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ABSTRACT: We report the case of a 76-year-old woman who experienced dizziness, vomiting, dyspnea, thoracic erythema, and vaginal itching within 5 minutes of eating cucumber. She had been diagnosed 3 months earlier with papaya urticaria and latex sensitization. The results of skin prick tests were positive for cucumber, watermelon, papaya, and latex and negative for melon and profilin extracts. ImmunoCAP for latex-specific serum immunoglobulin (Ig) E was positive. Cucumber-specific serum IgE was negative. Immunoblot analysis using patient serum revealed a 30- to 32-kDa protein band in the cucumber (peel) and papaya extracts. Immunoblot inhibition with latex extract demonstrated inhibition of the band in both extracts. Immunoblot inhibition with cucumber-papaya and papaya-cucumber revealed inhibition of the same band in the cucumber and papaya extracts, respectively. We present a case of IgE-mediated allergy to cucumber and papaya. Our results strongly suggest that the allergen(s) implicated are associated with latex sensitization. To our knowledge, this is the first report of cucumber-latex and cucumber-papaya cross-reactivity.
Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología 01/2011; 21(3):236-9. · 2.27 Impact Factor
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ABSTRACT: The study comprised 28 patients from the centre of Spain (Madrid and surroundings) who had suffered systemic reactions when stung by vespids. Specific IgE antibodies to Vespula spp. and Polisies spp. venoms were measured by RAST. All patients had positive RAST to Vespula venom and half of them also had positive RAST to Polistes venom. A patient can be sensitive to both venoms due to either a clinical sensitization to both venoms, or common antigenic determinants. To differentiate these states we used a RAST inhibition assay. We could inhibit Polistes RAST with either Polisies or Vespula venom to a similar degree. Inhibition of Vespula RAST was possible with Vespula venom, but only to a limited degree with Polistes venom. Direct RAST and RAST inhibition studies indicate that in our geographic region sensitization to Vespula venom is more common than to Polistes venom and Polistes might have cross-reactivity in our patients.
Allergy 04/2007; 45(2):126 - 129. · 6.27 Impact Factor
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Contact Dermatitis 10/2005; 53(3):178. · 3.51 Impact Factor
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Allergy 08/2004; 59(7):787-8. · 6.27 Impact Factor
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ABSTRACT: Most pneumologists assume that chronic asthma and emphysema associated with smoking differ both in their etiology and type of inflammation. However, it is difficult to study subjects who have both diseases simultaneously. We designed a prospective study to determine whether or not some advanced emphysema patients who are smokers have an asthmatic profile suggesting the two diseases overlap.
Twenty-three smokers with moderate to severe obstruction and radiologic signs of advanced emphysema were studied. The following signs of asthma were analyzed for all patients: positive acute response to bronchodilators, eosinophilia in peripheral blood, significant eosinophilia in sputum, significant total serum immunoglobulin E (IgE) and specific IgE positive for common allergens and fungi. An asthmatic profile was defined as the presence of 3 or more of the aforementioned signs. Statistical analysis was by calculation of the confidence interval on the total number of positive cases to estimate the population percentage.
Data on at least 4 characteristics were available for 21 of the 23 patients. Ten (48%) of the 21 had asthmatic profiles (3 or more of the aforementioned characteristics). This finding suggests that asthmatic characteristics are present in between 17.6 and 79.6% of the studied population with advanced emphysema, with a confidence interval of 99.9%.
We conclude that emphysema initially associated with smoking may mean that at least 17.6% of patients have a clear asthmatic profile, which indicates a high degree of overlap between asthma and emphysema in smokers. Thus, our findings are consistent with the Dutch theory that chronic obstructive diseases have a common origin in underlying allergic sensitization and bronchial hyperresponsiveness alongside various other influential factors such as tobacco smoking over the course of disease.
Archivos de Bronconeumología 06/2003; 39(5):221-5. · 2.17 Impact Factor
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Allergy 03/2003; 58(2):159. · 6.27 Impact Factor
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Allergy 11/2002; 57(10):963-4. · 6.27 Impact Factor
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Allergy 11/2002; 57(10):968. · 6.27 Impact Factor
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ABSTRACT: To assess the incidence of latex allergy in construction workers, we studied all the 230 construction workers who attended our clinic between 1996 and 2000. In the 54 (23.5%) patients who reported any kind of intolerance to rubber gloves or boots, we performed both patch testing with the TRUE Test standard series and a rubber series and prick testing for latex. Latex-specific IgE levels were measured when prick testing was positive. 16 patients (7.0%) had a positive prick test to latex, of whom 14 had allergic contact urticaria from latex (ACUL). All of these 14 patients (6.1%) showed 1 or more positive reactions to the True Test series, which included 1 or more rubber chemicals in 9 of them. The level of specific Ig E to latex was greater than 0.35 kU/L in 15 of the 16 patients. In conclusion, our data suggest that the incidence of latex allergic contact urticaria among construction workers may be as high as that among health care workers. Most of these construction workers with Type I latex hypersensitivity had a concurrent Type IV hypersensitivity to chromate or rubber chemicals, presenting as occupational allergic contact dermatitis, which could have facilitated sensitization to latex.
