RESUMO
BACKGROUND: Atopic dermatitis is a skin inflammatory disease which has been associated to high levels of IgE, eosinophiles and change of T lymphocytes. The transfer factor is an immunomodulator active substance and decreases the number of inflammatory cells and the severity of the symptoms of atopic dermatitis. OBJECTIVE: To determine the efficacy of the transfer factor as treatment of moderate and severe atopic dermatitis. MATERIAL AND METHODS: Articles related to treatment with transfer factor in the atopic dermatitis were looked up in Medline and EMBASE, and the ones referring to controlled studies in patients with moderate and severe atopic dermatitis in accord to SCORAD. RESULTS: We found seven articles with 121 patients and 88 controls demonstrating significant decrease in the symptoms of the SCORAD index, decreased IgE, and eosinophils in patients treated with transfer factor. CONCLUSIONS: The transfer factor is a choice treatment for moderate and severe atopic dermatitis.
Assuntos
Dermatite Atópica/tratamento farmacológico , Fator de Transferência/uso terapêutico , Dermatite Atópica/imunologia , Humanos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: First reports on sublingual immunotherapy were published in 1980. OBJECTIVE: To compare safety and effectiveness of sublingual immunotherapy, as compared with placebo, in asthmatic patients. MATERIALS: In a blinded randomized controlled trial asthmatic patients with positive skin prick tests to Dermatophagoides pteronyssinus, and with serum IgE at least 200 UI were included. According to GINA, asthma severity was mild persistent and moderate. All patients improved their baseline FEV1 at least by 14% after inhaled albuterol. Spirometry was performed again after three and six months after initiating treatment. Patients were randomized to receive for six months either sublingual immunotherapy with Der p 1 standardized allergens (IPI-ASAC, México) at a total dose of 10,469 UBE or identically looking and tasting placebo. Both groups received conventional pharmacological therapy. RESULTS: Sixty four patients enter the study; four were excluded because of systemic oral steroid therapy. Sixty patients underwent randomization. Both groups (30 patients in each one) were similar in their baseline characteristics. After six months, patients that received sublingual immunotherapy had less exacerbations than those in the control group (61 vs 123, T 2.61, p<0.001, IC 1.8-7.2), better FEV1 as compared with baseline values (25% vs 9%, Z=0.66, p=0.03), and less need of albuterol (50% of initial dose, vs 21% (Z=1.4, p=0.03, IC 1.39-1.49). CONCLUSION: Sublingual immunotherapy improves patient symptoms and pulmonary functional tests, makes exacerbations less frequent, and reduces albuterol needs. It may improve asthma related quality of life.
Assuntos
Alérgenos/uso terapêutico , Asma/tratamento farmacológico , Asma/imunologia , Dermatophagoides pteronyssinus , Administração Sublingual , Adolescente , Adulto , Alérgenos/efeitos adversos , Dermatophagoides pteronyssinus/imunologia , Feminino , Humanos , Imunoterapia , Masculino , Pessoa de Meia-Idade , Método Simples-CegoRESUMO
BACKGROUND: Currently, the skin tests are the most accepted methods for the diagnosis of allergy to penicillin. OBJECTIVE: To evaluate the efficacy and diagnosis security of the skin tests with high and minor determinants of penicillin, crystalline and penicillin, in patients with hypersensitivity reaction to penicillin. METHODS: Patients with doubtful antecedents of reaction to penicillin (problem group) and healthy patients (control group) were included. Both groups were submitted at the following tests: 1) Skin tests with high and minor determinants of penicillin, and crystalline penicillin, by prick and intradermoreaction methods. 2) In case of negativity, tests of direct challenge with penicillin were practiced. The formation of wheal with or without erythema 3 mm related to the negative control or systemic reaction, was considered positive test. RESULTS: 47 patients were included (24 for problem group, and 23 for control group), 50% of the group problem showed positive reactions with the method of prick, none patient of the control group (p < 0.001); with the intradermoreaction method, 79% in the problem group and only 13.4% in the control group showed positive reaction (p < 0.001). Cutaneous tests showed local adverse effects. Clinical history showed a sensitivity or 88%, method of prick, 50%, and intradermoreaction method, 95%.
