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Biomedical subjects

P M Gamboa

Publications and source records attributed to P M Gamboa.

At least 19 recordsLinked to original sources
PubMed2006

Hypersensitivity to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs).

Hypersensitivity to aspirin and other non steroidal anti-inflammatory drugs (NSAIDs) manifesting in the airways (rhinosinusitis, polyps, asthma) or in the skin (urticaria, angioedema) is the second most frequent untoward allergic reaction to drugs. Various aspects of this syndrome, such as its clinical features, the cell types and mediators involved, the role of underlying chronic inflammatory processes, the patterns of cross-reactivity between NSAIDs, the major role of sulfidoleukotrienes (LTC4) and of some other mediators such as prostaglandin E2 (PGE2) and C5a are briefly reviewed. It has been assumed for a long time that there were no reliable in vitro tests for that condition and that diagnostic confirmation can only be ascertained by provocation challenge. This appears no longer to be true, since several recent studies using a leukotriene release test (CAST) or a basophil activation test (BAT) on blood basophils, or a combination of both tests, yields positive results (70-75%) in a sizeable number of clinically validated cases, with a high specificity (above 85%). The finding in that syndrome of hyperreactive basophils suggests that the NSAID hypersensitivity syndrome is due to the associated effect of several factors: 1) Localized inflammatory processes causing a non specific cellular hyperreactivity; 2) An abnormal pharmacogenetic reaction to NSAIDs resulting in a hyperproduction of LTC4 and other mediators by activated mast cells, basophils and eosinophils.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Specific IgG to Thermoactynomices vulgaris, Micropolyspora faeni and Aspergillus fumigatus in building workers exposed to esparto grass (plasterers) and in patients with esparto-induced hypersensitivity pneumonitis.

BACKGROUND: Esparto is one the most frequent causes of hypersensitivity pneumonitis in Spain. OBJECTIVE: Determination of risk factors in the working environment that could explain the sensitisation process, and assessment of the differences in specific IgG levels to Aspergillus fumigatus, Saccharopolyspora rectivirgula and Thermoactynomices vulgaris in patients with hypersensitivity pneumonitis induced by esparto, exposed healthy plasterers and control population. METHODS: Determination of precipitins and specific IgG to Aspergillusfumigatus, Saccharopolyspora rectivirgula and Thermoactynomices vulgaris in the three previously mentioned groups. Questionnaire on possible risk occupational and extra-occupational factors. RESULTS: Both healthy and exposed plasterers have higher levels of specific IgG to Aspergillus fumigatus, Saccharopolyspora rectivirgula and Thermoactynomices vulgaris than the healthy controls. The patients had higher levels of IgG than exposed healthy plasterers only to Thermoactynomices vulgaris. Precipitins were detected in only two patients. There were no occupational factors influencing on the sensitisation process. CONCLUSIONS: Specific IgG is an occupational exposure marker among plasterers, but it has not been possible to establish a cut off point that differentiates exposed subjects from affected ones. This determination has a greater sensitivity than precipitins. We did not identify occupational or extra-occupational risk factors that facilitate the sensitisation process.

Adult↗
PubMed2005

Antigen specific quantification of sulfidoleukotrienes in patients allergic to Betalactam antibiotics.

BACKGROUND: After in vitro allergen-specific stimulation, basophils become activated and release sulfidoleukotrienes LTC4, LTD4 and LTE4. This can be detected by means of the CAST assay. We assessed the positivity criteria and the reliability of antigen-specific sulfidoleukotriene production (CAST) in the in vitro diagnosis of betalactam (BL) allergic patients. MATERIAL AND METHODS: We studied a sample of 67 patients (age 48.94 +/- 15.76 years) who had presented with anaphylaxis or urticaria-angioedema within the first 60 minutes after administration of Amoxicillin (54/67), Penicillin G (7/67), Cefuroxime (5/67) or Cefazoline (1/67). All of them had a positive skin test to at least one of the antigenic determinants of Penicillin. As control group 30 adults with negative skin tests who tolerated BL were included. All of them underwent skin tests, oral provocation tests, specific IgE (CAP-FEIA, Pharmacia) and CAST. RESULTS: Positivity criteria were established by means of ROC curves: a sLT release induced by Betalactams of at least 100 pg/ml and greater than or equal to 3 times the basal value. The overall sensitivity of CAST is 47.7% and specificity 83.3%. Sensitivity of specific IgE is 37.8% and specificity 83.3%. CONCLUSIONS: We have established validated positivity criteria for the CAST technique in patients allergic to Betalactams. This technique is a useful in vitro diagnostic method in patients with IgE-mediated allergy to Betalactam antibiotics.

Amoxicillin↗
PubMed2005

Hydrochlorothiazide-induced acute non-cardiogenic pulmonary edema.

