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Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT

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Immunotherapy selectively modulates the allergen-specific immune response. It involves the gradual administration of increasing amounts of allergen for the purpose of inducing protective immunological changes and it is the only curative approach for specific type I allergy (AU)

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Progress in nanotechnology and DNA recombination techniques have produced tools for the diagnosis and investigation of allergy at molecular level. The most advanced examples of such progress are the microarray techniques, which have been expanded not only in research in the field of proteomics but also in application to the clinical setting. Microarrays of allergic components offer results relating to hundreds of allergenic components in a single test, and using a small amount of serum which can be obtained from capillary blood. The availability of new molecules will allow the development of panels including new allergenic components and sources, which will require evaluation for clinical use. Their application opens the door to component-based diagnosis, to the holistic perception of sensitisation as represented by molecular allergy, and to patient-centred medical practice by allowing great diagnostic accuracy and the definition of individualised immunotherapy for each patient. The present article reviews the application of allergenic component microarrays to allergology for diagnosis, management in the form of specific immunotherapy, and epidemiological studies. A review is also made of the use of protein and gene microarray techniques in basic research and in allergological diseases. Lastly, an evaluation is made of the challenges we face in introducing such techniques to clinical practice, and of the future perspectives of this new technology

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The diagnosis of antibody-mediated allergic disorders is based on the clinical findings and the detection of allergen-specific IgE based on in vitro and in vivo techniques, together with allergen provocation tests.In vitro diagnostic techniques have progressed enormously following the introduction of the advances made in proteomics and nanotechnology – offering tools for the diagnosis and investigation of allergy at molecular level. The most advanced developments are the microarray techniques, which in genomics allowed rapid description of the human genetic code, and which now have been applied to proteomics, broadening the field for research and clinical use.Together with these technological advances, the characterisation of most of the different proteins generating specific IgE and which conform each natural allergen, as well as their purification or genetic engineering-based synthesis, have been crucial elements – offering the possibility of identifying disease-causing allergens at molecular level, establishing a component-resolved diagnosis (CRD), using them to study the natural course of the disease, and applying them to improvements in specific immunotherapy.Microarrays of allergic components offer results relating to hundreds of these allergenic components in a single test, and use a small amount of serum that can be obtained from capillary blood. The availability of new molecules will allow the development of panels including new allergenic components and sources, which will require evaluation for clinical use.The present study reviews these new developments, component-resolved diagnosis, and the development of microarray techniques as a critical element for furthering our knowledge of allergic disease

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Fundamento: El consejo antitabaco aumenta la probabilidad de que nuestros fumadores dejen el tabaco. Cuanto más intenso, mayor es la eficacia. Objetivo: Estimar la eficacia de nuestro protocolo de intervención(PDM) basado en el Conjunto Mínimo de Datos del Fumador(CMDF), respecto al Consejo simple (CS), como ayuda para el abandono del tabaco de nuestros pacientes. Material y método: Muestra aleatoria y representativa de la zona básica del Centro de Salud Felipe II de Móstoles (Madrid) de 227 pacientes, 71 de ellos fumadores (19/71 incluidos en la Cartera de Servicios de Atención Primaria, como grupo de riesgo cardiovascular (GRCV)). Análisis de las historias médicas abiertas, para determinar en función del tipo de intervención sobre el tabaquismo de los pacientes (ninguna, CS o PDM) durante los 28 meses del estudio, el porcentaje de abandonos y de recaídas, los meses desde la intervención hasta la cesación del tabaco y los meses de abstinencia. Estimación de proporciones y medias, odds ratio (OR) en fumadores según el tipo de intervención, estratificadas por sexo, y pertenencia o no a GRCV. Resultados: El 56,17% de los fumadores recibieron consejo antitabaco: el 24,66% como PDM, el 31,51% como CS y en el 43,84% no consta ninguno de ellos. El 21,91% de los pacientes dejaron de fumar, recayeron el 9,67%. Se incorporaron al tabaquismo un 5,50% de nuevos fumadores. La probabilidad de abandonar el tabaquismo es mayor en los hombres OR (hombre/mujer) = 3,5; y en fumadores con riesgo cardiovascular añadido OR (GRCV/sanos) = 2,63. La OR PDM/CS es 3,69. Conclusiones: Nuestro PDM es eficaz como instrumento en la intervención sobre pacientes fumadores, al ser más intensa consigue mejores resultados que el consejo simple (AU)

Background: Counselling from Primary Health Care specialists may achieve better results in assisting patients to stop smoking. Objectives: Determine the effectiveness of direct, thorough counselling with help of our Minimum Data Protocol (MDP) as opposed to the more widespread generic advice. Data collection means and analysis: Random sample of 227 patients(+ 16 years old) from the Felipe II Primary Health Care Centerat Móstoles, Madrid, 71 smokers (19 presence in other cardiovascular risk groups). The choice of data to be collected was taken based on theRecommendations on the Diagnostic and Therapeutic Approach toSmokers (RDTAS) and were added: age, sex, kind of counselling (brief counselling, thorough and MDP, or no advice at all), presence in other cardiovascular risk groups, together with rate of smoking cessation, new smokers, smoking relapse, months of abstinence, time lapse between last interview and smoking cessation. Upon these data we estimated ratios, averages and odds ratios (OR) with a 95% Confidence Interval. Main results: 1) 56,17% of smokers were given advice for smoking cessation. 31,51% were given brief advice, 24,66% using MDP and43,84% were not advised at all. 2) The rate of smoking cessation was of21,91%; the rate of new smokers was of 5,50%; and the relapse ratio9, 67%. 3) Man/woman ratio of smoking cessation odds: 3,50; cardiovascular risk group OR: 2,63; MDP/ brief counselling OR of 3,69. Conclusions: Our statistical analysis proves that the usage of thisMDP works as a better means of assisting smokers in their attempt to stop smoking, than the mere advice which is already common use. We have seen that the more strong and individualized the counselling is, the better its results are (AU)

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