A 31-year-old male diagnosed with hypersensitivity to cow's milk proteins in childhood with posterior tolerance, seasonal rinitis and mild intermittent asthma due to allergy to clinical grass pollen and to the epithelium that had a good response.
She suffers from severe dysphagia which, in the last four years, develops spontaneously without special measures.
In January 2005 and after the administration of a 400 mg ibuprofen tablet, the patient developed acute dysphagia with clear difficulty in taking the medication, including saliva.
Horses later and due to the persistence of the clinical picture, he came to the Emergency Department of Hospital X-Calde in Lugo, where the presence of the impacted tablet at 30 cm of the air could be verified.
Endoscopy was particularly difficult due to the narrowness of the esophagus at this level, and the use of an ultrafine endoscope was necessary.
Edema of the esophageal wall was so marked that fragmentation of the tablet was required for further extraction.
At this time, samples were taken for biopsy at various points of the esophagus in which the presence of eosinophilic infiltrate was demonstrated.
The patient was admitted to the Allergy Service of the Complejo Hospital Universitario de Santiago where fluone deglutide was administered at a dose of 500 mg every 12 hours.
Treatment was continued for 3 months and it was recommended to abstain from consumption of cheeses and milk products derived from cow's milk and sheep until the allergy study was conducted.
Endoscopic control with corresponding biopsies taken 4 months later showed no evidence of any lesion.
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Cutaneous tests were carried out on prick against the aeroallium infertaria latex, including vesicular stomatium pteronysescent, germlata, Penlyphnica, phagonum altera, Aspergillus grass,
Skin tests against commercial food extracts, including crab, squid, shrimp, mussel, oyster, cow's milk, casein, egg, wheat, rice, soya bean extract were negative.
A prick-prick test was performed on the patient's samples of cheese and yogures of ewes.
The prick-prick test consists in the performance of a classical prick test, using a lancet with the lancet that penetrates the anterior layer of the epidermis after it has been exposed on the face.
With this method, a positive response was obtained to the item residue (4 x 4 mm), ewe cheese (4 x 4 mm), residue (9 x 9 mm) and iogur).
The positive control with histamine produced a papule of 3 x 3 mm, considering positive those tests with a papule size equal to or greater than that obtained with histamine control.
Epicutaneous tests were carried out with the cheeses made from ewes to check the possible involvement of mechanisms of delayed cellular hypersensitivity.
For this purpose, patches were placed with the aforementioned cheeses, causing or ending for 48 hours, but the result was, in this case, negative.
Total serum IgE was 422 kU/l (normal values below 100 kU/l) and specific IgE to milk/a, positive milk/a, positive milk/a, kveja and cow (UCAP System, respectively).
Median SDS-PAGE immunoblotting technique was observed specific IgE bands of apparent molecular mass of 85, 66 and 55 kDa in extracts of cow's milk and milk, yoghr.
Using the same technique, it was possible to identify in this serum specific IgE that recognized epitopes present in the proteins lactoferrin, bovine immunoglobulin G and immunoglobulin G bovine molecular masses described (these proteins contain a chain of heavy immunoglobulin G).
56 kDa).
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Once the diagnosis has been made and after avoiding milk products derived from sheep and goats, the patient remains asymptomatic with normal endoscopic control.
