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J L Eseverri

Publications and source records attributed to J L Eseverri.

49 records · Page 3Linked to original sources

[Jeune syndrome and fungal bronchial asthma].

A young girl suffering from asphyxiating thoracic dystrophy secondary to bronchial asthma was submitted to an allergologic evaluation. We have not found these processes associated in what some authors have called the "minor forms" of the Jeune syndrome. Osteochondrodysplasia, called in recent papers thoracic-pelvic-phalangeal dysplasia, is characterised by marked retraction of the thoracic cage associated with changes in the bones of the pelvis and extremities. We placed special emphasis on the classification of the different forms of presentation as being of greater or lesser severity from a clinical point of view, and stressed the importance of associated abnormalities (such as renal complications, as in the case of our patient) with respect to the eventual prognosis. The diagnosis of allergy is based on a detailed clinical history, positive results to cutaneous testing and the presence of specific IgE, together with the results of nasal provocation. The recording by rhinomanometre, of the temperature and pressure, and the assessment of the nasal mucosa following contact with the suspected allergen was also of help. Finally, having established the diagnosis, we advised the corresponding treatment, both from the allergic and renal viewpoints and concluded with an evaluation of the prognosis as conditioned by the renal pathology.

Asthma↗

[Immunoglobulin levels at different ages in the healthy child population].

In this study, we report the IgE, IgA, IgM and IgG levels in the serum and the secretory IgA obtained from a group of children of different ages with normal morphgram, with no personal or family history of allergies and without recurrent infectious diseases. The IgG, IgA and IgM and salivary secretory IgA were determined by the immunonephelometry technique, using specific anti-serum for heavy chains obtained form rabbits and purified by affinitive chromatography. The IgE was determined by radioimmunoassay, using the PRIST technique. If we look at all published works about normal levels of immunoglobulins in serum, we can see many differences among the results obtained by different authors. Our results are different as well; however, there is no difference in IgE levels. In our work, the secretory IgA level cannot be compared as we do not have any other study available for comparison. We think that our results differ from those obtained by other authors because of differences in laboratory and statistical techniques and other factors such as environment, constitution, nutrition, etc.

Age Factors↗

[Bronchial asthma in the 2d and 3d year of life].

In studying age of onset in our cases of extrinsic asthma, we found that symptomatology occurred in 50% of our patients before the age of 3, and in 45.2% between the first and third year of life. We are therefore concerned about children coming to our service after a long period of illness, since difficulty of recuperation correlates with the duration of asthma. When the onset of asthma is between the first and third years, the child is not yet familiar with his own body's function, and learns how to live as an asthmatic with decreased lung capacity in the intercritic period. As noted by Shepherd, the retention of mucus in a child's lungs will impair the respiratory function more than it does in the adult, since the lesion of an immature structure may hinder its normal development. It is therefore important at this age to maintain respiratory function. 242 children aged between 1 and 3 were studied, who suffered from obstructive respiratory syndromes whose etiology was determined by clinical history and immunoallergic parameters, both "in vivo" and "in vitro". The correlation between the RAST and skin test values by planimetry was also studied. 4 groups were distinguished according to the Foucard score: Group I: consisted of children with a clinical history suggestive of extrinsic allergic asthma due to house dust/mites, with positive skin tests and RAST positive 3-4. Group IIa: also suggestive of extrinsic allergic asthma, with positive clinical history, positive skin test and RAST O. Group IIb: with a positive clinical history, positive skin test and RAST 1-2. Group III: consisted of children with obstructive bronchitis, and uncertain clinical history, negative skin and inhalant tests and RAST O. Group IV: consisted of children with extrinsic asthma due to moulds, with a suggestive clinical history, positive skin tests and RAST 1-2-3-4. Diagnostic methods and therapy in the different groups are discussed. There is a high incidence of onset between the 2nd and 3rd year of age (45%). In the pediatric allergic service the incidence of onset in this age group is only 7.8%. Early diagnosis is essential to avoid damage to lung function in the intercritic period. Difficulty of diagnosis: in the 2nd year we found 38.4% positive and 15.5% suggestive results, totalling 53.9%; and in the 3rd year we found 45.7% positive and 6.2% suggestive results, totalling 51.9%, giving us a more than 50% possibility of extrinsic allergic asthma as the diagnosis.

