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Background/objectives: Adverse reactions to local anesthetics are relatively common, but proven IgE-mediated allergy is extremely rare. We aimed to determine the frequency of local anesthetic allergy in pediatric patients., Patients and Methods: The medical records of 73 patients who presented to our clinic with a history of suspected allergic reaction to local anesthetics and underwent diagnostic testing between 2012 and 2020 were retrospectively analyzed. Diagnoses were based on case histories, skin tests, and subcutaneous challenge tests., Results: A total of 75 test series were carried out on the 73 patients (43 boys; median [IQR] age 9.25 [7.26-14.25] years, range 3-17.8 years). The most commonly tested drugs were lidocaine (n = 38; 50.6%) and prilocaine (n = 15; 20%). Local anesthetic allergy was confirmed in one (1.3%) of the 73 patients by positive subcutaneous challenge test with mepivacaine., Conclusion: There are limited data in the current literature regarding local anesthetic allergies and diagnosis test results in pediatric patients. Proven local anesthetic allergy is less common than expected by society and physicians, and therefore diagnostic tests are needed for patients with no contra-indications such as severe or life-threatening reactions.

Introduction and Objectives: Atopic individuals are characterized by increased IgE production and Th2 response if exposed to certain antigens. It is known that the mother transfers anti-mite antibodies to the fetus and newborn, IgG thru the placenta, and IgA thru breastfeeding, but it is not clear whether there is a protective mechanism mediated by them concerning the development of future allergies. This study aimed to compare the levels of IgA, IgG, and IgE antibodies specific to Der p 1 and Der p 2 between atopic and healthy individuals., Methods: Serum samples of 98 patients and 44 healthy controls were subjected to quantification for specific IgE, IgG, and IgA antibodies against Der p 1 and Der p 2 by ImmunoCap ® and ELISA, and subjected to statistical analysis as indicated., Results: Atopic patients had higher serum levels of IgE, IgG, and IgA specific to Der p 1 and Der p 2. The correlation was more robust between IgE and IgG antibodies., Conclusions: Allergic patients produce higher levels of antibodies against Der p 1 and Der p 2 compared with healthy individuals. The mechanisms involved still require detailed studies.

Background: Familial Mediterranean fever (FMF) is the most common auto-inflammatory disease and is characterized by self-limiting episodes of fever and polyserositis. The aim of this study was to determine the atopic clinical findings associated with the MEFV gene., Methods: A retrospective chart review was conducted of pediatric patients who had received a diagnosis of familial Mediterranean fever between August 2015 and November 2018., Results: A total of 454 patients with familial Mediterranean fever were evaluated. The median age of diagnosis was 60 months (min-max: 6-228) and the percentage of patients who were male was 57.5%. A MEFV gene mutation was determined in 310 (68.3%) children. The most frequent genetic mutation was a R202Q heterozygote mutation, which was found in 95 patients (20.9%). When compared with MEFV-negative patients, elevation of serum amyloid A and fibrinogen levels during an episode of FMF was found to occur more frequently in MEFV-positive patients (p=0.019 and 0.027, respectively). Male gender, cigarette exposure, and a younger diagnosis age were seen more frequently in patients who had episodes with fever (p=0.039, 0.022, and 0.001, respectively). Chronic cough with sputum and persistent purulent rhinitis were more frequent in the group which did not experience fever episodes (p=0.003 and 0.002, respectively)., Conclusions: While being a periodic fever syndrome, familial Mediterranean fever also presents as a multisystemic disease with heterogeneous clinical symptoms. Severe atopic diseases and recurrent respiratory tract infections are characteristic features of this disease., (Copyright © 2020 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.)

Vaccinations are one of the main public health tools for the control of vaccine-preventable diseases. If a child is identified as having had an allergic reaction to a vaccine, subsequent immunisations will probably be suspended - with the risks such a decision implies. The incidence of severe allergic reactions is very low, ranging between 0.5 and 1 cases/100,000 doses. Rather than the vaccine antigens as such, the causes of allergic reactions to vaccines are often residual protein components of the manufacturing process such as gelatine or egg, and less commonly yeasts or latex. Most vaccine reactions are mild and circumscribed to the injection site; although in some cases severe anaphylactic reactions can be observed. If an immediate-type allergic reaction is suspected at vaccination, or if a child with allergy to some of the vaccine components is scheduled for vaccination, a correct diagnosis of the possible allergic process must be made. The usual vaccine components must be known in order to determine whether vaccination can be safely performed., (Copyright © 2015 SEICAP. Published by Elsevier Espana. All rights reserved.)

