[EPICAP: educational intervention using instructional clips in patients with epilepsy. A randomised clinical trial]

AIMS

In patients with epilepsy health education has a positive influence on self-management of the disease, improves prognosis and enhances patient well-being. The aim of this study was to evaluate an educational intervention using instructional clips in patients with epilepsy in a video-electroencephalographic monitoring unit.

SUBJECTS AND METHODS

We conducted a randomised clinical trial with two groups (intervention and control). Adult patients with epilepsy admitted to the video-electroencephalographic monitoring unit were recruited. Nine videos about the diagnosis and treatment of epilepsy, together with recommendations on lifestyle, were produced and administered to the intervention group while admitted. Patients' knowledge of their disease was assessed by means of a questionnaire designed specifically for this study. A pre-assessment was conducted at the beginning of the study, at hospital discharge and at three months, and the knowledge of epilepsy in the two groups was compared at each time considered in the study.

RESULTS

Sixty-six patients were included, with a mean age of 39 ± 14.7 years (range: 17-76) and a median of 8 years since disease onset (range: 1-60 years). Fifty-three per cent of the patients were women. Focal epilepsy was the most frequent type (95.5%). The mean score on the pre-intervention test was 57.2 ± 15.3. Patients who received the educational intervention showed better post-test scores at discharge from hospital (81.8 ± 11.2 versus 62.8 ± 13.7; p = 0.001) and at three months (76 ± 9.6 versus 63.2 ± 12.8; p = 0.001).

CONCLUSIONS

The EPICAP educational intervention using instructional clips significantly improves patients' knowledge of epilepsy-related diagnostic, therapeutic and lifestyle issues.

Assessment of nasal obstruction: correlation between subjective and objective techniques

BACKGROUND

Nasal sensation of airflow describes the perception of the passage of air through the nose. Nasal obstruction can be assessed using subjective techniques (symptom scores and visual analogue scales [VAS]) and objective techniques (anterior rhinomanometry [RMN], acoustic rhinometry [AR], and peak nasal inspiratory flow [PNIF]). Few studies have evaluated the correlation between these techniques.

OBJECTIVE

The primary objective of our study was to determine the degree of correlation between subjective and objective techniques to assess nasal obstruction.

MATERIALS AND METHODS

Nasal obstruction was assessed using a symptom score, VAS, RMN, AR (minimal cross-sectional area [MCSA] and volume), and PNIF in 184 volunteer physicians. Spearman's rho was recorded. Correlations were considered weak if r ≤ 0.4, moderate if 0.4 < r < 0.8, and strong if r > 0.8.

RESULTS

Mean (SD) age was 37.1 (6.9) years (range, 25-56 years); 61% were women. We found a strong correlation (r > 0.8; p = 0.001) between the different parameters of RMN and a moderate correlation between symptom score and VAS (r = 0.686; p = 0.001) and between MCSA and RMN (resistance) (r = 0.496; p = 0.001) and PNIF (r = 0.459; p = 0.001). The correlations were weak or non-significant for the remaining comparisons.

CONCLUSION

Nasal obstruction can be assessed using subjective and objective approaches. The correlations between objective techniques were moderate to strong. In addition, between subjective techniques we reported a moderate correlation. Finally, the correlations between the subjective and objective techniques were weak and absent. These findings suggest that each of the techniques assesses different aspects of nasal obstruction, thus making them complementary.

Fear extinction and acute stress reactivity reveal a role of LPA(1) receptor in regulating emotional-like behaviors

