Occupational asthma from dried flowers of Carthamus tinctorious (safflower) and Achillea millefolium (yarrow).
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Achillea↗
Biomedical subjects
J Cuesta
Publications and source records attributed to J Cuesta.
Bronchial responsiveness to bakery-derived allergens is strongly dependent on specific skin sensitivity.
BACKGROUND: Quantitative relationships between immunological reactivity, non-specific bronchial responsiveness and bronchial responsiveness to allergens have scarcely been investigated in occupational asthma. METHODS: We assessed the above relationships in 24 subjects with baker's asthma. The skin endpoint titration to bakery allergens as a measure of immunological reactivity, together with the methacholine PC20 and allergen PC20 during early asthmatic reaction were determined. RESULTS: All patients had positive skin tests to some bakery allergens (wheat and rye flour, soybean flour, fungal enzymes and egg white proteins) and bronchial hyperresponsiveness to methacholine. Specific inhalation challenge (SIC) tests were performed with aqueous allergen extracts of cereal flour (n = 14), soybean (n = 8), baking enzymes (n = 12), and egg white proteins (n = 8) in sensitized workers. A positive asthmatic reaction was observed in 84% of the inhalation challenges. SIC elicited isolated early asthmatic reactions in 62%, dual reactions in 32% and isolated late reactions in 5%. Multiple linear regression analysis showed allergen PC20 as a function of skin sensitivity to allergen and methacholine PC20, yielding the following highly significant regression formula: log-allergen PC20 = 0.18 + 0.99 log(skin sensitivity) + 0.343 log(methacholine PC20) (r = 0.89, P < 0.001). This formula predicted allergen PC20 to within one double concentration in 67%, to within two double concentrations in 85% and within three double concentrations in 97%. CONCLUSION: The main determinant of bronchial responsiveness to allergen in patients with baker's asthma is the degree of sensitization to occupational allergens as determined by skin reactivity, modulated to a lesser extent by non-specific bronchial hyperresponsiveness.
Adult↗
[Intra-abdominal desmoid tumor].
Aggressive fibromatosis (desmoid tumor) are rare connective tissue tumors that occur sporadically or in association with familial adenomatous polyposis. The etiology is unknown and clinical findings depend on growth into neighboring structures. Biopsy is required to establish the diagnosis. The treatment of choice is surgery. We report a case with unusual localization in this form of presentation. The patient remains asymptomatic 15 months after surgery.
Adult↗
Anaphylaxis caused by cauliflower.
BACKGROUND: Cauliflower is a vegetable belonging to the family Cruciferae, genus Brassica, var. Botrytis. METHODS: We report the case of a 70 year-old man who suffered an acute episode consisting of oropharyngeal itching, facial and hand swelling, dyspnea and severe bronchospasm within a few minutes after eating vegetable paella containing cauliflower, green beans, red and green pepper. Due to the severity of the reaction he needed treatment in the emergency room. RESULTS: Skin prick tests with common aeroallergens were positive to Cupressus, Platanus and grass pollen. A strong skin prick test response was obtained with cauliflower and peach lipid transfer protein. Skin prick test with rice, green beans and pepper were negative. Specific IgE determinations were positive to cabbage and cauliflower, and negative to mustard. CONCLUSIONS: The clinical history and the results of the allergologic work-up point out to this patient having experienced an IgE-mediated anaphylactic reaction to cauliflower. To the best of our knowledge, this is the first case report of anaphylaxis due to cauliflower.
Aged↗
Immunological studies in a case of hydrochlorothiazide-induced pulmonary edema.
A case of acute onset non-cardiogenic pulmonary edema induced by hydrochlorothiazide (HCT) is presented. Rapid recovery was obtained with supportive therapy. Leukopenia was evident during the acute phase, with rapid recovery parallel to the clinical improvement, suggesting pulmonary sequestration of granulocytes. Immunological studies including lymphocyte stimulation test with HCT and measurement of specific IgG and IgE to HCT elicited negative results. The pathogenesis of this type of reaction remains to be elucidated.
