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Hospital de Órbigo, Spain

Montoro J.,Allergy Section
Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología | Year: 2011

Antihistamines have been classifed as first or second generation drugs, according to their pharmacokinetic properties, chemical structure and adverse effects. The adverse effects of antihistamines upon the central nervous system (CNS) depend upon their capacity to cross the blood-brain barrier (BBB) and bind to the central H1 receptors (RH1). This in turn depends on the lipophilicity of the drug molecule, its molecular weight (MW), and affinity for P-glycoprotein (P-gp) (CNS xenobiotic substances extractor protein). First generation antihistamines show scant affinity for P-gp, unlike the second generation molecules which are regarded as P-gp substrates. Histamine in the brain is implicated in many functions (waking-sleep cycle, attention, memory and learning, and the regulation of appetite), with numerous and complex interactions with different types of receptors in different brain areas. Bilastine is a new H1 antihistamine that proves to be effective in treating allergic rhinoconjunctivitis (seasonal and perennial) and urticaria. The imaging studies made, as well as the objective psychomotor tests and subjective assessment of drowsiness, indicate the absence of bilastine action upon the CNS. This fact, and the lack of interaction with benzodiazepines and alcohol, define bilastine as a clinically promising drug with a good safety profile as regards adverse effects upon the CNS.

Torres M.J.,Allergy Service | Ariza A.,Research Laboratory | Fernandez J.,Allergy Section | Moreno E.,Allergy Service | And 4 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2010

Background: Skin testing of subjects with immediate hypersensitivity to amoxicillin is performed using major and minor determinants of benzylpenicillin plus amoxicillin. However, sensitivity is not optimal, and other determinants need to be considered. We assessed the sensitivity of stable, well-characterized minor determinants of amoxicillin in subjects with immediate allergic reactions to amoxicillin to improve skin test sensitivity. Methods: Amoxicillin, amoxicilloic acid, and diketopiperazine were prepared and characterized by reverse-phase HPLC, tested in vivo by skin testing and in vitro by basophil activation test and RAST inhibition assay. Results: Patients with immediate hypersensitivity to amoxicillin were selected: Group A (n = 32), skin test positive just to amoxicillin; Group B (n = 19), skin test positive to benzylpenicillin determinants; Group C (n = 10), skin test negative and amoxicillin drug provocation test positive. In Group A, 27 subjects (81.8%) were skin test positive to amoxicillin, ten (30.3%) to amoxicilloic acid, two (6.1%) to diketopiperacine, and six (18.2%) negative. In Group B, nine (50%) were positive to amoxicillin, eight (42.1%) to amoxicilloic acid, none to diketopiperacine, and nine (50%) negative. In Group C, skin tests were negative. BAT was positive to amoxicillin in 26 patients (50.9%), to amoxicilloic acid in 15 (29.1%), and diketopiperazine in four (7.8%). RAST inhibition studies showed > 50% inhibition in all sera, with the highest concentration of amoxicillin and amoxicilloic acid. Conclusions: The combination of minor determinants of amoxicillin, amoxicilloic acid, and diketopiperazine seems to be of no greater value than the use of amoxicillin alone. Further efforts are needed to find new structures to improve sensitivity in the diagnosis of immediate hypersensitivity to betalactams. © 2009 John Wiley & Sons A/S.

Sanz M.L.,University of Navarra | Gamboa P.M.,Allergy Service Basurto Hospital | Garcia-Figueroa B.E.,Allergy Section | Ferrer M.,University of Navarra
Chemical Immunology and Allergy | Year: 2010

The application and development of new in vitro techniques aims to enable a diagnosis to be reached while incurring no risk for the patient, a situation which is particularly desirable in the case of severe reactions like anaphylaxis. The in vitro diagnosis of anaphylaxis includes, among other aspects, the serial measurement of mediators which are released in the course of an anaphylactic reaction such as tryptase, histamine, chymase, carboxypeptidase A3, platelet-activating factor and other products from mastocytes. The detection of agents which trigger the anaphylactic reaction can be made with the use of serologic methods: serum-specific IgE or with cellular tests which measure the release of basophil mediators (leukotrienes, histamine) or with the analysis of the expression of basophil markers, a technique known as the basophil activation test. These techniques offer interesting alternatives in the diagnosis of anaphylaxis. The basophil activation test provides important advantages in patients with anaphylaxis to β-lactams, non-steroidal anti-inflammatory drugs, neuromuscular blocking agents and drugs where there is no technique to measure specific IgE. Copyright © 2010 S. Karger AG, Basel.