Age Factors↗

Specific IgE determination using the CAP system: comparative evaluation with RAST.

The CAP system's main contribution is its solid phase, which consists of a cellulose polymer activated within a capsule (the ImmunoCAP). This solid phase can bind more protein to it, and, in addition, the conditions of reaction seem to make the system more sensitive at detecting antibodies to certain antigens. It is therefore important to assess the new analytical and diagnostic performance in comparison with previous systems. In this context, we studied the reliability and comparison with the RAST and with skin tests carried out on 144 pediatric patients. Skin tests and specific IgE for radioimmunological RAST (radio-allergosorbent test) and for the fluoroimmunological CAP system were performed on all the patients. The RAST/CAP correlation quotients for the different allergens tested varied between 0.971 and 0.991. Diagnostic sensitivity increased for all the allergens studied and specificity remained unchanged. The system provides reliable results, with better diagnostic capacity than RAST, but it must be quantified for each allergen because its results are not interchangeable.

Adolescent↗

The prick test and specific IgE (RAST and MAST-CLA) compared with the oral challenge test with milk, eggs and nuts.

In spite of the development of numerous in vivo and in vitro diagnostic techniques for food allergy, the oral challenge test (OCT) is still the "gold standard". Consequently, we have compared it with some of the more recent techniques. We studied 36 patients with a medical history compatible with food allergy (to milk, eggs or nuts) and 11 patients without food allergy (6 nonatopic and 5 with acarid allergy). A prick test, specific IgE (RAST and MAST-CLA) and an OCT with the suspected food were performed in all patients. The following parameters were calculated for all patients overall and for each of the three allergic groups separately: sensitivity, specificity and match with the OCT. We also studied the RAST-MAST-CLA correlation and the variability of the MAST-CLA. The prick test was the most sensitive (95%) and the MAST-CLA (13% divergence in two measurements) the most specific (92%). The RAST and the MAST-CLA (68% match) gave similar results, with an acceptable match (75% and 77%, respectively) with the OCT. The medical history could only suggest the diagnosis (39% false-positives). After comparing the results with those in the literature, it is suggested that greater attention should be paid to the limitations of these techniques compared with the OCT.

Adolescent↗

The value of specific IgG4 determination in childhood allergy to egg in relation to specific IgE and the provocation test.

The value of IgG4 determination in food allergy shows conflicting results in the medical literature. Our pediatric study was carried out in two phases. The first compared the percentage of detection and agreement of specific IgE (RAST) and IgG4 (FAST) for egg white and egg yolk in 104 patients with possible hypersensitivity to egg and positive skin tests. The second, in 22 new patients, compared IgG4 determination with the oral provocation test (OPT; the diagnostic "gold standard"). In the first phase, the percentage of positive cases for both antibodies was almost identical, but little agreement was observed between them. In the second phase, the sensitivity, specificity and agreement with the OPT were higher for IgE than for IgG4. Thus, we conclude that IgG4 levels may be high in food allergy, but their detection seems to have little diagnostic value in allergy to egg proteins in children.

Administration, Oral↗

Prevention of exercise-induced asthma in children using low doses of inhaled furosemide.

It has been demonstrated that inhaled furosemide inhibits indirect but not direct bronchoconstricting stimuli. The exercise test (ET; indirect) has been shown to be inhibited in adults. Our aim was to determine whether the ET was also inhibited in children by low doses of furosemide. We studied 10 asthmatic patients with a mean age of 11.1 years whose ET results were positive, and in whom the ET was repeated after inhaling 28 mg of furosemide. After 10 min, there were no significant signs of bronchodilatation. The percent decrease in mean FVC, FEV1, MF50 and peak flow (PF) was significantly lower with the premedication. The protection achieved was: FVC, 66.5%; FEV1, 51.4%; MF50, 30.3%; and PF, 63.9%. No clinical response was observed in 5 of 10 cases. It was concluded that 28 mg of inhaled furosemide inhibits the ET in asthmatic children.