Antihypertensive Agents↗
Egg white proteins as inhalant allergens associated with baker's asthma.
BACKGROUND: Bakery workers may develop IgE-mediated allergy to liquid and aerosolized hen's egg proteins that are commonly used in the baking and confectionery industries. METHODS: We studied four bakery workers who had work-related allergic respiratory symptoms upon exposure to egg aerosols. The causative role of egg proteins in their respiratory symptoms was investigated by immunologic and specific inhalation challenge (SIC) tests. RESULTS: Skin prick tests to egg white extract and to lysozyme gave positives responses in all the subjects, to ovalbumin in two, to ovomucoid in one and to egg yolk in two subjects. They were also sensitized to wheat, rye and barley flours. Specific IgE determinations to egg white were positive in all patients, to lysozyme in two, to ovalbumin in three, to ovomucoid in two and to egg yolk in two of them. Methacholine inhalation tests revealed bronchial hyperresponsiveness in all workers (PC20 < 16 mg/ml). SICs were performed with aqueous extracts of lysozyme (n = 4), ovalbumin (n = 2) and ovomucoid (n = 1), which elicited isolated early asthmatic reactions in all subjects. Double-blind, placebo-controlled, oral challenge tests with raw egg white were positive in three subjects. CONCLUSIONS: These bakery workers had developed IgE-mediated occupational asthma to hen's egg white proteins.
Adult↗
Generalized dermatitis due to pseudoephedrine.
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Administration, Oral↗
Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins.
There are some contradicting data about clinical allergic cross-reactivity to cephalosporins among patients who have had a previous allergic reaction to penicillins. The purpose of this study was to assess the safety of administering cephalosporins to penicillin-allergic patients. The diagnosis of penicillin allergy was made by positive skin tests to penicillin reagents and/or provocation tests with the penicillin suspected of causing the allergic reaction. To assess the clinical tolerance to cephalosporins, 41 well-characterized penicillin allergic patients diagnosed by positive skin tests and/or provocation tests were challenged with three cephalosporins that do not share the same side chain to the penicillin that induced the reactions: cephazoline, cefuroxime and ceftriaxone. Skin prick and intradermal tests with all cephalosporins tested were negative. All penicillin-allergic patients tolerated therapeutic doses of the three cephalosporins tested (cephazoline, cefuroxime and ceftriaxone) without any ill effect. These results indicate that the risk of suffering from an allergic reaction on administering cephalosporins to penicillin-allergic patients seems to be very low, provided that cephalosporins with a different side chain to the penicillin responsible for the allergic reaction are used.
Adult↗
Beer-induced anaphylaxis: identification of allergens.
BACKGROUND: We report on a 21-year-old atopic woman who developed urticaria, angioedema of the face, and wheezy dyspnea shortly after drinking beer and after eating a corn-made snack. METHODS: Skin prick tests and specific IgE determinations to beer ingredients and cereal extracts were performed. Immunoblotting inhibition assays were carried out to investigate possible common allergens shared by barley and malt with corn. RESULTS: Skin prick tests and specific IgE measurements with beer, barley, malt, wheat, corn, rye, rice, and oat flour were positive. Ten pollen-allergic patients showed negative skin tests to beer. Double-blind, placebo-controlled, oral challenge tests with sodium metabisulfite and wheat flour were negative. Immunoblotting demonstrated several IgE-binding bands at 31-56 kDa in malt and barley extracts, and a major band at 38 kDa in the beer extract. Immunoblot inhibition assays showed that malt extract was able to inhibit most of the IgE-binding bands in wheat and corn extracts, whereas corn did not produce significant inhibition to barley and malt extracts. CONCLUSIONS: This patient developed type I hypersensitivity to barley/malt and corn. Although she also showed IgE reactivity to wheat and other cereals, no symptoms were elicited upon ingestion of these cereals, probably indicating latent sensitization to them.
Administration, Oral↗
Allergy to goat and sheep cheese with good tolerance to cow cheese.