Assuntos
Hipersensibilidade a Drogas/diagnóstico , Epitopos , Penicilinas/efeitos adversos , Testes Cutâneos/métodos , Adolescente , Adulto , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/imunologiaRESUMO
AIMS: Incidence of gastroesophageal reflux (RGE) in asthmatic it is considered be of the rang of 33% until 89%. RGE can be classic or atypical and 30% will be payees of silent reflux. It considers at the moment so much as standard of gold to 24 hours pH esophagus like endoscopic digestive and biopsy, being determined a smaller sensibility to gastric gammagraphic but maybe a bigger utility in relation to their readiness and access easiness. OBJECTIVE: Comparative study is presented that reports sensibility/specificity of gastric gammagraphic, relating it with digestive endoscopic study and biopsy report. METHOD: All asthmatic patient of difficult control and of up to 6 years, selected of the External Consultation of the Service. Gastric gammagraphic was determined and later on the panendoscopic study with taking of biopsy. It integrated sensibility specificity for gammagraphic gastric. RESULTS: Study that understood 8 months, with a total of 44 patients, with a range of 1.4 year-old age to 6 years. Gastric gammagram was reported positive in 25 patients, (56.8%) and negative in 19,(43.18%). Endoscopic studies demonstrated incompetent hiatus in 33 (75%), esophagitis of variable degree in 20 patients, (45.4%), Gastritis in 8 (18.1%) and normal study in 8, (18.1%). Histopathologies: Esophagitis of variable degree in 33 patients (75%), chronic gastritis in 2 patients, (4.5%), Esophagus of Barrett in 2 patients, (4.5%), and normal histopathologic study in 7,(15.9%). Of the 44 patients, 81.5% showed significant reflux. It is integrated a sensibility and specificity of the gastric gammagraphic of 71.4% and 54.2%, respectively. CONCLUSIONS: Gastric gammagraphic contributes sensibility it mediates but acceptable for diagnose of RGE. In asthmatic of difficult control, it should be considered initially endoscopic study. The probability of RGE should always take into account in all asthmatic patient.
Assuntos
Asma/complicações , Refluxo Gastroesofágico/complicações , Asma/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Refluxo Gastroesofágico/diagnóstico por imagem , Gastroscopia , Humanos , Lactente , Masculino , México , Prevalência , RadiografiaRESUMO
UNLABELLED: Asthma is one of the main wheezing causes during the first years of life. In our country it is a common respiratory chronic illness but insufficient studies still exist on the asthma phenotypes during the first years of life. OBJECTIVE: To know the phenotype of asthma in a group of children younger than 6 years old. MATERIAL AND METHODS: 185 children of both sexes were studied with antecedent of having presented wheezing (tree episodes or more) and it registered data about the antecedents of family and personal allergy, dietary habits during the first year of life, infections, data on the beginning and the evolution of the condition, and they were practiced determinations of peripheral eosinophilia, total serum IgE and gastric gammagram to discard illness for gastroesophageal reflux. All were carried out skin tests for foods and aeroallergens. RESULTS: In the group of 185 patients of both sexes, they had data that supported the allergic process, in 137. It was correlated the atopy antecedents significantly, positive skin tests, eosinophilia (more than 300), with elevated IgE for the age (p < 0.05). The gastric gamagrama was carried out in 144 patients, of which were positive results for gastroesophageal reflux in 64 (44%) and in 79 (54%) it was reported doubtful or negative. It was related the gastroesophageal reflux presence and the positive skin tests significantly (p < 0.05). CONCLUSIONS: The more common phenotype of asthma in our patients corresponds to a wheezing pattern that persist after the 3 years old, in relation to an allergic component. Furthermore in most of those children a positive gastroesophageal reflux was an important finding.
