Rosetas en el quiste tricolémico proliferante: una nueva observación dermatoscópica

Las rosetas son un hallazgo dermatoscópico perteneciente algrupo de las estructuras blancas brillantes. Fueron descritas porprimera vez en 20091ysedefinencomo4puntosblancosbrillantes agrupados como un trébol de 4 hojas o terrones de 4puntos organizados en un cuadrado correspondiente a laapertura folicular2. Se observan exclusivamente condermatoscopia de luz polarizada, con o sin contacto3.Aunqueinicialmente se pensó que eran específicas de las queratosisactínicas y el carcinoma de células escamosas1, posteriormentese han descrito en muchas otras lesiones como el carcinomabasocelular, el melanoma, la piel con daño actínico, lasqueratosis seborreicas planas3, el tricoepitelioma múltiplefamiliar4, la queratosis liquenoide benigna5y enfermedadesinflamatorias y autoinmunitarias como el granuloma anular6oel lupus eritematoso discoide7. Presentamos un caso con rosetasen una lesión previamente no descrita. Varón de 74 años, sin antecedentes patológicos de interés, consultó por una lesión asintomática en cuero cabelludo, decrecimiento lento y varios años de evolución. En la exploración, presentaba una lesión nodular aislada, rosada, cupuliforme, de10 mm de diámetro en región interparietal del cuero cabelludo(fig. 1). Con el dermatoscopio de luz polarizada (Dermlite DL200HR), se observaba una lesión eritematosa, con vasos lineales yarboriformes mal enfocados de distinto calibre, y áreas centralesblanco-amarillentas entre las que se apreciaban varias rosetas(fig. 2). Ante el diagnóstico diferencial de quiste tricolémico, ..

Consensus document on allergic conjunctivitis (DECA)

Allergic conjunctivitis (AC) is an inflammatory disease of the conjunctiva caused mainly by an IgE-mediated mechanism. It is the most common type of ocular allergy. Despite being the most benign form of conjunctivitis, AC has a considerable effect on patient quality of life, reduces work productivity, and increases health care costs. No consensus has been reached on its classification, diagnosis, or treatment. Consequently, the literature provides little information on its natural history, epidemiological data are scarce, and it is often difficult to ascertain its true morbidity. The main objective of the Consensus Document on Allergic Conjunctivitis (Documento dE Consenso sobre Conjuntivitis Alérgica [DECA]), which was drafted by an expert panel from the Spanish Society of Allergology and Spanish Society of Ophthalmology, was to reach agreement on basic criteria that could prove useful for both specialists and primary care physicians and facilitate the diagnosis, classification, and treatment of AC. This document is the first of its kind to describe and analyze aspects of AC that could make it possible to control symptoms

The burden of allergens in surimi-based products diminishes with industrial processing

2 pags, 2 figs. -- Supplementary material is available at the Publisher's webThis research was funded by Spanish Ministry of Science and Innovation (CDTI-CIEN Tolera grant) . The funders had no role in any of the following: study design; data collection, analyses, or interpretation; writing of the manuscript; decision to publish the results.Peer reviewe

Clinical Management and Use of Health Care Resources in the Treatment of Nasal Polyposis in Spanish Allergy Centers: The POLAR Study.

Journal Article; Multicenter Study; Observational Study; Research Support, Non-U.S. Gov't;BACKGROUND Nasal polyposis (NP) is a chronic inflammatory disease that constitutes a major health problem with significant comorbidities and a considerable associated socioeconomic burden. OBJECTIVE To describe the clinical features and management of patients with NP attending Spanish allergy centers, the use of health care resources, and the degree of compliance with the diagnostic and therapeutic recommendations of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). METHODS We performed a multicenter, observational, and cross-sectional epidemiologic study of 671 patients consulting for NP in 67 Spanish allergy departments. We used sociodemographic and clinical questionnaires to evaluate clinical characteristics, use of health care resources, diagnostic methods, and treatment administered. RESULTS NP was closely associated with asthma (66%), allergic rhinitis (45.9%), and hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (26%). Atopy was present in the 50% of cases, with Dermatophagoides pteronyssinus as the most frequent sensitizing allergen. Eleven percent of NP patients visited the emergency department during the previous year, and more than 58% used primary care, allergy, or otorhinolaryngology services. The most frequently used diagnostic tests were skin prick tests (93.6%) and anterior rhinoscopy (79.4%). Intranasal corticosteroids were the drug class most frequently prescribed by allergists (74.6%). Specific immunotherapy was prescribed in 21% of patients. CONCLUSIONS NP is a chronic inflammatory disease that generates considerable use of health care resources. The close association with atopy, asthma, and NSAID hypersensitivity highlights the usefulness of an allergy workup in all patients with NP. Analysis of the clinical management of NP by allergists in Spain revealed a high degree of compliance with EPOS diagnostic and therapeutic recommendations.The study was funded by Merck Sharp & Dohme.YesIntroducción: La poliposis nasal es una enfermedad inflamatoria crónica asociada frecuentemente a otras enfermedades. Constituye un importante problema sanitario con un gasto económico considerable. Objetivo: Describir las características y manejo clínico de los pólipos nasales (NP) de pacientes asistidos en los centros alergológicos españoles, incluido el consumo de recursos sanitarios, y el grado de cumplimiento de los esquemas diagnósticos y terapéuticos del documento europeo de consenso sobre rinosinusitis y pólipos nasales (EPOS). Métodos: Estudio epidemiológico multicéntrico, observacional y transversal. Se estudiaron 671 pacientes con NP atendidos en 67 servicios de Alergología de España. Las características clínicas, el consumo de recursos sanitarios, los métodos diagnósticos y el tratamiento se evaluaron mediante cuestionarios sociodemográficos y clínicos. Resultados: Se detectó una alta asociación entre NP y asma (66%), rinitis alérgica (45,9%) e hipersensibilidad a antiinflamatorios no esteroideos (AINES) (26%). Se detectó atopia en el 50% de los casos, siendo el D. pteronyssinus el alérgeno más frecuente. El 11% requirió asistencia en urgencias el año anterior, y más del 58% asistencia en atención primaria, alergología u otorrinolaringología. Las pruebas diagnósticas más utilizadas fueron las pruebas cutáneas (93,6%) y rinoscopia anterior (79,4%). Los corticoides intranasales (74,6%) representaron el principal tratamiento farmacológico recomendado. La inmunoterapia específica se prescribió en el 21% de los pacientes. Conclusiones: Los NP es una enfermedad inflamatoria crónica con un elevado consumo de recursos sanitarios. La alta asociación con atopia, asma e hipersensibilidad a AINES resalta la utilidad de la evaluación alergólogica en estos pacientes. El manejo clínico de los NP por alergólogos españoles mostró un alto grado de cumplimiento con los esquemas diagnósticos y terapéuticos EPOS