LPA1 receptor is one of the six characterized G protein-coupled receptors (LPA1-6) through which lysophosphatidic acid acts as an intercellular signaling molecule. It has been proposed that this receptor has a role in controlling anxiety-like behaviors and in the detrimental consequences of stress. Here, we sought to establish the involvement of the LPA1 receptor in emotional regulation. To this end, we examined fear extinction in LPA1-null mice, wild-type and LPA1 antagonist-treated animals. In LPA1-null mice we also characterized the morphology and GABAergic properties of the amygdala and the medial prefrontal cortex. Furthermore, the expression of c-Fos protein in the amygdala and the medial prefrontal cortex, and the corticosterone response following acute stress were examined in both genotypes. Our data indicated that the absence of the LPA1 receptor significantly inhibited fear extinction. Treatment of wild-type mice with the LPA1 antagonist Ki16425 mimicked the behavioral phenotype of LPA1-null mice, revealing that the LPA1 receptor was involved in extinction. Immunohistochemistry studies revealed a reduction in the number of neurons, GABA+ cells, calcium-binding proteins and the volume of the amygdala in LPA1-null mice. Following acute stress, LPA1-null mice showed increased corticosterone and c-Fos expression in the amygdala. In conclusion, LPA1 receptor is involved in emotional behaviors and in the anatomical integrity of the corticolimbic circuit, the deregulation of which may be a susceptibility factor for anxiety disorders and a potential therapeutic target for the treatment of these diseases.

Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens

BACKGROUND

Multiple plant-food sensitizations with a complex pattern of clinical manifestations are a common feature of lipid transfer protein (LTP)-allergic patients. Component-resolved diagnosis permits the diagnosis of the allergen sensitization profile.

OBJECTIVE

We sought to clinically characterize and describe the plant-food and pollen molecular sensitization profile in patients with LTP syndrome.

METHODS

Forty-five subjects were recruited, after being diagnosed with multiple plant-food allergies sensitized to LTP, but not to any other plant-food allergen, according to the molecular allergen panel tested (Pru p 3 (LTP), Pru p 1 (Bet v 1-like), Pru p 4 (profilin) and those included in a commercial microarray of 103 allergenic components). IgE-mediated food-allergy symptoms and pollinosis were collected. Patients were skin prick tested with a plant-food and pollens panel, and specific IgE to Tri a 14 was evaluated.

RESULTS

A heterogeneous group of plant-foods was involved in local and systemic symptoms: oral allergy syndrome (75.6%), urticaria (66.7%), gastrointestinal disorders (55.6%) and anaphylaxis (75.6%), 32.4% of which were cofactor dependent (Non-Steroidal Anti-inflammatory Drugs, exercise). All tested subjects were positive to peach and Pru p 3, Tri a 14 and to some of the LTPs included in the microarray. Pollinosis was diagnosed in 75.6% of subjects, with a broad spectrum of pollen and pollen-allergen sensitization. Plane tree and mugwort were the statistically significant pollens associated with Pru p 3.

CONCLUSIONS AND CLINICAL RELEVANCE

Several plant-foods, taxonomically unrelated, independent of peach involvement, are implicated in LTP syndrome. Local symptoms should be evaluated as a risk marker for anaphylaxis because they are frequently associated with cofactor-dependent anaphylaxis. The association of these symptoms with pollinosis, especially plane tree pollinosis, could be part of this syndrome in our area.

Genetic association study in nasal polyposis

BACKGROUND AND OBJECTIVES

Nasal polyposis (NP) is a chronic inflammatory disease of the upper airways with a variable clinical course and unknown pathogenesis that often coexists with other conditions. Considering the possibility of genetic predisposition, we decided to analyze whether polymorphisms in LTC4S, CYSLTR1, PTGDR, and NOS2A were associated with NP.

METHODS

The study population comprised 486 Caucasian individuals. Polyposis and aspirin intolerance were diagnosed following the recommendations of the European Position Paper on Rhinosinusitis and Nasal Polyps. Genotypes were determined using polymerase chain reaction amplification and direct sequencing.

RESULTS

The -444A > C LTC4S polymorphism was significantly associated with NP and atopy (P = .033) and with NP and atopic asthma, (P =.012). In addition, a significant association was found when the (CCTTT) repetition of the NOS2A gene was present more than 14 times in patients with NP and asthma (P = .034), in patients with polyposis and intolerance to nonsteroidal anti-inflammatory drugs (P = .009), and in patients with the aspirin triad (P = .005). The PTGDR diplotype CCCT/CCCC (-613CC, -549CC, -441CC and -197TC) was more frequent in patients with NP (P = .043), NP with asthma (P = .013), and the aspirin triad (P = .041).

