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Biomedical subjects

J L Eseverri

Publications and source records attributed to J L Eseverri.

At least 37 records · Page 2Linked to original sources
PubMed1984

Aspirin-induced recurrent urticaria and recurrent angioedema in non-atopic children.

Recurrent urticaria and recurrent angioedema are frequent adverse reactions in non-atopic patients who do not tolerate aspirin. Of 1,632 infants and children who visited our allergy department for the first time, nine children (0.55%), five males and four females, presented recurrent urticaria or recurrent angioedema after taking aspirin. No evidence of atopy was disclosed either by clinical history (personal and family), skin testing, eosinophil levels or total IgE. Aspirin intolerance was established by oral challenge. Only three of the nine patients reported aspirin intolerance in their histories.

Angioedema↗
PubMedDate not supplied

[Latex allergy].

Explore the source record for details and available documents.

Allergens↗
PubMedDate not supplied

[Sublingual immunotherapy in children. Immunotherapy Committee of the Spanish Society for Clinical Immunology and Pediatric Allergology].

Sublingual immunotherapy is currently attracting growing interest because of its ease of administration and, according to previous studies, its infrequent and mild adverse effects. However, at least in children, the efficacy of this therapy has not been completely demonstrated. In addition, the mechanisms of action remain to be elucidated since few studies have been published and the results have been contradictory and sometimes inconclusive. For this reason, we performed a literature review through the MEDLINE database, selecting double-blind studies carried out in children. Only 10 studies meeting these requirements were retrieved. All the studies were performed by European researchers and nine were published in European journals. Efficacy was evaluated by clinical parameters and by reduction in medication use. The results on efficacy are not homogeneous, although most support the utility of this route of administration. Moreover, reports of allergens other than those used in these studies dust mites and grass pollens are lacking. In conclusion, further studies evaluating the efficacy of this therapy in children are required. Among the general population, if the efficacy of sublingual immunotherapy in the treatment of sensitization to hymenoptera venoms were demonstrated, as has been the case with subcutaneous immunotherapy, the utility of this route of administration would be definitively confirmed. Finally, sublingual immunotherapy could be used in children who have shown systemic reactions to subcutaneous immunotherapy or who refuse to undergo injections.

Administration, Sublingual↗
PubMedDate not supplied

[Adverse reactions to vaccines].

Adverse reactions to vaccines are highly varied, ranging from mild local reactions to fatal outcomes. In the last few years many adverse reactions have been attributed to vaccines, often without justification. In agreement with the World Health Organization, these reactions can be classified as follows, depending on the cause: vaccination-induced reactions (due to an effect of the vaccine itself or to an idiosyncrasy); reactions due to errors in storage, manipulation and/or administration; and coincidental reactions (no causal relationship with the vaccine). Hypersensitivity reactions fall into six categories, depending on the causative agent: reactions due to some component of the infectious agent or one of its products; reactions due to adjuvants: aluminium hydroxide; reactions due to stabilizers: gelatin; reactions due to preservatives: thiomersal; reactions due to antibiotics: neomycin; and reactions due to a biological culture medium: chicken embryo cells. Allergic children should not be excluded from the normal vaccine calendar. Immunologically, allergic individuals are more susceptible to infection and to microbial and viral diseases, which often play an aggravating role. Rubella, whooping cough, and influenza usually exacerbate respiratory allergies. Non-vaccination carries a marked risk of contracting serious diseases such as poliomyelitis, tetanus, and diphtheria, etc. In a not too distant future, the techniques of genetic recombination and monoclonal antibody production will allow the creation of vaccines from organisms that cannot be cultivated in the laboratory or that produce small quantities of antigen. These techniques will also lead to identification of the antigens with the greatest immunogenic power and, consequently, to extremely pure vaccines. The adverse reactions to vaccines referred to our service account for between 0.59 % and 1.27 % of first visits in the last three years. We recorded a total of 48 adverse reactions to vaccines. Of these, 44 were attributed to the tetanus vaccine (92 %), 2 to the measles-mumps-rubella vaccine (4 %) and 2 to the meningitis A and C vaccine (4 %). Clinical features consisted of urticaria (11 cases), urticaria with angioedema (7 cases), pseudo-shock (5 cases), fever and urticaria (4 cases), local reactions (4 cases), persistent crying with exanthema (3 cases), giant local reactions with angioedema of the limb (3 cases), anaphylaxis (3 cases), fever > 39.5 C (2 cases), bronchospasm (1 case), and severe atopic dermatitis (1 case).A regimen of hyposensitization to tetanus toxoid was required in 20 patients (45 %); in three, this could not be completed due to generalized urticaria but all the patients presented protective titers with diluted vaccine.

