PubMed Health⌕ Search

Biomedical subjects

Enrique Fernández-Caldas

Publications and source records attributed to Enrique Fernández-Caldas.

17 recordsLinked to original sources
PubMed2006

Successful management of mite-allergic asthma with modified extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae in a double-blind, placebo-controlled study.

BACKGROUND: Mite sensitivity is highly prevalent in tropical and subtropical regions, such as the Canary Islands. OBJECTIVES: To evaluate the clinical efficacy and safety of a depigmented polymerized allergen vaccine containing a 50% mixture of Dermatophagoides pteronyssinus and Dermatophagoides farinae. METHODS: Sixty-four patients participated in the study. It was prospective, double-blind, and placebo-controlled, with random allocation of patients to receive active treatment or placebo. The active group received a mixture of modified allergen extracts containing 50% D pteronyssinus and 50% D farinae; the control group received placebo. All individuals were diagnosed with mild/moderate asthma and rhinoconjunctivitis caused by sensitization to D pteronyssinus and D farinae. Bronchial provocation test (BPT) was considered the main outcome to document clinical efficacy. RESULTS: Fifty-four patients completed the study. The active group experienced a significant improvement in BPT (P < .001), whereas the placebo group did not (P = .648). At the end of the study, 20 patients in the active versus 9 in the placebo group (P = .013; odds ratio, 5.71 [1.76, 18.51]) needed more than twice the amount of allergen to obtain a positive BPT. The median improvement in the active group over placebo was 53.76% in total symptom and 58.09% in medication scores. CONCLUSION: Immunotherapy with a mixture of modified allergen extracts of D pteronyssinus and D farinae is safe and efficacious to treat mite-allergic asthma. CLINICAL IMPLICATIONS: This immunotherapy modifies the natural course of the illness because it improves all clinical outcomes measured and prevents the worsening of specific bronchial hyperreactivity.

Adult↗
PubMed2006

Mite immunotherapy.

Dermatophagoides pteronyssinus and D. farinae are the most common house dust mites and are among the most common sources of indoor allergens worldwide. These species are very common in humid regions, where most allergic individuals are sensitized to house dust mites. Specific immunotherapy with mite extracts has demonstrated clinical benefits in several double-blind, placebo-controlled trials that are included in recent reviews of subcutaneous immunotherapy, including pediatric and adult patients with rhinoconjunctivitis and or asthma. Most successful studies of mite immunotherapy have used native allergen extracts adsorbed onto aluminum hydroxide, or chemically modified mite-allergen extracts. Several studies have also shown efficacy using sublingual immunotherapy in pediatric and adult patients with asthma and/or rhinitis. Additionally, the efficacy of subcutaneous immunotherapy has been demonstrated in patients with atopic dermatitis, although more double-blind, placebo-controlled studies are needed. Based on several studies, it cannot be concluded that mite immunotherapy is more dangerous or safer than immunotherapy with grasses, epithelia, or animal epithelia. Because the delivery of high doses of allergen carries with it the risk for immunoglobulin E (IgE)-mediated events, several methods have been developed to reduce specific IgE binding to mite-allergen extracts. An important challenge for future mite immunotherapy modalities is the delivery of relatively high doses without a significant risk for severe reactions.

Allergens↗
PubMed2006

In vivo and in vitro allergenicity of the domestic mite Chortoglyphus arcuatus.