CONCLUSIONS

NP was associated with specific polymorphisms only when it occurred with related phenotypes. Our results suggest that this genetic background plays a more relevant role in the development of the associated clinical features of nasal polyposis than in simple polyposis.

Nasal and bronchial inflammation after nasal allergen challenge: assessment using noninvasive methods

BACKGROUND

Links between the upper and lower airways have been demonstrated in recent years. However, few studies have evaluated inflammation using noninvasive methods.

METHODS

A nasal allergen challenge was performed with pollen outside the pollen season in 30 patients with allergic rhinitis due to pollen but no asthma. Clinical and inflammatory nasal and bronchial responses to nasal allergen challenge were evaluated using the nasal symptoms score (NSS), visual analog scale (VAS), nasal geometry (volume between 2 and 5 cm [Vol2-5]) by acoustic rhinometry, lung function by spirometry, nasal nitric oxide (nNO), and exhaled nitric oxide (eNO). Values were recorded at baseline, 15 minutes, and 2 and 24 hours after challenge. Nasal lavage and exhaled breath condensate (EBC) samples were collected at 2 and 24 hours to assess 8-isoprostane, cys-leukotrienes, eosinophil cationic protein (ECP), tryptase, granulocyte-macrophage colony-stimulating factor, and interleukin (IL) 5.

RESULTS

NSS and VAS increased significantly at 15 minutes and 2 and 24 hours after challenge. Vol2-5 decreased significantly at 15 minutes and 2 hours, while nNO decreased at 15 minutes. All inflammatory mediators except ECP increased significantly at 2 hours in nasal lavage samples, while ECP, 8-isoprostane, and cys-leukotrienes increased at 24 hours (P < .01). In EBC, 8-isoprostane and cys-leukotrienes increased at 2 and 24 hours (P < .01). No significant changes were found at any time in lung function or eNO.

CONCLUSION

Nasal allergen challenge induces clinical and inflammatory responses in the nose and bronchi that can be assessed using noninvasive methods such as nasal lavage, EBC, and nNO.

Cupressus arizonica pollen: a new pollen involved in the lipid transfer protein syndrome?

BACKGROUND

Lipid transfer proteins (LTP) are responsible for systemic manifestations in food allergy. Their relationship with pollinosis is not clear. In our area, many patients allergic to multiple LTP-containing foods present pollinosis due to Cupressus arizonica.

METHODS

We selected 6 patients with cypress pollinosis and food allergy to peach. Skin prick tests (SPT) were performed for pollens (grass, cypress, wall pellitory, plane tree, and olive tree) and plant foods (hazelnut, kiwifruit, peach peel, maize, wheat, peanut, lettuce, apple, mustard, and melon). In vitro assays included specific immunoglobulin (Ig) E to C arizonica and peach LTP (Pru p 3), enzyme allergosorbent test (EAST) inhibition, immunoblotting, immunoblotting-inhibition, and immunocytochemical techniques for the detection of Pru p 3-like LTP in cypress pollen grains.

RESULTS

SPT were positive for C arizonica, peach, lettuce, mustard, and hazelnut in all patients. Specific IgE to C arizonica and Pru p 3 was positive in all but 1 patient, whose Pru p 3 IgE was negative. Immunoblotting under nonreducing conditions with C arizonica extract and patients' sera showed a band at 14-15 kDa that was inhibited by Pru p 3. Pru p 3 partially inhibited the C arizonica pollen extract in EAST-inhibition. Pru p 3-like LTP was localized in the cytoplasm and walls of C arizonica pollen grains.

CONCLUSION

A 15-kDa allergen in C arizonica pollen was found in a group of patients presenting peach allergy and respiratory symptoms to cypress. In vitro tests and immunocytochemical techniques indicate that this protein is an LTP.

