Asunto(s)
Humanos , Masculino , Femenino , alfa-N-Acetilgalactosaminidasa/efectos adversos , alfa-N-Acetilgalactosaminidasa/inmunología , Galactosa/análisis , Galactosa/inmunología , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/inmunología , Inmunoglobulina E , Urticaria/complicaciones , Urticaria/inmunologíaRESUMEN
Primary immunodeficiencies (PIDs) are genetic diseases that cause alterations in the immune response and occur with an increased rate of infection, allergy, autoimmune disorders, and cancer. They affect adults and children, and the diagnostic delay, morbidity, effect on quality of life, and socioeconomic impact are important. Therapy (gamma-globulin substitution in most cases) is highly effective. We examine adult PIDs and their clinical presentation and provide a sequential and directed framework for their diagnosis. Finally, we present a brief review of the most important adult PIDs, common variable immunodeficiency, including diagnosis, pathogenesis, clinical signs, and disease management.
Asunto(s)
Síndromes de Inmunodeficiencia/diagnóstico , Síndromes de Inmunodeficiencia/terapia , Adulto , Anticuerpos Monoclonales/uso terapéutico , Diagnóstico Diferencial , Humanos , Inmunidad Innata/genética , Inmunidad Innata/inmunología , Síndromes de Inmunodeficiencia/genética , Interferón gamma/uso terapéutico , gammaglobulinas/uso terapéuticoRESUMEN
Evaluation of allergic reactions to drugs is difficult because of the poor sensitivity of in vivo tests, which makes controlled administration of the drug necessary to confirm the diagnosis. In vitro tests are important in order to avoid the risks of in vivo testing. In the present review, we describe the different methods for detecting immunoglobulin (Ig) E antibodies that are specific to drugs involved in the development of type I (immediate) reactions. The 2 main in vitro methods are immunoassays and the basophil activation test, both of which have sufficient sensitivity and specificity for the detection of specific IgE antibodies, although with a limited number of drugs, and they have proven complementary to in vivo methods. We show the importance of the allergological workup of the patient within less than 1 year from the occurrence of the allergic reaction in order to obtain positive results in both in vivo and in vitro tests.
Asunto(s)
Prueba de Desgranulación de los Basófilos , Basófilos/metabolismo , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad Inmediata/diagnóstico , Inmunoensayo , Basófilos/inmunología , Basófilos/patología , Biomarcadores/metabolismo , Reacciones Cruzadas , Hipersensibilidad a las Drogas/sangre , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/inmunología , Epítopos/inmunología , Humanos , Hipersensibilidad Inmediata/sangre , Hipersensibilidad Inmediata/inducido químicamente , Hipersensibilidad Inmediata/inmunología , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Guías de Práctica Clínica como Asunto , Sensibilidad y Especificidad , España , beta-Lactamas/efectos adversosRESUMEN
The diagnostic gold standard for food allergy is challenge with the culprit food, particularly in double-blind placebo-controlled challenge. This approach involves risks and consumes both time and resources. A more efficient system would be desirable. The detection of serum specific immunoglobulin E (sIgE) against the culprit food enables us to establish sensitization, although this is not always accompanied by clinical reactivity. Age, symptoms (immediate/late reaction, local/systemic reaction), concomitant condition (eg, atopic dermatitis, pollinosis) and selection sample criteria (eg, presence of symptoms related to ingestion, positive skin prick test result) can influence the detection and concentration of IgE against foods. We analyze the clinical usefulness of sIgE determination in light of studies in which oral food challenge is used as the diagnostic method. We review clinical usefulness at diagnosis and in the decision to reintroduce the food, as well as the prognostic value of the determination of IgE to foods.