BACKGROUND: We report on a patient who experienced allergic reactions after eating goat cheese and after touching goat and sheep cheese, but not after consuming cow's milk dairy products. OBJECTIVE: To assess the allergenicity and IgE-binding capacity of the caseins from the three different species. METHODS: Skin prick tests were carried out using whole milk and caseins from three different species (goat, sheep and cow), and whey fractions of cow's milk. Total serum IgE and specific IgE to cow's milk proteins were measured by CAP system and specific IgE against caseins and whole milk were determined by ELISA technique. To evaluate allergenic cross-reactivity, inhibition of the IgE ELISA activity to goat's milk and goat casein was tested for the three caseins. SDS-PAGE and immunoblotting was used to determine IgE binding bands in caseins. RESULTS: Skin tests were positive to sheep and goat's milk, sheep and goat casein, as well as to sheep and goat cheese. Total serum IgE was 66 kU/L and IgE determinations by CAP were negative. IgE ELISA against the caseins from goat and sheep was strongly positive, whereas it was negative to cow casein. ELISA inhibition assays revealed a high degree of cross-reactivity between goat casein and sheep casein. Immunoblotting showed three IgE-binding bands in goat casein at 31, 27 and 22 kDa, which may correspond to alpha-, beta- and gamma-caseins. A band at about 31 kDa was observed in sheep casein and another band at 34 kDa was recognized in cow casein. CONCLUSION: This patient developed allergy to goat and sheep cheese with good tolerance to cow's milk. We identified goat casein as the main allergen causing sensitization in this patient as demonstrated by in vivo and in vitro tests. A high degree of cross-reactivity between goat and sheep casein was observed.
Allergens↗
[outbreak of invasive pulmonary mycosis in neutropenic hematologic patients in relation to remodelling construction work].
BACKGROUND: An increase was observed in the number of cases of invasive pulmonary mycosis in neutropenic hematologic patients coinciding with construction work being carried out in the Hospital Clínico San Carlos (Madrid, Spain). The aim of this study was to confirm the existence of an outbreak, identify the factors related and adopt adequate control measures. METHODS: A descriptive, epidemiologic, environmental microbiologic study was performed. The incidence of cases in the study period and a control period was compared. Air samples were collected in the affected area and other areas of hospitalization not related to the construction work. The ventilation system of the Hemalotogy Isolation Unit (HIU) was also sampled. The control measures undertaken included: hermetic sealing of the construction work adjacent to hematology followed by transfer of the patients to another floor of the hospital. RESULTS: The existence of an outbreak was confirmed (significant increase in the incidence, p = 0.017). Eleven cases and one death by massive hemoptisis were reported. The mean total fungal count and to Aspergillus spp were 120 and 35 UFC/m3, respectively in the hematologic hospitalization area adjacent to the construction work and 37 and 5 UFC/m3 in other areas (p < 0.001). Contamination was detected in the ventilation system of the HIU by A. fumigatus (125 UFC/m3 of air from the interior of the conduct). CONCLUSIONS: An elevated number of fungal spores found in samples from the hematologic hospitalization area as well as no further new cases being reported following the transfer of the patients suggest that the outbreak was related to the adjacent construction work being carried out.
Disease Outbreaks↗
Visceral leishmaniasis with cutaneous lesions in a patient infected with human immunodeficiency virus.
We report a case of visceral leishmaniasis (VL) with cutaneous lesions in a patient infected with human immunodeficiency virus (HIV). The cutaneous lesions consisted of erythematous papules on the legs. Biopsy of one lesion showed abundant Leishmania amastigotes within epithelial cells of an eccrine sweat gland in the dermis. Leishmania organisms were also found in a blood smear. Rapid and complete clearance of the cutaneous lesions was achieved after antimony therapy. Cutaneous lesions in VL are being reported increasingly frequently in patients with HIV infection and their significance remains in discussion.
AIDS-Related Opportunistic Infections↗
[Miller-Fisher syndrome associated with toxoplasmosis].
