Biomedical subjects

M Fernández-Benítez

Publications and source records attributed to M Fernández-Benítez.

11 recordsLinked to original sources

PubMed2005

Validation of the Spanish version of the Phase III ISAAC questionnaire on asthma.

The prevalence of allergic diseases in childhood has increased significantly over the last decades. This increase seems to be closely associated with the way of life of western societies. The high prevalence differences on different regions may be due to linguistic and cultural reasons and not to real variations in prevalence. This is the reason why several authors felt the need to perform an objective validation of their versions. Our working group has published the results of the Phase I validation and now is publishing the Phase III validation in order to guarantee the reliability of this phase results. The study sample is formed by 366 children aged 3 to 17 years. The following steps were followed in this study: I. Assessment of the "Criterion validity" of the Spanish ISAAC-Bronchial Asthma questionnaire, evaluating the sensitivity, specificity, relative value, and positive and negative predictive values. 2. Determine the questionnaire reliability, analysing its "Inner consistency". 3. Statistical comparison between our ISAAC-Bronchial Asthma results and the ones obtained by other groups (external concordance and consistency), in order to prove the previously evaluated reliability. 4. Comparison between the ISAAC-Bronchial asthma questionnaire diagnostic ability and the standard diagnostic criteria universally used in clinical praxis. We could confirm that there is a high and very significant concordance between the questions aimed to detect children with asthma. In this sense, it is especially useful the question about "ever had wheezing" because of its high sensitivity (93.3%) and specificity (89.9%), that make it able to be used as initial screening test in a general population, and that has shown a high concordance percentage with the questions "ever had asthma" (98%), "wheezing with exercise" (75%), and "cough at night"(80%). The questions that give more information about the evolution and control of the asthmatic disease are "wheezing in the last 12 months", "number of attacks in the last 12 months", "wakening at night", "wheezing with exercise" and "dry cough at night in the last 12 months". The questions more related to asthma severity were "number of attacks in the last 12 months", "wakening at night", "stop speaking in order to breath", and "wheezing with exercise". We conclude that ISAAC-Asthma questionnaire Phase III is a useful tool for the assessment of childhood asthma due to its criterion validity, inner consistency and external concordance.

Adolescent↗

PubMed2002

Respiratory infection in asthma.

Ever since the first decades of the 20th century, some authors have given respiratory infection triggered by bacteria an etiologic role in bronchial asthma, focusing on infection and the asthmatic response. In 1995 our group already presented a study in this sense on nasal secretion cultures and the relationship between IgE and sensitization to allergens. There is a significant association between patients with sensitization to Dermatophagoides, high levels of total IgE, and positive culture to Staphylococcus aureus. Following studies by Norn, we performed a study with 40 children, aged 2-14 years, where we observed that children with sensitization to mites and a positive culture had higher levels of histamine release than did children with negative culture and controls, the differences being significant. We also found, like other authors, that the joint presence of Staphylococcus aureus and Derrmatophagoides pteronyssinus potentiates antigen-specific histamine release. In recent years, with the increasing prevalence of bronchial asthma being studied, the role that infection could play in this increase is being considered again among other factors. As participants of the ISAAC project and using the same methods as in this study, we performed a simultaneous questionnaire with questions related with triggering and contributing factors, etc., including respiratory infection. We found an association between having had more than three episodes of "bronchitis" with fever and lasting for longer than seven days in the last year and having ever had asthma (OR 29.09). This association is still greater with having had wheezing in the last 12 months (OR 43.26), a finding that it is also associated with requiring attention in an emergency room (OR 30.65). From these results, we concluded that respiratory infection is an aggravating factor of asthma, something we already knew. In order to have our own experience, we studied serum interleukin 4 (IL-4) and interferon gamma (IFNgamma) in a sample of 41 children aged 3 to 17 years. The most frequent values of IL-4 ranged between 0.25 and 0.40 ng, and very low dispersion was found in the sample, which did not allow correlation with other parameters. Regarding IFNgamma, we found values between < 5 pg/ml and 605 pg/ml. When we studied children under treatment with antigen-specific immunotherapy, we observed mean values of IFNgamma of 115.86 pg/ml, whereas the ones who did not follow this treatment or had followed it for less than one year had a mean of 66.06 pg/ml, these differences being significant (p = 0.035), and proving a Th1 response to immunotherapy. This significance is not found if children who have been under immunotherapy for less than one year are included. When we studied children with bacterial immunotherapy, we found that the mean IFNgamma value in children under immunotherapy for longer than one year was 56.4 pg/ml, whereas in children with no immunotherapy it was 101.75 pg/ml (p = 0.034). We conclude that bacterial immunotherapy modifies the Thl response, inhibiting it in those children with greater susceptibility to infections.

