RESUMEN
BACKGROUND: Erythromycin and its salts belong to the larger class of macrolides. Erythromycin is well tolerated. The most common side effects are gastrointestinal distress, nausea, and vomiting, which are dose related. Allergic and pseudoallergic reactions due to macrolide antibiotics are uncommon. Anaphylaxis and acute respiratory distress appear in the literature as case reports. METHODS: We report a 24-year-old man who presented 12 years ago a systemic allergic reaction to penicillin, confirmed by skin tests and detection of specific IgE (RAST). Since then he had tolerated erythromycin on several occasions. Nine months ago, his general practitioner prescribed erythromycin orally as treatment for a respiratory infection. Thirty minutes after taking the first dose, 500 mg, he developed an anaphylactic reaction. The episode subsided with treatment with high dose corticosteroids, antihistamines, and epinephrine. Skin prick tests and intradermal tests were performed with erythromycin at different concentrations. We also measured total IgE and specific IgE to erythromycin by CAP and Phadezym RAST (Pharmacia, Uppsala, Sweden), respectively. We also performed a Prausnitz-Küstner test (PK test), and oral challenge test. RESULTS: Skin testing to erythromycin was not helpful because of cutaneous hyperreactiviness. No significant levels of specific IgE to erythromycin were detected. The oral challenge and the Prausnitz-Küstner test were positive. CONCLUSIONS: The positive history and oral challenge test suggested an anaphylactic reaction to erythromycin. The positive Prausnitz-Küstner test demonstrated the presence of specific IgE to erythromycin.
Asunto(s)
Anafilaxia/inducido químicamente , Eritromicina/efectos adversos , Adulto , Hipersensibilidad a las Drogas/etiología , Eritromicina/administración & dosificación , Humanos , Inmunoglobulina E/sangre , Pruebas Intradérmicas , Masculino , Hipersensibilidad Respiratoria/inducido químicamente , Pruebas Cutáneas , Urticaria/inducido químicamenteRESUMEN
BACKGROUND: Allergy to both house dust and storage mites is well established, but information about other species of mites is scant. OBJECTIVE: One hundred and fifty patients directly exposed to an occupational environment were studied to assess whether spider mites (Tetranychidae) caused their allergic symptoms. We also studied a group of 50 patients from an urban environment, who were not occupationally exposed to spider mites, with a strong sensitization to Dermatophagoides pteronyssinus (RAST class 4). METHODS: Case history (including questions about work-related symptoms), skin tests, RAST and conjunctival provocation tests were performed in both groups using Tetranychus urticae and Panonychus citri extracts as allergens. Cross-reactivity between spider mites and D. Pteronyssinus was determined by RAST inhibition. RESULTS: Fifty-four of 150 rural workers were positive to Tetranychidae and in all cases there was an associated sensitization to D. pteronyssinus. All individuals belonging to the urban group were positive to spider mites. RAST inhibition demonstrated a significant cross-reactivity between Tetranychidae and D. pteronyssinus. Five of fifty-four rural workers sensitized to spider mites developed symptoms only when they handled plants or fruits infested with spider mites and they became asymptomatic when exposure ceased. CONCLUSION: In the rural population studied, 36% of workers were found to be sensitized to spider mites and 10% had symptoms associated with occupational exposure. Since specific IgE antibodies to spider mites could not be detected in the absence of the specific IgE antibodies to D. pteronyssinus, and as all the affected workers were RAST positive to D. pteronyssinus, prior sensitization to house dust mites may be a risk factor for occupational allergy to spider mites.
Asunto(s)
Ácaros/inmunología , Exposición Profesional/efectos adversos , Adulto , Anciano , Animales , Asma/etiología , Conjuntiva , Reacciones Cruzadas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prueba de Radioalergoadsorción , Rinitis/etiología , Pruebas CutáneasRESUMEN
A patient developed a scarlatina-like rash on two separate occasions after receiving a dose of pseudoephedrine. Patch tests with this substance and other structurally related substances (i.e. ephedrine, phenylephrine, and epinephrine) were negative. The oral test with pseudoephedrine provoked a new episode. It is difficult to clarify the exact mechanism of the described reaction; the nature of this eruption probably resembles many other drug-induced adverse reactions in which there is no certainty if mechanisms of type I or III are involved.
Asunto(s)
Erupciones por Medicamentos/etiología , Efedrina/efectos adversos , Adulto , Femenino , HumanosRESUMEN
Very few cases of hypersensitivity due to ingestion of mustard have been described in the literature, although this spice enjoys widespread use. We present three cases of anaphylactic reactions to ingestion of a small amount of mustard sauce. In our patients we performed skin prick tests with mustard and with the rest of the vegetables belonging to the Cruciferae family. We also performed skin prick tests with common pneumoallergens. We measured specific serum IgE to mustard using the CAP System (Pharmacia). Oral challenges with the other vegetables of the Cruciferae family were performed in the patients with no evidence of previous tolerance. Skin prick tests and specific serum IgE determinations to mustard were positive in all three patients. The tests with the rest of the vegetables belonging to the same family were negative. In conclusion, we consider that skin prick tests and the measurement of specific serum IgE to mustard are good methods for the diagnosis of mustard hypersensitivity. We did not detect cross-sensitivity with other vegetables of the same family or with pneumoallergens.
Asunto(s)
Anafilaxia/etiología , Hipersensibilidad a los Alimentos/etiología , Planta de la Mostaza/efectos adversos , Plantas Medicinales , Adolescente , Adulto , Anafilaxia/inmunología , Hipersensibilidad a los Alimentos/inmunología , Humanos , Inmunoglobulina E/sangre , Pruebas Intradérmicas , Masculino , Planta de la Mostaza/inmunologíaRESUMEN
Of 32 women included in the in vitro fertilization (IVF) program in our hospital in 1987, in whom a medium containing bovine serum albumin (BSA) (Menezo's medium) was employed for rinsing follicles, 5 (15%) developed a symptom complex compatible with serum sickness within 8-12 days after oocyte retrieval by echographic puncture. All the patients had specific IgG antibodies against BSA, and intradermal skin testing with BSA and Menezo's medium were positive. We could not demonstrate the presence of specific IgE against BSA in serum by RAST, probably due to the presence of high levels of specific IgG antibodies, which can interfere in the RAST procedure. Statistical analysis showed that the volume of Menezo's medium was significantly greater (p < 0.05) in patients developing the disease. The risk of disease development is directly related to the amount of heterologous protein administrated.