Gamez C.,IIS Fundacion Jimenez Diaz | Gamez C.,CIBER ISCIII | Sanchez-Garcia S.,IIS Fundacion Jimenez Diaz | Ibanez M.D.,Allergy Section | And 9 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2011

Background: Shrimp is a common cause of food allergy. Our aims were to determine the value of IgE antibodies in the diagnosis of shrimp allergy and to study red shrimp (Solenocera melantho) tropomyosin both as a new allergen and as a cross-reactive IgE-binding protein. Methods: We have studied 45 subjects. Skin prick test (SPT) was carried out in all subjects, and specific IgE (sIgE) to shrimp, recombinant and natural shrimp tropomyosins rPen a 1 and nPen m 1, recombinant Der p 10, and Dermatophagoides pteronyssinus was assessed by fluoroimmunoassay and/or immunoblotting. Double-blind, placebo-controlled food challenges were carried out to confirm diagnosis of shrimp allergy. Also, in vitro inhibition tests were performed to evaluate cross-reactivity. Results: Shrimp allergy was confirmed in 18 shrimp-allergic patients. Skin prick test and IgE antibodies to shrimp were positive in all shrimp-allergic patients; sIgE to rPen a 1 was detected in 98% of these patients. Of the 18 shrimp-tolerant patients, 61% had positive SPT to shrimp, 55% were IgE-positive to shrimp, and 33% showed IgE antibodies to rPen a 1. Determination of IgE to rPen a 1 yielded a positive predictive value of 0.72 and a negative predictive value of 0.91. Conclusion: IgE levels to rPen a 1 provided additional value to the diagnosis of shrimp allergy. Some allergens in mite extract are recognized by patients who are allergic to shrimp, though their clinical relevance remains unknown. © 2011 John Wiley & Sons A/S.

Brito F.F.,Allergy Section | Gimeno P.M.,Allergy Unit | Carnes J.,Laboratory LETI S.L. | Fernandez-Caldas E.,Laboratory LETI S.L. | And 4 more authors.
Journal of Investigational Allergology and Clinical Immunology | Year: 2010

Background: In allergic individuals, onset of symptoms is related to atmospheric pollen grain counts and aeroallergen concentrations. However, this relationship is not always clear. Objectives: To analyze the correlation between grass pollen grain and aeroallergen concentrations in Ciudad Real, Spain, during the year 2004 and establish their association with symptoms in patients with allergic asthma, rhinitis, or both. Methods: Two different samplers were used to assess allergen exposure: a Burkard spore trap to collect pollen grains and a high-volume air sampler to collect airborne particles. Individual fi lters were extracted daily in phosphate-buffered serum and analyzed by enzyme-linked immunosorbent assay based on serum containing high titers of specifi c immunoglobulin (Ig) E to grasses. The study population comprised 27 grass-allergic patients whose symptoms and medication were recorded daily. Results: Grass pollens were detected between April 28 and July 18. There was a positive correlation between pollen grain counts and symptoms (r=0.62; P>.001). Grass aeroallergens were detected not only during the grass pollination period, but also before and after this period. There was also a very signifi cant correlation between aeroallergen levels and symptoms (r=0.76; P<.0001). The threshold level for grass pollen was 35 grains/m3. Conclusions: Grass-related allergenic activity is present throughout the year, demonstrating the existence of aeroallergens outside the pollen season. Symptoms in allergic patients may be related to airborne particle concentrations. This fact should be taken into account in the clinical follow-up and management of allergic patients. © 2010 Esmon Publicidad.

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