Adolescent↗

PubMedDate not supplied

[The role of infection in asthma].

Since the first decades of the twentieth century, some authors have believed bacterial respiratory infection to be an important triggering factor in bronchial asthma, drawing attention to an asthmatic response to infection. In this context, already in 1995, we presented a study on nasal secretion cultures and the relationship between IgE and sensitization to allergens. There was a statistically significant association between patients with sensitization to Dermatophagoides, elevated IgE levels and Staphylococcus Aureus positive cultures. Following the studies by Norn, we performed a study in 40 children, aged 2-14 years, and observed that these children with sensitization to mites and positive culture released higher histamine levels than did children with negative cultures and controls. The differences were statistically significant. In agreement with other authors, we also found that the presence of both S. aureus and D. pteronyssinus favored antigen specific histamine release. In the last few years, when the increase in the prevalence of bronchial asthma began to be studied, the role of infection, among other factors, in favoring this increase began to be examined. Using the methodology of the ISAAC project, we distributed a parallel questionnaire containing questions on triggering and contributing factors among which was respiratory infection. We found that there was an association between having three of more episodes of bronchitis in the previous year, accompanied by fever and with a duration of more than 7 days and having asthma at some time (OR: 29.09). This association was even higher in patients with wheezing in the previous 12 months (OR: 43.26) and was also associated with the need to present to the emergency department (OR: 30.65). From these results we conclude that respiratory infection is an aggravating factor in asthma, as we already know. For several years, several authors have studied how non-nosocomial respiratory infections can directly modulate Th1/Th2 response. In order to obtain our own results, we studied serum interleukin 4 (IL4) and interferon-gamma (IFN-gamma) in 42 children aged 3-17 years. The most frequent IL-4 values expressed in ng/ml were between 0.25-0.40, with little variation in the sample, which did not permit correlation among variables. Concerning IFN-gamma, we found values between < 5 and 605 pg/ml. In children undergoing antigen-specific immunotherapy, we observed mean IFN-gamma values of 115.86 pg/ml, while children not undergoing immunotherapy and those who had been administered this treatment for less than 1 year, had a mean of 66.06 pg/ml. These differences were statistically significant (p = 0.035), thus revealing a Th1 response to immunotherapy. These differences were not statistically significant when children who had been administered immunotherapy for less than 1 year were included. When we studied children with bacterial immunotherapy and grouped them in the same way, we found that the mean IFN-gamma of the children undergoing immunotherapy for more than 1 year was 56.4 pg/ml compared with 101.75 pg/ml in those without immunotherapy. This difference was statistically significant (p = 0.034). We are able to conclude that bacterial immunotherapy modifies Th1 response, inhibiting it in children with higher susceptibility to infection. In view of these preliminary results, it would be interesting to continue to study interleukins in order to determine the modification of these substances by immunotherapy in a prospective study and with a sample selected in relation to immunotherapy and not other parameters, since those we have studied have shown no relationship.

Adolescent↗

PubMedDate not supplied

Allergic vulvovaginitis in infancy: study of a case.

BACKGROUND: the role of dust mites (Dermatophagoides pt.) in the pathogenesis of allergic vulvovaginitis is still controversial. Association between this mite and atopic dermatitis, conjunctivitis, rhinitis or asthma is already known. Some authors study the possible relationship between some vulvovaginitis and local hypersensitivity. The aim of this study was to corroborate the allergic aetiology due to the mite Dermatophagoides pt. in a girl with vulvovaginitis and perennial rhinitis. METHODS AND RESULTS: we studied a nine year-old patient with symptoms of perennial rhinitis and unspecific vulvovaginitis of torpid evolution. In vivo and in vitro allergologic tests were performed as well as complete analytic tests including immunoglobulins, urine tests, nasal culture, exudative vaginal culture, and parasitic test. Skin test was positive for Dermatophagoides pt. as well as specific IgE (99.5 kU/L). Total IgE was elevated for her age (492 kU/L). In the rest of the complementary tests, no values out of normality or pathological findings were obtained. CONCLUSIONS: considering these results, it was suspected that the nasal symptoms and the vulvovaginitis presented by the patient are of allergic aetiology by hypersensitivity to the mite Dermatophagoides pt. The study did not prove relation with bacteria, parasites, Candida albicans or any inhalant allergens other than mites. After three months of treatment with oral antihistamines and topical chromones, as well as environmental avoiding measures, the symptoms totally yielded.

Animals↗

PubMedDate not supplied

Allergy to pine nut.

