Biomedical subjects
Publications and source records attributed to J Jerez.
The rare association of lepromatous leprosy and allergic contact dermatitis due to chromium in cement was confirmed clinically and biologically in a male patient. The apparent lack of influence of lepromatous leprosy on the development and maintenance of this dermatitis dependent upon cell-mediated immune mechanisms is discussed.
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Papain is a plant protein with a wide pharmacological, domestic and industrial use. It leads a high sensitisation, being the most common rotue of entry the inhalation. The occupational allergy to papain in exposed workers was described some years ago, being presented with bronchial asthma, rhinitis or both. In most of the cases, the specific IgE was positive. We present a case contact urticaria, rhinoconjunctivitis and bronchial asthma per papain of occupational origin. Papain prick test, specific IgE and nasal challenge were positive. The peak flow record showed diary decreases during the working week and the basal spirometry showed obstruction to the airflow. The patient was moved away the place where papain was handled and this resolved the clinical symptoms and the spirometry returns to the normal values. We present a case of IgE-mediated allergy, vehicled by tow routes: contact and airborne. The latest produced clinical manifestations later. Papain was used as Cephalopoda softening, because of that it worth emphasising its seasonal use.
There is a wide variety of criteria in regard to the etiology of atopic dermatitis of neurodermitis. The allergic factor may play a very important role in its etiology. There is neither a general agreement on the importance of food allergy in this regard. Broadly considered, these patients may evoke intense positive reactions to intradermal tests to food and inhalative allergens, nevertheless it will be possible to establish that the lesions appear or disappear after the exposure of suppression of the antigens which evoked the positive reaction. On this basis, many dermatologists deny the allergic etiology in atopic dermatitis, even though in most instances no food skin tests are performed. In this study, 110 patients, both children and adults of both sexes, suffering from atopic dermatitis are investigated. The onset in most of the cases is before the age of six months, following the ages between 1-10 years; the groups between 6 months and one year, and 10-20 years followed a descending order per decade until 70 years. 60.9% of the cases showed food allergy to one or more food items. In 39% of the cases, no food allergy was found. The food-stuffs more commonly involved were: milk (37.7%), egg (26.3%) and fish (20.9%), followed by coca, wheat flour, seafood, fruits, vegetables and meat. A remission of the reaction followed the suppression of the allergen. Intestinal parasitosis is evaluated in relation to atopic dermatitis. 30.9% of the 110 cases were affected with intestinal parasitosis, being the most common the flagelates (lamblias), protozoa (amoeba) and nematodes (ascaris, tricocephalus and oxijrus). Finally, a concurrence is found between atopic dermatitis and other allergic diseases in 81 cases (73.6%), being bronchial asthma and asthmatic bronchitis the most frequent, and allergic rhinitis, urticaria and Quincke's edema less frequent.
Cell-mediated immunocompetence was assessed in 16 healthy and 10 uremic subjects by "in vivo" and "in vitro" techniques, simultaneously. PHA-induced lymphocyte transformation, Multitest and classical skin testing with a panel of 7 antigens have been used. Similar cutaneous delayed-type hypersensitivity (DTH) results were obtained when using either Multitest or the classical panel, both in healthy subjects (R = 0.66) and in uremic patients (R = 0.61). The results were the same for both the total scores and the number of positive responses per subject. The two DTH methods were of similar accuracy in the evaluation of normal DTH responses and hypoergy in both populations but the sensitivity in detecting anergy among the uremics was higher for the classical panel (80%) than for Multitest (60%). However, no method proved to be more prone to classify a healthy subject as anergic. Anergy was more frequent among uremic patients both with Multitest (60%) and the conventional panel (80%) but was unusual among healthy controls (6.3% and 7.1%, respectively) (p less than 0.0001 for both). Depressed DTH reactivity in uremia was correlated with longer blood transfusion-free intervals (p less than 0.05) and influenced by the duration of haemodyalisis and the number of blood transfusions. Similar CMI impairment rates were found in uremic patients with Multitest (76.9%), the classical panel (63.8%) and "in vitro" techniques (63.7%). Therefore, cutaneous DTH testing proved to be a useful mean of evaluating CMI. Moreover, the high cost and technical complexity of "in vitro" techniques are major drawbacks against their use and strenghthen the role of DTH skin testing as a useful clinical tool to measure CMI.(ABSTRACT TRUNCATED AT 250 WORDS)
In the treatment of bronchospastic states, primary bacterial bronchial asthma and asthmatic bronchitis, one of the most controversial aspects is the use of bacterial vaccines. In general, the treatment of these conditions is symptomatic, neglecting for the most part the existing bacterial allergy. At present, as a result of great advances in the immunotherapy of these disorders, the importance of an allergic response to bacteria in the etiology of these bronchopathies is beyond doubt. The subjects were 120 patients, 59 women and 51 men, with ages ranging from 7 to 73 years. Of this group, 21 were children less than 12 years old and all had a diagnosis of bronchial asthma or asthmatic bronchitis, with or without paranasal sinusitis, and exclusively of bacterial etiology. In order to study and evaluate the effectiveness of immunotherapy, a questionnaire, reproduced in fig. 1 was sent to the patients three years after the beginning of treatment. For this study, only the answers to this questionnaire were considered. Examination of the results shows that in bronchial disorders with bacterial allergy, treatment with bacterial vaccine achieves a 75% success rate. In the small group of children studied (a larger group is currently under investigation), the results are even more satisfactory, reaching 90.47%. It is noteworthy that the immediate reaction to the skin test was positive (++ to ++++) in 83.32% of the cases. Of the greatest importance also is the associated paranasal sinusitis in 83% of the cases, part of a sinobronchopulmonary syndrome which contributes substantially to this state of bacterial allergy. Significant side effects were found in 52.6% of the patients and consisted mainly of slight catarrhal symptoms, apparent at the beginning of treatment. At present, we have no doubt whatsoever that immunotherapy is much more valuable than prolonged symptomatic therapy in the treatment of primary bacterial bronchial asthma.
