RESUMEN

Introdução: As quinolonas, amplamente usadas na prática clínica, correspondem à segunda causa de reações de hipersensibilidade aos antibióticos. Reações às quinolonas (RQ) são um desafio para o alergista, pois ocorrem por mecanismos IgE mediados, mas também por uma via não imunológica, o receptor MRGPRX2. Objetivo: Este trabalho avalia a reatividade cutânea de pessoas sem alergia ao ciprofloxacino em diversas concentrações. Metodologia: Foram realizados prick tests (PT) e testes intradérmicos de leitura imediata (ID) com ciprofloxacino em voluntários atendidos em um ambulatório de serviço terciário. No PT, foram usadas concentrações de 2 mg/mL (solução mãe), 1:10 e 1:50. No ID, 1:10, 1:50, 1:100 e 1:500. Resultados: Foram incluídos 31 indivíduos sem histórico de RQ. A média de idade foi de 40,5 anos, sendo 74,1% do gênero feminino. Doenças atópicas foram encontradas em 48,4% dos participantes, 100% destes com rinite alérgica, 20% com conjuntivite alérgica, 13,3% com asma, e 13,3% com dermatite atópica. Uso prévio de quinolonas foi relatado por 45,2% dos indivíduos. O PT puro e 1:10 foi positivo em 25,8% e 6,5%, respectivamente; na concentração 1:50 não mostrou positividade. O ID 1:10, 1:50 e 1:100 foi positivo em 96,8%, 45,2% e 6,5%, respectivamente, mas foi negativo na diluição 1:500. Nos que já usaram quinolonas, o PT puro e 1:50 foram positivos em 28,6% e 14,3% dos participantes, respectivamente, versus 25% e 0% nos que não usaram. O ID entre os indivíduos que já usaram foi positivo em 100% na diluição 1:10, 57,1% na 1:50, e 14,3% na 1:100. Entre os que não usaram, 93,7% na diluição 1:10, 37,6% na 1:50, e 0% na 1:100. Nos atópicos, o PT foi positivo em 26,7% e 13,3% na concentração mãe e 1:10; e negativo em 1:50. Nos participantes não atópicos, observou-se positividade de 25% no PT com a solução mãe e testes negativos nas demais diluições. O ID com as soluções 1:10, 1:50 e 1:100 foi positivo em 100%, 46,7% e 6,7% dos atópicos, e 93,7%, 43,7%, 6,3% nos não atópicos, respectivamente. Conclusão: O ciprofloxacino apresenta reatividade cutânea através de vias imunológicas e pelo MRGPRX2, sendo recomendada a realização de testes cutâneos em concentrações igual ou menores de 0,02 mg/ mL para investigação de reações de hipersensibilidade imediata, pois essas concentrações apresentam boa especificidade.

Introduction: Quinolones, widely used in clinical practice, are the second leading cause of antibiotic hypersensitivity. Hypersensitivity to quinolone poses a challenge for allergists, as it occurs through immunoglobulin E (IgE)-mediated mechanisms as well as nonimmunologic ones (specifically the MRGPRX2 receptor). Objective: To assess cutaneous hypersensitivity to ciprofloxacin at different concentrations. Methodology: Skin prick test (SPT) and immediate-reading intradermal test (IDT) with ciprofloxacin were performed on volunteers treated at a tertiary outpatient clinic. Concentrations of 2 mg/mL (main solution), 1:10, and 1:50 were used for the SPT, and concentrations of 1:10, 1:50, 1:100, and 1:500 were used for the IDT. Results: Thirty-one individuals with no history of hypersensitivity to quinolone were included, of whom 74.1% were women. Mean patient age was 40.5 years. Atopic diseases were found in 48.4% of participants, of whom 100% had allergic rhinitis, 20% had allergic conjunctivitis, 13.3% had asthma, and 13.3% had atopic dermatitis. Previous quinolone use was reported by 45.2%. SPT performed with the main solution and 1:10 dilution was positive in 25.8% and 6.5% of cases, respectively, whereas SPT with 1:50 dilution was negative in all cases. IDT performed with 1:10, 1:50, and 1:100 dilutions was positive in 96.8%, 45.2%, and 6.5% of cases, respectively, but negative with 1:500. Among the individuals who had used quinolones, SPT with main solution and 1:50 dilution was positive in 28.6% and 14.3% of cases, respectively, compared with 25% and 0% in those who had not used quinolones. Among those who had used quinolones, IDT results were positive in 100% at 1:10, 57.1% at 1:50, and 14.3% at 1:100. Among those who had not used quinolones, IDT results were positive in 93.7% at 1:10, 37.6% at 1:50, and 0% at 1:100. In atopic individuals, SPT was positive in 26.7% with the main solution and 1:10 dilution, and negative with 1:50. Among nonatopic individuals, 25% had a positive SPT with the main solution, and the remaining individuals were negative. IDT results with 1:10, 1:50, and 1:100 dilutions were positive, respectively, in 100%, 46.7%, and 6.7% of atopic individuals and in 93.7%, 43.7%, and 6.3% of nonatopic individuals. Conclusion: Ciprofloxacin triggers cutaneous hypersensitivity via immunologic mechanisms and the MRGPRX2 receptor. It is recommended that skin tests be performed at a dilution of 1:100 or greater to investigate immediate hypersensitivity.

