4 research outputs found

    LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later

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    Introduction: Allergy to nonspecific lipid transfer protein (nsLTP) is the main cause of plant-food allergy in Spain. nsLTPs are widely distributed in the plant kingdom and have high cross-reactivity but extremely variable clinical expression. Little is known about the natural evolution of this allergy, which complicates management. The objective of this study was to assess the development of allergy to new plant foods in nsLTP-sensitized patients 10 years after diagnosis. Methods: One hundred fifty-one patients showing specific IgE to nsLTP determined by ISAC (Thermofisher) were included. After clinical workup (i.e., anamnesis, skin test, and challenge when needed), these patients were divided into two groups: 113 patients allergic to one or more plant food (74.5%) and 38 patients not allergic to any plant food (25.1%). Ten years later, a telephone interview was conducted to check whether patients had developed additional allergic reactions to plant foods. Results: Ten years after diagnosis, 35 of the 113 (31%) plant-food-allergic patients sensitized to nsLTP reported reactions to new, previously tolerated plant foods, mainly Rosaceae/Prunoideae fruits and nuts followed by vegetables, Rosacea/Pomoideae fruits, legumes, and cereals. Five out of 38 (13.2%) patients previously sensitized to nsLTP but without allergy to any plant food had experienced allergic reactions to some plant food: two to Rosaceae/Prunoideae fruits, two to Rosaceae/Prunoideae fruit and nuts, and one to legumes. Conclusion: Patients sensitized to nsLTP developed allergic reactions to other plant foods, mainly Rosaceae-Prunoideae fruits and nuts. This was more frequent among plant-food-allergic patients than among those who had never had plant-food allergy

    Influence of CYP2C19 phenotype on the efect of clopidogrel in patients undergoing a percutaneous neurointervention procedure

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    This observational retrospective study assessed the antiplatelet response and clinical events after clopidogrel treatment in patients who underwent percutaneous neurointervention, related to CYP2C19 metabolizer status (normal (NM), intermediate/poor (IM‚ÄźPM), and ultrarapid (UM); inferred from *2, *3, and *17 allele determination). From 123 patients, IM‚ÄźPM had a higher aggregation value (201.1 vs. 137.6‚ÄČNM, 149.4 UM, P‚ÄČ<‚ÄČ0.05) and lower response rate (37.5% vs. 69.8% NM, 61.1% UM), along with higher treatment change rate (25% vs. 5.7% NM, 10.5% UM). The highest ischemic events incidence occurred in NM (11.3% vs. 6.3% IM, 10.5% UM) and hemorrhagic events in UM (13.2% vs. 0% IM and 3.8% NM). No differences were found regarding ischemic event onset time, while hemorrhagic event frequency in UM was higher with shorter onset time (P‚ÄČ=‚ÄČ0.047). CYP2C19 no‚Äźfunction and increased function alleles defined the clopidogrel response. UM patients had increased bleeding risk. Therapeutic recommendations should include dose reduction or treatment change in UM.M. Saiz-Rodriguez is co-financed by Consejer√≠a de Educaci√≥n, Juventud y Deporte from Comunidad de Madrid and Fondo Social Europeo. D. Koller is co-financed by the H2020 Marie Sklodowska-Curie Innovative Training Network 721236 grant.Peer reviewe

    CYP2C19 defines clopidogrel response in patients undergoing percutaneous neurointervention procedure

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    Resumen del trabajo presentado al 5th Symposium on Biomedical Research: "Advances and Perspectives In Pharmacology, Drug Toxicity and Pharmacogenetics", celebrado en Madrid del 15 al 16 de marzo de 2018.[Introduction]: Clopidogrel is a widely prescribed thienopyridine prodrug which inhibits platelet aggregation. It is prescribed to prevent atherothrombotic and thromboembolic events in patients who are given a stent implant in carotid, vertebral or cranial arteries. CYP2C19 is the most studied enzyme involved in clopidogrel metabolism. The most common CYP2C19 no function polymorphisms (*2 and *3) have been associated with hyporesponse to clopidogrel, showing lower levels of the active metabolite. On the contrary, the presence of the increased function allele (*17) has demonstrated enhanced platelet inhibition and clopidogrel hyperresponse.[Methods]: This observational retrospective study assessed antiplatelet response and clinical events after clopidogrel treatment in patients who underwent percutaneous neurointervention, related to CYP2C19 metabolizer status (normal (NM), intermediate/poor (IM-PM) and ultra-rapid (UM); inferred from *2, *3 and *17 allele determination by real-time PCR).[Results]: One hundred twenty-three patients were analysed, of which 83% had cardiovascular risk factors. The most common type of intervention was angioplasty with stent. According to the aggregation value, 58.7% of the patients were responders to clopidogrel; moreover, 4.1% required dose reduction and 12.2% change of treatment. CYP2C19 IM-PM had higher aggregation value (201.1 vs 137.6 NM, 149.4 UM, p<0.05) and lower response rate (37.5% vs. 69.8% NM, 61.1% UM), along with higher treatment change rate (25% vs. 5.7% NM, 10.5% UM). Moreover, 20% of the patients suffered from a subsequent clinical event. The highest ischemic events incidence occurred in NM (11.3% vs. 6.3% IM, 10.5% UM; p=0.358) and haemorrhagic events in UM (13.2% vs. 0% IM and 3.8% NM; p=0.041). No differences found regarding ischemic events’ onset time, while haemorrhagic events’ frequency in UM was higher with shorter onset time (p=0.047). Additionally, 53% of the patients were receiving concomitant treatment with proton-pump inhibitors (PPIs), which showed significantly higher aggregation value when compared to those not receiving PPI concomitant treatment (178.1 vs. 134.4; p=0.009).[Conclusion]: CYP2C19 no function and increased function alleles defined clopidogrel response. CYP2C19 genotyping and platelet reactivity quantification help to determine whether a patient could be at risk of ischemic or haemorrhagic event. CYP2C19 UM patients have increased bleeding risk after percutaneous neurointervention. Therapeutic recommendations should include an alternative therapeutic option in IM-PM or UM patients.M. Saiz-Rodriguez was co-financed by Consejería de Educación, Juventud y Deporte from Comunidad de Madrid and Fondo Social Europeo. D. Koller is co-financed by the H2020 Marie Sklodowska-Curie Innovative Training Network 721236 grant.Peer reviewe
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