Contact Dermatitis 10/2002; 47(3):154-6. · 3.51 Impact Factor
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ABSTRACT: Patients allergic to fish usually present with skin reactions after handling raw fish. Less frequently, these reactions are seen without symptoms after oral intake, often in chefs and food handlers. We have attempted to explain the skin selectivity of such reactions in a 36-year-old woman with contact urticaria after handling raw fish. We obtained aqueous extracts of raw and cooked fish (sole and hake) for in vivo (prick test) and in vitro (SDS-PAGE, IgE Immunoblot) tests. Prick-by-prick test, 20-min closed patch test, rub test with fresh and cooked fish (sole, hake and cod) and specific IgE (CAP-system) to sole, cod and hake were performed. The strength of positive reaction to raw fish was greater than to cooked fish on both prick and prick-by-prick testing. Rub tests showed positive responses only to raw fish. Specific IgEs to sole (45 KU/l), hake (66.9 KU/l) and cod (18.7 KU/l) were obtained. IgE immunoblot recognized 3 antigens of 25, 48, 56 kDa in raw sole and 1 of 42 kDa in raw hake extracts. No IgE binding was observed with the cooked extracts or control sera. Our findings strongly suggest a Type-I hypersensitivity to fish. Immunoblot analyses demonstrated a loss of specific IgE binding to cooked extracts. We have reported a case of contact urticaria caused by heat-sensitive raw-fish allergens in a patient who probably became sensitized via the cutaneous route.
Contact Dermatitis 10/2001; 45(3):139-42. · 3.51 Impact Factor
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Journal of Allergy and Clinical Immunology 05/2001; 107(4):743-4. · 11.00 Impact Factor
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ABSTRACT: Acetaminophen (paracetamol) is an analgesic antipyretic drug with no antiinflammatory effects and is widely used worldwide. Earlier clinical studies reported IgE-mediated adverse reactions to acetaminophen, but in vivo and in vitro tests have been inconclusive.
We propose to demonstrate an IgE-mediated mechanism in four patients with adverse reactions to acetaminophen (paracetamol). Tolerance to aspirin and other nonsteroidal antiinflammatory drugs are present in all patients.
We studied four patients with anaphylactic reactions to acetaminophen who tolerated aspirin and other nonsteroidal antiinflammatory drugs. Skin tests, oral challenges and immunoassay for allergen-specific IgE antibodies with acetaminophen were performed in all patients.
All patients tolerated the aspirin oral challenge without adverse effects. In contrast, the oral challenge with acetaminophen produced adverse effects in all patients. Skin tests with acetaminophen were positive in two patients (3-mm wheal and flare) and IgE antibodies acetaminophen were detected in serum from two patients.
We describe four patients with adverse reactions to acetaminophen but with tolerance to aspirin and other nonsteroidal antiinflammatory drugs. Skin tests, oral challenges, and serum IgE results with acetaminophen suggest that an IgE-mediated mechanism is responsible for these reactions.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2001; 85(6 Pt 1):508-11. · 2.83 Impact Factor
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Allergy 07/2000; 55(6):581-2. · 6.27 Impact Factor
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Allergy 06/2000; 55(5):511-2. · 6.27 Impact Factor
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ABSTRACT: It is not uncommon that patients allergic to fruits such as apple, pear, and peach, refer adverse reactions after the ingestion of the whole fruit, but subsequently tolerate the pulp.
This study aimed to compare the allergenicity of peels and pulps of apple, peach, and pear in 33 patients allergic to these fruits.
Clinical reactivity to the ingestion of whole fruit (peel + pulp) and pulp was established by medical history. Peels and pulps were tested separately in skin prick tests (SPTs), histamine release tests (HRTs) and RASTs. Cross-allergenicity between peel and pulp of apple and peach was studied by RAST inhibition.
Adverse reactions appeared more frequently and were more severe when the whole fruit was eaten. More than 40% of patients allergic to apple and pear tolerated the ingestion of the pulp of these fruits, and reactions were only elicited by the intake of the whole fruit. Peels induced higher SPTs, HRTs and RASTs than pulps. An important cross-allergenicity was found between the peel and pulp of apple and peach, although the amount of the shared allergenic epitopes seemed to be higher in peels.
Our results suggest that peels of Rosaceae fruits such as apple, peach, and pear, have a higher allergenicity than pulps, which is clinically relevant. This aspect should be considered in the evaluation of patients allergic to Rosaceae fruits, and in the production of diagnostic materials.