Adjuvants, Immunologic↗
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A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites.

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1%) were recorded, representing 4.8% of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5% of the administered doses) and occurred in 10 patients (3.8% of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose.

Adult↗
PubMedDate not supplied

Evaluation of paediatric tolerance to an extract of Alternaria alternata under two treatment regimes. A multicentre study.

In order to evaluate the efficacy and safety of an extract of Alternaria alternata in a paediatric population, a two phase study plan has been elaborated that in the first place consists of a retrospective analysis of tolerance under the standard treatment regimes used by the clinical groups involved. This was achieved by analysing the records of 94 patients that have been treated with this extract, these being consecutive patients included at 7 clinics over a period of 6 months. Two regimes were used: a conventional short regime of 7 doses and a cluster regime. Under neither of these two regimes were any serious reactions registered. The percentage of local reactions was significantly greater using the short conventional regime than with the cluster regime (1.9% and 0.4% respectively, p = .035). In contrast, no significant differences were observed with respect to the systemic reactions (0.5% and 1.2%), these percentages also being similar to those registered with other extracts in which identical regimes have been used. In conclusion, we can confirm that a very satisfactory tolerance profile was observed, with the advantage that through using shorter regimes than the conventional regime of 13 doses, a considerable saving is made both in the number of visits and the doses necessary to reach the maintenance dose.

Adolescent↗
PubMedDate not supplied

[Round Table: Immunological urticaria mediated by IgE].

Urticaria is characterized by the appearance of hives and pruritus. Those hives are formed by oedema and vasodilatation and they disappear when they are pressed on. The acute presentation is extremely common and affects between 10 and 20% of the population at a determined moment. In its simplest form, urticaria is envisioned to represent the same sort of wheal-and-flare reaction observed when histamine is injected into the skin. It produces erythema because of capillary vasodilatation, oedema because of increased permeability in capillary and pruritus secondary at local specific receptors stimulation. Angioedema is caused by the same pathologic alterations that occur in the deep dermis and subcutaneous tissue. Thus, an area involved with angioedema has swelling as the prominent manifestation and appearance of the skin itself may be normal. Due to reduced nerve supply in dermis, angioedema is associated with oppression and not pruritus. Immunoallergological study of urticaria and/or angioedema was requested in 133 cases from 648 from the first patient's visits to the surgery. It supposes a 20.52%. The family suspicion of etiology was food in 62 cases, chemical products in 39 cases, other factors (physical, stings, balloons and other manufactured products.) in 7 cases and 25 cases without a direct relation. Out of 100 children diagnosed of allergic urticaria-angioedema 67 was by food; the foods implicated in frequency order were: eggs and nuts, fruit, milk, vegetables, fish and shellfish. In second place, chemical products were responsible of urticaria in 12 children; five of them were positive in diagnosed proof (prick, oral challenge) for penicillin and amoxicillin, both from beta-lactamic group; two of them had and adverse reaction to anesthetic agents; other two cases were after administration of vaccination and due to tetanus toxin; and three cases were due to aspirin, confirmed by oral provocation test. In 10 children the etiological agent was latex. Other etiologies were: three cutaneous reactions after stings (two by wasps and one by mosquito) three reactions due to spices (paprika, cumin, anise, mustard) and two reactions caused by manufactures products containing additives as yellow-orange.

Adolescent↗
PubMedDate not supplied

Prevalence of allergy to latex in the pediatric population.