We report on an immunocompetent patient who developed acquired toxoplasmosis and Miller-Fisher syndrome with central and peripheral neural involvement. We suggest the possible relationship between acquired toxoplasmosis and Miller-Fisher syndrome, even though we cannot exclude a mere coincidence. To our knowledge such an association has not been reported.
Adult↗
Renal invasive aspergilloma: unusual infection in AIDS.
Invasive aspergillosis is a devastating infection that mainly affects immunocompromised hosts. Nevertheless it is not a common infection in AIDS probably due to specific immune aspects. Even more rare in this group of patients is infection limited to the kidney without dissemination as occurred in our case reported here. He had heroin addiction, AIDS in advanced stage C3, neutropenia and received antifungal prophyllaxis as predisposing factors to aspergillosis. Despite correct therapy with Amphotericine B and drainage of one of the abscesses, he died due to antibiotic side-effects and persistence of not-drained contralateral abscess. Our experience supports the fact that we should have a high index of suspicion for fungal aetiology in kidney infection in AIDS patients with predisposing factors discussed in the text, in order to make early diagnosis and to establish prompt aggressive antifungal therapy supported by drainage of fungus collections, or even nephrectomy if required.
Acquired Immunodeficiency Syndrome↗
Primary amebic meningoencephalitis in a patient with AIDS: unusual protozoological findings.
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AIDS-Related Opportunistic Infections↗
Clinical cross-reactivity between amoxicillin and cephadroxil in patients allergic to amoxicillin and with good tolerance of penicillin.
In recent years, patients allergic to amoxicillin (AX) but with good tolerance of penicillin G (PG) have been described. It has been suggested that the epitope implicated in this type of sensitization might be located on the side-chain of the AX molecule. Thus, cross-reactivity between AX and cephadroxil (CEPH), a cephalosporin which shares an identical side-chain with AX, is suspected. This study aimed to demonstrate clinical cross-reactivity between AX and CEPH in patients allergic to AX and showing good tolerance of PG. In 76 of 576 subjects with suspected allergic reaction to PG and/or AX, the diagnosis of allergy was confirmed. All of these had specific IgE to PG, penicillin V, or AX, and/or positive skin tests to PPL (penicilloyl-polylysine), or MDM (minor determinant mixture), or PG, or AX, and/or positive challenge tests with PG and/or AX. Sixteen subjects (21%) allergic to AX (11 with positive skin test and five with positive challenge test to AX) and good tolerance of PG (all with negative parenteral challenge test) were selected. These 16 patients were subsequently challenged with CEPH (up to 500 mg). Fourteen patients tolerated CEPH, and two (12%) had an immediate allergic reaction. Our study indicates that allergy to the side-chain of aminopenicillins seems to have little clinical relevance in patients with allergic reactions to aminopenicillins but with good tolerance of PG, as 88% of patients with this clinical characteristic tolerate a cephalosporin which shares an identical side-chain. It seems that IgE from most of these patients recognizes an epitope different from the side-chain and the beta-lactam ring.
Adolescent↗
Evaluation of the optimal number of faecal specimens in the diagnosis of cryptosporidiosis in AIDS and immunocompetent patients.
This study determines the optimal number of faecal samples that should be examined in order to minimize the occurrence of false-negative results in the diagnosis of cryptosporidiosis using routine techniques. A total of 23,023 faecal samples from 10,870 patients submitted for parasitological examination were processed by the formalin-ethyl acetate concentration technique and stained using a modified Ziehl-Neelsen method. Cryptosporidiosis was diagnosed in 232 patients (2.13%), 44 of whom were infected by HIV, the prevalence rate in this population group being 15.54%. The increase in the number of diagnoses obtained by the examination of n and (n-1) specimens was evaluated statistically. This study found that three is the optimal number of faecal samples that should be examined when cryptosporidiosis is suspected in immunocompetent patients; whereas, only two samples are required for diagnosing this protozoosis in AIDS patients.
Acquired Immunodeficiency Syndrome↗