Background: The aim of this study was to assess the sensitivity profile of the population of Fez and Casablanca in Morocco to dry broad bean (Vicia faba), and to investigate the effect of food processing (heat and/or enzymatic hydrolysis by pepsin) on the human IgE binding capacity to broad bean proteins (BBP)., Methods: Sera samples from 146 patients with atopic hypersensitivity were recruited in order to evaluate specific IgE levels to native and processed broad bean proteins by ELISA. Under the same conditions, we assessed the immunoreactivity of rabbit IgG obtained by immunisation with native BBP., Results: High IgE levels to BBP were found; in fact, 79.3% of children and 80.4% of adults had positive values. The heat treatment (70°C during 60 min) of dry beans proteins showed slight reduction in recognition of these antigens by rabbit IgG (22%) and by human IgE (12%). Pepsin hydrolysis decreased rabbit-IgG recognition by 55% in the first 30 min of treatment. In contrast, and under the same conditions, pepsin increased human-IgE recognition with an average of 143% for all patients. However, the combination of the two treatments (heating and pepsin digestion) showed a decrease of 16% in BBP recognition for all patients., Conclusions: This study demonstrates a high sensitivity of a Moroccan population to broad bean proteins which was resistant to heat and digestion by pepsin., (Copyright © 2012 SEICAP. Published by Elsevier Espana. All rights reserved.)

Background: COX-2 inhibitors are safe alternatives in patients with cross-reactive non-steroidal anti-inflammatory drug (NSAID) hypersensitivity. These drugs are recommended to these patients after negative drug provocation tests (DPTs). However, cumulative data on encouraging results about the safety of COX-2 inhibitors in the majority of these patients bring the idea as to whether a DPT is always mandatory for introducing these drugs in all patients with cross-reactive NSAID hypersensitivity., Objective: To document the safety of COX-2 inhibitors currently available and to check whether or not any factor predicts a positive response., Methods: This study included the retrospective analysis of cases with cross-reactive NSAID hypersensitivity who underwent DPTs with COX-2 inhibitors in order to find safe alternatives. DPTs were single-blinded and placebo controlled., Results: The study group consisted of 309 patients. COX-2 inhibitors were well tolerated in the majority of the patients [nimesulide: 91.9%; meloxicam: 90.2%; rofecoxib: 94.9%; and celecoxib: 94.9%)]. Twenty-five patients (30 provocations) reacted to COX-2 inhibitors. None of the factors were found be associated with positive response., Conclusion: Our results suggest to follow the traditional DPT method to introduce COX-2 inhibitors for finding safe alternatives in all patients with cross-reactive NSAID hypersensitivity before prescription as uncertainty of any predictive factor for a positive response continues. However, these tests should be performed in hospital settings in which emergency equipment and experienced personnel are available., (Copyright © 2012 SEICAP. Published by Elsevier Espana. All rights reserved.)

Background: Our aim was to assess the prevalence and associated risk factors of common hypersensitivity reactions to drugs in the adult population, for which limited data are available., Methods: The data consisted of 1052 questionnaires obtained from adults. The questionnaires consisted of questions on immediate-type hypersensitivity reactions induced by drugs (itching, skin rash/hives, angio-oedema, shortness of breath, hypotension, and loss of consciousness). The questionnaire added knowledge on physician's diagnosis of asthma, allergic rhinitis, eczema, and other chronic systemic diseases., Results: The prevalence of self-reported drug hypersensitivity reactions was 11.8% for all reactions. Hypersensitivity reactions to analgesics were the most common (37.2%) followed by antibiotics (24.2%). Multivariate analysis showed that female gender (Odds Ratio (OR) 95% Confidence Interval (CI) (2.00 (1.25-3.21)), physician-diagnosed allergic rhinitis (3.03 (1.64-5.59)), and eczema (3.22 (1.87-5.53)) were associated with any type of drug hypersensitivity reactions. Itching was associated with allergic rhinitis (4.50 (2.06-9.81)) and eczema diagnosis (4.24 (2.14-8.64)). Skin rash/hives were associated with female gender (2.67 (1.24-5.74)), allergic rhinitis (4.57 (1.99-10.05)), and eczema (5.36 (2.65-10.84)). Angio-oedema was higher in females (5.74 (1.69-18.5)). In addition, eczema (2.87 (1.12-7.32)) and systemic hypertension (2.60(1.03-6.10)) were associated with angio-oedema. Shortness of breath was only associated with ever asthma diagnosis (6.59 (2.09-20.83)). Factors associated with loss of consciousness were female gender (5.56 (1.27-24.30)), allergic rhinitis diagnosis (4.76 (1.73-13.14)), and systemic hypertension (2.74 (1.02-7.41))., Conclusion: The study showed that females and subjects with allergic diseases and hypertension were more susceptible to drug hypersensitivity reactions., (Copyright © 2009 SEICAP. Published by Elsevier Espana. All rights reserved.)