Ten non-sensitized normal blood donors and thirty five patients with a strongly positive intracutaneous test to Candida albicans, positive anamnesis to Candida allergy, or with an actual Candida infection demonstrated by positive cultures of the focus, were studied. In all of them, an evaluation of the humoral and cellular response to Candida antigens, was performed both in vivo and in vitro. The results obtained in the tests performed in the control group were considered as extreme values of a normal response and taken as reference in order to evaluate the patients' response. The results of the test performed on the 35 patients were processed in an IBM S.370/M.125 computer and submitted to a General Taxonomy Program in order to group the patients according to their characteristics and similar behaviour. Two main groups, each one including three minor groups, were obtained and only one individual was not classified. According to this classification it was possible to distinguish two immunological patterns: a) The patients that had a normal or increased percentage of T lymphocytes were capable of responding adequately to Candida albicans antigens. They showed positive immediate and delayed skin tests, increased hemagglutination titres, increased lgE values, and their lymphocytes were capable of undergoing positive blast transformation. Those patients from this group who had a candidaemia at the time of the study, reached the highest hemagglutination values and presented precipitin antibodies as a characteristic. b) The patients that had a decreased percentage of T lymphocytes presented a partial deficiency in their response to Candida albicans antigens. They showed negative delayed skin tests; hemagglutination and precipitation tests both negative, normal lgE values and their lymphocytes did not undergo blast transformation. These findings suggest that a normal percentage of T cells is required in order to obtain a suitable cellular response against Candida albicans, and that an appropriate co-operation between T and B cells is also necessary in order to obtain a good humoral response to Candida antigens.
We present a case of fixed drug eruption on the genital mucosa induced by amoxycillin. Topical provocation was carried out, applying amoxycilin (10% pet) on the glans penis. No reaction was observed. Oral challenge with amoxycillin was followed by pruritic erythema on the glans penis 6 hours after the intake of 125 mg. The study of cross-reactivity to other betalactams showed good tolerance of phenoxymethyl-penicillin, which shares an identical nuclear structure with amoxycillin. The patient also tolerated cephadroxil, a cephalosporin with a side chain identical to that of amoxycillin. On reviewing the literature we have only found three reports of fixed drug eruption fue to amoxycillin.
We present a case of a patient showing a cutaneous and systemic affectation compatible with the Stevens-Johnson syndrome due to the intake of tetrazepam as a muscular relaxant. The symptoms remitted after the suspension of the involved medicines and after treatment with systemic corticoids. Months later, a study with patch tests, with the standard battery and the medicines that she took (indapamide, tetrazepam, acetyl salicylic acid, botriozolam and levomepromazine) was carried out. She presented positivity to tetrazepam at 48 and 96 hours. The oral provocations with the other medicines, which she consumed, were negative. The study of cross reactivity with other benzodiazepines was negative. In the medical literature, different cutaneous affectations regarding benzodiazepine use (generalised drug eruptions, contact dermatitis, erythema multiforme, ...) have been described byt non Stevens-Johnson syndrome. The patch tests are useful in the diagnosis of this type of cutaneous reactions, avoiding in this way the achievement of oral provocations, with the potential risk for the patient that they imply. The absence of cross-reactions with other substances of the same group has to be pointed out, even with those with which keeps great structural similarity as the diazepam. In spite of the absence of cross reactions with the rest of benzodiazepines, faced with the seriousness of the case presented, it is advised to the patient to avoid this type of medicines.