Assuntos
Asma/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , FenótipoRESUMO
BACKGROUND: The allergy to latex is an illness whose prevalence has been increased in very significant form in the last years. OBJECTIVE: To know the allergy incidence to latex in population of risk, as well as to identify the related sintomatology and the importance or paper that play the atopia antecedents and time of contact with latex for the development of the illness. METHOD: We carry out a prospective, descriptive, experimental and traverse study in population of risk, in the service of Allergy and clinical Immunology of the Hospital Regional Lic. Adolfo López Mateos, ISSSTE. One hundred patients of both sexes were included, with age of 20 to 50 years, with the antecedent of being personal medical and paramedic and to have presented contact with latex material in a minimum period of one year. They were carried out clinical history with registration of sintomatology nasal, bronchial, cutaneous and associated to contact with latex. They were carried out cutaneous test for prick to latex with positive control with the help of histamine solution and negative control with solution of Evans and immediate reading of the same one. RESULTS: 22% of the patients in study, they presented positive skin test latex, with a time of exhibition 10 year-old average, 68% presented antecedent of atopy personal, family and, likewise the associate sintomatology was in a 33.3% dermatology, 54.5 nasal, nobody presented bronchial symptoms and a 9% asymptomatic was reported. CONCLUSION: We support that the immediate skin test latex for Prick is an important parameter of support diagnosis for allergy to type 1 latex.
Assuntos
Hipersensibilidade ao Látex/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
The objective of the present article is to revise the biochemical and pharmacological knowledge of the leukotrienes, including the enzymatic and cellular processes that participate in its synthesis. The half-filled biological effects through diverse receptors as the cystenil-leukotrienes, have a primordial participation in the physiopathology of the asthma. The 5-lipooxigenase inhibitor, 5-lipooxygenase-activating protein antagonist, and cystenil-leukotrienes, are three classes of new modulators for clinical use. Their effect has been revised in diverse clinical models of asthma, as the one induced by allergens, exercise, aspirin and in multicenter asthma trials are reviewed. The conclusions in general guide to that their pharmacology and the clinical experience that one has, contain them as a new therapeutic role in the treatment of the asthma.
Assuntos
Asma/fisiopatologia , Leucotrienos/fisiologia , Animais , HumanosRESUMO
BACKGROUND: The atopic dermatitis is a chronic skin disease that appears in patients with a personal or family history of allergic asthma and rhinitis. It is associated to the specific activation of a gene group. In most instances, the response to the conventional treatment is adequate. The are cases, though, know as refractory, where that is not the case. The study of two therapeutic alternatives, Transfer Factor (TF) and Cyclosporin A (CyA), was elaborated for this type of patients. MATERIAL AND METHODS: Patients with severe refractory AD were studied, being admitted to the Allergic Service to the ISSSTE Lic. Adolfo López Mateos, ISSSTE, between September 1997 and june 1998. They were randomly divided in two groups. The first one was subjected to CyA, on a 4 mg/kg/day dosage, with monthly surveillance of kidney and hepatic functions and blood pressure twice a week. Group two was subjected to TF, as follows: one unit every third day for the first week, two units per week for the next three weeks and one monthly unit to complete six months. Initial and final clinical and immunologic testing was performed on both groups (eosinophils, total IgE, CD4 and CD8). RESULTS: Six patients included group A, and 12 patients in group B. Both groups showed a significant statistic reduction in the total eosinophils count, without an statistic difference between them. None showed changes in the total IgE. CyA reduced the CD4 levels, while the TF increased the levels of CD8 cells, both with a p < 0.05. Both groups showed clinical improvement satistically significant, but no differences with a p > 0.05 appeared between them. Tolerance to the treatments was adequate, and there was not need to suspend the treatment in any case. Only three patients showed hypertricosis and other one presented headaches, with CyA. CONCLUSION: Both treatments showed therapeutic benefits in the treatment of patients with severe refractory AD, with similar immunologic improvement. Both drugs present different action mechanisms, so their joint application could offer clinical benefit to the patient (synergetic action), cost reduction, and long term treatments with reduced adverse effects.
