has not been previously reported as a cause of fixed drug eruption. We describe a patient who experienced several episodes of fixed drug eruption during treatment with indapamide. The diagnosis was confirmed by positive controlled oral challenge test. The possible existence of cross-reactivity with other sulfonamide derivatives was investigated by controlled oral challenge test with sulfamethoxazole, sulfadiazine and furosemide, with the tests with sulfamethoxazole and sulfadiazine resulting positive.
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Affiliation(s)
- M De Barrio
- Section of Allergology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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