Allergy workup in immediate-type local reactions to glatiramer acetate

Local reactions to glatiramer acetate are common, but few cases of hypersensitivity reaction have been reported. We present 3 patients with multiple sclerosis who suffered immediate-type local reactions after subcutaneous injection of glatiramer acetate. Skin prick test (SPT), intradermal test (IDT), and determination of immunoglobulin (Ig) E to glatiramer acetate were performed in patients and controls (enzyme-linked immunosorbent assay). The results of SPT were all negative. Those of IDT in controls were negative at concentrations below 200 microg/mL, but positive for patients 1, 2, and 3 at 2, 20, and 200 microg/mL, respectively. Serum IgE to glatiramer acetate in patient 1 was 2.1 times higher than in the controls, whereas no differences were found between controls and patients 2 and 3. Glatiramer acetate was safely reintroduced in patients 2 and 3. The results obtained for patient 1 suggest that an IgE-mediated mechanism was probably involved. In conclusion, IDT and serum IgE determination to glatiramer acetate seem useful for identifying allergic reactions among the common local reactions induced by this drug.

Behavioral phenotype of maLPA1-null mice: increased anxiety-like behavior and spatial memory deficits

Lysophosphatidic acid (LPA) has emerged as a new regulatory molecule in the brain. Recently, some studies have shown a role for this molecule and its LPA(1) receptor in the regulation of plasticity and neurogenesis in the adult brain. However, no systematic studies have been conducted to investigate whether the LPA(1) receptor is involved in behavior. In this study, we studied the phenotype of maLPA(1)-null mice, which bear a targeted deletion at the lpa(1) locus, in a battery of tests examining neurologic performance, habituation in exploratory behavior in response to low and mild anxiety environments and spatial memory. MaLPA(1)-null mutants showed deficits in both olfaction and somesthesis, but not in retinal or auditory functions. Sensorimotor co-ordination was impaired only in the equilibrium and grasping reflexes. The mice also showed impairments in neuromuscular strength and analgesic response. No additional differences were observed in the rest of the tests used to study sensoriomotor orientation, limb reflexes and co-ordinated limb use. At behavioral level, maLPA(1)-null mice showed an impaired exploration in the open field and increased anxiety-like response when exposed to the elevated plus maze. Furthermore, the mice exhibit impaired spatial memory retention and reduced use of spatial strategies in the Morris water maze. We propose that the LPA(1) receptor may play a major role in both spatial memory and response to anxiety-like conditions.

Urticaria caused by antihistamines: report of 5 cases

Antihistamines are widely used drugs. Hypersensitivity reactions with these drugs are rare and a challenge for the physician. We describe 5 outpatients who experienced urticaria after taking antihistamines. All 5 were treated at our outpatient clinic over a period of 15 years. The allergy workup included a clinical history, skin prick testing, patch testing with antihistamines, and single-blind placebo-controlled oral challenge tests. Biopsy samples were taken and serum tryptase levels were determined in 1 patient. The results of the skin prick tests and patch tests were negative in all patients but 1, in whom the prick test result was positive to some antihistamines. We confirmed all diagnoses using a single-blind challenge test. The biopsy obtained from 1 patient strongly supported urticaria. We present 5 cases of antihistamine-induced urticaria where the immunologic mechanism remains unclear. Hypersensitivity reactions should be taken into account in patients receiving antihistamines, especially in those who experience urticaria.

Serological responses to Ascaris suum adult worm antigens in Iberian finisher pigs

Adult Ascaris suum were dissected to obtain different worm components (body wall, body fluid, ovaries, uterus and oesophagus) which were used as antigens when testing 95 sera of naturally A. suum-infected Iberian pigs by enzyme-linked immunosorbent assay (ELISA) and Western blot (WB). Pigs with patent Ascaris infections had significantly lower ELISA optical density values than pigs without adult worms when using the body fluid and the body wall as antigens. A poor negative correlation was found between adult intestinal worm burden or eggs in faeces and specific antibody responses, measured by ELISA and WB using all antigens. By WB, the recognition of specific bands was variable, but three groups of bands with molecular weights of 97 kDa, 54-58 kDa and 42-44 kDa were generally recognized by sera from naturally infected pigs as well as from hyperimmunized pigs when using the five antigen extracts. The ELISA and WB techniques may be used for immunodiagnosis, using somatic adult worm antigens, to declare young pigs to be Ascaris-free but cannot be used for individual Ascaris-diagnosis in adult Iberian pigs.