Latex is a substance that is extracted from the plant Hevea Brasiliensis, and world production is 6 million metric tons per year. After gathering it undergoes a series of processes in which ammonia, vulcanization-accelerating additives or anti-oxidants are added. All of this may constitute the antigenic load that latex contains. It is used in medicine for gloves, drainage tubes, dental implants and a growing number of products from condoms to sport products or automobile components. Over fifteen different allergenic bands have been described, with molecular weights of between 2 and 100 kDa. In a joint study, USA-Finland identified three antigenic bands that predominate according to the population type studied (2). In children with spina bifida, congenital urogenital abnormalities or those submitted to multiple surgical interventions, the band of 27 kDa is predominant. This antigen has not been detected in adult serum, which suggests that contact with the antigen is through the mucous membranes and the sensitization is triggered from here. The incidence of allergy to latex in the general population is not known, but it seems to be lower than 1%. Turjanmaa (1) establishes a frequency of 0.125% (1/800) in patients submitted to general surgery. The incidence of sensitization to latex varies according to the population studied. Among the population considered to be at risk are the workers of the health environment, where the incidence is between 2.6 and 16.9%, whereas in the general population the percentage is around 1%. Sensitivity to latex is of great importance in patients suffering from spina bifida, in whom an incidence of between 28 and 67% has been found. We present our experience in a group of children attending our service for the first time for diverse reasons of supposed allergic etiology. The objective is to determine the incidence of sensitization to latex according to the diagnostic methodology [cutaneous test or by determination of specific IgE (CAP)]; according to the type of patient (atopic or non-atopic), the direct relationship with latex material and the role that can be played by a history of surgical intervention. In our experience with 282 children studied in our pediatric allergology service using diverse methods, the incidence of allergy to latex is 3.19%. Nevertheless, if we analyze this percentage we observe that if the diagnosis is based exclusively on cutaneous tests, it is only 1.08%; if to establish a diagnosis we used exclusively the determination of specific IgE (CAP) we would label 7. 2% of our children as allergic. Atopy is a factor that facilitates sensitization. In our sample, the incidence among the atopic population is 4.4%, though this percentage may vary between 1.69% and 9.5% depending on the methodology used. There are several hypotheses for explaining these discrepancies in the diagnostic tests. Although there do not seem to be differences regarding the ammonia content of the different lots, it seems that the differential factor could lie in the type of extract and in whether it is commercial or a natural latex extract. It could be a consequence of the existence of a prophyllin, so it has not been ruled out that a part of the IgE is an antiprophyllin. The presence of different epitopes would mean that each of them has the ability to produce its own specific IgE, though the RAST/CAP was not able to differentiate them and identified them as whole. The rate of allergy to latex in a group of children suffering from myelomeningocele is 80%. At a paediatric level, sensitization to latex is influenced by the means of contact, the duration of the exposure to the antigen and the fact that the exposure occurs early, which in the case of children with myelomeningocele is associated with the immaturity of the defence mechanism of the mucous membranes.

Child↗
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Reagent strip for semiquantitative total and specific IgE measurement: a comparison to radioisotopic methods.

Determination of total and specific IgE using reactive test strips may afford a useful screening method in the in vitro diagnosis of allergens owing to easy use and possible correlation with established methods. T.D. LETI reactive strips for the semiquantitative determination of total IgE is a method combining classical fundamentals (sandwich anti-IgE-IgE-labeled anti-IgE) and the use of strip methods. It also permits determination of specific IgE levels in a wide range of Mediterranean and food (10) allergens. In a preliminary assessment, this method was correlated with isotopic PRIST for total IgE and with Phadebas RAST for specific IgE. The most important features are: a) no additional equipment besides serum or whole blood; b) cheaper and faster than PRIST for total IgE; c) correlation coefficient of 0.88 in the proposed range (n = 20) and 0.91 (n = 25) in the 10-500 U/ml range for PRIST/T.D. LETI for total IgE; d) specific IgE determination strips present sensitivity and specificity of 88 and 91%, respectively, in 180 allergens assayed in relation to Phadebas RAST. In conclusion, the in vitro diagnosis of allergens using reactive strips is currently a practical and simple method. By optimizing the top of the scale for total IgE and reducing the volume and/or time in specific IgE, it may prove to be an important screening method.