Real world evidence of adjuvant trastuzumab in HER2 positive early breast cancer

Abstract Adjuvant trastuzumab in HER2+ breast cancer reduces recurrence and mortality, and has been the standard treatment since 2006. The objective was to analyze health outcomes in the real world. Observational, retrospective study of patients with HER2+ breast cancer, stages I–III, treated with adjuvant trastuzumab in the past 15 years in only one center and for the first time in Spain. Survival was analyzed according to the number of cycles and cardiotoxicity. Two hundred and seventy-five HER2positive patients (18.60%) out of 1479 received adjuvant (73%) or neoadjuvant/adjuvant (26%) trastuzumab, concomitantly (90%) or sequentially (10%) with chemotherapy. The probability of overall and disease-free survival (OS and DFS) at 5 years was 0.93 (95% CI 0.89–0.96), and 0.88 (95% CI 0.83–0.92). The number of cases with a significant and asymptomatic decrease in ventricular ejection fraction and heart failure were 54 (19.64%) and 12 (4.36%), respectively. Sixty-eight patients (24.70%) received 16 or fewer cycles, especially those older than 65 (OR 0.371, 95% CI 0.152–0.903; p = 0.029) and with cardiotoxicity (OR 15.02, 95% CI 7.437–30.335; p < 0.001). The risk of cardiotoxicity was associated with having received radiotherapy (OR 0.0362, 95% CI 0.139–0.938; p = 0.037). Arterial hypertension (HR 0.361, 95% CI 0.151–0.863, p = 0.022), neoadjuvant treatment (HR 0.314, 95% CI 0.132–0.750, p = 0.009) and cardiotoxicity (HR 2.755, 95% CI 1.235–6.143, p = 0.013) maintained significant association with OS. Only neoadjuvant treatment maintained a significant association with DFS (HR 0.437, 95% CI 0.213–0.899, p = 0.024). The effectiveness of neoadjuvant and adjuvant trastuzumab can be considered comparable to those of clinical trials. In the real world, factors such as age, hypertension, radiotherapy, neoadjuvant treatment, and cardiotoxicity should be taken into consideration to optimize outcomes

Supplementary Material for: Cross-Reactivity between <b><i>Anisakis</i></b> spp. and Wasp Venom Allergens

<b><i>Background:</i></b> Anisakiasis is caused by the consumption of raw or undercooked fish or cephalopods parasitized by live L3 larvae of nematode <i>Anisakis </i>spp. Larvae anchor to stomach mucosa releasing excretion/secretion products which contain the main allergens. It has been described that nematode larvae release venom allergen-like proteins among their excretion/secretion products. We investigated potential cross-reactivity between <i>Anisakis </i>and wasp venom allergens. <b><i>Methods:</i></b> Two groups of 25 patients each were studied: wasp venom- and <i>Anisakis-</i>allergic patients. Sera from patients were tested by ImmunoCAP, dot-blotting with recombinant <i>Anisakis</i> allergens and ADVIA-Centaur system with Hymenoptera allergens. Cross-reactivity was assessed by IgE immunoblotting inhibition assays. Role of cross-reactive carbohydrate determinants (CCDs) was studied by inhibition with bromelain and periodate treatment. <b><i>Results:</i></b> A total of 40% of wasp venom-allergic patients had specific IgE to <i>Anisakis simplex </i>and 20% detected at least one of the <i>Anisakis</i> recombinant allergens tested. Likewise, 44% of <i>Anisakis-</i>allergic patients had specific IgE to <i>Vespula </i>spp<i>.</i> venom and 16% detected at least one of the Hymenoptera allergens tested. Wasp venom-allergic patients detected CCDs in <i>Anisakis</i> extract and peptide epitopes on <i>Anisakis </i>allergens rAni s 1 and rAni s 9, whereas <i>Anisakis-</i>allergic patients only detected CCDs on nVes v 1 allergen from <i>Vespula </i>spp. venom. The only <i>Anisakis</i> allergen inhibited by <i>Vespula </i>venom was rAni s 9. <b><i>Conclusions:</i></b> This is the first time that cross-sensitization between wasp venom and <i>Anisakis </i>is described. CCDs are involved in both cases; however, peptide epitopes are only recognized by wasp venom-allergic patients

Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma?

Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis