Search PubMed⌕ Search

Biomedical subjects

J M Olaguíbel

Publications and source records attributed to J M Olaguíbel.

15 recordsLinked to original sources
PubMed2005

Efficacy of sublingual allergen vaccination for respiratory allergy in children. Conclusions from one meta-analysis.

BACKGROUND: Sublingual route, that allows the safe administration of allergen vaccination at home and without injections, is a highly attractive alternative to parenteral delivery, especially among the youngest population. However, its efficacy in children has been questioned. OBJECTIVE: To evaluate the efficacy (symptom and medication scores) of sublingual allergen vaccination compared to placebo in paediatric patients. SEARCH STRATEGY: MEDLINE, EMBASE, ISI and the Cochrane Central Register of Controlled Trials were explored (completed in January/04) for potentially relevant studies. SELECTION CRITERIA: Randomized double-blind placebo-controlled clinical trials involving children < or = 14 years-old with either rhinitis or asthma of proved allergic aetiology. Data collection and analysis. Two reviewers analyzed independently the eligibility of studies for inclusion. The combined standardized mean difference (SMD) method was used to evaluate differences. Since heterogeneity was expected, probably due to the different procedures from each trial, we used the random effect model to obtain SMD. However, we also present the SMD values from the fixed effect model. The main outcomes were clinical symptom (asthma, rhinitis and conjunctivitis) and drug requirement scores. Safety, immunological and clinical changes were also reviewed. RESULTS: Seven double-blind placebo-controlled trials, enrolling 256 children (129 treatment and 127 placebo recipients), were analyzed. We observed decreases in symptom (SMD: -1.42 for asthma, -0.44 for rhinitis and -1.49 for conjunctivitis) and medication requirement (SMD: -1.01) scores. Only reductions in asthma (p=0.01) and drug dosage (p=0.06) scores reached statistical significance with the random effect model but changes in rhinitis symptoms (p=0.27) or conjunctival symptoms (p=0.19) were not statisticaly significant. Results obtained with the fixed effect model were similar in magnitude (SMD: -1.60 for asthma, SMD: -0.47 for rhinitis, SMD: -1.09 for conjunctivitis and, SMD: -0.54 for drug intake). Safety was a constant in all the studies; neither severe nor systemic reactions were observed and, oral and gastrointestinal complains were the most common adverse effects. CONCLUSION: In children, sublingual delivery of allergen vaccination constitutes a safe and effective alternative to the sublingual route to reduce allergy respiratory symptoms and drug intake. Further studies in this group of age are required to establish the optimal conditions for sublingual allergen vaccination.

Administration, Sublingual↗
PubMed2005

Comparative analysis of the bronchodilator response measured by impulse oscillometry (IOS), spirometry and body plethysmography in asthmatic children.

BACKGROUND: Asthma is common among young children. The assessment of respiratory resistance by the impulse oscillometry system (IOS), based on the superimposition of respiratory flow by short-time impulses, requires no patient active collaboration. AIM: We evaluated the baseline repeatability and bronchodilator response of IOS indices in preschool children, their correlation with spirometry and whole body plethysmography, and differences between atopic and nonatopic children. PATIENTS AND METHODS: Thirty-three asthmatic children (3-6 yrs.) underwent IOS measurement (R5rs, R20rs and X5rs) by triplicate at the baseline, after placebo and after salbutamol inhalation. Spirometry (FEV1) and whole body plethysmography (sRaw) were made at the baseline and after salbutamol. Baseline within-test (coefficient of variation: CV%) and between-test repeatability (baseline-placebo) were addressed. Bronchodilator response was evaluated by the SD index (change in multiples of the between-test repeatability). RESULTS: Baseline repeatability for R5rs was 4.1%. Its values decreased by 2SD after salbutamol inhalation, and correlated with FEV1 and sRaw at both, baseline (r=-0.51 and r=0.49) and post-salbutamol (r=-0.63 and r=0.54). A trend towards correlation between salbutamol-induced changes in R5rs and in sRaw (r=0.33) was observed. Atopic and non-atopic children showed no differences in lung function. CONCLUSION: IOS was well accepted by young asthmatic children and provided reproducible and sensitive indices of lung function. Resistance values obtained by IOS at low frequency (R5rs) were reproducible and correlated with spirometry and plethysmographic values.