BACKGROUND: food allergy is highly prevalent in our environment, especially among atopic patients. Pinus pinea is common in our region and its fruit, the pine nut, is allergologically important. Several cases have been reported in the literature that demonstrate the existence of common antigenic bands between pine nut and almond. In this study we try to assess this finding and the possible existence of common allergens by in vitro techniques. METHODS AND RESULTS: we present a 10-year-old boy, previously diagnosed of seasonal rhinoconjunctivitis with sensitisation to grass and olive pollen, who had an anaphylactic reaction after eating pine nut. We performed in vivo (prick test, prick-by-prick) and in vitro tests (total and specific IgE determinations [CAP-FEIA]), histamine release test, and immunoblotting (SDS-PAGE). We also reviewed the literature through the MEDLINE database in PubMed. CONCLUSIONS: because pine nut is commonly consumed in our environment, the prevalence of allergic reactions is probably considerable and these reactions take place at an early age. We demonstrate the existence of common antigenic proteins between pine nut and peanuts.

Child↗

PubMedDate not supplied

[Etiologic implication of foods in atopic dermatitis: evidence in favor].

Some of the immunopathologic mechanisms involved in IgE responses are currently being identified; Th2 lymphocytes are known to be activated in patients with atopic dermatitis with subsequent production of the cytokines interleukin (IL)-4 and IL-5, which are responsible for IgE production and eosinophil recruitment. Nevertheless, T cell activation in this disease takes place in two phases. In the first phase, Th2 cells are activated and IL-4, IL-5 and IL-13 are produced; this first stage is produced with the initial activation induced by the antigen. In the second phase there are chronic lesions, Th1 lymphocytes are activated and IFg is produced. This chronic phase is associated with the presence of eosinophils and macrophages that produce IL-12.Numerous articles have demonstrated food sensitization to be an etiopathogenic factor in atopic dermatitis. The prevalence of sensitization varies, depending on the patient's age and the severity of the disease. Children with moderate-to-severe atopic dermatitis have been observed to have a positive skin test and high IgE concentrations to various foods. Nevertheless, a positive skin test to foods in such children does not always implicate these foods as the cause of the clinical manifestations; moreover, in children showing subsequent tolerance to these foods, skin tests can sometimes remain positive and high levels of specific IgE can persist. It is now known that IgE not only participate in the degranulation of mastocyte cells but also in reactions mediated by T cells and other antigen-presenting cells (dendritic cells) which have high-affinity receptors for IgE.The immediate IgE response is well known but it is also known that in addition to the immediate response, a delayed response is also involved, evidenced by the presence of antigen-specific T cells to foods or other allergens such as inhalant allergens. After a strict exclusion diet, children with atopic dermatitis and sensitivity to foods such as milk, egg, flour and soya can develop tolerance; for this reason provocation tests with the food in question should be repeated every 2-3 years. In children with sensitivity to other foods such as dried fruits, fish, and shellfish, sensitivity can sometimes persist into adulthood without tolerance being achieved. In conclusion, there are two groups of children with atopic dermatitis. One group consists of those with atopic dermatitis (allergic disease), which is characterized by early development, high IgE titers, the presence of antigen-specific IgE to allergens and a family history of atopy and which is clinically moderate or severe. Early diagnosis and treatment are important in these children, as is the prevention of progression of the disease to bronchial asthma. The other group consists of children whose dermatitis is clinically atopic in terms of its localization and morphology, who have no demonstrable allergic disease and whose management differs from that in children presenting allergic disease.

Child↗

PubMedDate not supplied

Allergy to heparin: a new in vitro diagnostic technique.

INTRODUCTION: Few descriptions of allergic reactions to heparin have been published, because these reactions are not well known, their prevalence is low and they are difficult to diagnose due to the lack of an in vitro test until now. We propose a new technique, the basophil activation test (BAT) for the diagnosis of these reactions. METHODS AND RESULTS: We performed in vivo and in vitro studies with heparin and its derivatives in two patients with heparin-induced acute urticaria. In both patients the results of prick tests with sodium and calcium heparin, enoxaparin and nadroparin with immediate reading were negative. Intradermal skin tests with immediate reading and reading at 48 and at 96 hours with calcium heparin, enoxaparin and nadroparin were positive in the immediate reading and after 48 hours in the first patient. The second patient showed positivity to nadroparin in the immediate reading. The same drugs were also tested using patch tests, with reading after 48 and 72 hours. The second patient showed positivity to nadroparin after 48 hours. The BAT was positive to enoxaparin in the first patient and revealed showed slight positivity to sodium heparin in the second patient. CONCLUSIONS: We consider the BAT to be a useful, safe and reliable test for the in vitro diagnosis of heparin allergy. This test avoids the use of provocation tests, which present a risk to the patient.

Adolescent↗

PubMedDate not supplied

Allergy to dexchlorpheniramine. Study of a case.