BACKGROUND: Chortoglyphus arcuatus is frequently identified in mattress dust samples in coastal areas of northern Spain. OBJECTIVES: To establish the prevalence of positive skin test reactions to C. arcuatus and to analyze its allergenicity and cross-reactivity. METHODS: One hundred thirty-eight consecutive patients entered the study. The main referred symptoms were rhinoconjunctivitis and asthma. Skin tests were performed with extracts of Dermatophagoides pteronyssinus, Lepidoglyphus destructor, Tyrophagus putrescentiae, C. arcuatus, and Glycyphagus domesticus. Enzyme-linked immunosorbent assay inhibition experiments were conducted with the different mite species and immunoblots with serum samples from 31 sensitized patients. Conjunctival provocation tests were performed in 10 patients with C. arcuatus-positive skin test reactions and in 9 with negative results; all the patients had positive skin test reactions to D. pteronyssinus. RESULTS: The prevalence of positive skin test reactions to D. pteronyssinus was 94.2% and to C. arcuatus was 58%. There was a significant correlation between the number of mites to which patients were sensitized and the time of disease evolution (P = .02). Results of enzyme-linked immunosorbent assay inhibition experiments suggested minimal cross-reactivity between C. arcuatus and D. pteronyssinus. Immunoblot results confirmed specific IgE binding to several bands. Conjunctival test results were positive in 9 of 10 C. arcuatus-positive individuals and slightly positive in 2 of 9 C. arcuatus-negative, D. pteronyssinus-positive individuals. CONCLUSIONS: There is a high prevalence of sensitization to C. arcuatus in northern Spain. Sensitization to this species should be considered of clinical significance. There is minimal cross-reactivity between C. arcuatus and D. pteronyssinus.

Adult↗
PubMed2006

Sensitization and exposure to house dust and storage mites in high-altitude areas of ecuador.

BACKGROUND: Few studies have addressed exposure and sensitization to mite allergens in Andean countries. OBJECTIVES: To identify the main mite species in 3 locations at different altitudes in Ecuador and to verify skin test reactivity to various mite species in allergic individuals in Quito, Ecuador. METHODS: Mattress dust samples were collected in Quito (2,800 m above sea level), Cuenca (2,500 m above sea level), and Guayaquil (sea level). Mite species present in the samples were isolated, identified, and counted. Der p 1 and Der f 1 levels were measured using monoclonal antibody-based enzyme immunoassays. Four hundred thirty-five patients in Quito diagnosed as having allergic rhinitis or asthma underwent skin testing with commercial extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Tyrophagus putrescentiae, and Lepidoglyphus destructor. In addition, Glycyphagus domesticus, Acarus siro, and Aleuroglyphus ovatus were tested in 362, 262, and 279 patients, respectively. RESULTS: Twenty-one mite species were identified. Large populations of mites were detected above 2,500 m of altitude. All the dust samples contained detectable levels of Der p 1 or Der f 1. Positive skin prick test reactions to D. pteronyssinus, D. farinae, B. tropicalis, L. destructor, T. putrescentiae, A. ovatus, A. siro, and G. domesticus were obtained in 60.9%, 56.8%, 17.0%, 19.3%, 10.6%, 15.8%, 8.8%, and 11.0% of the patients, respectively. CONCLUSIONS: Most analyzed mattresses contained several species of mites. Mite allergen levels were high. This study confirms the importance of house dust and storage mite allergens in Ecuador in areas above 2,500 m of altitude, where humidity remains high year round.

Acaridae↗
PubMed2006

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.

Adult↗
PubMed2006

Allergenicity of 10 different apple varieties.

BACKGROUND: More than 100 apple varieties are consumed worldwide. However, the allergenic composition of most apple varieties has not been fully characterized. OBJECTIVE: To analyze the antigenic and allergenic profiles of 10 different commercially available apple varieties. METHODS: Golden, Golden Perlim, Reineta, Reineta Parda, Fuji, Verdedoncella, Granny-Smith, Pink Lady, Royal Gala, and Starking apple varieties were carefully peeled. Peels were individually extracted and centrifuged, and the supernatants were collected, dialyzed, filtered, frozen, and freeze-dried. The extracts were characterized using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblots. Protein content was measured using the Lowry-Biuret method. Twenty-two Spanish patients with oral allergy syndrome after apple ingestion were included in the study. Specific IgE to all apple varieties and birch pollen was evaluated. Eleven patients underwent skin prick testing using extracts of Golden, Starking, and Reineta Parda varieties to determine differences in their in vivo allergenicity. RESULTS: The antigenic profile of the 10 varieties showed differences using sodium dodecyl sulfate-polyacrylamide gel electrophoresis. A 9-kDa band, which could correspond to Mal d 3, was visualized in all the extracts. The Starking variety had the highest protein content. Higher specific IgE values were also obtained for the Starking variety, and the lowest values were for Reineta Parda and Royal Gala. The largest wheals were obtained in all patients with the Starking variety, and the smallest with Reineta Parda. Fourteen patients (64%) recognized Mal d 3 in the Golden variety using immunoblots; 6 patients (27%), who also had specific IgE to Betula, recognized bands with higher molecular weights. CONCLUSIONS: We demonstrated differences in the antigenic and allergenic profiles of the analyzed varieties and a significant variation in Mal d 3 content.