Airway Resistance↗
PubMed2003

[From rhinitis to asthma, one or two diseases?].

Rhinitis and asthma commonly coexist in allergic patients. This observation might be attributable to their coexistence in time, but it is also possible that both diseases are the opposite poles of a single disease affecting the respiratory system, or even an anomalous systemic immune response to the allergen. Nose-lung interactions have been widely studied from epidemiological, physiopathological, aetiological and pharmacological aspects. In the present article we review this topic and its main clinical implications.

Asthma↗
PubMed2003

[New techniques in the study of asthma].

Asthma is a chronic inflammatory disease of the airways that is functionally characterized by variability of lung function and bronchial hyper-responsiveness. Its diagnosis and management is commonly hampered by the lack of objective parameters. This article reviews additional techniques for evaluating both, lung function (bronchial challenge with adenosin-monophosphate, lung resistance measurement by either the impulse oscillometry system or whole body pletismography) and bronchial immuno-inflammatory response (induced sputum, condensates of exhaled air, monitoring of nitric oxide in exhaled air), as well as our experience with them.

Airway Resistance↗
PubMed2003

[Latex. An important aeroallergen involved in occupational asthma].

Latex has become one of the most frequent aetiological agents of occupational asthma in the last decade, especially amongst health personnel. The prevalence of occupational asthma due to latex in the different affected occupations varies between 2.5 and 10%, figures that give an idea of the magnitude of the problem. Latex proteins, absorbed in the dust of cornstarch, used as a lubricant, are responsible for asthma due to latex gloves. This cornstarch dust that covers the inside of the gloves acts as a vehicle for dispersing allergenic proteins. Latex aeroallergens are found in particles of different dimensions. The levels of latex aeroallergens in the environment capable of causing sensitization and of unleashing symptoms are not well defined. The determination of these levels of exposure to latex is complicated, since with latex one is dealing with a complex mixture of allergens with differing stability and bio-availability. The bioaerosol of latex is mainly produced by the active use of powdered gloves, but rugs or carpets and coverings act as important reservoirs of the allergen. Besides, the movement of people from areas with a high environmental concentration of latex constitutes an important means of dispersing the allergen, and probably ventilation systems as well. As in other cases of occupational asthma, diagnosis in many cases requires that a bronchial challenge be realized. The specific challenge tests through inhalation with latex have been carried out by different methods, which can be grouped by those that use an aqueous extract of latex and those that consist in handling or shaking gloves, which thus generate a dust aerosol. Each method has its advantages and drawbacks as described. Once the sensitized patient begins manifestations of the disease, his prognosis is poor if measures aimed at a maximum reduction of exposure to latex are not applied.

Allergens↗
PubMed2003

[Associations of allergic and asthmatic patients in Europe].

Patients' associations are NGOs that emerge as a result of the needs of patients with chronic diseases that cannot be solved in the doctor's surgery. At the start, the role of the health personnel, in guiding and collaborating with them, was fundamental, and their aims and interests coincided to a high degree. Their healthy operation favored both the patients and, indirectly, the health professionals related to them. However, we must bear in mind that those interests are not identical and, on occasion, can be clearly divergent. This is why the independence of these associations cannot be renounced upon, and they are managed according to the growth in their size and social influence.

Asthma↗
PubMed1996

Diversity of allergens causing occupational asthma among cereal workers as demonstrated by exposure procedures.