Administration, Inhalation↗

Alternative milk formulas in allergies to proteins in cow's milk.

A variety of "hypoallergenic" formulas have appeared on the market over the last few years for feeding lactating infants prone to a high atopic risk of allergy to cow's milk. These formulas consist of soya preparations, hydrolyzed proteins and so-called basic formulas. This paper describes the main characteristics of such formulas, with particular emphasis on their tolerance, indications, related immunological aspects and antigenic capabilities. Notifications of anaphylactoid reactions with hydrolyzed proteins and the possibility of interactions with the IgE antibodies in cow's milk indicate such formulas in cases of non-IgE-mediated intolerance. Although soya preparations may be allergenic, they do not present interactions with the proteins in cow's milk; thus, they are particularly indicated in children with protein allergy to cow's milk with specific IgE antibodies.

Humans↗

Study of the sensitization to storage mites in a pediatric population in Barcelona.

We performed the following study in order to determine the prevalence and characteristics of sensitization to storage mites in children mostly from the city of Barcelona. All children over 3 years of age attending our unit for the first time due to respiratory problems were given cutaneous tests using the prick test for the house dust mites Dermatophagoides pteronyssinus and D. farinae, and the storage mites Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae. We carried out a RAST and conjunctival test when it was considered appropriate. Of a total of 356 children studied, 39 showed cutaneous sensitization to storage mites, which represented 11% of the population studied, and 20% of the total sensitized to mites. However, only 3 of these children were only sensitized to storage mites, the remaining 36 (92%) also showing sensitization to house dust mites. Of the storage mites studied, L. destructor was the most significant. A history of immunotherapy to mites was associated with a greater percentage of positive cutaneous tests to storage mites, although this was not the case with the RAST test.

Animals↗

[Perennial rhinitis: antihistaminic and anti-inflammatory treatment].

The use of various medications in chronic rhinitis in children is discussed. Evastin has been shown to eliminate histamine papules in 93% of cases and those caused by D. pteronyssinus in 68% of cases. After 10 days of treatment, conjunctival response decreased or disappeared in 80% of cases and nasal response decreased in 69%. Clinically, evastin was effective in 14 of 22 children and produced moderate effects in 2 and no effect in 6. There were no dropouts because of problems of tolerance. In a preliminary study of intranasal azelastin in 21 children with chronic allergic rhinitis, clinical improvement was significant. Various multicenter trials are reported, focusing on those using fluid budesonide. Both medications were effective in reducing symptoms and the antihistamine effect usually was earlier. There were no differences between medications as evaluated by nasal challenge or tolerance. Finally, budesonide was used in 13 patients for 4 months. Nasal obstruction and secretion improved, and rhinomanometry results improved significantly.

Adolescent↗

[Epidemiology and chronology of allergic diseases and their risk factors].

An increase in allergic diseases in Western societies has been observed in all epidemiological studies. Various risk factors have been invoked to explain this increase, but the results are still inconclusive. We examined the type of patients who visited a hospital pediatric allergology unit in terms of the type of pathology presented, environmental factors, and time from the onset of symptoms until referral for allergy study. We evaluated 200 children ranging in age from 1 month to 15 years who were distributed by pathology: 119 referrals for respiratory manifestations (asthma, rhinitis, coughing, ...), 46 for food-related pathology, and 35 for adverse reactions attributed to medications. Among the risk factors, 69% of the children had a family history, 63.5% were exposed to smoking, and all of the patients were from urban and urban-industrial areas. We found no relation between the type of pathology and birth month. The natural history of allergic disease showed the following sequence: food allergy--respiratory allergy--medication allergy. In every case there was an important delay in diagnosis. The patients who visited our department soonest were infants (for presumptive allergy to cow milk protein or suspected adverse reaction to medications). It is evident that in recent years we are seeing a major increase in allergic diseases, particularly in industrialized countries. From a clinical point of view, manifestations such as asthma, rhinitis, and atopic dermatitis are increasing, which all working groups attribute to an increase in the prevalence of allergy. Epidemiological studies of large population samples use non-standard methods, with different selection criteria, ethnic breakdown and geographic differences. This makes it difficult to compare available data. Therefore, we think that it would be advisable if epidemiological studies would attempt to follow a model, which would facilitate the comparison of studies. Our aim was to evaluate the type of patients who required allergy studies in relation to the pathologies that they present and the different diagnostic methods to determine the presence of false allergies or non-allergies, the delay until study, most frequent pathologies, and environment. We report the data obtained from a sample of 200 children who visited our department for the first time in the period of a natural year.