Clinical & Experimental Allergy 10/1999; 29(9):1239-47. · 5.03 Impact Factor
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ABSTRACT: An association between allergy to fruits and latex, and between pollen and plant-derived food has been described. The cross-reactive structures responsible for these associations have not yet been completely elucidated.
IgE reactivity to the recombinant allergens Bet v 1 and Bet v 2, different pollens, natural latex, papain, and bromelain was investigated in 29 patients with allergy to fruits or vegetables who lived in an area without birch trees.
Exactly 79.3% of patients were allergic to grass pollen, and two of them had clinical allergy to latex. Serum IgE reactivity (CAP) to birch pollen was found in 65% of patients, to Bet v 2 in 51.7%, to Bet v 1 in 3.4%, to latex in 58.6%, to bromelain in 51.7%, and to papain in 17.2% of patients. All subjects with positive IgE to Bet v 2 had also reactivity to latex, grass, olive tree, birch, and mugwort pollens. The six patients not allergic to pollen did not show IgE reactivity to latex, Bet v 1, or Bet v 2. A significant correlation was found between CAP to latex with Bet v 2 (r=0.86, P<0.001), with birch (r=0.86, P<0.001), and with ryegrass (r=0.81, P<0.001). Immunoblotting using nine sera with positive CAP to birch pollen showed IgE-binding to a 15-kDa band that was recognized by antiprofilin monoclonal antibody. Bet v 2 CAP could be inhibited up to 52% by ryegrass and up to 23% by mugwort. CAP to latex was almost completely inhibited by ryegrass pollen with sera from five subjects without symptoms due to latex, whereas no inhibition was observed with serum from one patient with allergy to latex.
Patients with allergy to plant-derived food and associated pollinosis showed a high frequency of IgE reactivity to Bet v 2, which may cause positive serum IgE determinations to latex and birch pollen due to the presence of cross-reactive epitopes. IgE reactivity to Bet v 2 may serve as an indicator of broad sensitization.
Allergy 10/1999; 54(9):951-61. · 6.27 Impact Factor
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Allergy 08/1999; 54(7):766-7. · 6.27 Impact Factor
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Allergy 02/1999; 54(1):86-7. · 6.27 Impact Factor
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ABSTRACT: A significant number of cases of chronic eosinophilic pneumonia remain idiopathic in spite of a comprehensive search of associated causes. This study reports a patient with a classical clinical presentation of chronic eosinophilic pneumonia and peripheral blood eosinophilia in whom selective sensitization to Candida albicans was demonstrated. This yeast was present in the bronchoalveolar lavage culture and specific serum immunoglobulin (Ig)E and IgG against C. albicans were found in the patient's serum. Levels of these specific immunoglobulins diminished with corticosteroid treatment and increased coinciding with a new outbreak of symptoms after lowering the dosage of corticosteroids. To the author's knowledge, this is the first case described of chronic eosinophilic pneumonia associated with sensitization to C. albicans. Evaluation of allergy to C. albicans should be performed in chronic eosinophilic pneumonia before labelling cases as idiopathic.
European Respiratory Journal 09/1998; 12(2):502-4. · 5.89 Impact Factor
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ABSTRACT: Several egg white and egg yolk and avian proteins have been described as a cause of inhalant allergy. Sometimes inhalational type I hypersensitivity to these proteins is associated with food allergy to egg.
We studied two patients who experienced respiratory and food allergic symptoms upon exposure to egg or avian antigens through the inhalative or digestive routes. Clinical and immunological studies were carried out in order to identify individual allergens from these sources that could be responsible for crossreactivity reactions.
Patient 1 showed IgE sensitization to egg yolk livetins, feathers, and chicken serum. Specific bronchial challenge with chicken albumin and livetin extracts elicited a positive early asthmatic response and an increase in serum eosinophil cationic protein. Immunoblot and CAP-inhibition studies in this patient supported that chicken albumin (alpha-livetin) was the crossreactive antigen present in egg yolk and chicken serum and feathers. Patient 2 showed sensitization to egg white, ovomucoid and lysozyme. However, SDS-PAGE and immunoblot studies demonstrated contaminating lysozyme in the ovomucoid extract and identified lysozyme as the main allergen causing egg sensitization in this patient. Conjunctival challenge test confirmed allergy to lysozyme.
Egg yolk and egg white proteins may act not only as ingested allergens but also as aeroallergens. Immunological studies using highly purified preparations of egg proteins are useful for the accurate diagnosis of allergic reactions to egg proteins and to identify individual allergens that may be responsible for crossreactivity reactions.
Clinical & Experimental Allergy 05/1998; 28(4):478-85. · 5.03 Impact Factor