BACKGROUND: Occupational asthma among cereal workers is frequently due to cereals but other allergens can also be responsible. OBJECTIVE: We evaluated the allergens causing occupational asthma in the patients who had been diagnosed in our Department during the last 5 years. Specific bronchial reactivity to the implicated allergens was assessed and compared by standardized bronchial challenge. METHODS: Twenty-one patients (12 bakers, three millers and six farmers) were studied. We carried out in vivo tests (skin and challenge tests) and in vitro tests (specific IgE measurement) with cereals, enzymes, soyabean, storage mites and egg. A definitive diagnosis was established by means of specific bronchial provocation tests (BPT), except in three patients in whom it could not be carried out due to the severity of their asthma. In these cases the causative agent had to be determined by means of conjunctival challenge. RESULTS: Cereals were the main sensitizers among bakers (75%) and farmers (66%). Bakers were also sensitive to alpha-amylase (41%) and soyabean (25%), and farmers, to soyabean (33%) and storage mites (33%). Occupational asthma was due to cereals, soyabean and storage mites among millers. CONCLUSIONS: Besides cereals, other allergens such as enzymes, leguminous, egg and storage mites can be the causative agents of occupational asthma among cereal workers. Sensitization to different allergens in the different jobs is very likely due to differences in exposure.

Adult↗
PubMed1996

Anaphylaxis from cow's milk casein.

The case of a 35-year-old woman who suffered anaphylaxis after the ingestion of milk or milk-containing products is presented. Symptoms also appeared after the patient used a cosmetic which contained casein. Skin prick tests, specific IgE measurement, and immunoblotting were carried out with cow's milk extract, and its purified proteins: casein, beta-lactoglobulin, and alpha-lactalbumin. Specific IgE to cow's milk casein was detected with the three tests. Immunoblotting revealed one band of 24 kDa approximately corresponding to the beta-fraction of casein. Negative results to beta-lactoglobulin and alpha-lactalbumin were obtained with the three methods. Symptoms were controlled by rigorous dietary and behavior measures.

Adult↗
PubMed1993

Occupational asthma and contact urticaria from dried flowers of Limonium tataricum.

Dried flowers of Limonium tataricum (LT) are widely used for semipermanent floral arrangements. We report a case of a floral industry worker in whom exposure to LT precipitated rhinoconjunctivitis, asthma, and contact urticaria. Studies revealed the presence of immediate skin test reactivity and positive leukocyte histamine release in response to LT extract. Specific anti-LT antibodies were detected in the patient's serum by direct RAST. Bronchial challenge with LT extract also resulted in an isolated immediate asthmatic response. Both the positive methacholine inhalation test and the significant changes observed in PEFR measurements when the patient handled LT supported the diagnosis of occupational asthma. These findings strongly suggest that an IgE-mediated immunologic mechanism is responsible for the patient's respiratory and cutaneous symptoms.

Adult↗
PubMedDate not supplied

[The study of the inflammation of the airway in bronchial asthma by cytological and chemical analysis in the fluid phase of samples taken by sputum induction].

In recent years the study of samples of bronchial biopsies and bronchoalveolar lavage fluid has made it possible to show the existence of significant airway mucosal inflammation, even in cases of mild bronchial asthma. This has led to a renewed interest in the use of sputum to assess airway inflammation non-invasively. Sputum induction has recently been proposed as a non-invasive alternative to bronchoscopy for the collection of airway secretions from asthmatic subjects. Sputum induction yields satisfactory samples of sputum in the great majority of asthmatic subjects, and both differential cell counts and the measurement of molecular markers of inflammation in the sputum fluid phase are feasible. In this paper we review studies where these measurements have been taken from subjects who were asthmatic, affected by other respiratory pathologies or healthy, and we assess their validity. Finally, we consider possible future clinical applications of sputum measurement of airway inflammation in asthma.

English Abstract↗
PubMedDate not supplied

Long-term immunotherapy with an optimal maintenance dose of a standardized Dermatophagoides pteronyssinus extract in asthmatic patients.