Asunto(s)

RESUMEN

Allergic dogs are commonly sensitized to food allergens. We evaluated the use of the prick test to diagnose food allergies in dogs with pruritus and the efficacy of an exclusion diet based on the test. The prick test was performed in 10 healthy dogs and 34 dogs with pruritus, of which 25 received an exclusion diet for 60 days and was challenged with positive food on the test. pVAS and CADESI-4 were assessed on days 0, 30, and 60 after re-exposure. As a result, two control group dogs reacted to a single food allergen, milk and wheat. Of the 25 dogs with pruritus that reacted to food allergens, 24 (96%) reacted to more than one food allergen, and only one (4%) reacted to a single food protein: pork. In the test group (n=25), there was a significant improvement of pVAS and CADESI-4 after 30 and 60 days of dietary exclusion, with significant worsening of the scores with food allergen challenge. In conclusion, the prick test can be used for screening food allergens to make an exclusion diet.

Cães alérgicos são comumente sensibilizados a alérgenos alimentares. Nós avaliamos o uso do teste de puntura para o diagnóstico de alergias alimentares em cães com prurido e a eficácia de uma dieta de exclusão baseada no teste. O teste de puntura foi realizado em 10 cães saudáveis e em 34 cães com prurido, dos quais 25 receberam uma dieta de exclusão por 60 dias e depois desafiados com o alimento que foi positivo no teste. pVAS e CADESI-4 foram realizados nos dias 0, 30, 60 e depois da reexposição. Como resultados, dois cães do grupo controle reagiram a um único alérgeno alimentar, leite e trigo. Dos 25 cães com prurido que reagiram aos alérgenos alimentares, 24 (96%) reagiram a mais de um alérgeno alimentar e apenas um (4%) reagiu a uma única proteína, que foi porco. No grupo teste (n=25), houve uma significativa melhora do pVAS e CADESI-4 depois de 30 e 60 dias de dieta de exclusão, com significante piora dos scores com o desafio alimentar. Como conclusão, o teste de puntura pode ser usado para selecionar alérgenos alimentares para fazer uma dieta de exclusão.

Asunto(s)

RESUMEN

This study aims to evaluate the sensitization distribution of aeroallergens in patients with allergic conjunctivitis (AC) living in a temperate subhumid region and to describe the prevalence in a Mexican cohort. A total of 761 patient records were revisited, including the results of the skin prick test (SPT) for 45 aeroallergens. We found 292 patients with AC and a positive SPT in a 5-year period. The most frequent aeroallergens include dust mites (69.2% for Dermatophagoides pteronyssinus and 47.6% for Dermatophagoides farinae), trees (36% for cypress and 22.6% for ash), animals (33.9% for dogs and 26.7% for cats), and grasses (21.2% for Paspalum notalum and 19.9% for Poa pratensis). Among the studied population, a prevalence of 38.4% for the disease was calculated. House dust mites were responsible for most sensitizations found in the studied population. There is a high prevalence of AC in the selected cohort during the period studied.

RESUMEN

INTRODUCTION: People who live in highly allergenic regions have a greater risk of being sensitized; therefore, these areas have a higher prevalence of mono and polysensitized patients. The aim of the present study was to investigate the allergen sensitization profiles in patients with asthma in an agricultural zone in Mexico. METHODS: An analytical cross-sectional study was conducted in a secondary care hospital in Obregon City, Mexico. The allergen sensitization pattern profiles were analyzed through a skin prick test (SPT) in 294 patients. Data was collected before SPT: asthma control was classified according to the Global Initiative for Asthma Criteria, nutritional status was assessed with the Body Mass Index (BMI) using Quetelet's index (BMI = weight/height2), and comorbidities, asthma, and smoking habits were collected from the patients' medical records. RESULTS: In this study, in a group of adults with asthma, the prevalence of sensitization was 77%. The most frequent categories of aeroallergens were in indoors, in zones with weeds and abundant trees. A low proportion of monosensitized patients (2%) was observed. House dust mites were the most common allergens. CONCLUSIONS: Our study describes the sensitization pattern among asthma patients. This study will help identify the panel of most common allergens in this region of Mexico, and aid in selection of specific treatment through immunotherapy.

Asunto(s)

RESUMEN

INTRODUCTION: Cow's milk protein allergy (CMA) is the most common type of food allergy in childhood and exclusion diet is a challenge for patients. OBJECTIVE: The study aim was to investigate the frequency of tolerance to baked foods containing milk and evaluate immediate skin prick test (SPT) and specific IgEs for different cow's milk (CM) protein types as predictors of tolerance to baked foods containing milk for CMA patients. METHODS: A cross-sectional study was performed. Fifty-four CMA patients were enrolled and oral food challenge (OFC) was performed with baked product, 6 different milk SPTs and specific IgEs to CM, casein, α-lactalbumin, and ß-lactoglobulin. RESULTS: Thirty-nine (72.2%) patients tolerated OFC with baked milk cupcake. CM-specific IgE and casein SPT showed statistical difference between positive and negative OFC groups. Probability curves for baked milk tolerance were created for specific CM IgE (Z = 2.542, p < 0.0110) and casein SPT (Z = 2.290, p < 0.0220) using logistic regression. CONCLUSIONS: The high percentage of patients able to tolerate baked goods enables an improvement in intake possibilities and quality of life of CMA patients and families. Specific CM IgE and casein SPT demonstrated to be useful predictors in relation to baked milk tolerance.