Different causes of asthma have been established. The most common cause is conditioned to a genetic predisposition towards atopy (atopic asthma), although other factors can also give rise to bronchial inflammation, such as over-exposure to environmental irritants (occupational asthma), altered arachidonic acid metabolism (aspirin-induced asthma) and also exercise - in which different thermal and osmotic mechanisms are known to intervene. The prognosis of these different variants of asthma depends on the severity of the condition; patient age at onset of the disease; patient age at the time of diagnosis; the treatment provided; and adherence to therapy. The concept of "natural history" refers to the spontaneous evolution or course of the disease process in the absence of pathogenic or etiological treatment, with the provision of only symptomatic treatment. In order to gain increased certainty regarding the course of these patients, the study groups must present similar baseline characteristics in terms of the start and severity of the condition; the start of treatment; compliance; and the clinical and functional control findings., (Copyright © 2010 SEICAP. Published by Elsevier Espana. All rights reserved.)

The diagnosis of antibody-mediated allergic disorders is based on the clinical findings and the detection of allergen-specific IgE based on in vitro and in vivo techniques, together with allergen provocation tests. In vitro diagnostic techniques have progressed enormously following the introduction of the advances made in proteomics and nanotechnology--offering tools for the diagnosis and investigation of allergy at molecular level. The most advanced developments are the microarray techniques, which in genomics allowed rapid description of the human genetic code, and which now have been applied to proteomics, broadening the field for research and clinical use. Together with these technological advances, the characterisation of most of the different proteins generating specific IgE and which conform each natural allergen, as well as their purification or genetic engineering-based synthesis, have been crucial elements--offering the possibility of identifying disease-causing allergens at molecular level, establishing a component-resolved diagnosis (CRD), using them to study the natural course of the disease, and applying them to improvements in specific immunotherapy. Microarrays of allergic components offer results relating to hundreds of these allergenic components in a single test, and use a small amount of serum that can be obtained from capillary blood. The availability of new molecules will allow the development of panels including new allergenic components and sources, which will require evaluation for clinical use. The present study reviews these new developments, component-resolved diagnosis, and the development of microarray techniques as a critical element for furthering our knowledge of allergic disease., (2010 SEICAP. Published by Elsevier Espana. All rights reserved.)

Background: The treatment in non-atopic young children with recurrent wheezing remains controversial., Objective: The aim of the study was to compare the response of inhaled budesonide in atopic versus non-atopic infants/preschoolers with recurrent wheezing (more than three episodes in the last year or one episode per month in the last three months)., Methods: One hundred and seventy three infants/preschoolers (mean age 1.58+/-0.9 yrs) with recurrent wheezing without previous use of inhaled corticosteroids were enrolled and divided into two categories: atopics (eosinophils in peripheral blood > or =4%) and non-atopics (<4%). Both groups were treated with budesonide (200 mcg bid delivered by MDI and spacer) for three months. The primary outcome was the prevalence of wheezing exacerbation episodes at the end of the treatment., Results: Thirty-seven out of 173 (21.4%) were atopics and they were significantly younger, more frequently with a father with asthma, maternal grandparents with asthma and rhinitis, paternal and maternal grandparents with eczema, and higher number of wheezing episodes in the last year than non-atopics. At the end of the study, among those with good compliance (>70% of the weekly doses), the proportion of wheezing episodes were similar among atopics and non-atopics (57.7% vs. 44.1%, p=0.25, respectively); the number of exacerbations requiring emergency department (ED) visits and hospital admission were also similar., Conclusion: Regular budesonide therapy may decrease the episodes of wheezing in infants/preschoolers with recurrent wheezing, independently of atopy., (Copyright 2009 SEICAP. Published by Elsevier Espana. All rights reserved.)

Background: Atopy is an important risk factor for asthma, rhinitis, atopic eczema and urticaria. For this reason, several studies have been done to determine the prevalence of atopy in the paediatric population. The important differences among these studies do not allow the extrapolating of results. In this study, we calculate the prevalence of atopy and atopy-related diseases in a paediatric population using a different methodology., Methods: Retrospective study among children referred for drug allergy in which the latter was discarded. We evaluated the prevalence of atopy (measured by allergen sensitisation), asthma, rhinitis, urticaria, atopic eczema and their characteristics., Results: Three hundred and forty-two patients were studied for adverse drug reaction. This was discarded in 325/342 patients. 20 % of the children in the sample were atopic. Atopy prevalence increased with age. Some atopy related disease was observed in 83/325 (25.5 %) children. Among these children allergen sensitisation increased from 42.3 % in the 0-3 years age group to 93.3 % in the 7-14 age group (p < 0.0001). Prevalence of asthma was 11.5 %, 10.2 % and 7 % in the 0-3, 4-6 and 7-14 age groups, respectively. Prevalence of rhinoconjunctivitis increased through age groups with a prevalence of 20 % among the 7 to 14-year old children., Conclusion: The use of this type of methodology seems to be correct to estimate the prevalence of atopy. Prevalence of allergen sensitisation is very high among 7 to 14-year old children with asthma and/or rhinoconjunctivitis.

Clopidogrel is a new antiplatelet prescribed for the secondary prevention of atherosclerotic events. The literature shows that the clinical manifestations of clopidogrel hypersensitivity include urticaria1, skin rash2-4, and angioedema5. The precise immunological mechanism underlying clopidogrel hypersensitivity has not been established. We describe two cases of hypersensitivity reaction due to clopidogrel. The first constituted an immediate reaction after clopidogrel intake. In this case we demonstrated type 1 hypersensitivity using cutaneous tests. The second case represented a delayed hypersensitivity reaction confirmed by oral challenge testing, in which good tolerance to other antiplatelet drugs such as ticlopidine was demonstrated.

Background: Anisakis simplex is a helmintic parasite of fish and shellfish that can induce in humans, after consumption, an immunoallergic response with multiorganic affectation, especially cutaneous (urticaria and angioedema), gastrointestinal and anaphylactic symptoms. Nephrotic syndrome can be produced by helmintic infection, especially schistosomiasis., Objective: To report the unusual case of nephrotic syndrome associated to an allergic response to A. simplex., Methods: A 60-year-old woman suffered from nephrotic syndrome three weeks after a generalized urticaria, angioedema and nauseas episode, following a raw anchovy's ingestion. Etiological study of nephrotic syndrome and urticaria/angioedema, cutaneous test, serum total and specific IgE determination, IgE-immunoblotting, and HLA typing were performed for diagnostic evaluation., Results: Prick-test with A. simplex extract was positive. It was observed a significance increase of total IgE to the three weeks of anchovy's ingestion and then it diminished progressively. Specific IgE to A. simplex was > 100 UI/ml. Immunoblotting to A. simplex, revealed the existence of IgE-binding proteins with molecular mass ranging from 20 kDa to 99 kDa. Class I HLA expressed by the patient was type HLA-B12. Other secondary causes of nephrotic syndrome were carefully ruled out., Conclusions: These data suggest, for the first time, the association between allergy to A. simplex and nephrotic syndrome.

Background: Approximately 150 species of Lepidoptera have been described as causing damage to human skin. One of these species is the pine processionary caterpillar, which is responsible for dermatitis, contact urticaria, ocular lesions and rarely respiratory signs and anaphylactic reactions through IgE-mediated or non-IgE-mediated mechanisms. We report a pediatric case of severe orofacial edema mimicking an allergic reaction after ingestion of a pine processionary caterpillar; urgent airway intubation was required., Case Report: A 15-month-old boy was sleeping under a pine tree when his mother noted a pine caterpillar on his tongue. Because of rapidly developing facial swelling and respiratory distress, the infant was first taken to a local hospital where he received intravenous dexamethasone and pheniramine hydrogen maleate. On arrival at our emergency department, diffuse swelling and edema involving the tongue, perioral, nasal and perimandibular regions, and neck was noted, requiring urgent orotracheal intubation. There were no findings of anaphylaxis. The results of skin prick tests and specific IgE to common aero- and food allergens were negative. A skin prick test with extract of pine caterpillar was also negative. Prednisolone and pheniramine hydrogen maleate were administered for 7 days. The child gradually improved and was successfully extubated 4 days later., Conclusion: Although oral contact with a pine processionary caterpillar in the form of ingestion is rare, it may cause significant local reaction and airway compromise mimicking an allergic event. In this situation, early intubation to maintain airway patency is a life-saving measure.

