Nurse abstracts

Below are all the presented abstracts from nurses during the EAACI 2008 Congress. Click here to down-load them.

Abstract Book

XXVII Congress of the European Academy of
Allergology and Clinical Immunology
Barcelona, 7-11 June 2008

European Meeting of Allergy Nursing
Barcelona, 7-8 June 2008

Allergy Nursing Scientific Programme Committee
Amparo Gaitano, Sp Amena Warner, UK
Mercedes Guillén, UK Susan Beattie, UK
Alfonso Malet, Sp Birhe Hellquist, Dk
Nursing Committee of the Spanish Society of Allergy and Clinical Immunology

POSTERS
will be displayed in room 122/123 during lunchtime on Saturday 7 June

1. Evaluation of the difficulty to realize the determination of exhaled oxide nitric
Abstract body

Martí , Natalia1; López, Laura1; Elvira, Yolanda1; Martí , Nuria1; Ferrer, Berta1; Bolos,
Marta1;
Dordal, Teresa1; Martí , Enric1; Amorós, Mariona2; Martínez, Nuria1
1Fundació Hospital Sant Pere Claver, Allergy Department, Barcelona, Spain;
2Fundació Hospital Sant Pere Claver, Software Department, Barcelona, Spain
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Background: The determination of exhaled nitric oxide (eNO) allows evaluating the degree of bronchial inflammation in a non-invasive, comfortable and simple way, sensitive and reproducible way as well. However, an inaccurate manoeuvre would difficult the achievement and interpretation of the medical test. So, specific instructions from the technician in charge are required. Objective: Evaluate the difficulty in carrying out the manoeuvre of determination of eNO. Determine if there is some relation with several factors such as age, sex, smoking habit or eNO values.
Methods: The determination of eNO is obtained from NIOXMINO device. We perform the test to those patients with respiratory pathology attended in our hospital, when the doctor requests this type of test. Before carrying out the test the nursing team gives the patient a detailed explanation of the instructions for its implementation.
Results: 369 patient data are gathered, 140 men (37.94%) and 229 women (62.06%).
The average age is 34.39 years, with a standard deviation of 14.22 (minimum age 4 years old and maximum age 72 years old). 17.62% of the patients are smokers, 75.34% non-smokers and 7.05% ex-smokers. 37.40% of all the patients have normal eNO values (under 25ppb), 29% show borderline results (between 25 and 50ppb) and 30.62% patients have pathologic values (eNO> 50 ppb). The average attempts to achieve successfully the manoeuvre are 1.98, with a standard deviation of 1.36 (minimum 1 attempt and maximum 9 attempts). The manoeuvre at the first attempt is successful in 9.21% of the patients, and at the fourth attempt in 6.50%. More than four manoeuvres are needed in less than 3% of the patients.
Conclusion: We conclude that there is a major difficulty to carry out successfully the manoeuvre in patients older than 60. The maintenance of a respiratory constant flow is the technical aspect that endures more difficulties to realize correctly the manoeuvre.

2. Aplicación de las nuevas tecnologías en alergología
Beatriz Ollo Jordan, María Gurpegui Resano, Asunción Gómez Lerga, Mónica Catalá Navarro, Mª Luisa Talens Armand.
Servicio de Alergología Asistencia Especializada, Servicio Navarro de Salud-Osasumbidea. Pamplona.

Introducción: La constante renovación de la tecnología favorece su implantación tanto en la vida laboral como personal. La medicina, incluida la Alergología, se ha incorporado de forma activa a esta corriente.
Objetivos: Dar a conocer las nuevas tecnologías utilizadas en el ámbito de la Alergología. Analizar su utilización, tanto por profesionales como por pacientes.
Valorar las posibilidades de mejora que estos sistemas pueden aportar en la prevención, diagnóstico, tratamiento y seguimiento de los pacientes alérgicos.
Metodología: Revisión de los principales sistemas tecnológicos de nueva implantación, con los que cuenta la sociedad actual, y exposición de sus usos, tanto por parte de los profesionales sanitarios como de los usuarios.
Resultados: Para los profesionales, Internet permite un mayor flujo de conocimientos:
desarrollo de páginas Web especializadas, bases de búsqueda bibliográfica y acceso a revistas científicas; favoreciendo la formación continua.
La Historia Clínica Informatizada, permite el conocimiento inmediato de todos los datos referidos al paciente y su seguimiento.
El correo electrónico facilita la comunicación entre Atención Primaria y Especializada y agiliza diagnósticos, reduciendo costes en interconsultas presenciales.
Para el paciente, Internet se convierte en un medio útil de consulta sobre su problema y las posibles soluciones, control de síntomas, etc., siempre y cuando recurra a páginas especializadas y avaladas por sociedades científicas.
Otras tecnologías útiles tanto para el profesional como para el paciente, son los teléfonos móviles, PDA y cámaras fotográficas. Estos dispositivos permiten una rápida comunicación para la recogida de información, envío de mensajes e imágenes, recordatorios y organización de la consulta.
Conclusión: En alergología, las nuevas tecnologías permiten que el acceso a la información, tanto científica como del paciente sea más rápida y eficaz. Cabe esperar que en la difusión de su empleo se consigan mejoras en la atención integral del paciente.
A medida que se perfecciona la calidad de los dispositivos portátiles éstos van adquiriendo mayor aceptación en una sociedad regida por el cambio y la actualización constante de la información.