Asunto(s)

RESUMEN

OBJECTIVES: Nasal specific IgE (NsIgE) is the most common marker to identify type-2 inflammation in local allergic rhinitis (LAR). However, the comparison of NsIgE in different types of rhinitis, its frequency in tropical countries, and its diagnostic performance for predicting the outcome of a nasal challenge test (NCT) has had limited study. The main objective of this study was to explore the diagnostic performance of NsIgE to Dermatophagoides pteronyssinus (Der p) among different types of rhinitis and control subjects in a tropical population. METHODS: We evaluated the frequency of NsIgE, systemic atopy (serum sIgE and Skin Prick Test), and nasal eosinophils, and we performed nasal challenge tests (NCTs) with Der p in 3 groups of patients; rhinitis without atopy (RWoA) (n = 25), rhinitis with atopy (RWA) (n = 25), and control subjects (n = 18). RESULTS: NsIgE had a low sensitivity and specificity to predict a positive NCT in the RWoA group: 48% had NsIgE, but only 28% had a positive NCT. Among the RWA group 84% had NsIgE and 80% had a positive NCT; the association of NsIgE and positive NCT was high (>80%). In the control group 27.8% had NsIgE, but none had a positive NCT. CONCLUSIONS: NsIgE performs poorly in predicting NCT results in patients with non-allergic rhinitis. More methodical investigations are needed in this complex area of rhinitis. In patients with allergic rhinitis, NsIgE was useful in predicting a positive nasal challenge, but not superior to the systemic atopic test.

RESUMEN

The skin prick test is used to diagnose patients' sensitization to antigens through a mediated IgE response. It is a practical and quick exam, but its diagnosis depends on instruments for measuring the allergic response and observer's interpretation. The conventional method for inferring about the allergic reaction is performed from the dimensions of the wheals, which are measured using a ruler or a caliper. To make this diagnosis less dependent on human interpretation, the present study proposes two alternative methods to infer about the allergic reaction: computational determination of the wheal area and a study of the temperature variation of the patient's skin in the puncture region. For this purpose, prick test using histamine was performed on 20 patients randomly selected. The areas were determined by the conventional method using the dimensions of the wheals measured with a digital caliper 30 min after the puncture. The wheal areas were also determined by a Python algorithm using photographs of the puncture region obtained with a smartphone. A variable named circularity deviation was also determined for each analyzed wheal. The temperature variation was monitored using an infrared temperature sensor, which collected temperature data for 30 min. All results were statistically compared or correlated. The results showed that the computational method to infer the wheal areas did not differ significantly from the areas determined by the conventional method (p-value = 0.07585). Temperature monitoring revealed that there was a consistent temperature increase in the first minutes after the puncture, followed by stabilization, so that the data could be adjusted by a logistic equation (R2 = 0.96). This adjustment showed that the optimal time to measure the temperature is 800 s after the puncture, when the temperature stabilization occurs. The results have also shown that this temperature stabilization has a significant positive correlation with wheal area (p-value = 0.0015). Thus, we concluded that the proposed computational method is more accurate to infer the wheal area when compared to the traditional method, and that the temperature may be used as an alternative parameter to infer about the allergic reaction.

Asunto(s)

RESUMEN

BACKGROUND: Improved understanding of the normal range of blood eosinophil counts (BEC) and conditions that influence them in non-asthmatic individuals should allow more accurate estimation of the threshold at which eosinophilic disease should be considered, diagnosed, and treated. This analysis investigated the impact of atopy, smoking, and parasitic infection on BEC. METHODS: This was a post hoc analysis of non-asthmatic subjects from a case-control study (CONEP 450/10) conducted at the Program for Control of Asthma in Bahia (ProAR). Participant BECs were measured at baseline; correlations between predefined risk factors and BEC were assessed via univariate and stratified analysis. RESULTS: Of the 454 participants included, 3% were helminth parasite-positive, 18% were non-helminth parasite-positive; and 450 had BEC data. The median (interquartile range [IQR]) BEC was 152 (96, 252) cells/µL. Any positive skin prick test, elevated total immunoglobulin E, allergic rhinitis, and being a current smoker were all individually associated with higher BEC (p < 0.05) compared with BEC in participants without these factors, but having a non-helminthic parasitic infection was not. Participants with all 4 risk factors that were associated with higher BEC had a median (IQR) BEC of 192 cells/µL (94, 416) versus 106 cells/µL (70, 164) for those with no risk factors. CONCLUSIONS: In non-asthmatic subjects, atopy, allergic rhinitis, and current smoking status were associated with higher BEC compared with subjects without these factors, but BEC values were well below the threshold commonly accepted as normal. Therefore, BEC should be interpreted in the context of an individual's medical conditions and other BEC-influencing factors.

RESUMEN

BACKGROUND: Grass pollinosis is an important contributor to allergic diseases, with varying patterns and frequency of allergens according to the geographical location studied. Our study aims to provide a better understanding of subtropical grass pollinosis in Argentinian patients with seasonal allergic rhinitis. METHODS: We conducted a retrospective cross-sectional study involving 894 patients with seasonal allergic rhinitis from Bahía Blanca, Argentina. Skin prick tests were performed to selected pollen species belonging to three subfamilies of the Poaceae genera. Frequency of sensitization to specific grass pollen extracts, cross-reactivity of allergens assessed by skin prick test, and possible associations between allergen extracts and asthma or allergic conjunctivitis were analyzed. RESULTS: Sensitization to the Pooideae subfamily was the most frequent, encompassing 86.8% (CI: 84.4%-88.9%) of the studied population. Positive reactions to allergen extracts from the Chloridoideae and the Panicoideae subfamilies showed smaller papule size than allergen extracts from the Pooideae subfamily (χ2(5) = 83.75, p < 0.001). Patients with a positive skin prick test (SPT) to a specific extract were more likely to present some degree of cross-reactivity to the remaining pollens when compared to patients with negative SPT to the same specific extract. Even though the proportion of patients presenting with asthma (46.9%) was higher than those with conjunctivitis (22.6%), there was only a statistically significant association between sensitization to Festuca arundinacea (φ = 0.089, p = .009), Phalaris arundinacea (φ = 0.074, p = .032) and Paspalum notatum (φ = 0.070, p = .038) and the presence of conjunctivitis. CONCLUSIONS: Our results suggest a high frequency of sensitization to grass pollen extracts from the Poaceae family among patients with seasonal allergic rhinitis. Overall, sensitization to the Pooidae subfamily was the most common, where Phalaris arundinacea presented the highest frequency.

