The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

ABSTRACT Objective: Controversies continue over the diagnostic approach, prediction, and premedication in radiocontrast media (RCM) hypersensitivity. One of the most important problems encountered in daily clinical practice is that patients do not recall which contrast agent has been used in previous exposures. Also, in most cases, the details of the reaction have not been recorded. Therefore, difficulties are experienced in decision-making about skin testing and premedication in patients who are suspected of RCM hypersensitivity. To assess the clinical value of skin tests and premedication in RCM hypersensitivity. Materials and Methods: A retrospective evaluation was made of the medical records of patients between October 2014 and December 2019. The skin tests were performed with the culprit agent if it was known, otherwise, with iohexol, one of the most commonly used RCM in Turkey. As premedication, oral methylprednisolone 40 mg 13-7-1 hours before the procedure and oral pheniramine 22.7 mg 1 hour before the procedure were prescribed. Results: A total of 41 patients were evaluated (32 females and 9 males). Of the reactions, 35 (85.4%) were immediate and 6 (14.6%) were non-immediate. Three (7.3%) had a positive intradermal test result. It was determined that 20 patients (17 immediate, 3 non- immediate), required imaging with RCM again. Of these, 18 received premedication and two did not, although it was recommended. Of the patients who received premedication, one (5.5%) had an urticarial reaction of the same grade, while both patients (100%) who did not receive premedication developed an immediate allergic reaction that was of a similar grade to that of the previous reaction. Conclusion: Skin test positivity for RCM was observed at low rates. In cases with negative skin tests and when the culprit drug cannot be identified, re-exposure to alternative RCM under premedication may reduce the risk of the reaction. Keywords: Allergy, iodinated contrast media, iobitridol, iohexol, premedication

Allergic Response

The term hypersensitivity refers to diseases caused by an immune response, regardless of whether the response is against a pathogen, nonpathogen, or self and regardless of whether the response is directed by antibodies, lymphocytes, or innate pathways. The term anaphylaxis was coined in 1902 by Charles Richet, who received the Nobel Prize in 1913; this systemic allergic response is now known to be an immediate hypersensitivity reaction, initiated by allergen delivered to a host having allergen-specific IgE, thereby causing an IgE-mediated immunologic response and activating mast cells and basophils to secrete bioactive mediators. In 2005, the National Institutes of Health organized a consensus conference to develop a working definition of anaphylaxis, designed to be used by physicians at the bedside, as a serious allergic reaction that is rapid in onset, typically eliciting various combinations of cutaneous, cardiovascular, respiratory, and gastrointestinal manifestations, and may cause death.1,2 This facilitated the early treatment of such patients with epinephrine. Confusion arises over the misapplication of the term allergy or hypersensitivity to describe any untoward reaction to food, medications, or environmental exposures. Furthermore, non–IgE-mediated forms of local and systemic mast cell or basophil activation events can occur, causing signs and symptoms similar to those mediated by IgE. This review contains 3 figures, 9 tables, and 62 references. Keywords: allergy, hypersensitivity, anaphylaxis, interleukin, chemokines, immunoglobulin E, mast cell, eosinophil

Allergic Response

The term hypersensitivity refers to diseases caused by an immune response, regardless of whether the response is against a pathogen, nonpathogen, or self and regardless of whether the response is directed by antibodies, lymphocytes, or innate pathways. The term anaphylaxis was coined in 1902 by Charles Richet, who received the Nobel Prize in 1913; this systemic allergic response is now known to be an immediate hypersensitivity reaction, initiated by allergen delivered to a host having allergen-specific IgE, thereby causing an IgE-mediated immunologic response and activating mast cells and basophils to secrete bioactive mediators. In 2005, the National Institutes of Health organized a consensus conference to develop a working definition of anaphylaxis, designed to be used by physicians at the bedside, as a serious allergic reaction that is rapid in onset, typically eliciting various combinations of cutaneous, cardiovascular, respiratory, and gastrointestinal manifestations, and may cause death.1,2 This facilitated the early treatment of such patients with epinephrine. Confusion arises over the misapplication of the term allergy or hypersensitivity to describe any untoward reaction to food, medications, or environmental exposures. Furthermore, non–IgE-mediated forms of local and systemic mast cell or basophil activation events can occur, causing signs and symptoms similar to those mediated by IgE. This review contains 3 figures, 9 tables, and 62 references. Keywords: allergy, hypersensitivity, anaphylaxis, interleukin, chemokines, immunoglobulin E, mast cell, eosinophil

CATÁLOGO DE AEROALÉRGENOS DE UNA ZONA PERIURBANA DE LA CIUDAD DE VILLAHERMOSA, TABASCO, MÉXICO

En el aire que respiramos encontramos fungosporas y pólenes capaces de generar alergias en los seres humanos. De acuerdo a la Organización Mundial de Alergias, el número de personas que padecen esta enfermedad es actualmente de 400 millones (10-40 %) pero con posibilidad de incrementarse. En México, el 5.5 % de la población padece rinitis alérgica o asma, éstas dos enfermedades son comórbidas, es decir, hay personas con rinitis alérgica que tienen asma o viceversa. En Villahermosa, la prevalencia de rinitis alérgica es de 39 %. Se empleó una trampa de esporas para la recolecta de partículas biológicas. Se utilizó la metodología propuesta por la Red Española de Aerobiología (REA). La zona de estudio se ubicó al poniente de la ciudad de Villahermosa, Tabasco. Se obtuvieron 18 taxa polinicos y 21 fungoesporas. Palabras clave: Rinitis alérgica; polen; fungosporas; clima tropical. Keywords: Allergy rhinitis; pollen; fungal spores; tropical climate.