Allergens↗
PubMedDate not supplied

Allergy to pomegranate (Punica granatum).

We present the case of a 7-year-old IgE-dependent asthmatic child who, moments after ingesting several pomegranate seeds, showed a clinical condition of bronchospasm which responded to treatment with inhaled salbutamol. Cutaneous tests using the prick-by-prick techniques with extract of the fresh fruit were positive and the RAST for pomegranate was 0.8 PRU/ml. In the literature studied, we have found few specific references to allergy to pomegranate.

Asthma↗
PubMedDate not supplied

Penicillin allergy: in vivo and in vitro diagnostic methods.

Hypersensitivity to beta lactams, especially that mediated by IgE or IgG4, is the most frequent complaint of adverse drug reactions. There are multiple studies dedicated at establishing a method that can permit us to arrive at an accurate diagnosis, but from these studies one deduces that the difficulty lies in the lack of a test with a 100% reliability. In the present study we evaluate the correlation between the different methods. For this we selected 16 children, composed of 8 males and 8 females, whose ages ranged between 2 years 7 months and 9 years 8 months, and who had a reaction to penicillin G via parenteral. The following tests were done on them: Skin tests with a major determinant antigen (constant composition and molecular weight), with minor determinants. Human basophil degranulation test (modified Leynadier technique). Mathov's progressive controlled provocation test, which we considered the most reliable. Only in eight cases a diagnosis of penicillin allergy was arrived at. The correlation between the different tests were: Mathov - HBDT 93.75%; Mathov - PPL 93.75% and PPL - HBDT 87.5%.

Angioedema↗
PubMedDate not supplied

Aspirin-induced asthma in children.

Since Cooke first described bronchospasm induced by acetyl salicylic acid in asthmatic patients in 1919, numerous studies have been done with the objective of understanding the pathology, treatment and incidence of aspirin-induced asthma. The incidence is difficult to establish but according to two recent studies, the percentage in the infantile asthmatic population was estimated at 13% and 28%. This prevalence is greater than that suspected at first and reveals the necessity of reviewing this problem. In this study we present 4 pediatric patients, 2 atopics and 2 non-atopics affected with aspirin-induced asthma. A detailed clinical history, oral provocation test to acetyl salicylic acid, other non-steroid anti-inflammatory analgesics and additives was performed. The oral provocation test with acetyl salicylic acid was positive in all 4 cases. The oral provocation with non-steroid anti-inflammatory analgesics and other additives was negative in 2 patients. In the remaining 2 patients, one demonstrated sensitivity only to tartrazine and the other to tartrazine, red coccine, mefenamic acid and benorylate. In conclusion, aspirin-induced asthma is not infrequent in infancy. Therefore, it is important to bear it always in mind and to diagnose it through oral provocation besides looking for possible cross reactions.

Aspirin↗
PubMedDate not supplied

Monosodium glutamate and skin pathology in pediatric allergology.

This study presents the cases of five children who consulted us because of skin pathology, in which a hypersensitivity to monosodium glutamate (MSG) was detected. In four children, the motive for consultation was urticaria; in two children, urticaria was accompanied by angioedema, while the fifth child presented with atopic dermatitis and urticaria. In the four cases of urticaria, the etiological diagnosis was probable drug allergy. The oral provocation test (OPT), carried out with monosodium glutamate (MSG) in opaque capsules containing 50 and 100 mgr., was positive in two hours in four of the five children. MSG's mechanism of action is unknown, and though its use is world-wide, no evidence of hypersensitivity with cutaneous symptomatology has been found in any of the studies carried out to date.

Administration, Oral↗
PubMedDate not supplied

Acetyl salicylic acid induced-urticaria and/or angioedema in atopic children.