RESUMEN

BACKGROUND: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.

Antecedentes: En México, la inmunoterapia con alérgenos (ITA) y con veneno de himenópteros (VIT) se practica tradicionalmente combinando criterios de las escuelas europea y estadounidense; los dos tipos de extractos están comercialmente disponibles en México. Para una ITA adecuada es crucial un diagnóstico oportuno. Objetivo: Presentar GUIMIT 2019, Guía Mexicana de Inmunoterapia 2019, de base amplia, actualizada, que abarca temas de diagnóstico, indicaciones, dosificación, mecanismos, efectos adversos de la ITA y expectativas con esta modalidad de tratamiento. Método: Con la participación de múltiples grupos mexicanos de alergólogos, que incluían los centros formadores universitarios en alergia e inmunología, se desarrolló el documento de la guía según la metodología ADAPTE. Las guías de inmunoterapia de la European Academy of Allergy and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology, German Society for Allergology and Clinical Immunology y del American College of Allergy, Asthma, and Immunology se seleccionaron como guías fuente, ya que recibieron la puntuación AGREE-II más alta entre las guías internacionales disponibles; su evidencia conforma la base científica de GUIMIT 2019. Resultados: En GUIMIT 2019 se emiten recomendaciones fuertes o débiles (sugerencias) acerca de temas directamente relacionados con el diagnóstico in vivo o in vitro de las enfermedades alérgicas mediadas por IgE, la preparación y aplicación de ITA o VIT y sus efectos adversos; se incluye la revisión de las modalidades de ITA para el futuro. Todos los argumentos que se exponen fueron discutidos y votados con > 80 % de aprobación. Conclusión: Un grupo amplio y diverso de expertos en ITA y VIT emitió recomendaciones transculturizadas basadas en evidencia, que alcanzaron consenso; con ellas se pretende mejorar y homologar la práctica de la inmunoterapia en México.

Asunto(s)

RESUMEN

BACKGROUND: The skin prick test is recognized as the gold standard for the specific diagnosis of allergy. OBJECTIVE: To determine the sensitivity and specificity of the epicutaneous patch test that has been modified for the diagnosis of respiratory allergy to Dermatophagoides pteronyssinus. METHODS: An observational, interpretative, prolective, and transversal study. The included patients were between 6 and 49 years old, with symptoms of a respiratory allergy, and a skin test was performed on them by using the European standardized prick test and a modified epicutaneous patch test with the variable of the scarification that occurred before the antigen was applied, and its homogenization with a wooden applicator, which occurred after the antigen was applied. The levels of sensitivity, specificity, and prevalence influence and positive and negative predictive values were calculated. RESULTS: 104 patients were included, of which 72 (69.2%) were women. The age category of the patients was 24 ± 11.3 years of age. 78.9% of the patients were diagnosed with allergic rhinitis, 1.9% were diagnosed with asthma, and 19.2% were diagnosed with both rhinitis and asthma. The prevalence of the respiratory allergy to Dermatophagoides pteronyssinus was of 62.5%; 94.23% with a correct diagnosis. The sensitivity and specificity of the test was of 93.85% and 94.87%; the positive and negative predictive values were of 96.83% and 90.24%, and the positive and negative likelihood ratios were of 18.30 and 0.06. CONCLUSIONS: The modified epicutaneous patch test was highly sensitive and specific; it decreased the risk of allergen carryover and it lowered the cost of the material that was used.

Antecedentes: La prueba por punción cutánea es el estándar de oro en el diagnóstico específico de alergia. Objetivo: Determinar sensibilidad y especificidad de la prueba epicutánea modificada para el diagnóstico de alergia respiratoria a Dermatophagoides pteronyssinus. Métodos: Estudio observacional, interpretativo, prolectivo y transversal. Se incluyeron pacientes de seis a 49 años de edad, con cuadro clínico de alergia respiratoria, en quienes se realizó punción cutánea con técnica europea y prueba epicutánea con la variante de escarificación previa a la aplicación del antígeno y posterior homogenización del mismo con aplicador de madera. Se calculó sensibilidad, especificidad, influencia de la prevalencia, valores predictivos positivo y negativo. Resultados: Se incluyeron 104 pacientes, 72 (69.2 %) del sexo femenino. La edad fue de 24 ± 11.3 años, 78.9 % tuvo diagnóstico de rinitis alérgica, 1.9 % de asma y 19.2 % de rinitis y asma. La prevalencia de alergia respiratoria a Dermatophagoides pteronyssinus fue de 62.5 %; 94.23 % estaba correctamente diagnosticado. La sensibilidad y especificidad de la prueba fue de 93.85 y 94.87 %, los valores predictivos positivo y negativo de 96.83 y 90.24 % y los cocientes de probabilidades positivo y negativo de 18.30 y 0.91. Conclusiones: La prueba epicutánea modificada fue altamente sensible y específica, disminuyó el riesgo de contaminación por arrastre de alérgenos y los costos en el material utilizado.