PÓLENES ALERGÉNICOS EN EL AIRE DE DOS SITIOS DEL VALLE DE MÉXICO, MEXICO

En el aire que respiramos se encuentran suspendidos pólenes anemófilos. Estos se rigen por factores climáticos, geográficos, entre otros. Los granos de polen pueden generar alergia, motivo por el que la aerobiología estudia su diversidad y comportamiento en la atmósfera. En este estudio se emplearon dos trampas de esporas para monitorear polen aéreo de dos sitios del Valle de México. Las muestras se analizaron bajo microscopio óptico de contraste de fases y se determinaron a nivel cualitativo y cuantitativo los grupos polínicos alergénicos. Además obtuvo un total de 62 taxa, de los cuales 24 son reportados como aeroalergénos. En relación a la comparación de los conjuntos polínicos, se observó que 22 taxa se presentaron en ambos sitios, pero únicamente Carya en el sitio “Nw” y Abies en el sitio “Sw”. Palabras clave: Alergia; atmósfera; parámetros meteorológicos; aeroalérgenos. Keywords: Allergy; atmosphere; meteorological parameters; aeroallergens.

The Cognizant of Allergy Diseases and Climate Change

Objective- This paper discover about factors influencing food allergy knowledge and understanding. It also includes experience, training and information of food allergy as well as points out to the inadequate attentions is given to the allergy diseases that focus on food allergy risk outlets such as nurseries, schools and university food service establishments Methodology/Technique - This paper review of the existing literature about allergy disease and climate change. Findings - This paper contributes to the understanding about the importance of food allergy awareness among public. Novelty - This paper discover about allergy disease and climate change to enhance public knowledge and awareness. Type of Paper- Empirical paper Keywords: , Allergy diseases; climate change; Allergy sufferer; allergen

Alergia à Proteína do Leite de Vaca Persistente em Adulto: Relato de Caso / Persistent Cow’s Milk Allergy in Adult: Case Report

RESUMOIntrodução: Alergia à Proteína do Leite de Vaca (APLV) é uma doença inflamatória secundária à reação imunológica contra uma ou mais proteínas do leite de vaca (LV) que afeta principalmente a faixa pediátrica. A real prevalência é discutida em muitos estudos. As manifestações clínicas dependem do tipo da resposta imunológica, ser IgE mediada ou não. Os sintomas se iniciam por volta dos 06 meses de vida e na maioria dos casos, esse processo alérgico regride, com o paciente desenvolvendo tolerância até a adolescência. Casuística: Relata-se um caso de um paciente do sexo masculino, apresentando desde os 6 meses de idade de anafilaxia e broncoespasmo. Nesta época foi levado em hospitais e ambulatórios sendo diagnosticado e tratado como asma apenas, porém sem sucesso. Aos 18 anos, em consulta com especialista foi diagnosticado com APLV, apesar da dieta de exclusão, apresentou diversas reações anafiláticas, devido a ingestão acidental do alérgeno. Discussão: O paciente iniciou os primeiros sintomas quando houve contato com LV e apresentou teste laboratorial com valores compatíveis a patologia. Segundo a literatura a prevalência de APLV cai para menos de 1% aos 6 anos de vida e está persistência pode estar associada a múltiplos fatores, no caso relatado, o paciente não apresentou tolerância até o presente momento. Conclusão: APLV é uma doença usualmente de criança em que, se estas não adquirirem tolerância, complicações podem perdurar indefinidamente. O Diagnóstico precoce e o manejo adequado desta condição, revela grande importância na qualidade de vida e na prevenção de anafilaxia.Palavras chave: Alergia, Proteína do leite de vaca, Anafilaxia. ABSTRACT Introduction: Allergy to cow's milk (CMPA) is an inflammatory disease Introduction: Allergy to cow's milk (CMPA) is an inflammatory disease secondary to immune response against one or more cow's milk proteins (LV) which primarily affects pediatric patients. The current prevalence is discussed in many studies. The clinical manifestations depend on the type of immune response, being IgE mediated or not. Symptoms start at about 06 months of life and in most cases, the allergic process subsides, and the patient develops tolerance through adolescence. Case Report: We report the case of a male patient, who was presenting, since his 06 months of age, anaphylaxis and bronchospasm. At that time he was taken into hospitals and clinics being diagnosed and treated as asthma, but without success. At 18, in consultation with expert was diagnosed with CMPA, and despite the exclusion diet, presented several anaphylactic reactions due to accidental ingestion of the allergen. Discussion: The patient began the first symptoms when there was contact with LV and presented laboratory test values compatible with the pathology. According to the literature the prevalence of CMPA drops to less than 1% to 6 years of life and this persistence can be associated with multiple factors, in our case, the patient did not develop tolerance to date. Conclusion: CMPA is usually a child disease but ,if they do not acquire tolerance, complications can last indefinitely. Early diagnosis and appropriate management of this condition, reveals a great deal on quality of life and prevention of anaphylaxis. Keywords: Allergy, Cow’s milk protein, Anaphylaxis.