We report the case of a 64 year-old male with non cardiogenic pulmonary edema episodes after oral administration of 12.5 mg of hydrochlorothiazide. In vitro immunologic study with basophil activation test and late cellular activation study (CD69 and production of interferon gamma) with chlorothiazide were performed, and no activation was observed. As a consequence, like in previous cases published, the pathogenic mechanism remains unknown, and it probably is an idiosyncratic reaction.

Antihypertensive Agents↗
PubMed2005

Latex-vegetable syndrome due to custard apple and aubergine: new variations of the hevein symphony.

An increasing number of vegetables with crossreactions to latex are being described in patients with latex-vegetable syndrome. We present two of these vegetables, custard apple linked in two previous cases with latex sensitisation, and aubergine, that had not been described up to now in patients with latex sensitisation. The diagnosis of both cases was based on the clinical history, positive skin prick test (SPT) and specific IgE to the offending vegetables, as well as to positive SPT and specific IgE levels to latex and the major fruits involved in the latex-fruit syndrome (avocado, banana, and chestnut). Further, crude extracts from latex, custard apple and aubergine, as well as the purified allergens Hev b 6.02 and Prs a 1 were used in in vitro and in vivo assays: IgE immunodetection, histamine release (HRT) and basophil activation (BAT) tests and skin prick tests. In case 1, both purified Hev b 6.02 and Prs a 1 induced positive responses in skin prick tests, high levels of basophil activation and histamine release. Specific IgE immunodetection uncovered a reactive band of 45 kd in the crude custard apple extract, which was also recognized by anti-chitinase monospecific antibodies. The serum from patient 1 also detected Prs a 1 in immunodetection. Hev b 6.02 produced positive skin responses and showed high biological activity in HRT and BAT in the case of patient 2. However, Prs a 1 was reactive neither in SPT nor in IgE immunodetection. In fact, no band was detected using the serum of patient 2 in avocado or aubergine extracts. By contrast, Prs a 1 reached high values of basophil activation and over 10% of histamine release in case 2.

Adult↗
PubMed2004

Biological characterization of glutaraldehyde-modified Parietaria judaica pollen extracts.

BACKGROUND: Allergoids are widely used in specific immunotherapy (SIT) for the treatment of IgE-mediated allergic diseases, but all techniques for standardization of conventional allergic extracts may not be appropriate for standardization of a glutaraldehyde (GA)-modified extract because of the unique characteristics of these extracts. OBJECTIVE: To assess an accurate methodology for standardization of chemically modified extracts. METHODS: GA-modified extracts from Parietaria judaica pollen were purified by diafiltration. Biochemical properties were investigated by determination of amino groups, chromatography, and SDS-PAGE. The IgE-binding activity was determined by skin prick test, enzyme allergosorbent test inhibition, basophil activation, and histamine release tests. Peripheral blood mononuclear cells (PBMCs) from P. judaica pollen-allergic subjects were stimulated with either native or allergoid extracts, and proliferation was measured. RESULTS: Biochemical data indicated a high degree of allergen polymerization resulting in extract components higher than 100 kDa. IgE-binding activity, both in vivo and in vitro, was reduced by more than 99.8%. Both allergen and allergoid induced PBMC proliferation and synthesis of blocking IgG antibodies at similar rates. Moreover, no evidence of introduction of new determinants by chemical modification was found. CONCLUSIONS: The preparation of GA-modified extracts by diafiltration is faster and more reliable than previous chromatographic methods. These modified extracts have drastically reduced their allergenicity while maintaining their immunogenicity, and therefore they can be used in safer and shortened schedules of SIT.

Adolescent↗
PubMed2004

Basophil activation and sulfidoleukotriene production in patients with immediate allergy to betalactam antibiotics and negative skin tests.

BACKGROUND: New in vitro diagnostic methods for IgE-mediated drug allergic reactions, such as basophil activation test and antigen specific sulfidoleukotriene test, have proven their usefulness in patients with positive skin tests. OBJECTIVE: To assess the usefulness of basophil activation test and antigen specific sulfidoleukotriene test in the diagnosis of patients with IgE-mediated allergy to Betalactam antibiotics and negative skin tests. METHODS: The 23 patients included in the study underwent basophil activation test, antigen specific sulfidoleukotriene test and specific IgE. The patients were classified into three groups. GROUP A: patients with positive specific IgE. GROUP B: patients with a unique immediate reaction to Betalactams, negative specific IgE and positive oral provocation tests. And Group C: patients with at least two immediate reactions induced by Betalactams and negative specific IgE. RESULTS: The sensitivity/specificity of the different tests are: basophil activation test 39.1 %/93.3%, antigen specific sulfidoleukotriene test 22.7%/83.3%, specific IgE 21.7%/86.7%. The joint use of the three tests allows diagnosis of 60.9% of the patients. CONCLUSION: In vitro diagnostic tests, especially basophil activation test, are very important tools in the diagnosis of patients with IgE-mediated allergy to Betalactams and negative skin tests, avoiding performance of potentially dangerous oral provocation tests in a high percentage of cases.