Asunto(s)

RESUMEN

BACKGROUND: Allergic rhinitis is the most common allergic disease worldwide and it is caused by a reaction of hypersensitivity to aeroallergens. To our knowledge, there aren't any previous studies of aeroallergenic sensitization in Aguascalientes, Mexico. OBJECTIVE: To describe the sensitization to aeroallergens in patients with allergic rhinitis who have been treated at a private clinic in Aguascalientes, Mexico. METHODS: A descriptive, cross-sectional and retrospective study was done in which patients diagnosed with allergic rhinitis were included. Skin prick tests with 32 allergenic extracts were carried out and the frequencies at each were determined. RESULTS: In total, 350 patients were analyzed. The most frequent aeroallergens were grass pollens (74.8%), followed by tree pollens (64.8%) and dust mites Dermatophagoides pteronyssinus (64%). The group of patients under 20 years of age was predominant (67.1%), followed by the group of 21 to 40 years old (22.5%). CONCLUSIONS: This research provides information about regional patterns of sensitization, which shall facilitate diagnostic tests in the region and the best practices of specific immunotherapy.

Antecedentes: La rinitis alérgica es la enfermedad alérgica más común en el mundo y es causada por hipersensibilidad a los aeroalérgenos. Hasta donde sabemos, no hay estudios previos de sensibilización aeroalergénica en Aguascalientes, México. Objetivo: Describir la sensibilización a aeroalérgenos en pacientes con rinitis alérgica tratados en una clínica privada en Aguascalientes, México. Métodos: Estudio descriptivo, transversal y retrospectivo; se incluyeron pacientes diagnosticados con rinitis alérgica. Se realizaron pruebas cutáneas con 32 extractos alergénicos y se determinaron las frecuencia de reacción a cada uno. Resultados: En total se analizaron 350 pacientes. Los aeroalérgenos más frecuentes fueron los pólenes de pastos (74.8%), seguidos por los pólenes de árboles (64.8%) y Dermatophagoides pteronyssinus (64%). El grupo de edad predominante fue el menor de 20 años (67.1%), seguido del grupo de 21 a 40 años (22.5%). Conclusión: La investigación proporciona información sobre los patrones regionales de sensibilización, que facilitará las pruebas de diagnóstico en la región y las mejores prácticas de inmunoterapia específica.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: The aim of this study was to evaluate the positivity rates of atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis in patients with respiratory diseases such as asthma and allergic rhinitis with or without atopic dermatitis. METHODS: The patients' clinical histories were collected, and the patients were subjected to skin prick and patch tests with the three different house dust mites on the same day. The patch tests were examined 48 hours later, and then patients were divided into two groups: I- patients with respiratory diseases, such as asthma and/or rhinitis, and atopic dermatitis and II-patients with only respiratory diseases. A total of 74 patients ranging in age from 2 to 60 years were included in this study; 16 patients were included in group I and 58 were included in group II. This study was approved by the human ethics committee of the Faculty of Medical Science and Health SUPREMA (number 2.007.135), and written informed consent was collected from each patient or their parents prior to enrollment. RESULTS: In the skin prick tests, the most prevalent mite that evoked a reaction was Dermatophagoides pteronyssinus, followed by Dermatophagoides farinae and Blomia tropicalis. Regarding the atopy patch tests, the mite that most frequently induced a positive reaction was Dermatophagoides farinae (78.4%), followed by Dermatophagoides pteronyssinus (77%) and Blomia tropicalis (52.7%). A comparison of the skin prick and atopy patch tests revealed that 53 patients (71.6%) were positive on both tests, and 30 (56.6%) patients were positivite for the same mite. We found six patients (8%) who had a positive clinical history of allergy and only exhibited positivity on the atopy patch test. DISCUSSION: Most studies have been performed with atopic dermatitis patients, but in this study, most of the patients had respiratory conditions. Blomia tropicalis is a mite that is prevalent in tropical areas, such as Brazil, and only two publications include these three mites, wich are present in Brazil. The APT may produce positive results in concordance with the SPT resuts, but may also be the only positive test ( 8%) as we observed in our study. These results suggest that the mite atopy patch test is relevant and should be considered as an additional test for patients with clinical histories of allergic respiratory disease who have negative prick test results. CONCLUSION: The APT should be considered as an additional test when the SPT and specific serum IgE tests are negative in patients with clinical histories of allergies.

RESUMEN

BACKGROUND: Food allergy is a public health problem that has increased in the last decade. Despite the increasing rates in children, quality data on the burden of these diseases is lacking particularly in developing countries. Honduras has no studies in pediatric patients. OBJECTIVES: The objective of this research was to identify the most common sensitization patterns to food through epicutaneous skin testing and food allergy rates in children and their correlation with common allergic diseases in a group of patients from Hospital of Pediatrics Maria. METHODS: Cross-sectional retrospective, descriptive study in which records and database of all allergic patients in the immunology outpatient clinic from Hospital of Pediatrics Maria were reviewed between the periods of January 2015 through June 2016. RESULTS: A total of 365 children were analyzed, the age of participants were in the range from 1 to 18 years, with an average of 9.8 years. Sensitization to food allergens were found in 23, and 58.3% were poly-sensitized. The most common food allergens that patients were sensitized to: milk 9.0%, eggs 6.9%, peanut 4.9% and pork meat 4.4%. Food allergy was confirmed via oral food challenged in 9.3% of the patients. The most frequent food allergies found were: cow's milk allergy 6%, hen's egg allergy 5.2% and wheat allergy 1.9%. CONCLUSIONS: Milk and egg were the most common a food allergens found in the population studied. Most of the patients were found to be poly-sensitized. The frequent food allergies confirmed via oral food challenge were cow's milk allergy, hen's egg allergy and wheat allergy.

