Piperacillin, is a b-lactam, usually used for treatment of severe hospital-acquired infections. METHODS: We retrospectively analysed 649 medical records with a suspicion of drug allergy, 24 patients of which were studied for piperacillin-tazobactam allergy. RESULTS: We included13 women and 11 men. Average age was 65,54 years (616,31, age range 29-90). 18 patients were included per protocol; 8 of them (44,4%) presented delayed reaction and 10 (55,6%) immediate reaction. Among immediate reactions; 4 patients presented anaphylaxis, 2 had hypotension and 2 itching and cutaneous symptoms. 80% developed symptoms with the first administration. Delayed reactions appeared 2 to 22 days after treatment was initiated, average 8,71 days(66,55). Most common symptom was maculopapular rash (90%), 2 added itching and 1 skin desquamation. Allergic study included skin prick, intradermal and patch test with the main components involved in b-lactam allergy, also piperacillin. Finally, 9 patients were diagnosed of piperacillin allergy, 6 of them
RATIONALE: Paediatric rhinitis phenotypes have been understudied. The aim was to analyze the clinical characteristics and the response to nasal allergen provocation test (NAPT) of a large paediatric population. METHODS: Patients aged 10-20 years were evaluated with detailed clinical history including severity, comorbidities, triggers and evolution. An initial allergological study (AE) including skin prick test (SPT), and specific IgE (sIgE) classified patients in AE+ or AE-. Afterward, NAPT classified patients in systemic allergic rhinitis (SAR5SPT/sIgE+, NAPT+), local allergic rhinitis (LAR5SPT/sIgE-, NAPT+), dual allergic rhinitis (DAR5SPT/sIgE+ to seasonal allergens, NAPT+ to perennial), and idiopathic rhinitis (IR5SPT/sIgE-, NAPT-). RESULTS: 134 subjects were included. The initial AE was negative in 45 (33.5 %) and positive in 89 (66.5 %). Pruritus was the differential symptom in AE+ vs. AE-(OR 6; IC 95%5 1,79-20,02; p5 0,003) and in LAR (p50.01, OR58.07). Severity was moderate-severe and perennial in AE+/ AE-, being milder in IR (27%, p50.04). In AE+ triggers were specific (allergens, p50.03), and in AE-non-specific (irritants, p50.011). Conjunctivitis and asthma were the main comorbidities. NAPT classified patients as SAR 56%, LAR 22.4%, DAR 10.4% and IR 11.2%. NAPT was positive in 30/45 subjects with AE-(misdiagnosis of 66.7% if only the initial study was performed). Pollen was the principal sensitizer by SPT/ sIgE, and D. pteronyssinus the main sensitizer in NAPT. CONCLUSIONS: Paediatric rhinitis is mostly allergic, perennial and moderate-severe, with conjunctivitis and asthma as main comorbidities. Pruritus is a distinctive symptom of SAR including LAR. NAPT correctly phenotypes rhinitis. DAR has been first described in children.
RATIONALE: Lymphocyte Transformation Test (LTT) allows to determine the specific proliferation of concrete cell populations in response to a particular drug. The sensitivity of this test to evaluate immediate allergic reactions to clavulanic acid (CLV) had not been evaluated. We had previously demonstrated that specific immunological recognition of CLV antigenic determinants (AD) increases the sensitivity in basophil activation tests. Therefore, our goal was to evaluate the T-cell recognition of synthetic CLV AD using LTT. METHODS: Different analogs of two potential ADs of CLV (AD-I and AD-II) were synthetized. Peripheral blood was obtained from 11 patients with immediate reactions to CLV and from 10 healthy subjects. Proliferation of different cell populations (CD3 + , CD4 + , CD8 + , CD4 + Th2 and Treg cells) was analyzed by flow cytometry using Carboxyfluorescein-succinimidyl ester (CFSE). Results were presented as Proliferation Index (PI). RESULTS: Higher PI was obtained after the inclusion of each analog in CD3 + and CD4 + cells in CLV patients compared with controls, especially in CD4 + Th2 cells, suggesting its important role in these diseases. Only a 27% of allergic patients showed a positive proliferation result (PI>2) when cells were cultured with CLV. Interestingly, when AD-I was included, 45,5% of patients gave positive results and, when the two ADs were included, positivity increased to 63,7%. No proliferation was observed in controls with any of the stimuli. CONCLUSIONS: The inclusion of different CLV ADs improves LTT sensitivity in immediate allergic reactions to this drug mimicking the response at acute phase. Interestingly, some patients recognize both AD or only one, suggesting a different recognition pattern. 285 Genetic Association between CYSLTR2 Polymorphisms and Nonsteroidal Antiinflammatory Drugs-induced urticaria/ angioedema
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