3. Food allergies and school canteens. Educational program support in school
canteens and leisure centres.
Gaitano. A, Guillén. M, Duocastella. P.
A.C.A.D.I (Catalonian Association Nurses of Allergology)

Introduction: Since 20 years ago the introduction of catering to school groups as well as the incorporation of working world, it has been an unstoppable fact. According to the latest health data, 20% of children eat their meal at school.
The problems of food allergies, habits and eating disorders, accompanied by the child population growth appear in every school / canteens. The information that the kitchen staff and the suppliers know is scarce.
Accountability and performance of teachers, monitor, staff canteen and cooks, it is of great importance to an allergy problem, especially food, due to its seriousness.
Goals: Help schools and canteens to recognize food problems and act against them, as the preparation of food, the carers and users.
Reduce anxiety to raise awareness about the situation.
Defining actions in situations of risk.
Establishing preventive measures: special care at parties, celebrations and special meals.
Scope of action
Official and private school/school canteens
Human and material resources
Nursing specialist
Cannon and computers
Fact Sheets
Whiteboard or flip charts
File / control
Issues
Allergies to various foods
Anaphylaxis
Eating disorders
Intolerances
Eating habits, obesity, cholesterol
Food manipulation
Emergency treatment
Justification
From public health: For children with food problems.
The training / information for teachers, coaches and for all workers related to school
meals.
Legal: ensuring security in the dining rooms.
Social: make the colleagues aware of the problem.
Conclusions:
We are unable to provide figures because it has been presented in a few schools, but if we see the satisfaction expressed by school personnel to resolve doubts and provide a protocol for action in the event that any children present an allergic reaction to some food.
Our intention is to insist that the Administration has an implementation of this program in a systematic way to achieve minimize the risks of our small allergic.

Oral Presentations – will be presented on Sunday 8 June 10.30 - 12.00 in room 122/123

1. ACADI Association: Catalan Allergy Association of Qualified Nurses
Alberto Hernández* Natalia Martí** Amparo Gaitano ***Members of Catalan Nurse
Allergy Association (ACADI).
*Nurse of Allergy -Departement. Hospital Valle Hebrón Barcelona. Spain
** Nurse of Allergy -Departement Hospital San Pere de Ribes. Barcelona. Spain
***Nurse of Allergy -Al.lergo Center. Barcelona. Spain

In Catalonia there are 50 Allergy nurses. Theses nurse practices meet each other in annual Allergy Congresses and Symposiums.
Six years ago, we decided these sporadic meetings could be more fruitful and so, we thought of joining up and forming an association.
This is how ACADI, Catalan Allergy Association of Qualified Nurses was born. It was legally established in April 2003 with a mutual aim: to give a better service to society inall the fields included within this speciality.
The following are the specific aims:
· To group together the Allergy Nurses
· Exchange experiences and knowledge, unifying protocols and technical criteria, introducing the NANDA taxonomy.
· Promote and improve the scientific development of Nurses with specific training seminars, courses and worktraining.
· Take part in training seminars for other circles, such as school teachers, gym teachers, leisure clubs instructors or associations of allergic patients .
· Collaborate with Nursing schools and other scientific organizations with aspects that can affect the profession and the quality of the assistance given.

We offer:
· Worktrainig, seminars, graduate and pre-graduate training courses
· Access to allergy bibliography
· Up to date information with news from our specialty
We have recently published a book of food recipes for allergic children.
We have created a web page to include our association to the internet world, and from this point, spread our services. www.acadi.cat
Even though we are a young association, after more than four years journey, we can say we have achieved practically all our aims. And we carry on with hope for the future to continue with our line of service for the community.

2. Correlation between allergy and adenotonsillar hypertrophy - A descriptive -
cross sectional study
M.Sadeghi Shabestari, Y.jabari Mogadam, N.salami
Division of Immunology and Allergy and ENT, Tabriz Children hospital, Tabriz
University of Medical Scienses, Tabriz, Iran

Background: Tonsils and adenoids are parts of "Waldeyer's ring"; the basic function of which is antibody formation, which later react against a great variety of antigens .The adenotosillectomy is the most common operation done in small children; but the exact reasons of adenotonsillar hypertrophy remains unclear. Some researches have shown that allergy can be a risk factor for adenotonsillar hypertrophy in children.
Methods: Two separated groups of children admitted from October 2006 to June 2007 at the ENT, Allergy ward of Tabriz Children hospital, were recruited for the study. The study group was consisted of 117 children between 1 to 14 years old (with average of 6.1) who had adenotonsillar hypertrophy. The control group consisted of 100 children who had not adenotonsillar hypertrophy in similar age. Both groups were examined for the incidence of adenotonsillar hypertrophy and its relation to allergic diseases, results of skin prick test, serum total IgE and close contact to smoke.
Results: According to the results of skin prick test; in 70.3% of children with adenotonsillar hypertrophy in the study group, prick test was positive. But only 10.0% of children in control group showed positive skin prick test.
Increased serum total IgE level was confirmed in 8.3% of study group and only 1% in control group. In addition, 48% of children with positive skin prick test in study group were in close contact with smoker parents.
Conclusion: Allergy and sensitivity to different kinds of allergens are important risk factors for adenotonsillar hypertrophy in children. Allergy control may have role in reducing the rate of adenotonsillectomy in children suffering allergic reactions with adenotonsillar hypertrophy

3. An association between tick bite reactions and red meat allergy
Suran L. Fernando1, Kate S. O’Connor2, Lesley R. Clarke1, Sheryl A. Van Nunen1
1Department of Allergy Royal North Shore Hospital, Sydney Australia.
2Immunology Department, Royal Victoria Infirmary, Newcastle upon Tyne, United
Kingdom.

Introduction: Red meat allergy is rare in the adult population. An association between allergic reactions following red meat consumption and a prior history of large local reactions to Ixodes holocyclus tick bite has been recently observed at one Allergy Practice in Sydney, Australia. A retrospective analysis was conducted to further examine the strength of this association in an adult population.
Methods and Results: Twenty-five patients with a history of clinical reaction following the ingestion of red meat between 2003 and 2007 were analysed. Seventeen of these individuals had severe reactions characterised by cardiorespiratory involvement. Eleven individuals recorded reactions to more than one type of red meat.
All these patients had confirmed IgE-mediated responses to red meat on skin-prick tests and/or RASTs, with 88% demonstrating responses to more than red meat. Twenty-four of these 25 patients gave a history of large local reactions to Ixodes holocyclus tick bites. In all but one case, the history of tick exposure preceded the development of the meat allergy. The records from 29 randomly selected control subjects from the same practice with confirmed IgE-mediated responses to foods other than red meat were also examined. None of these subjects reported a history of tick bite reactions.
Conclusions: These findings suggest that in this population, the overwhelming majority of cases of the relatively rare condition of red meat allergy are preceded by sensitization to tick bites. We speculate that individuals are sensitized to tick salivary proteins that are cross-reactive with proteins found in various red meats. Further studies are required to characterize these allergens. This is the first cross-reactive allergy to be reported between an insect and food protein. A prospective study examining consecutive patients with tick bite reactions and/or red meat allergy is necessary to determine the true prevalence of this cross-reactivity.

4. Tolerance of omalizumab: 18 months of experience
Esther Gimeno, Asunción Lis, M. Carmen Armiñana, Dolores Sanz, Miguel Díaz,
Dolores Hernández
Department of Allergy. Hospital Universitari La Fe, Valencia, Spain

Background: Omalizumab is a monoclonal antibody that selectively binds to human immunoglobulin E (IgE). It has the main indicatioin in allergic severe asthma. The dosage is adjusted to weight and total IgE serum levels and it is administered subcutaneously every two or four weeks. It has shown good tolerance although two types of adverse reactions have been described: a) local reactions in the site of inyection, and b) systemic reactions. The risk of anaphylaxis is 0.1% per dose, thus omalizumab must be administered by health care providers.
We describe our experience with this medication after 18 months of administration to nine patients.
Methods: Patients suffering from severe allergic asthma were selected among patients atending our unit.
In order to evaluate the efficacy we designed a protocol including lung function, skin prick and blood tests and quality of life, symptoms and medication cosumption questionaries. Data was collected before first administration and after 8, 16, 32, 52 and 78 months.
Doses of omalizumab, adjusted to weight and serum total IgE levels, were prepared following instructions of the manufacturer. After reconstitution, vials were swirled for some minutes until complete dissolution of the lyophilized product. Inyections were administered subcutaneously in the arm. No more than 150 mg were inyected per site.
To assess tolerance, patients remained under observation for 120 minutes and were instructed to communicate any adverse effect. Before each dose were asked about tolerance of the previous one.
Results: We have administered 115 doses (4 - 24 doses per patient, with a mean number of 12 doses). No immediate local reactions were observed. Patient 4 developed unspecific symptoms after the first dose which resolved spontaneously. Two patients requiered hospitalization during the follow up: patient 7 due to asthma exacerbation and patient 6 because of pneumonia. None of these episodes was attributed to omalizumab.