Adult↗
PubMed2003

Use of CD63 expression as a marker of in vitro basophil activation and leukotriene determination in metamizol allergic patients.

BACKGROUND: We assessed the reliability of basophil activation test (FAST) and sulphidoleukotriene production (CAST) in the in vitro diagnosis of allergy to metamizol, evaluating its sensitivity and specificity. METHODS: Twenty-six patients allergic to metamizol and 30 control individuals were studied. Skin tests with metamizol, FAST, and CAST were performed. RESULTS: FAST sensitivity was 42.3% and specificity 100%. The PPV of FAST is 100% and the NPV 99.4%. The likelihood ratio for a positive value cannot be calculated because the specificity is 100% and the likelihood ratio for a negative value is 0.58. CAST sensitivity was 52%, and specificity 90%. The PPV of the test is 5% and the NPV 99.5%. The likelihood ratio for a positive result was 5.2 and that for a negative result 0.53. FAST detects a larger number of cases when patients are studied within the first 6 months after the clinical reaction (chi = 4.2, P = 0.04) than later. Together with skin tests, FAST allowed detection of 69.2% patients allergic to metamizol, the same as CAST 76%. The joint use of the three techniques allowed identification of 76.9% of cases. CONCLUSIONS: FAST and CAST are useful for the diagnosis of allergy to pyrazolones. Its usefulness clearly increases when recent reactions are studied.

Adult↗
PubMed2003

[Basophil activation test in the diagnosis of allergy to medicines].

In this paper we study the reliability of the basophil activation test (BAT) in the "in-vitro" diagnosis of allergy to betalactams and to metamizol, and the sensitivity and specificity of the technique are analyzed. To this end, we studied 58 patients allergic to betalactam antibiotics with a positive cutaneous test facing any derivative of penicillin and 30 healthy controls who tolerated betalactams, and 26 patients allergic to metamizol with an immediate reaction and 30 healthy controls who tolerated the medicine. Sensitivity to BAT in allergy to betalactams was 52.8%, and specificity was 92.6%. For metamizol, sensitivity was 42.3% and specificity was 100%. The positive predictive value of BAT in allergy to betalactams was 18.9% and the negative predictive value was 98.4%. For metamizol, the positive predictive value of the technique was 100% and the negative predictive value was 99.4%. The joint use of BAT and CAP (specific IgE) makes it possible to diagnose some 65% of patients allergic to betalactams. The combined use of cutaneous tests and BAT in allergy to metamizol detects 70% of the cases. BAT is a useful, non-invasive technique in the "in-vitro" diagnosis of allergy to betalactams and metamizol.

Basophil Degranulation Test↗
PubMed2002

Flow cytometric basophil activation test by detection of CD63 expression in patients with immediate-type reactions to betalactam antibiotics.

BACKGROUND: In this study, we used flow cytometry to determine the percentage of activated basophils that expressed the CD63 marker after in vitro stimulation by different betalactam antibiotics. The diagnostic reliability of the technique was assessed, as well as its correlation with specific IgE. METHODS: Fifty-eight patients with clinical allergy to betalactam antibiotics and presenting positive skin tests to at least one of the allergens (minor determinant mixture (MDM), benzylpenicilloyl-polylysine (PPL), penicillin, ampicillin, amoxicillin, cephalosporins) were tested. Thirty subjects non-allergic to betalactams were also studied as controls. The flow assay stimulation test (FAST) uses flow cytometry to determine the percentage of basophils that express CD63 as an activation marker after in vitro stimulation with allergen. Double labelling with monoclonal antibodies anti-CD63-PE and anti-IgE FITC was used. RESULTS: The allergic patients show a statistically greater number of activated basophils than the control subjects, after the incubation of cells with all the betalactams at various concentrations. The sensitivity of the technique is 50%, the specificity 93.3%, the likelihood ratio for a positive value 7.46 and the likelihood ratio for a negative value 0.54. In spite of having a greater sensitivity (37.9%) and specificity (86.7%) than CAP, differences between sensitivity and specificities of both techniques (CAP and FAST) do not reach statistical significance. CONCLUSION: The basophil activation test is a particularly useful technique in the diagnosis of patients with IgE-mediated allergy to betalactams and allows the identification of 50% of patients. Used in conjunction with CAP, it allows the identification of 65.5% of such patients.