From the report of Hirschberg, only 3 years after aspirin synthesis, there have been numerous works dedicated to showing the different types of adverse reactions found following aspirin administration. However, there are few publications on the process of urticaria and/or acute angioedema induced by ASA and few reported cases were found in children. Thus, we present 6 atopic children with urticaria and/or angioedema related with ASA. A carefully detailed history, oral provocation with ASA, oral provocation with other NSAI and HBDT with ASA were done to all of them. The oral provocation with ASA was positive in 5 of the 6 cases. The provocations with the rest of the NSAI and tartrazine and sodium benzoate were negative in all of the patients. The HBDT was positive in 5 of the cases. In conclusion, we insist that aspirin intolerance is not infrequent in infancy and it is not rare to see urticaria and or angioedema, in spite of the fact that asthmatics, atopics or non atopics, usually present as bronchospasm. We also believe that the HBDT can be a method of diagnosis used in these cases.

Adolescent↗
PubMedDate not supplied

Sulfites and skin pathology in children.

We report the case of 8 children (whose ages ranged between 2 and 7) who consulted us because of urticaria, accompanied by angioedema in 5 of the cases. An additives study was performed based on a habitual program. Sodium bisulfite hypersensitivity was detected with oral provocation test with doses of 5 and 25 mgs. The tests were positive within the first hour of observation in 2 cases, in the rest the reaction appeared later after the administration of the second dose; the reaction in 2 of the cases were semi-delayed. No respiratory symptomatology was detected in these patients.

Angioedema↗
PubMedDate not supplied

Dyes, preservatives and salicylates in the induction of food intolerance and/or hypersensitivity in children.

We present 25 patients, aged between 18 and 153 months, with clinical symptoms suggestive of allergy to food antigens. After undergoing exhaustive studies (including case histories, cutaneous tests for reactions to food antigen, peripheral eosinophils, secretory and humoral immunity, determination of total IgE and of specific RAST, exclusion-provocation diets) and without being able to identify an offender, patients were submitted to oral provocation with different food additives (tartrazine, sunset yellow FCF, new coccine, erythrosine, sodium benzoate, 4-methyl hydroxybenzoate and acetylsalicylic acid) after 48 hours of exclusion from their diets of dyes, preservatives and salicylates. The results obtained reflect, at a global level, 57.89% of positivities for dyes, 34.21% for the benzoates and 7.81% for acetyl-salicylic acid. The low incidence of crossed intolerance phenomena should be emphasized (32% of the patients). The disparity of our results with those of other authors could be due to the age of our patients, the clinical patterns they present and the dietary habits of different countries and regions.

Aspirin↗
PubMedDate not supplied

[Ketotifen in childhood asthma].

In 1981 a double blind study was conducted at random with Ketotifen. Fifty children were chosen at random (40 males and 10 females) who had been diagnosed as suffering from extrinsic bronchial asthma and had not undergone any previous treatment either with sodium cromoglycate or with immunotherapy. In all cases the treatment lasted 12 weeks, with monthly controls, in some cases on a weekly basis, which measured the following parameters: Daily written control by the parents of the clinical evolution. Monthly clinical examination with cardiovascular control (Cardiac frequency, T A , etc.) respiratory examination with lung function study, auxomatric control (height, weight), etc. Monthly control of the additional medication received, specifying type of medication, dosage and length of time administered (bronchodilators, antihistamines, antibiotics, etc.). Monthly control of possible collateral and side effects: subjective symptoms: neurologic, digestive, dermatologic, psychic, neuro-vegetative, genito-urinary, cardiorespiratory, etc. Analytical control at the commencement and termination of treatment which consists of: a) complete blood cell count, b) platelets and c) hepatic function study (GOT, CPT and alkaline phosphatases). The results of the overall evaluation of the group of children submitted to treatment with active substances were as follows: In asthma 70.35% was VERY EFFECTIVE and EFFECTIVE and 29.61% SLIGHTLY or NOT EFFECTIVE. In dermorespiratory cases 57.13% was VERY EFFECTIVE or EFFECTIVE and 42.85% SLIGHTLY EFFECTIVE. In concomitant rhinitis 74.93% was VERY EFFECTIVE and EFFECTIVE and 25% SLIGHTLY EFFECTIVE.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