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Background and Objectives: Various treatment options are available for use in moderate-to-severe psoriasis and election is dependent upon the clinical criteria applied by the attending physician. We undertook a survey among dermatologists to assess the treatment of moderate-to-severe psoriasis currently used in clinical practice in Spain., Methods: A cross-sectional study was performed by sending a questionnaire to dermatologists in Spain who treat patients with moderate-to-severe psoriasis. The questionnaire comprised 33 items distributed in 6 sections: profile of the dermatologist, case load, patient profile, follow-up and management of the disease, treatment regimens, and assessment of pharmacological treatments., Results: According to the responses of the 164 dermatologists surveyed, 6.8% of patients seen in their clinics have moderate-to-severe psoriasis; of those, 45.8% receive systemic treatment and 22.9% are treated with biologic drugs. In many of those patients (50.2%), the dermatologist felt that a change in treatment was necessary; in 51.1% of cases, this change would be from systemic therapy to a biologic drug. The principal reason for the change (50.8%) would be lack of efficacy or the appearance of adverse effects. Efficacy and safety were considered essential criteria in the choice of an appropriate treatment (82.9% and 28.0% of dermatologists, respectively). Patient quality of life was also considered an essential consideration in choice of treatment by 28.0% of dermatologists., Conclusions: Optimal treatment for moderate-to-severe psoriasis should be effective and safe, and improve patient quality of life. This makes it essential to use drugs with an excellent efficacy and safety profile.

Introduction: Skin diseases account for a high proportion of presenting complaints in primary health care. In Spain, the growing demand for consultations and the resulting longer waiting lists make it necessary to establish criteria for appropriate referrals to a specialist. This study aimed to investigate the characteristics of referrals from primary care centers to dermatology specialists as well as the correlation between the presenting complaint and the final dermatologic diagnosis., Patients and Methods: We collected data from 3164 patients seen for the first time by dermatologists in our specialist service during 1998. Patients were stratified according to the referring primary health care center and the reason for referral. The agreement between the presenting complaint and the final dermatologic diagnosis was studied. For each dermatologic condition, the positive predictive value, diagnostic sensitivity, and k statistic were calculated., Results: The overall diagnostic agreement was 65.52 %. Primary care physicians were found to over diagnose diseases caused by papillomavirus and the diagnostic sensitivity was very low for diseases such as basal cell carcinoma and seborrheic keratosis., Conclusions: It is necessary to insist on training primary care physicians, ensuring appropriate referral from primary health care clinics, and promoting an effective dialogue with the specialist.

Introduction: In recent years there has been an increase in the size of the immigrant population consulting dermatology services in Spain. The aim of this study was to describe the epidemiological characteristics of this sector of the population in the health care area served by Miguel Servet Hospital in Saragossa, Spain., Material and Methods: Data were collected on immigrant patients seen in the dermatology department of our hospital during 2004. Dermatological diagnoses were classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Statistical analysis was undertaken using the SPSS statistical package, Access database management software, and Excel spreadsheets., Results: A total of 706 patients were seen, corresponding to approximately 4 % of all first appointments, and more women were seen than men, a difference that was statistically significant. The mean age of the patients was 31 years and there were no statistically significant differences in age between the sexes. In order of frequency, the most common countries of origin of the patients were Ecuador, Colombia, Romania, Morocco, Gambia, Guinea, and Senegal. The most common skin diseases in this population group were infectious diseases, in particular mycoses, followed by viral diseases and pyodermatitis, as well as sexually transmitted diseases. In all cases, the incidence of the disease was higher than in the Spanish population., Conclusions: An appropriate knowledge of dermatological diseases in this population group is necessary both to obtain correct diagnosis and to develop preventative measures for imported diseases.

The occurrence of allergic diseases depends on genetic and environmental factors. Genetic factors determine individual risk and these persons should undergo early detection. However, the methods currently available (mainly clinical history and IgE in umbilical cord blood) have poor predictive value so their use in the general population is not practical. In contrast, the feeding habits of newborns and infants can influence the development of food allergies in children at risk. Therefore, several modes of action have been proposed, based mainly on prolonging breast-feeding (with the mother avoiding allergenic foods) and delaying the introduction of complementary foods considered to be a risk. Use of cow milk protein hydrolysates may have a preventive effect similar to that of breast-feeding, but their administration is not problem-free. The preventive effect of partial hydrolysates or soybean formulas is even more questionable.