Adult↗
PubMed2006

Occupational allergic rhinoconjunctivitis and asthma to goat and cross-reactivity with cow epithelium.

BACKGROUND: The development of sensitization and symptoms after the inhalation of epithelial allergens is common. OBJECTIVES: To investigate the allergic response (in vivo and in vitro) of 3 individuals clinically sensitive and occupationally exposed to cow and goat and to evaluate the allergenic cross-reactivity between cow and goat epithelium extracts. METHODS: Three patients--a butcher and 2 doctors in veterinary medicine--were evaluated. These patients reported allergic respiratory symptoms after occupational exposure to goats and cows. Extracts were prepared from epithelia of both animals. All the patients underwent organ-specific allergen challenges with cow and goat extracts. Four nasal and 2 bronchial challenges were conducted following standardized procedures. RESULTS: All 3 patients had positive challenge results with the offending allergen extract. Specific IgE to goat allergens was detected in all patients. Several IgE-binding bands were detected. Inhibition assays (enzyme allergosorbent test and immunoblots) confirmed moderate-to-high cross-reactivity between goat and cow extracts. CONCLUSIONS: We confirm clinical sensitivity and specific IgE binding to goat and cow allergens in occupationally exposed individuals. There was good correlation among the clinical history, exposure, and the laboratory findings.

Adult↗
PubMed2005

Comparative study of tolerance between unmodified and high doses of chemically modified allergen vaccines of Dermatophagoides pteronyssinus.

BACKGROUND: The physiochemical modification of allergens to reduce allergenicity, while retaining immunogenicity, provides a chance for the administration of higher doses of immunotherapy, with a decreased risk of systemic reactions. OBJECTIVE: To evaluate the safety of doses of depigmented glutaraldehyde-polymerized vaccine of Dermatophagoides pteronyssinus increasing those used in normal clinical conditions in comparison with regular doses of a non-modified vaccine. MATERIALS AND METHODS: The study was double-blind, parallel and included two patient groups. Twenty-three patients were treated weekly during 9 visits for the build-up phase, followed by 2-weekly maintenance doses (a total of 11 injections per patient). Eleven patients (mean age 22 years) received immunotherapy with the standardized modified vaccine. The maximum dose used was the result of depigmenting and polymerizing 100 times the maximum dose used with the native extract. The maximum concentration used was 990 mug/ml of freeze-dried material. Twelve patients (mean age 24 years) received a standardized, unmodified allergenic extract. The maximum concentration used was 70 mug of freeze-dried material/ml, with a potency of 10 HEP(L)/ml. The tolerance was evaluated recording all the side reactions related to immunotherapy and graded following the recommendations of the European Academy of Allergology and Clinical Immunology. RESULTS: In both groups, all immediate local reactions were clinically not relevant. Patients treated with the native extract experienced 42 local immediate and 24 delayed reactions (1 of them had a diameter >10 cm), whereas patients treated with the modified extract experienced 30 local immediate and 21 delayed reactions (2 of them had a diameter >10 cm). Four systemic reactions in 2 patients, 1 immediate of grade 1 and 3 delayed of grade 2 were reported in the group treated with native extract and 1 delayed of grade 2 in the group treated with the modified preparation. CONCLUSIONS: The modified extract of D. pteronyssinus, used at concentrations which are 10 times higher than those regularly administered in clinical practice, demonstrated to be safe to treat D. pteronyssinus-sensitive patients. The majority of the local reactions (immediate and delayed) were clinically not relevant (diameter <5 cm). No systemic reactions of grade 3 or 4 were noted.