Assuntos
Ciclosporina/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Imunossupressores/uso terapêutico , Fator de Transferência/uso terapêutico , Humanos , Estudos ProspectivosRESUMO
La etiología de la hiperrespuesta de la vía aérea es variada. Algunos autores mencionan la participación de la alergia a alimentos en los pacientes con procesos crónicos del aparato respiratorio. Se estudiaron a 26 niños con diagnóstico de hiperrespuesta de la vía aérea y alergia a alimentos diagnosticada por: pruebas cutáneas positivas a diversos alimentos y reto simple ambulatorio a alimentos. Se les indicó dieta de restricción alimentaria, principalmente la leche de vaca, que fue sustituida por semihidrolizado de proteínas, durante 12 semanas. Se registraron la intensidad de los síntomas: rinorrea, obstrucción nasal, tos y sibilancias durante el periodo de estudio. Se realizaron pruebas cutáneas a diversos alimentos y reto simple ambulatorio con leche de vaca. Se aplicó la prueba de Chi cuadrada para el análisis estadístico. El 23 por cinto de los pacientes fueron del sexo femenino, el 76.9 por ciento del sexo masculino, de seis meses a tres años de edad, con un promedio de 19.5 meses de edad. El 76 por ciento de los pacientes tenían antecedentes heredo-familiares de alergia. La alimentación con leche materna sólo se ofreció hasta el 5o. mes de vida al 38.4 por ciento. Para el 6o. mes de vida el 100 por ciento ya había iniciado ablactación. La mayoría de los pacientes tenían intensidad 4-5 de los síntomas al inicio del estudio: 96.2 por ciento de los niños con rinorrea y obstrucción nasal y 88.5 por ciento con tos y sibilancias. En 45 por ciento se reportó IgE elevada. El reto ambulatorio a alimentos fue positivo en 42.3 por ciento de los niños. La intensidad de los síntomas mejoró al final del periodo de la dieta de restricción en la mayoría de los niños (88.5 por ciento) con una p<0.0001. De nuestro estudio concluimos que la dieta de restricción de alimentos es un recurso que demostró efectividad en el tratamiento de los niños con hiperrespuesta de la vía aérea y alergia a alimentos
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/fisiopatologiaRESUMO
A prospective clinical study to compare the skin prick test method e intradermal method as a diagnostic tool in allergic rhinitis: There were 100 patients with allergic rhinitis of both sexes in the study with ages ranging from 3 to 18. All of them received skin tests by the prick method to 10 common pollen extracts in Mexico City. If the patient showed positively was included in the control group, and if negative the intradermal method to the same extracts was performed. The intradermal method was utilized in 50 patients, of which only 12 (24%) showed positivity to the tests. This result doesn't showed a significant difference with the prick method, with a value of p greater than 0.05.
Assuntos
Hipersensibilidade/diagnóstico , Rinite/diagnóstico , Testes Cutâneos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hipersensibilidade/imunologia , Testes Intradérmicos , Masculino , Estudos Prospectivos , Rinite/imunologiaRESUMO
We studied 40 patients with the clinical diagnostic of chronic urticaria from January to June, 1995 and excluded 4 patients who did not fulfilled the entry criteria. 29 women and 7 men with age from 4 to 62 years old. We performed a basic clinics history and the oral challenge tests (PRO) included Tartrazine (Ta), Sodium Metabisulfite (MS), Potasium Metabisulfite (MP) and Sodium Bisulfite (BS) in consecutive days with increasing doses unless an adverse reactions appear. Other tests included Skin Prick tests for food (PC), complete blood counts, coprology and immunology tests (IgE, IgA, IgM, IgG, C3, C4, Cel LE and ANA) and paranasal sinus X Ray. 63.8% (23/36) had positive PRO. 47.2% (17/36) positives to Ta,, 36.1% (13/36) to MS, 33.3% (12/36) to BS and 30.5% (11/36) to MP. 72.2% (26/36) had positive PC to one or more foods, 65.3% (17/26) besides had positive PRO. 41.1% (7/17) of the patients who had positive PRO and positive PC to foods had sinusitis. One patient (0.23%) had palpebral angioedema with PRO. The prevalence was 3.1%. Ta was the additive that cause more reactivity. It is possible to find reactivity to one or more additives in a patient with chronic urticaria.