Aims: To assess distribution and correlation between serum concentrations of specific IgE for food allergens and clinical symptoms after exposure., Patients and Methods: Four hundred and thirty seven allergic children with 1097 sensitizations to food allergens, confirmed by prick-test and/or Phadezym RAST, were evaluated. From these sensitizations, 558 were associated to clinical symptoms after food intake (SFS), demonstrated by clinical history and/or open oral provocation, and 539 were asymptomatic food sensitizations (AFS)., Results: In these patients, the most frequent values of serum specific IgE (44%) were found in the 0.7 and 3.5 PRU/ml range, although in 18% of the cases no specific IgE was detected. Some differences in this distribution exist for different groups of food allergen, with predominance of negative results for food of the rosaceae group. On the contrary, specific IgE values higher than 17.5 PRU/ml are predominant for fish allergens. There is a statistically significant correlation (chi 2 p < 0.001) between anti-food allergen specific IgE concentrations and the clinical symptoms occurred after intake, so the serum specific IgE values between 0.35 and 3.5 PRU/ml are present with higher frequency in the AFS, while values higher than 17.5 PRU/ml are found with a statistically significant higher frequency in the SFS. When different food groups are evaluated separately, some mild differences exist., Conclusions: A statistically significant correlation between anti-food allergen specific IgE concentrations and the clinical symptoms ocurred after intake. Therefore, specific IgE quantitative assessment and its relationship to clinical symptoms may be of great interest in the management of food allergy.

We present a retrospective study of allergic drug reactions seen in our pediatric allergy consulting room during the last 6 years. During this time, 840 patients were examined for suspected adverse drug reactions. Drug allergy was confirmed in 72 cases (8.5%). Of these cases, 29 (40.2%) were considered to be IgE mediated, or immediate hypersensitivity reactions. We have not found significant differences with regards to age, sex, atopic family history or atopia between patients with IgE mediated reactions compared to patients with allergic drug reactions of different mechanisms or to patients without drug allergies. Sulfonamides, streptomycin, beta-lactam and analgesics were the drugs most frequently involved in immediate type reactions. Among non-immediate reactions, fixed eruption by sulfonamides and contact dermatitis due to Mercurochrome were the most frequent.

Over one half of the cases of chronic severe childhood asthma, refractory to conventional therapy and without other over aetiology, are associated to gastroesophageal reflux (GER). The aetiopathogenic role of GER in asthma is uncertain, and is only confirmed when therapy of the former induces evident improvement of the latter. We have instituted medical antireflux therapy over two years in 17 patients (17.6%) became asymptomatic after less than three months of therapy, and a further four (23.5%) by the sixth month. Seven patients showed clinical improvement by the third month (41%) and even a greater one by the sixth month, only very slight symptoms persisting thereafter. In three cases (17.6%) there was no improvement after two years of outcome of asthma and the persistence or not of pathological between the outcome of asthma and the persistence or not of pathological 24-hour pHmetry. On the contrary. macroscopic oesophagitis disappeared in the cases of asthma with good outcome, but persisted in all the cases who remained symptomatic. In conclusion, we consider that medical management of GER associated to asthma should be maintained for at least six months (if the clinical course so permits) before considering a surgical indication.

In a group of 41 infants with immediate, IgE mediated, food hypersensitivity, food anamnesis was specific in 60 per 100 and food challenge positive in 29 out of 34 times. Total serum IgE levels were raised in 80 per 100. In 26 instances symptoms appeared with the first food intake (15 cases) or there was sensitization before ingestion (11 cases); all but three were breast fed. Moreover, breast feeding in patients of the whole group had higher prevalence (p less than 0,001) than in a non-sensitized control group. These results suggest that food hypersensitivity in infants occurs very often without previous antigen intake and it is not always followed by clinical intolerance. Breast milk and/or transplacental antigen passage are probably important ways of sensitization. If so, it seems that minute quantities of antigen may be more fit for sensitization, provided the possible genetic high responsiveness for IgE synthesis in those infants.