RESUMEN

INTRODUCCIÓN: La rinitis alérgica (RA) es una enfermedad inflamatoria de la mucosa nasal mediada por IgE. Existen controversias en los diferentes estudios acerca de la relación entre la gravedad de los síntomas de RA y la magnitud de la sensibilización medidas por pruebas cutáneas con alergenos. OBJETIVOS: Relacionar la magnitud de sensibilización alérgica con los grados clínicos de la RA. POBLACIÓN Y MÉTODO: Estudio Observacional, analítico y transversal, que incluyó pacientes de ambos sexos, entre 6 y 18 años con diagnóstico de RA. Se clasificaron según el grado clínico establecido por Allergic rhinitis and its impact on asthma (ARIA). La sensibilización alérgica se midió a través de pruebas cutáneas por puntura con aeroalergenos y se determinó su magnitud según: PC1 (número de alérgenos positivos), PC2 (sumatoria de milímetros de pápulas) e Índice de atopía (relación entre PC2/PC1). Se dividieron según la presencia de monosensibilización y/o polisensibilización. ANÁLISIS ESTADÍSTICO: Se realizó estadística descriptiva y analítica utilizando prueba de Wilcoxon Mann Withney y prueba de Kruskal Wallis. Se consideró un valor significativo a una p<0,05. RESULTADOS: Se incluyeron 156 pacientes con una mediana de edad de 11,18 años (5-18,66 años). No se encontró diferencia en los valores de PC1, PC2 ni en el índice de atopía entre los cuatro grados clínicos de rinitis (p=0,3370, p=0,2222 y p=0,8774 respectivamente). Tampoco se observó diferencia en el índice de atopia entre los pacientes monosensibilizados y polisensibilizados (p=0,5493). Al comparar la rinitis según la frecuencia no se encontró diferencia en los valores de PC1, PC2 ni en el índice de atopía entre los grupos intermitente y persistente (p=0,0810; p=0,0587 y p=0,5705). Con respecto a la gravedad de la rinitis no se encontró diferencia en los valores de PC1, PC2 ni en el índice de atopía entre los grupos leve y moderado/grave (p=0,5693; p=0,1653 y p=0,4613). CONCLUSIONES: Las pruebas cutáneas por puntura de lectura inmediata no son un método diagnóstico capaz de diferenciar los grados clínicos de rinitis. (AU)

INTRODUCTION: Allergic rhinitis (RA) is an inflammatory disease of nasal mucosal mediated by IgE. There are controversies in the different studies about the relationship between the severity of RA symptoms and the magnitude of sensitization measured by skin tests with allergens. OBJECTIVE: Relate the magnitude of allergic sensitization to the clinical grades of AR. PATIENTS AND METHODS: In a observational, analytical and crosssectional study, we included patients aged 6 to 18 years with diagnosis of allergic rhinitis (RA). Were classified according to the clinical grade established by Allergic Rhinitis and its Impact on Asthma (ARIA) guide. Allergic sensitization was measured through skin prick test with aeroallergens and their magnitude was determined according to: PC1 (Number of positive allergens), PC2 (sum of millimeters of papules) and index of atopy (relation between PC2/PC1). The patients were divided in two groups according to the presence of monosensitization and/or polysensitization. RESULTS: We included 156 patients with a median age of 11,18 years (5-18,66 years). There were no difference in the values of PC1, PC2 or in the index of atopy between the clinical grades of rhinitis (p=0,337; p=0,2222 and p=0,8774 respectively). There was no difference in the index of atopy between monosensitized and polysensitized patients (p=0,5493). When comparing rhinitis according to the frequency, no difference was found in the values of PC1, PC2 or the index of atopy between the intermittent and persistent groups (p=0,0810; p= 0,0587 and p= 0,5705). Regarding the severity of rhinitis, no difference was found in the values of PC1, PC2 or in the index of atopy between the mild and moderate/severe groups (p=0,5693; p=0,1653 and p= 0,4613). CONCLUSIONS: Skin prick tests with aeroallergens are not a diagnostic method capable of differentiating the clinical grades of rhinitis. (AU)

Asunto(s)

RESUMEN

BACKGROUND: Allergic diseases are a public health problem; estimates indicate that between 30% and 40% of the world population is affected by some allergy. Knowing the prevalence of allergen sensitization allows for adequate diagnoses and treatments to be offered. In Honduras there are no studies available in pediatric patients. OBJECTIVE: The purpose of this research was to identify the most common types of sensitization in children and their correlation with the most common allergic diseases in patients on immunotherapy at the Maria Hospital of Pediatric Specialties. METHODS: Cross-sectional, descriptive, retrospective study in which medical records and databases of patients on allergic immunotherapy at the Maria Hospital of Pediatric Specialties were reviewed between January 2015 and June 2016. RESULTS: 215 children on immunotherapy were assessed; ages ranged from 3 to 18 years, with a mean of 10.8 years. Aeroallergen-positive epicutaneous tests were identified in 73.02%. The most common aeroallergens were Dermatophagoides farinae and Dermatophagoides pteronyssinus mix (96.74%), American cockroach 37.21%, and Aspergillus fumigatus and Homodenderum cladosporioides (16.28%). CONCLUSION: House dust mites and American cockroach were the most common causes of sensitization in patients on immunotherapy.

