No abstract

We aimed to evaluate the accuracy of baseline exhaled nitric oxide fraction (FeNO) to recognise individuals with difficult-to-treat asthma who have the potential to achieve control with a guideline-based stepwise strategy.102 consecutive patients with suboptimal asthma control underwent stepwise increase in the treatment with maximal fluticasone/salmeterol combination dose for 1 month. Then, those who remained uncontrolled received oral corticosteroids for an additional month.With this approach, 53 patients (52%) gained control. Those who achieved control were more likely to have positive skin results (60.4% versus 34%; p50.01), positive bronchodilator test (57.1% versus 35.8%; p50.02) and peak expiratory flow variability o20% (71.1% versus 49.1%; p50.04). Conversely, depression was more frequent in those who remained uncontrolled (18.4 % versus 43.4 %; p50.01). An FeNO value o30 ppb demonstrated a sensitivity of 87.5% (95% CI 73.9-94.5%) and a specificity of 90.6% (95% CI 79.7-95.9%) for the identification of responsive asthmatics.The current results suggest that FeNO can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids.

No abstract

Palabras clave: Inmunoterapia frente a veneno. Veneno de avispa. Trastornos autoinmunológicos.Venom immunotherapy (VIT) is the only highly effective way of treating patients with hymenoptera venom allergy (HVA). The most serious anaphylactic symptoms of HVA (HVA-SYS IVo) are life-threatening, thus making their occurrence an unconditional recommendation for VIT. Yet, VIT is contraindicated in immune-mediated inflammatory diseases.We present the case of a 55-year-old woman with autoinflammatory neurological disease (initially diagnosed with relapsing remitting multiple sclerosis) who received VIT following an anaphylactic reaction (SYS-IVo) to wasp sting (Vespula germanica). Allergy tests showed the presence of specific IgE antibodies to wasp venom (intradermal test at 0.001 µg/mL, 12×12 mm; sIgE class 2). The basal serum tryptase concentration was normal. Her past medical history included gastrointestinal reflux, mild gastritis, allergy to ketoprofen and metamizole sodium, and seronegative spondyloarthropathy. At the age of 50, she was diagnosed with remitting-relapsing multiple sclerosis. Her first symptoms of neurological damage were mild facial weakness, mild instability with the eyes closed in the Romberg test, and clumsy movements of the left hand. Magnetic resonance imaging (MRI) was performed twice and revealed multiple hyperintense areas that were considered demyelinating lesions. The cerebrospinal fluid study showed intrathecal production of immunoglobulins 1.75 [normal range,). Visual evoked potentials were normal. Lyme disease was excluded. The patient was treated with intravenous methylprednisolone (Solu-Medrol, 1000 mg/d over 5 days) during 3 exacerbations of the disease. Progression in her disability was measured using the Kurtzke Expanded Disability Status Scale (EDSS). Her initial EDSS was 1.5, which rose to 4.0 after the last exacerbation of the disease.The patient met the clinical and immunological criteria for VIT. Another reason in support of the decision to administer VIT was the patient's physical disability, which might have hindered attempts to avoid a sting, especially given that she lives in an area with high exposure to stinging insects. The decision to start VIT was made despite the hitherto accepted belief that autoimmunological diseases constitute a contraindication to immunotherapy. At the time the patient qualified for VIT, her condition was stable, with no new active neurological symptoms.No complications were recorded during the induction phase (ultrarush; Pharmalgen, ALK-Abelló) and a complete 5-year course of VIT. There were no local or systemic allergic reactions. Neurological symptoms did not intensify, and no new symptoms appeared. The patient did not experience exacerbation of her neurological disease; the EDSS score remained unchanged. The findings in subsequent MRI examinations of the brain were stable, with no new lesions. The MRI revealed no lesions in the temporal lobes or posterior fossa structures and no juxtacortical lesions (Figure, A). However, numerous, small,...

Background: The role of profilin as a food allergen is well established, but little research has been done about its ability to elicit respiratory disease. Profilin is considered more of a confounding allergen on skin testing with whole pollen extracts than other airborne allergens. Our aim was to find out whether or not profilin can cause symptoms in sensitized individuals, which would be compatible with its role as an airborne allergen. Methods: We performed conjunctival allergen challenges with date palm profilin in a series of consecutive pollen-allergic patients with rhino-conjunctivitis, divided in two groups: profilin sensitized (n = 17) and not sensitized (n = 14), who served as controls. We investigated the possible association between profilin sensitization and profilin allergy in these groups of patients. Results: None of the patients from the not profilin-sensitized group had a positive result in conjunctival allergen challenges. In contrast, 65% of profilin sensitized patients had a positive conjunctival allergen challenge and were considered allergic to profilin. We found a significant statistical association between being profilin allergic and being profilin sensitized (χ² = 10.39, p < 0.005). Conclusions: Profilin seems to work as an aeroallergen in a significant proportion of profilin-sensitized patients. This might explain the uselessness of conjunctival challenges with whole pollen extracts to disclose genuine sensitization. In the future, the possibility of quantifying this allergen in pollen immunotherapy vaccines should be considered.