Adolescent↗

[From atopic dermatitis to asthma].

The prevalence of atopic dermatitis and other allergic diseases is increasing in industrialized countries. Today we know that atopy is conditioned genetically, but the development of the atopic phenotype requires environmental factors. It is believed that the genetic factors have not changed and that the increased prevalence is due to the increase in exposure to allergenic and non-specific environmental factors. The potential for sensitization is greater in the early years of life, so it is necessary to reduce harmful environmental exposure at these ages. Atopic clinical manifestations develop sequentially, in many cases beginning with atopic dermatitis in the early months of life. We know that children with atopic dermatitis present non-specific bronchial hyperreactivity (58 to 82%), which is a risk factor for the later development of asthma. The presence of specific bronchial hyperreactivity for mites in atopic dermatitis with mite sensitization also has been described, and it has been demonstrated that signs of eczema can develop or become exacerbated by airway exposure during bronchial challenge tests. The evolution from atopic dermatitis to asthma is a possibility that must be kept in mind. Patients should be followed-up and study of hyperreactivity and sensitization to allergens should be carried out in order to prevent the development of clinical symptoms. Prevention should include pneumoallergens, food allergens, and non-specific environmental risk factors, such as parental smoking (particularly mothers), pollution inside and outside the home, etc. Prevention is particularly important in children at risk of allergy, as determined by a family history among first-degree relatives, as well as the presence of atopic dermatitis, particularly of early onset, because these patient are most at risk of developing bronchial asthma in later years. At present, pharmacological prevention is being studied, without overlooking environmental prevention, in children at high risk of atopic disease for the purpose of preventing chronic inflammations that will condition their future as adults. In our daily clinical experience, atopic dermatitis is responsible for 8% of visits to a pediatric allergology unit. We emphasize that 62.5% of our patients with dermatitis are referred when they already have bronchial asthma, which represents an important delay in diagnosis with respect to the onset of symptoms.

Adult↗

Determination of total and specific IgE using UNICAP 100: comparative study with the CAP system.

The methods of serum determination of specific IgE to different allergens have showed lower diagnostic sensitivity than the alternative in vivo methods, the skin tests. The CAP system from Pharmacia, owing to its solid phase, has ameliorated this disadvantage, showing in various studies greater diagnostic sensitivity than the classic RAST, without affecting specificity. However, this system is still semi-automatic and requires daily calibration. UNICAP 100 is a completely automatic autoanalyser for total IgE, specific IgE and Eosinophil Cationic Protein, which combines the high sensitivity of the CAP system with complete automation and monthly calibration. The aim of the present study is to assess the practicality and reliability of UNICAP 100, when compared to the CAP System, for the determination of total IgE and specific IgE, as well as the sensitivity and diagnostic specificity; using as a reference skin tests in 150 paediatric patients. The coefficients of variation in the study of intraseries imprecision ranged between 2.1% and 3.6% for total IgE and between 2.2% and 5.1% for specific IgE, depending on the allergen and the level studied. The intraseries imprecision ranged between 3.3% and 7.7% for total IgE and between 5.2% and 8.9% for specific IgE. The coefficients of correlation of the study of interchangeability with the results of the CAP System varied between 0.985 and 0.998, all the allergens tested (9) being interchangeable. Finally, the diagnostic sensitivity varied between 70% and 95% and the specificity between 87% and 100%. In conclusion, UNICAP 100 showed results that were interchangeable with the CAP System, noticeably improving the benefits owing to its complete automation and its calibration system.

Allergens↗