INTRODUCTION: Dexchlorpheniramine (DH) is a classical or first generation antihistamine belonging to the ethanolamine group. Adverse effects related to these antihistamines are frequent, but the hypersensitivity reactions described in the literature since 1940 are exceptional. We report the case of a 32-year-old woman who experienced two episodes of akathisia secondary to intravenous (i.v.) dexchlorpheniramine administration for a possible hypersensitivity reaction to local anesthetics. MATERIAL AND METHODS: Allergological study consisted of the following tests: skin prick tests with routine allergens, with a negative result; skin prick and intradermal tests with local anesthetics and DH, with a positive result to DH in the intradermal skin test (+ +); serum specific IgE, which was within normal levels; histamine release test with DH with a negative result, and the basophil activation test (BAT) with local anesthetics and DH, which was positive for DH and weakly positive to Lidocaine. CONCLUSION: BAT is proving to be a highly useful tool in the field of drug allergy, with a higher sensitivity and specificity than other in vitro tests. Because it avoids the need for provocation tests, this is especially important in drug-induced allergic reactions in which in vivo tests are repeatedly negative despite a clear clinical history.

Adult↗

PubMedDate not supplied

Bronchial asthma prevalence in childhood.

BACKGROUND: at the moment there is a considerable interest in the international comparison of the bronchial asthma prevalence, stimulated by the growing evidence of an increment in the frequency. The comparison among studies of bronchial asthma prevalence present the problem of the varied and different methodologies used by the authors, as well as of the lack of a clear definition of what is considered bronchial asthma. METHODS: in this work we try to offer a global vision of the studies published on childhood asthma prevalence in the world. CONCLUSIONS: in the studies carried out at European level, they highlight the high figures found in the British Islands superiors to those referred in the countries from the continent to exception of those observed in Switzerland. In Spain the figures of the studies carried out at national level are something below the countries of our environment, although there have been higher figures in studies carried out in Barcelona and Huelva. In Oceannia they are observed from all over the world in general the highest figures, above the American countries and very above the countries of Asia and Africa to exception of South Africa. Although there are considerable geographical differences in its presentation, bronchial asthma is an illness in constant increase in the entire world. It is for this reason that efforts should be carried out in the search of the causes of this increment, as well as in the standardization of the instruments of measure of the appearance of the illness.

Adolescent↗

PubMedDate not supplied

Eosinophilic gastritis due to Anisakis: a case report.

BACKGROUND: the parasite Anisakis simplex is a helminth included in the nematode class. When man eats raw or rare fish and cephalopods infested by Anisakis larvae, he can acquire the parasitic disease (anisakidosis). The parasite can also originate manifestations of immediate IgE mediated hypersensitivity in patients with sensitisation to it. METHODS AND RESULTS: we present the case of a 14 year old boy diagnosed of eosinophilic gastritis after endoscopic examination and biopsy associated to recurrent abdominal pain. After allergologic study, a type I hypersensitivity mechanism against Anisakis simplex is confirmed by means of prick test, antigen specific IgE determination and antigen specific histamine release test. Sensitisation against fish proteins is ruled out as well as parasitic infestation. CONCLUSIONS: in this case report we demonstrate a type I hypersensitivity mechanism against Anisakis simplex in a patient diagnosed of eosinophilic gastritis. This can be suspected in cases of gastritis or non filiated enteritis with a torpid evolution following the conventional treatment and especially if the onset of the symptoms is related with the intake of fish. The therapeutic success was reached when fish and shellfish were taken out of the diet. After two years without seafood ingestion our patient is asymptomatic and the allergologic study has been normalised.

Abdominal Pain↗

PubMedDate not supplied

International Study of Asthma and Allergies in Childhood. Results on rhinitis of first phase in Pamplona, Spain.

BACKGROUND: The ISAAC (International Study of Asthma and Allergies in Childhood) was thought in order to maximize the value of epidemiological research into asthma and allergic diseases in childhood, establishing a standardized methodology and facilitating collaboration and comparison between several countries. METHODS AND RESULTS: The written questionnaires in the group of children aged 6-7 years was answered by the parents and the group of children aged 13-14 years self-completed the written questionnaires. RESULTS: 3,040 children aged 13-14 years answered the questionnaire and 3,002 in the group aged 6-7 years. In the group of children aged 13-14, 49.7% referred rhinitis symptoms some time, and 15.6% in the 6-7 year old group. The prevalence of nasal symptoms in the last year was 35.5% in the 13-14 year group and 10.6% in the 6-7 year group. The presence of nasal symptoms was more frequent in winter. The prevalence of seasonal allergic rhinitis (hay fever) was 6.1% in the 13-14 year group and 4.8% in the group of children aged 6-7 years. CONCLUSIONS: These results can contribute to a better control of some factors and to future studies where the etiology and incidence of the disease could be investigated.

Adolescent↗