Background: The reference values for total serum IgE are accepted to vary according to the geographical area involved. In 1981 we published the reference values for a donor population in the city of Valencia (Spain) and its metropolitan area. Since then, we have noted an increase in the prevalence of asthma and rhinitis in countries with a Western lifestyle, including Spain., Aim: To update the adult reference values for total serum IgE in the city of Valencia and its metropolitan area, and to determine their diagnostic usefulness in asthma and allergic rhinitis., Material and Methods: We studied two groups of 69 and 100 individuals each. One group comprised apparently healthy blood donors, as assessed by a routine blood bank study protocol and the application of a questionnaire to exclude perceived allergic or parasitic diseases, while the other group consisted of individuals with atopic respiratory disease (bronchial asthma and allergic rhinitis) studied in our service in the same time period (spring 2004). Total serum IgE was determined by the UniCAP method developed by Pharmacia., Results: The geometric mean of total serum IgE among blood donors was 46.65 kU/l (95% CI: 15.5-77.8) versus 204.29 kU/l (95% CI: 93.3-515) among allergic subjects. The difference between the two groups was statistically significant. No significant difference was found between our donor sample in 1981 and the sample in the present study. Establishing an arbitrary cut-off point of 1.65 standard deviations (SD)(equivalent to 95 % of the donor population), we obtained a figure of > 183 kU/l whereby 44% of all allergic individuals presented a value below this cut-off point. To practical effects, these allergic patients behaved as low responders (LRs) in relation to total IgE, whereas the remaining individuals were high responders (HRs) in relation to total IgE., Conclusions: Our data confirm the current validity of the reference values obtained in 1981, which continue to be significantly different from those of the UniCAP method for Swedish donors. The population of allergic subjects can be divided into two subgroups: subjects with total IgE levels similar to those of the donors, which we refer to as LRs, and which represent 44% of all allergic subjects, and a second subgroup with total IgE values above those of the donors (HRs), who would therefore be the only subjects that would be identified by individual serum IgE study.

Background: Although the treatment of asthma has been addressed in several guidelines, the management of the first acute wheezing episode in infants has not often been evaluated. We surveyed practicing pediatricians in Spain about the treatment they would provide in a simulated case., Material and Methods: A random sample of 3000 pediatricians and physicians who normally treated children was surveyed. The questionnaire inquired about how they would treat a first mild-to-moderate wheezing attack in a 5-month-old boy with a personal and family history of allergy. Pediatricians were asked about their professional background., Results: A total of 2347 questionnaires were returned with useful data (78.2%). Most (90.4%) of the pediatricians would use a short-acting beta2 agonist (SABA) via a metered-dose inhaler with a spacer and a face mask or nebulizer. However, only 34.5% chose a SABA alone: 31.3% added an oral steroid and 27.6% added an inhaled corticosteroid (ICS). The factors associated with the use of ICS in the acute attack were: (1) lack of specific training in pediatrics (OR 1.45; 1.12-1.85) and (2) primary care health center setting (OR 1.31; 1.01-1.69) or rural setting (OR 1.28; 1.01-1.66). Forty-four percent did not recommend any follow-up treatment while 20.7% prescribed ICS as maintenance therapy. The factors related to this decision were the same as those described above., Conclusions: The management of a first wheezing episode seems to meet published guidelines among Spanish pediatricians with formal training in pediatrics and in those who work in a hospital setting or in urban areas.

Background: Some anti-allergic and anti-asthmatic drugs should be discontinued before skin prick test. But there is no knowledge about zafirlukast effects on skin prick test. We investigate the effects of zafirlukast on cutaneous response to histamine and specific allergens., Material and Methods: 9 patients suffering from allergic mild asthma or allergic rhinitis and 8 healthy individuals were recruited to the study. All of them took 20 mg zafirlukast twice daily for at least 5 days. Skin prick test was performed before and after treatment by histamine and specific allergens. There was no significant difference between pre- and post-treatment skin prick tests in spite of zafirlukast treatment., Conclusion: Zafirlukast does not affect skin reactions against histamine and specific allergens. Diagnostic skin prick test can be performed under zafirlukast treatment.