In a previous dose-titration study of specific immunotherapy (SIT) with a Dermatophagoides pteronyssinus extract in asthmatic patients, we proposed a dose of 3.2 micrograms of Der p and 1/1.6 micrograms of Der p 2 as an optimal maintenance dose. Changes presented by a high-dose immunotherapy group, with a maximum tolerated dose between 4 and 16 micrograms Der p 1, were compared with those of a conventional immunotherapy group, with a maximum tolerated dose of 3.2 micrograms Der p 1 or lower. After 2 years of SIT, both groups achieved the same level of clinical benefit. We now present the results of long-term monitoring of 25 of these patients, covering the 5 years of SIT in which the maintenance dose was set at 3.2 micrograms Der p 1. The aims of the study were firstly to examine if this maintenance dose could sustain the changes induced by immunotherapy in the first 2 years; and secondly, to determine if this dose is clinically effective in patients known to tolerate higher maintenance doses. The clinical severity index (CSI), medication and symptom scores, cutaneous sensitivity and specific IgE and IgG4 to D. pteronyssinus, Der p 1 and Der p 2 were measured. Positive clinical and immunological changes presented in the first 2 years of SIT were sustained (CSI, medication score, specific IgE) or even increased (symptom score, cutaneous sensitivity) after 3 additional years of SIT. In conclusion, a maintenance dose of 3.2 micrograms of Der p 1/1.6 micrograms of Der p 2 induced intense clinical and immunological changes which were sustained during a 5-year course of treatment, even in patients able to tolerate higher doses.

Adolescent↗
PubMedDate not supplied

Dermatophagoides pteronyssinus cluster immunotherapy. A controlled trial of safety and clinical efficacy.

We designed a cluster schedule of immunotherapy for patients allergic to Dermatophagoides pteronyssinus to reach the maximal recommended dose in 7 weeks. We compared its safety and clinical efficacy with those of a conventional schedule in a controlled trial. Sixty-three patients were randomized as follows: 29 were treated with the cluster schedule, 15 with a conventional schedule and 19 without immunotherapy. A standardized extract was used. Clinical efficacy was measured by visual analog scale, clinical severity score, symptom/medication diary cards and control of peak expiratory flow (PEF) in asthmatic patients, before immunotherapy (T0), on reaching the maintenance phase (T1), and after 6 (T2), 12 (T3) and 18 months of maintenance (T4). The safety of immunotherapy was found to be good. Visual analog scale improved significantly at T4 in the cluster and conventional schedules, and clinical severity score also improved from T1 in these schedules. Diary cards improved from T1 in the cluster schedule and from T2 in the conventional schedule in asthmatic patients. Significant improvements in diary cards in rhinitis patients and PEF were found only in the cluster schedule. There were no changes in the group without immunotherapy. In conclusion, our cluster schedule showed as good tolerance and clinical efficacy as the conventional schedule in patients allergic to D. pteronyssinus. These clinical improvements did not appear in the group without immunotherapy.

Adolescent↗
PubMedDate not supplied

Immunotherapy with a standardized Dermatophagoides pteronyssinus glutaraldehyde-modified extract against an unmodified extract: a comparative study of efficacy, tolerance and in vivo and in vitro modification of parameters.

We comparatively studied clinical efficacy, tolerance and modifications of different in vivo and in vitro parameters induced by two biologically standardized Dermatophagoides pteronyssinus extracts (HEP units), one glutaraldehyde-modified, in patients with allergic rhinitis and/or bronchial asthma after a year of treatment. A decrease in drug consumption was observed in both treatment groups (p < 0.0001). Of all the in vivo parameters studied (cutaneous, conjunctival and bronchial reactivity to the allergen), a decrease in specific bronchial reactivity was only observed in the group treated with the modified extract (p < 0.05). The modifications in total IgE, specific IgE and specific total IgG levels are superimposable on those described in previous papers on immunotherapy. However, IgG4 levels remained stable with respect to time. Tolerance was good and very similar for both treatments; both types of extracts are equally efficacious and safe.

Adolescent↗
PubMedDate not supplied

Reactive airways dysfunction syndrome: two case reports.

Reactive airways dysfunction syndrome (RADS) is a type of asthma that develops in subjects without prior pulmonary disease, following single or multiple exposure to high levels of nonimmunogenic irritants. The main difference from classic occupational asthma is the absence of a latency period. Non-specific bronchial hyperresponsiveness is characteristic of the disease and usually persists after cessation of exposure. We report the cases of two subjects in whom RADS developed after occupational exposure to irritants.

Adult↗