Antecedentes: Las enfermedades alérgicas constituyen un problema de salud pública; se estima que entre 30 y 40 % de la población mundial se encuentra afectada por alguna. Conocer la prevalencia de sensibilización a alérgenos permite ofrecer diagnósticos y tratamientos adecuados. En Honduras no se cuenta con estudios en pacientes pediátricos. Objetivos: El objetivo de esta investigación fue identificar el tipo de sensibilización más frecuente en los niños y su correlación con las enfermedades alérgicas más frecuentes en los pacientes en inmunoterapia del Hospital María de Especialidades Pediátricas. Métodos: Estudio retrospectivo transversal descriptivo en el cual se revisaron los expedientes y base de datos de los pacientes en inmunoterapia alérgica del Hospital de Especialidades Pediátricas María entre enero de 2015 y junio de 2016. Resultados: Se evaluaron 215 niños en inmunoterapia, las edades oscilaron entre 3 y 18 años, con una media de 10.8 años. Se identificó que 73.02 % tenía pruebas epicutáneas positivas a aeroalérgenos. Los aeroalérgenos más frecuentes fueron Dermatophagoides farinae y Dermatophagoides psterossynium mix (96.74 %), cucaracha americana (37.21 %) y Aspergillus fumigatus y Homdonderum cladosporioides (16.28 %). Conclusiones: Los ácaros domésticos y la cucaracha americana constituyeron la mayor causa de sensibilización en pacientes en inmunoterapia.

Asunto(s)

RESUMEN

BACKGROUND: Allergic diseases diagnosis must be based on adequate allergological anamnesis and an immunological sensitization test; the most sensitive and specific is the skin prick test. OBJECTIVE: To determine the frequency of skin reactivity to aeroallergens, by age groups, in patients of the Department of Allergy and Clinical Immunology of the Hospital Universitario de Puebla, in Mexico. METHODS: A cross-sectional study was conducted that included patients aged 2 to 64 years with symptoms suggestive of allergic disease, in which skin prick tests with aeroallergens were performed; the diagnostic criteria were those of international guidelines. Frequencies, percentages and dispersion measures were calculated. RESULTS: Of 173 patients, 63 % were females. Mean age was 22.3 years. The frequency of skin reactivity for Quercus sp. was 12.72 %, for Periplaneta americana, 9.83 %, for Dermatophagoides farinae, 9.25 %, for Cynodon dactylon, 8.09 %, for Blatella germanica, 8.09 %, for Holcus halepensis, 6.94 %, for Dermatophagoides pteronyssinus, 6.36 %, for Schinus molle, 5.78 %, for Fraxinus uhdei, 5.20 %, for Lolium perenne, 5.20 %, for Ambrosia eliator, 5.20 % and for Artemisa tridentata, 4.62 %. CONCLUSION: Although Dermatophagoides are the most frequently reported aeroallergens, the most common aeroallergen in this study was pollen, probably owing to geographical and environmental factors, although this was not observed in the analysis by age groups.

Antecedentes: El diagnóstico de las enfermedades alérgicas debe basarse en la historia clínica alergológica adecuada y en una prueba inmunológica de sensibilización; la de mayor sensibilidad y especificidad es la prueba cutánea por punción. Objetivo: Determinar la frecuencia de la reactividad cutánea hacia aeroalérgenos, por grupos etarios, en pacientes del Servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla, México. Métodos: Se realizó estudio transversal que incluyó a pacientes de 2 a 64 años de edad, con síntomas sugestivos de enfermedad alérgica, en quienes se realizaron pruebas cutáneas con aeroalérgenos; los criterios diagnósticos fueron los de las guías internacionales. Se calcularon frecuencias, porcentajes y medidas de dispersión. Resultados: De 173 pacientes, 63 % fue del sexo femenino. La edad media fue de 22.3 años. La frecuencia de la reactividad cutánea para Quercus sp. fue 12.72 %, Periplaneta americana 9.83 %, Dermatophagoides farinae 9.25 %, Cynodon dactylon 8.09 %, Blatella germanica 8.09 %, Holcus halepensis 6.94 %, Dermatophagoides pteronyssinus 6.36 %, Schinus molle 5.78 %, Fraxinus uhdei 5.20 %, Lolium perenne 5.20 %, Ambrosia eliator 5.20 % y Artemisa tridentata 4.62 %. Conclusión: Los Dermatophagoides son los aeroalérgenos más identificados, pero en el presente estudio fue más común un polen, probablemente debido a factores geográficos-medioambientales, aunque no fue así en el análisis por grupos etarios.