Adolescent↗
PubMed2005

Mite allergens.

There is an increasing awareness of the health implications of mite sensitivity, as it is closely related to asthma. Mite allergy constitutes a complex worldwide problem, with sanitary and economical implications. Not only are mite species present in house dust, producing potent allergens, but other, less studied species are also responsible for significant allergic reactions in occupational settings. In this review, we focus on the growing number of mite species that are implicated in allergic cutaneous and respiratory diseases in humans. Mite allergy is not restricted only to the human "indoor" environment, because numerous reports clearly demonstrate that many species that can induce sensitization and symptoms are encountered in occupational settings. An important component of allergy research is the evaluation of the allergenic cross-reactivity to verify to what extent different mite species have unique, species-specific, or cross-reactive allergens. The results of these investigations have important clinical consequences for the diagnosis and treatment of allergic diseases. Internationally standardized mite extracts are needed to compare sensitization rates around the world and clearly establish risk factors associated with sensitization and asthma. In spite of recent controversial results, a significant reduction in the exposure to mite allergens continues to be an important challenge and one of the main goals in the treatment of mite-induced respiratory symptoms. In many cases, this reduction must be achieved in the workplace as well as in the home environment.

Agriculture↗
PubMed2005

Characterization and improvement of apple extracts for the diagnosis of apple IgE-mediated allergy.

BACKGROUND: The production process of reliable fruit extracts is not well established. OBJECTIVES: To improve the overall quality of apple extracts by reducing protein loss during the manufacturing process and to evaluate the improved extracts using in vivo and in vitro experiments. METHODS: Two types of extracts were prepared from peels of Golden Delicious apples (Malus domesticus). Extract A was extracted, 1:2 wt/vol, for 30 minutes at 40 degrees C in 0.01 M phosphate-buffered saline, and extract B was extracted, 1:2 wt/vol, in phosphate-buffered saline with 20% polyvinylpolypyrrolidone and 2-mmol/L EDTA. Both extracts were filtered, dialyzed in 3.5-kDa dialysis membranes, and lyophilized. The antigenic and allergenic profiles were analyzed using immunoblot and enzyme-linked immunosorbent assay. Nine patients clinically sensitive to apples and 12 controls underwent skin testing with both extracts. RESULTS: Extracts A and B had dry weight yields of 0.71% and 1.86% and protein contents of 104.6 and 257 microg/mg of freeze-dried material, respectively. A steady and progressive loss of protein, greater in extract A than in extract B, was detected at different intervals during the manufacturing process of both extracts. Extract B produced larger wheal sizes than extract A (P = .008). Enzyme-linked immunosorbent assay inhibition results confirmed that extract B had a greater inhibition capacity than extract A. CONCLUSIONS: A progressive loss of protein content occurs during the manufacturing of apple extracts. Wheal sizes induced by extract B were significantly larger than those induced by extract A and prick-by-prick solutions. Extract B was also more potent in vitro than extract A.

Adult↗
PubMed2004

Allergy to kiwi: a double-blind, placebo-controlled food challenge study in patients from a birch-free area.

