Javier Alcover Diaz

Background: Environmental fungi play an important role in allergic respiratory diseases. Alternaria alternata sensitization has been associated with more severe respiratory phenotypes and poorer asthma control. Mediterranean agricultural environments may favor environmental exposure because of their climatic conditions and intensive agricultural activity. Objective: To analyze the prevalence of sensitization to Alternaria alternata, evaluate its association with asthma control and quality of life, and describe household environmental findings in a Mediterranean agricultural population. Methods: An observational, analytical, cross-sectional study with standardized collection of clinical, allergological, and environmental data was conducted in 100 consecutive adult patients (18–65 years) with allergic rhinitis/rhinoconjunctivitis, with or without associated asthma. Sensitization to Alternaria alternata was defined by a positive skin prick test and/or molecular determination against Alt a 1 (>0.35 kUA/L). Asthma control was assessed using the Asthma Control Test (ACT), quality of life using the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), and rhinitis control using the Spanish Rhinitis Questionnaire (SPRINT). Household environmental evaluation was performed in sensitized patients. Results: Sensitization to Alternaria alternata was observed in 29% of patients (95% CI: 20.1–38.8). Skin prick testing was positive in 25 patients, whereas molecular sensitization against Alt a 1 was observed in 20 patients. Sensitized patients showed poorer asthma control and greater quality-of-life impairment than non-sensitized patients. No significant differences in the polysensitization burden were observed. Among sensitized patients, household microbiological assessment demonstrated Alternaria alternata detection in 46.4% of indoor samples and 28.6% of outdoor samples. Conclusions: Sensitization to Alternaria alternata was frequent in this Mediterranean agricultural population and was associated with poorer asthma control and greater quality-of-life impairment. Environmental findings support further investigation of fungal exposure in Mediterranean agricultural settings.

Between 1% and 2% of the world’s population is sensitised to mites. Aetiological diagnosis is key to the management of allergic patients. However, methods based solely on morphological criteria are ambiguous in many cases. Polymerase chain reaction of ribosomal genes represents a valuable complementary approach. The 5 most representative species (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Tyrophagus putrescentiae, Blomia tropicalis and Lepidoglyphus destructor) were selected as sources of allergens. They were first identified morphologically and the 18S rRNA gene sequences were obtained from the GenBank database. Alignment of the nucleotide sequences of the 18S rRNA ribosomal gene enabled the identification of the conserved and divergent regions in all of them. The alignment allowed the design of a pair of oligonucleotides in conserved regions of the gene, to amplify the sequence of interest in each of the species. We performed genomic DNA extraction, quantification and purity. PCR, using oligonucleotides designed to amplify the 18S sequence fragment of interest, showed the exact size for each species. Amplification, efficiency curves and melting points resulting from the amplification of the 18S amplicon of the five species were obtained. The oligonucleotides designed for real-time PCR studies, allow species identification by amplifying the specific fragment of each species using real-time PCR.

Introduction: House dust mite allergy affects 65–130 million people worldwide. Untreated patients could develop severe allergic diseases such as atopic dermatitis and asthma. Methods: We consecutively recruited 50 patients with a clinical diagnosis of allergic rhinitis/rhino conjunctivitis. Mite Skin Prick Tests were performed. Mite specific IgE were tested. Results: Ninety‐six per cent of the patients had a positive prick test for Dpt, Dfar 94%, Ldt 86%, Tput 82%, and Blot 82%. Der p1 was recognized by 70%, Der p2 84%, Der p23 72%. Regarding serodominances, Der p2 was the highest one (30.2 kU/L). Forty‐three patients presented sensitization to 3 Dermatophagoides pteronyssinus molecules, been 1 + 2 + 23 the main combination. Der p 1, 2, and 23 prevalence were similar in patients with intermittent or persistent allergic rhinitis. All patients with asthma recognized to Der p2 and more than 80% Der p1 and 23. In the group of patients without asthma, sensitivity to Der p23 is considerably reduced. Conclusion: Ninety per cent of patients recognize Der p1, 2, and 23, alone or in any of their combinations. The high prevalence of sensitization to Der p23 (72%) stands out, that all asthmatic patients are sensitive to Der p2 and that sensitization to Der p23 in non‐asthmatic patients drops to 50%.

The aim of this study is to explore the safety and efficacy of bee venom immunotherapy without HSA, in real-life patients. Methods: This is an observational retrospective study developed in seven hospitals in Spain, where patients treated with this immunotherapy were included. They gathered the protocol used to initiate the immunotherapy, adverse reactions, field re-stings, and the patient clinical data (clinical history, biomarkers, and skin prick test). Results: A total of 108 patients were included. In total, 4 protocols were used (5 weeks reaching 200 μg, and 4, 3, and 2 weeks reaching 100 μg). An incidence of systemic adverse reactions for each 100 injections of 1.5, 1.7, 0, and 0.58, respectively, was found. The demographic data showed not to directly affect the appearance of adverse reactions, except for those having a grade 2 systemic reaction with immunotherapy previously had a grade 4 systemic reaction; the IgE to Apis mellifera was 3 times higher in patients with systemic reactions of grade 1 than in the general group, and other specific IgEs were lower in those with systemic reactions. Most of the patients recognized Api m 1 followed by Api m 10. In the sample, 32% experienced spontaneous re-stings, without presenting systemic reactions, after a year of treatment.