Background: Blomia tropicalis is a mite that is one of the most important causes of allergic sensitization in studies of tropical and subtropical regions. Nonetheless, there are no published studies of the sensitivity and specificity of B. tropicalis extracts., Method: An open, non-randomized study was carried out in 205 asthmatic children and in 205 non-asthmatic children, both groups with an age range of 1 to 14 years. Duplicate skin prick tests were made using allergen extracts standardized by biological units and positive and negative controls. The test was considered positive when the average diameter of the wheal was > or = 3 mm and negative when it was < 3 mm. The validity of the test was estimated by calculating sensitivity, specificity, and the positive and negative predictive values., Results: The skin prick test was positive in 82.92% of the asthmatic children and in 10.7% of the non-asthmatic children, yielding a sensitivity of 82.9%, 95% CI 76.9; 87.7 and a specificity of 89.3%, 95% IC 84.0; 93.0. The positive predictive value was 88.5%, 95% IC 83.0; 92.5 and the negative predictive value was 83.9%, 95% IC 78.2; 88.4., Conclusions: Blomia tropicalis is an important cause of bronchial asthma among the children of the northern Camagüey region.

Background: human basophils release mediators of allergy after cross-linking of IgE receptors by allergens. Specific activation of basophils is detectable through flow cytometry (FCM) using an anti-CD63 fluorescein-conjugated monoclonal antibody., Objectives: this study evaluate the detection of activated basophils by FCM in routine diagnosis of atopic diseases as regard to skin prick tests and specific immunoglobulin E antibodies., Methods and Results: whole blood from twenty patients suspected of atopy was preincubated with interleukin-3 (IL-3), then incubated with specific allergens. After staining using anti-CD63 antibodies, activated basophils were detected through FCM. IL-3-preincubation increases the spontaneous expression of CD63 even at low concentrations (0.1 ng/ml) on the basophils of 2 patients out of 20. The sensitivity and specificity of FCM were respectively 0.56 +/- 0.17 (m +/- SD) and 1.0 +/- 0.0 for the detection of dust mite-activated basophils without IL-3 preincubation, and 0.73 +/- 0.13 and 1.0 +/- 0.0 for the detention of grass pollen-activated basophils. IL-3-preincubation increased the sensitivity in a dose-dependent manner but decreased the specificity fo FCM for detecting dust mite hypersensitivity., Conclusion: this method allow for rapid and easy detection of activated basophils from whole blood, and could be of interest for detecting allergies to non-conventional allergens such as pharmaceutical drugs.

The methods of serum determination of specific IgE to different allergens have showed lower diagnostic sensitivity than the alternative in vivo methods, the skin tests. The CAP system from Pharmacia, owing to its solid phase, has ameliorated this disadvantage, showing in various studies greater diagnostic sensitivity than the classic RAST, without affecting specificity. However, this system is still semi-automatic and requires daily calibration. UNICAP 100 is a completely automatic autoanalyser for total IgE, specific IgE and Eosinophil Cationic Protein, which combines the high sensitivity of the CAP system with complete automation and monthly calibration. The aim of the present study is to assess the practicality and reliability of UNICAP 100, when compared to the CAP System, for the determination of total IgE and specific IgE, as well as the sensitivity and diagnostic specificity; using as a reference skin tests in 150 paediatric patients. The coefficients of variation in the study of intraseries imprecision ranged between 2.1% and 3.6% for total IgE and between 2.2% and 5.1% for specific IgE, depending on the allergen and the level studied. The intraseries imprecision ranged between 3.3% and 7.7% for total IgE and between 5.2% and 8.9% for specific IgE. The coefficients of correlation of the study of interchangeability with the results of the CAP System varied between 0.985 and 0.998, all the allergens tested (9) being interchangeable. Finally, the diagnostic sensitivity varied between 70% and 95% and the specificity between 87% and 100%. In conclusion, UNICAP 100 showed results that were interchangeable with the CAP System, noticeably improving the benefits owing to its complete automation and its calibration system.

Background: Since the development of the radioallergosorbent test (RAST) for quantification of allergen-specific IgE, numerous non-radoisotopic methods have been devised which combine the proven cellulose disc technology with enzyme-linked immunoassay methods. The HY.TEC EIA (Hycor Biomedical, Inc. Irvine, CA) was compared with Pharmacia CAP with respect to overall system features and assay performance characteristics., Methods: The HY.TEC EIA and Pharmacia CAP were compared with respect to calibrator range, sensitivity, type of detection, type of solid phase, throughput, and mode of operation. To determine the assay sensitivity and specificity for a variety of allergens, a total of 2,447 tests were performed on both CAP and HY.TEC EIA. The samples were scored positive in both cases using a cutoff of 0.35 IU/mL., Results: The general features of the HY.TEC EIA system are comparable to Pharmacia UniCAP, with the added advantage of higher throughput. Intra-assay precision was 7% and inter-assay precision was 9-15%. Using CAP as a comparative method, HY.TEC EIA has a sensitivity of 94.0% and a specificity of 94.4%., Conclusions: The HY.TEC EIA demonstrates excellent agreement with the Pharmacia CAP system in the determination of allergen-specific IgE. With the automation necessary in today's clinical laboratory, we conclude that the HY.TEC EIA is a state-of-the-art tool for the diagnosis of allergic disease.

Giardia lamblia is a protozoa that invades the high portions of human small bowel, as well the gall bladder and biliary passages. The absorption from the gut of extrinsic particles which have all properties occurs at full scale in the small bowel. Infections by this protozoa may lead to different clinical symptoms: departing free-symptom, urticarial manifestations of variable intensity and malabsorption syndromes, as well. In Cuba, Giardia lamblia parasitism constitutes a health problem because of its high incidence and prevalence. Investigators have showed allergic dermatological disorders and others, in patients with giardiasis, that may obey from two mechanisms: first, the parasite or its metabolic products might be antigenic for the host; second, the parasite may act as a hapten, that in successive sensitizations might lead to such manifestations, producing specific antibodies which have been found in patients' sera with giardiasis. We recently have elaborated an allergenic extract from Giardia lamblia (we called it giardine ), for demonstrating cutaneous sensitization to such protozoa. In other way, Prausnitz and Küstner, in 1921, showed that a dermal allergic reaction could be passively transferred by means of sensitized patient's serum to a non-sensitized subject. More recently, in 1967, Ishizaka and Ishizaka and Johansson and Benich, in separate studies, showed that skin sensitizing antibodies belonged to a different kind of immunoglobulin, IgE, and it could be measured in serum from sensitized patients. So, a study of sensitization to Giardia lamblia has been performed. Twenty-two patients have been studied suffering from giardiasis with at least 3 month evolution of this disease.(ABSTRACT TRUNCATED AT 250 WORDS)

The basis of an allergy diagnosis is the patient's case history. In patients with inhalant allergy, an accurate diagnosis is often received when the case history is supported by the result of skin prick test (SPT) or in vitro-test for allergen specific IgE. IgE screening tests should, in cost-effective clinical routines, preferably be used in patients with a doubtful allergy history, in order to find out which patients do not require allergen specific testing. Determination of allergen specific IgE in the serum could be used when there is suspicion of allergy against only one or a few allergens, whereas SPT should be used when testing with many allergens is necessary. In patients with suspicion of allergy against food stuffs or drugs, test methods are of more limited value than in inhalant allergy and double blind placebo controlled challenge tests often have to be performed in order to get a definitive diagnosis. In insect venom allergy, the history should be supplemented with SPT and determination of venom specific IgE before starting desensitisation therapy.

In 1985-90, 1612 subjects were submitted to allergic tests for respiratory diseases. In a retrospective survey we have evaluated clinical features, symptoms, diagnostic procedure and allergic tests of skin positives and skin negatives. Prick tests were supplemented by intradermal reaction and RAST under guideline of history. Allergens examined were Gramineae, Parietaria, Olea, house dust, Dermatophagoides farinae and pteronyssinus. 80% of patients were found positive to one or more allergens; their average age (30.1 +/- 13.7) was found lower (p < 0.001) and allergic family history prevalence higher (p < 0.01) than skin negatives. Skin positives prevalence was statistically significant under 50 yrs and skin negatives one over 50 yrs. Asthma or rhinitis only were prevalent among skin negatives while associated symptoms (asthma + rhinitis and/or conjunctivitis) were prevalent among skin positives. Considering skin results pollens were found positive in 34%, inhalants in 24% and pollens + inhalants in 42% of subjects. Gramineae were found positive in 57.8% of subjects, Parietaria in 39.8%, olea in 28.8%, Dermatophagoides farinae in 53.3%, house dust in 52.1% and Dermatophagoides pteronyssinus in 48.2%. Prick test showed a high sensitiveness in detecting pollens sensitization while intradermal reactions were often necessary in sensitization to inhalants; for the diagnosis RAST contribution was negligible.

Seventy atopic patients were studied. Pin-prick skin tests with cat epithelium extract (Ifidesa-Aríste-gui) were made. The results were compared by dividing the patients into a group with clinical manifestations of contact with cats and a group without clinical manifestations of contact with cats. Our results show that skin tests for cat epithelium, such as those carried out routinely in clinical practice, are not very sensitive or specific, and, therefore, are not suitable for diagnosis or prevalence studies.

A limited survey on the allergic status and total IgE was performed on 205 persons of Turkish origin aged between 16 and 76 years living in Stockholm, Uppsala, Sweden in 1990. A questionnaire was mailed to 205 persons and was returned by 92%. 71 persons were randomly selected among those who returned the questionnaire, and were examined after an interview, skin-prick test (SPT) and total IgE levels were also measured. The atopy prevalence of the randomly selected group of Turks was found 32.4%. Clinical symptoms were significantly associated with positive SPT reactivity. IgE levels in the atopic group were significantly higher than those of non atopic group (78.2 ku/l vs 28.4 ku/l respectively). However, the difference in IgE levels were significant between non atopic and atopic groups residing in Sweden longer than 10.5 years, but not significant between those who resided less than 4.5 years. The allergic spectrum changed with residence time spent in Sweden in Turks. Skin test positivity to birch, cat, and dog increased with time. This increase may be related to the change in life styles and habits, such as indoor contact with pets, and intensive environmental birch pollen exposure. In conclusion, our data indicate that immunologic status of persons is influenced by a new millieu. Within a few years the allergic status of Turkish immigrants adapted to the new environment.

In 1986, a Program on Prevention of Allergic Diseases was initiated in our country which was possible on account of the organization conditions of our health system. The program includes IgE measurement in umbilical cord serum by means of an ultramicroanalytic technique for IgE quantification. This is an heterogeneous sandwich-type immunoassay that requires only 10 microliters of reactive on each reaction step and its processing is carried out on the Cuban SUMA equipment. Two groups of children were selected and followed-up: group I included 80 one-year-old infants and group II included 60 18-months-old infants. Both groups followed hypoallergenic diets and had minimal exposure to aeroallergens within their microenvironment. Results were compared with those of respective control groups. Compliance of both groups with the prophylactic measures brought about a reduction in the existence of allergic diseases and a comparison with the control groups offered a statistically significant difference (p less than 0.001). Similarly, incidence of asthma was found more reduced in groups I and II than in the control groups (p less than 0.001). Within the groups treated under the Program on Prevention of Allergic Diseases, IgE values were lower, while the control groups exhibited a higher number of infants with figures of 200 IU/ml or more (p less than 0.05). Our results support the usefulness of preventive measures in avoiding the presence of atopic diseases.

The immediate skin test due to interaction between allergen and mast cell bound IgE is one of the cornerstones in the clinical allergy workup. The release of histamine and other mediators from basophils and mast cells depends on the influx of Ca2+ into these cells when stimulated. The aim of this study was to evaluate the effect of common therapeutic doses of nifedipine (NFD), one of the calcium channel blockers, on the allergen skin tests. We prick tested 23 grass sensitive individuals with 7 different grass pollens at three times: at basal conditions (T0), 30 min. after having taken 20 mg of NFD s. l. (T1), and 17 of them after a week of receiving twice a day 20 mg of a NFD retard form (T2). The wheal surface obtained for each substance (allergen, histamine) at T0 was considered as basal value and compared with the one obtained at T1 and T2 for the same substance by the Wilcoxon's test. We found a significant increase in the wheal surfaces, both with allergen and histamine, at T1 and T2. In contrast to what could be expected, common therapeutic doses of NFD produce a discrete but statistically significant increase of the PT. Factors such as arteriolar vasodilation could be implicated. The increase of the allergen prick test and the increase of the histamine prick test both at T1 and T2 were not statistically different. Therefore, we do not think it necessary to stop NFD before allergen skin testing.

In the past, and for the majority of clinicians, methods of evaluating allergic reactions have centered on attempts to associate specific allergen contact with induction of symptoms. In this regard, it has always been emphasized that a careful history obtained by a knowledgeable physician is the single most important aspect of an allergic evaluation. Attention to the nature of the reaction and its proximity to possible allergic contact, and variations based on seasonal, regional and climatic changes, as well as avoidance and modification by medication can do more to establish a probable cause and effect relationship than any isolated test. However, there are now a multitude of in vivo and in vitro tests which may be employed to confirm or deny a clinical suspicion of a specific allergen-induced reaction. The majority of these procedures have less variability but suffer from the traditional problems of the imprecision of allergens. Additionally, in the case of skin testing, inhalation challenges and histamine release, these tests may be used to quantitate the degree of reactivity by titration of the response with varying doses of antigen. The improvement in allergy testing has occurred because of the better quantitation of some in vitro testing and will improve with standardization of extracts. The latter may some day include the use of recombinant allergens.