BACKGROUND: Allergy to kiwi fruit is being increasingly reported, but it has never been evaluated by means of a double-blind, placebo-controlled food challenge (DBPCFC) study. OBJECTIVE: We sought to assess kiwi allergy on the basis of a DBPCFC and identify the patterns of allergen recognition in sensitized patients from a birch-free area. METHODS: Forty-three patients with allergy symptoms who were sensitized to kiwi were evaluated by means of clinical history, skin tests, IgE determinations, and DBPCFCs. The pattern of allergen recognition was assessed by means of IgE immunoblotting. Sequence analysis of IgE-binding bands was performed by using Edman degradation. RESULTS: DBPCFCs were performed in 33 patients; 4 patients had experienced severe anaphylaxis, and 6 patients declined informed consent. DBPCFC results were positive in 23 patients and negative in 10 patients. The most frequent clinical manifestation was oral allergy syndrome. Twenty-one percent of the patients were not allergic to pollen. Forty-six percent of patients experienced systemic symptoms, and this happened with higher frequency in patients not allergic to pollen (100%). Twenty-eight percent of the patients were sensitized to latex. The IgE-binding bands in kiwi extract more frequently recognized by patient sera were those of 30, 24, 66, and 12 kd, and they could not be associated with any pattern of kiwi-induced allergic reactions. CONCLUSION: The results provide evidence that kiwi allergy is not a homogeneous disorder because several clinical subgroups can be established. No definite allergen-recognition pattern was associated with the type of allergic reactions to kiwi. One of 5 patients with kiwi allergy was not allergic to pollen, and these patients had the highest risk of systemic reactions to kiwi.

Actinidia↗
PubMed2004

Mite allergens.

Explore the source record for details and available documents.

Allergens↗
PubMed2003

Mite and cockroach sensitization in allergic patients from Caracas, Venezuela.

BACKGROUND: Mites and cockroaches are important allergen sources in most countries, especially in the tropics. They have been incriminated as the cause of the increased prevalence of inhalant allergen sensitization that has occurred in many areas of Latin America. OBJECTIVE: To study the prevalence of sensitization to mites and cockroaches in allergic patients from Caracas, Venezuela. METHODS: Patients who attended the allergy clinics of two medical institutions, one public and the other private, were skin tested with two mite (Dermatophagoides pteronyssinus and Blomia tropicalis) and six cockroach extracts (Periplaneta americana, Periplaneta fuliginosa, Periplaneta australasiae, Blattella germanica, Blattella orientalis, Supella longipalpis) by the skin prick method. The socioeconomic level of the patients was determined by a modification of the Graffar method. RESULTS: Of the 176 patients included in the study, sensitization to D. pteronyssinus was present in 97.2% of the patients and sensitivity to B tropicalis in 91.6%, whereas skin prick test results to at least one cockroach extract were positive in 83.1% of the atopic patients. An increased sensitization rate to cockroach allergens was observed in patients from lower socioeconomic levels and those attending the public institution. CONCLUSIONS: Because of the high sensitization rates observed in this study, we propose that mite and cockroach allergens are important inducers of symptoms in allergic patients in Caracas. People from low socioeconomic levels and those who live with inadequate hygienic conditions show higher degrees of sensitization to cockroach allergen.

Adolescent↗
PubMed2002

Dust mite allergens: mitigation and control.

In recent years, greater attention has been given to the role of indoor allergens as a cause of sensitization and allergic respiratory diseases. Although indoor allergen control measures to reduce symptoms in individuals allergic to mites have produced controversial results, environmental allergen avoidance is today one of the four primary goals of asthma management recommended in several guidelines of asthma treatment. Exposure to high indoor aeroallergen levels, especially to house dust mite allergens, is an important environmental risk factor for allergic sensitization and the subsequent development and exacerbation of asthma. Therefore, effective aeroallergen avoidance is of use to prevent and treat allergic diseases. Although endotoxin exposure may be protective in early life, it has been demonstrated that the inhalation of endotoxin may exacerbate asthma in house dust mite sensitized patients. Mite-allergic asthmatic patients should be aware of the dangerous combination of mite allergen exposure associated with high endotoxin levels in house dust. These two immunologically active substances have been associated with severe asthma and seasonal exacerbation of symptoms. Effective house dust mite allergen avoidance will never be achieved using a single control measure; various methods are required to affect the multiple factors that facilitate high indoor allergen levels. Education of the patients and their families is also an important component of environmental control strategies.