Adult↗
PubMed2002

Flow cytometric basophil activation test: a review.

Flow cytometry is a technique enabling the analysis of physical and biological characteristics of cells or other biological particles when labeled with antibodies coupled to fluorochromes or other dyes. The basophil activation test (BAT), also called flow-cytometric allergen stimulation test (FAST) [commercially available under the name of Flow CAST (Bühlmann Laboratories) or BASOTEST (Beckton-Dickinson)] is based on the in vitro allergen-induced specific activation of basophils. This assay rests on the demonstration of some membrane protein markers that appear after exposure to the allergen. This paper reviews some of the literature about the use of this technique in the investigation of immediate-type allergies to inhalant allergens, drugs, and foods, as well as our own experience with this diagnostic technique. Flow cytometry is a reliable method for the quantification of basophil activation after allergenic stimulus in vitro and in vivo. It also enables us to detect allergic and pseudoallergic reactions because of other mechanisms than allergen-specific IgE antibodies. Further clinical evaluation of this technique will allow validation and better establishment of its diagnostic value in allergy.

Adult↗
PubMed2001

Allergen-induced basophil activation: CD63 cell expression detected by flow cytometry in patients allergic to Dermatophagoides pteronyssinus and Lolium perenne.

BACKGROUND: In this study, we determined by flow cytometry the percentage of basophils activated after in vitro stimulation by allergens and expressing the CD63 marker. The diagnostic reliability of the technique was assessed as well as its correlation with other in vitro diagnostic parameters. METHODS: Fifty-three patients suffering from asthma and/or allergic rhinitis following sensitization to Dermatophagoides pteronyssinus and 51 patients sensitized to Lolium perenne were investigated. Twenty-four atopic patients not sensitive to these allergens and 38 healthy subjects were also selected as controls. The basophil activation test determines the percentage of basophils which express CD63 as an activation marker, by means of flow cytometry, after in vitro stimulation with allergen, using double labelling with monoclonal antibody anti-CD63-PE and anti-IgE-FITC. RESULTS: No differences in basal values (non-activated control) were found between sensitized patients, atopic controls and healthy controls. On the other hand, sensitized patients showed a significantly higher percentage of activated basophils after stimulation by allergens in vitro than both control groups (P < 0.001). We found a significant correlation between skin tests and basophil activation tests (r = 0.72, P < 0.001). We also found a positive and significant correlation between basophil activation tests and histamine release tests (r = 0.80, P < 0.001), allergen-specific sulphidoleukotriene production (r = 0.7, P < 0.001) and the occurrence of serum allergen-specific IgE (r = 0.71, P < 0.001). CONCLUSION: The basophil activation test is a highly reliable technique in the diagnosis of allergy to inhalant allergens. The sensitivity of the basophil activation test was 93.3%, and its specificity 98.4%, when using a cut-off point of 15% activated basophils as positive result.

Adult↗
PubMed1999

Prevalence of pollinosis in the Basque Country.

BACKGROUND: The prevalence of allergic diseases, mainly pollinosis, has increased within the last decades. Our study aimed to determine the prevalence of sensitization to Poaceae pollen in the Basque Country. This is a region of northern Spain, with an area of 7261 km2 and a population of 2109009 inhabitants. Two different climatic regions may be distinguished in the Basque Country (the Atlantic and the Oceanic). METHODS: A transversal study was carried out on 2216 subjects, aged 10-40 years. A personal interviewwas carried out in order to compile study data, by means of a questionnaire that had been previously validated with a clinical history and an allergy study. RESULTS AND CONCLUSIONS: Our results show the prevalence of pollinosis in the Basque Country to be 10.6% (C.I. 95% 9.35-11.96%) without significant differences between men and women. The prevalence in the Atlantic climate area (9.71%) was lower than in the Oceanic climate area (13.61%). There were no differences between persons living in a rural environment (10.87%) and those living in an urban setting (10.51%). Pollinosis was more frequent in individuals aged 10-20 (11.41%) and 20-30 (12.54%) than those aged 30-40 years (7.43%). Three features significantly distinguished pollinic from nonpollinic patients: 1) a more common complaint of symptoms after ingestion of Rosaceae fruits or nuts (10.2%) 2) a family history of atopy (8.8%) 3) a greater occurrence of bronchial asthmatic symptoms (23%).

Adolescent↗
PubMed1996

Occupational asthma in a coal miner.

Occupational asthma in coal miners is hardly recognised. A report is presented of a coal miner whose clinical picture suggested a respiratory allergy which occurred only in the mine where he worked. Serum specific IgE levels, skin tests, and bronchial provocation tests with different commercial extracts showed sensitisation to Rhizopus nigricans. Rhizopus spp were found inside the mine, as demonstrated by cultures on petri plates.

Adult↗