Asunto(s)

RESUMEN

BACKGROUND: Allergic sensitization is dependent on the geographical and climatic conditions in each region; therefore, identify agents most commonly sensitized children with asthma is important for planning prevention measures. OBJECTIVE: To determine the prevalence of the sensitization to allergens in children with asthma. MATERIAL AND METHOD: This cross-sectional and prolective study includes children from ages 6 to 14, who have asthma, attended for the first time in an allergy service. The patients were recruited consecutively between the months of January 1st 2014 to December 31st 2014. The frequency of the allergen sensitization was estimated. RESULTS: This study included 186 children, the median age was 7 years olds, the male group was 104/186 (55.9%) The median of the positive results was 5 and monosensitized were 47/186 (2.2%). The most common category of allergens was the indoor (90.3%), then trees (71.0%), and finally the fungi (9.7%). Individually, the house dust mites were more common in between the interior allergens, followed by the epithelial; in the tree pollen were oaks (31.7%) and ashes (28.0%), in weeds was mugwort (21.5%), in grasses was Zea mays (18.3%) and in the fungi was Cladosporium spp. (6.5%). CONCLUSION: The high prevalence of the sensitization to house dust mites and epithelial in children with asthma, stimulates to implement methods of environmental control for contributing a better control of the disease.

Antecedentes: la prevalencia de rinosinusitis crónica en pacientes adultos con inmunodeficiencia común variable (IDCV) es de 52%. Los pacientes con esta enfermedad tienen mayor frecuencia de rinosinusitis crónica, enfermedad inflamatoria que afecta a la mucosa de uno o más senos paranasales y la cavidad nasal. Objetivo: identificar los microorganismos de secreción del meato medio obtenida por endoscopia asociados con rinosinusitis crónica en pacientes adultos con inmunodeficiencia común variable (IDCV). Material y método: estudio descriptivo, transversal, que incluyó a pacientes adultos con inmunodeficiencia común variable, de quienes se obtuvo una muestra vía endoscópica de secreción del meato medio de ambas fosas nasales, que se envió a cultivo para bacterias aerobias, anaerobias y hongos. Se obtuvo consentimiento informado de todos los pacientes. Resultados: se estudiaron 29 pacientes: 18 mujeres y 11 hombres, con edad promedio de 40±13 años. Los resultados obtenidos fueron: 2 muestras de pacientes no tuvieron desarrollo microbiano, 24 tuvieron desarrollo de bacterias aerobias, en 3 casos hubo crecimiento fúngico sin desarrollo de bacterias anaerobias. Conclusiones: nuestros resultados muestran que los microorganismos asociados con rinosinusitis crónica en pacientes adultos con inmunodeficiencia común variable más comunes son: Moraxella catarrhalis, Staphylococcus, Sphingomonas paucimobilis y Citrobacter koseri; los agentes micóticos asociados fueron: Candida albicans y Aspergillus fumigatus.

Asunto(s)

RESUMEN

BACKGROUND: Diagnostic options for immune reactions to mosquito bites are limited. In Cuba, IgE-mediated reactions are frequently related to Culex quinquefasciatus bite. OBJECTIVE: To determine the sensitivity and specificity of skin prick test with two doses of standardized extract in nitrogen protein units (PNU of Culex quinquefasciatus (BIOCEN, Cuba). MATERIAL AND METHOD: An analytical study was conducted on 100 children between 2 and 15 years old. Fifty atopic patients with a history of allergy to mosquito bite and positive specific serum IgE Culex quinquefasciatus and fifty atopic patients without a history of allergy to mosquito bite and negative specific serum IgE to Culex quinquefasciatus. Skin prick tests (SPT) were performed by duplicates on the forearms of the patients. Investigated doses were 100 PNU/mL and 10 PNU/mL. RESULTS: SPT with the highest concentration obtained a mean wheal size of 22.09 mm2 and for lower doses of 8.09 mm2, a statistically significant difference (p=0.001, Student's t test). Positive skin test correlated in 100% of patients with the presence of specific IgE. Testing with both doses showed a 94% of specificity and 88% of sensitivity. CONCLUSION: The diagnostic accuracy of SPT using both doses of standardized extract was similar, which justifies its use for diagnosis of sensitization to Culex quinquefasciatus in patients with symptoms of allergy to mosquito bite.

Antecedentes: las opciones diagnósticas de las reacciones inmunológicas a la picadura del mosquito son limitadas. En Cuba, las reacciones mediadas por IgE más frecuentes son por picadura de Culex quinquefasciatus. Objetivo: determinar la sensibilidad y especificidad de la prueba cutánea por punción con dos dosis del extracto estandarizado en unidades de nitrógeno proteico (UNP) de Culex quinquefasciatus (BIOCEN, Cuba). Material y método: estudio analítico efectuado en 100 niños entre 2 y 15 años de edad: 50 pacientes atópicos con antecedentes de alergia a la picadura de mosquito e IgE sérica específica positiva a Culex quinquefasciatus y 50 pacientes atópicos sin antecedentes de alergia a la picadura de mosquito e IgE sérica específica negativa a Culex quinquefasciatus. La prueba cutánea por punción se realizó por duplicado en los antebrazos de los pacientes. Las dosis investigadas fueron 100 y 10 UNP/mL. Resultados: en la prueba cutánea por punción con el extracto de mayor concentración se obtuvo un tamaño del área del habón de 22.09 mm2 y con la menor concentración de 8.19 mm2; una diferencia estadísticamente significativa (p=0.001, prueba t de Student). La prueba cutánea positiva se correlacionó en el 100% de los pacientes con la existencia de IgE específica. La prueba con ambas dosis mostró 94% de especificidad y 88% de sensibilidad. Conclusión: la alta coincidencia en el resultado de la prueba cutánea nos muestra que puede sustituirse la concentración del extracto a 100 UNP/mL por la de menor concentración, sin perder confiabilidad en el diagnóstico de sensibilización al mosquito Culex quinquefasciatus, utilizando ese método in vivo.

Asunto(s)