Allergens↗
PubMed2002

Conjunctival provocation tests in the diagnosis of Anisakis simplex hypersensitivity.

INTRODUCTION: The prevalence of positive skin tests to Anisakis simplex is high compared with the low incidence of true gastroallergic Anisakiasis. There is little information about the prevalence of positive conjunctival tests in A. simplex-sensitized individuals. This study assesses the predictive value of conjunctival provocation test in two groups of A. simplex-sensitized subjects and negative controls. METHODS: Group A consisted of 28 individuals with a clinical history strongly suggestive of gastroallergic anisakiasis and group B, of 32 individuals without such history. The 60 individuals had positive skin tests and in vitro specific IgE determinations to A. simplex. Skin and conjunctival provocation tests were performed with an extract of A. simplex at a concentration of 1 mg of lyophilized material per ml. RESULTS: Conjunctival provocation tests were positive in 21/28 (75%) of group A patients and in 10/32 (31%) of group B patients. This difference was statistically significant (p < 0.015); the odds ratio was 6.6 (2.11-20.5; p < 0.05). The diagnostic value of the conjunctival provocation test was expressed by the following statistical indicators: sensitivity 75% (55.8%-88.6%), false positive 25% (11.4%-45.2%), specificity 68.7% (49.9%-83.2%), false negative 31.2% (16.7%-50%), positive predictive value 67.7% (48.5%-82.7%), negative predictive value 75.9% (56.1%-89%), Yuden index 1.43. There were no statistical differences related to age, sex, or atopic status in patients with a positive or negative conjunctival challenge. Total and specific IgE levels to A. simplex were significantly greater (p < 0.05 and p < 0.001, respectively) in the group of patients with a positive challenge. CONCLUSIONS: The results demonstrate that positive conjunctival provocation tests and high specific and total IgE levels are more prevalent in patients with a clinical history strongly suggestive of gastroallergic anisakiasis. Despite the significant differences obtained in both groups, this test has a limited diagnostic value to clinically discriminate patients with a history consistent with gastroallergic anisakiasis.

Adult↗
PubMed2002

In vivo and in vitro sensitization to domestic mites in German urban and rural allergic patients.

Sensitization to domestic mites is common in Germany. The main objectives of this study were (1) to establish the rate of skin test sensitivity to Dermatophagoides pteronyssinus, Acarus siro, Lepidoglyphus destructor, and Tyrophagus putrescentiae in 512 consecutive patients evaluated for upper and/or lower respiratory complaints; (2) to verify how many of the patients with a positive skin test to at least one of the three storage mites were also skin test positive to D. pteronyssinus; and (3) to verify how many of the patients with at least one positive skin test to one of the storage mites previously mentioned were also sensitized, in vitro, to other mite species. A total of 512 consecutive patients with rhinitis and/or asthma, living in urban or rural areas of central Germany were skin tested with extracts of D. pteronyssinus, A. siro, L. destructor, and T. putrescentiae. In addition, specific IgE determinations to Euroglyphus maynei, Blomia tropicalis, Blomia tjibodas, Blomia kulagini, and Gohieria fusca were conducted in those individuals with a positive skin test to at least one of the storage mites used in skin testing. Of the 512 patients, 103 (20.1%; 77 urban dwellers and 26 farmers) reacted to at least one of the storage mites. From this latter group, 88 individuals (85.4%) also skin tested positive to D. pteronyssinus. In vitro specific IgE determinations revealed a high rate of sensitization to the other mite species studied. We conclude that sensitization to storage mites in Germany is frequently associated with sensitivity to D. pteronyssinus. Overall, skin test sensitivity to storage mites was greater in rural than in city dwellers. In vitro sensitization to B. tjibodas was also significantly greater in rural than in city dwellers.

Allergens↗