PATIENT

AGE

GENDRE

Total IgE
(kU/l)

DOSE
(mg)

FREQUENCY
(weeks)

N. OF
DOSES

1

45

F

59

150

4

20

2

38

F

582

300

2

24

3

48

F

423

225

2

20

4

50

F

183

300

4

8

5

24

F

560

300

2

13

6

48

F

352

300

2

13

7

24

F

57

150

2

7

8

41

F

150

300

4

4

9

40

M

589

375

2

6

Conclusions: Omalizumab was easily administered and well tolerated. No local reactions were observed.

5. Evaluation of the nurse’s knowledge about subcutaneous immunotherapy
Comella-Fiestras, Thaïs; Pascua-Rodríguez MªJosé; Prados-Chica, MªIsabel
Allergology Unit. Hospital Santa Maria. Lleida. Spain

The administration of immunotherapy isn’t always possible in the allergy department.
The distance between health center and patient´s home becomes one of the major problems to permit the monthly appointment.
The people who are working at the primary care level will develop an important role in all these treatments. Even thought all these nurse´s do not feel able to resolve some special situations.
The main reason for doing this study is to evaluate the level of immunotherapy knowledge of the nurse´s who are administrating this therapy, and also share some experiences.
We have used sixteen questions test with four possible options including "does not know/ does not answer". This test has been done before and after an exposition of an hour about immunotherapy. Statistical was powered by SPSS V.15.
The evaluation was done in twenty-one primary attention centers with N=156 before our intervention and N=182 after it. Differences about professional’s characteristic werenot statistically significative (p>0´05).
Significance reach p=0.000 in some variables:
Device, administration zone and technical: we obtain at the first time 73´8 % of correct answers and finally we obtain 98´3%.
Interruption of the administration, from 28´1% to 71´9% of correct answers.
Patient advices, from 59´2% to 87´6 of correct answers.
Dose of vaccine in case of interruption, from 14´7% to 64´9% of correct answers.
Procedures in systemic reaction, from 13´7% to 86´3% of correct answers.
Procedures in local reaction, from 90´1 to 94´4% of correct answers.
This study gives us some information about the lack of knowledge in our primary care areas, and also we have seen some good results after our intervention.

6. Seguridad de inmunoterapia con veneno de himenópteros en pauta agrupada
Mónica Catalá Navarro. Asunción Gómez Lerga. María Gurpegui Resano. Beatriz Ollo
Jordán. Marisa Talens Armand.
Servicio de Alergología Asistencia Especializada, Servicio Navarro de Salud-Osasumbidea. Pamplona.

Resumen: La gravedad inherente a la hipersensibilidad IgE mediada a veneno de himenópteros impone la necesidad de alcanzar, en el menor plazo de tiempo posible, la dosis de mantenimiento en la inmunoterapia con venenos.
Objetivo: Valorar la seguridad de una pauta agrupada (cluster) de inmunoterapia subcutánea con veneno de himenópteros, que reduce de 12 a 3 semanas el tiempo necesario para llegar a la dosis de mantenimiento.
Material y métodos: El estudio fue realizado en 30 pacientes, 24 varones y 6 mujeres con una media de edad de 46,06. Los pacientes recibieron inmunoterapia frente a veneno de himenópteros Pharmalgen® (ALK Abelló), 13 fueron de apis mellífera, 12 de véspula spp, y 5 de polistes spp, con una pauta agrupada que consistió en: día 1( 4μg+ 6μg), día 8 (10μg + 30μg) y día 15 (40μg + 60μg). Se valoraron las reacciones ocurridas durante la fase de inicio entre abril de 2005 y febrero de 2008.
Resultados: De los 30 pacientes vacunados 2 presentaron reacción local exagerada, otros síntomas inespecíficos en dos ocasiones y 2 más reacción sistémica. Uno tras administrar la dosis de 40μg, presentó reacción sistémica grado III. Y el otro tras recibir la dosis de 60 μg, presentó una reacción sistémica grado II. Ambos pasaron a una pauta convencional de administración de inmunoterapia y tuvieron nuevas reacciones de grado III por lo que se les mantiene la inmunoterapia con premedicación con antihistamínicos orales.
Conclusión: El estudio confirma que la pauta utilizada es segura con una baja incidencia de reacciones adversas, 1,67% presentó reacción local exagerada, 1,11% tuvo reacción inespecífica y 1,11% reacción sistémica.



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