Assuntos
Aditivos Alimentares/efeitos adversos , Urticária/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Estudos Cross-Over , Feminino , Aditivos Alimentares/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Urticária/induzido quimicamenteRESUMO
We did a prospective, comparative, experimental study with 30 patients with moderate to severe atopic dermatitis from the allergy section from September 1994 to March, 1995. The test laboratory examination was performed in all patients: complete blood cell count, immunoglobulins A, G, M and E determination, lymphocyte subpopulations CD3, CD4, CD8, CD4-CD8 proportion, CD25, rosette formation for B and T lymphocytes, coproparasitoscopic examination, throat and nose cultures, nasal cytology, skin tests of cellular immunity to PPD, thrichophytin, candidine, varidasa; skin prick test to poliens, fungi, inhalants and foods. All patients underwent to a sign and symptom grading score system as follows: the parameters were erythema, pruritus, eczema, papule valorated on a scale from 0 a 4+( O = no symptoms, + = mild, ++ = moderate, + ++= severe, ++ ++ = very severe). Initially all patients received one placebo unit every 15 days orally 3 times, then one after 30 days. Laboratory examination was performed and then treatment with transfer factor was initiated, initially 1 unit every 15 days three times and the fourth 30 days after. 15 days after the last dose a new immunological valoration was done. Results demonstrate a CD4 cell decrement, blood eosinophil and lgE dissemination although they're not statistically significative. There was a statistically significative improvement in the 4 clinical parameters: erythema, eczema, pruritus and populous with the use of Transfer Factor.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Dermatite Atópica/imunologia , Adolescente , Adulto , Linfócitos B/imunologia , Relação CD4-CD8 , Criança , Pré-Escolar , Feminino , Humanos , Imunidade Celular , Estudos Longitudinais , Masculino , Linfócitos T/imunologiaRESUMO
Los superantígenos son moléculas derivadas de virus, bacterias o parásitos, que una vez que se unen al complejo pricipal de histocompatibilidad y al receptor de células T tienen la capacidad de estimular en forma potente a los linfocitos T, los que liberan masivamente linfocinas y pueden causar daño tisular. Los superantígenos también pueden provocar anergia clonal, por efecto selectivo sobre las subpoblaciones de las células CD4 (Th0/Th1/Th2)
Assuntos
Toxinas Bacterianas/imunologia , Complexo Principal de Histocompatibilidade/imunologia , Superantígenos/imunologia , Linfócitos T/citologia , Linfócitos T/imunologiaRESUMO
An investigation was done to know IgE levels and prick skin test correlation in 300 patients with allergic rhinitis and extrinsic bronchial asthma groups to IgE levels. Correlations themselves contribute to variability index in 15.6% and diagnosis sensitivity in 0.86. We concluded that study (IgE levels) is and indispensable test for atopic patient.
Assuntos
Imunoglobulina E/sangue , Hipersensibilidade Respiratória/diagnóstico , Testes Cutâneos , Adolescente , Adulto , Asma/sangue , Asma/diagnóstico , Asma/imunologia , Criança , Pré-Escolar , Conjuntivite Alérgica/sangue , Conjuntivite Alérgica/diagnóstico , Conjuntivite Alérgica/imunologia , Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hipersensibilidade Respiratória/sangue , Hipersensibilidade Respiratória/imunologia , Rinite Alérgica Perene/sangue , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/imunologia , Rinite Alérgica Sazonal/sangue , Rinite Alérgica Sazonal/diagnóstico , Rinite Alérgica Sazonal/imunologia , Sensibilidade e EspecificidadeRESUMO
DiGeorge Syndrome is a congenital immunodeficiency characterized clinically by hypocalcemic tetany, congenital heart disease, unusual facies, and increased susceptibility to infection. Pathologically, the syndrome is marked by the abscence or hipoplasia of the thymus and parathyroid glands as well as cardiac or aortic arch abnormalities. Most patients show partial or complete T cell immunodeficiency and normal or near-normal B-cell immunity. A review is made on a clinical case of DiGeorge syndrome is presented. A 52 days old boy, was admitted through emergency. There was no familial evidence of alcoholism or immunodeficiency. He showed irritability due to hypocalcemia. The examination revealed facial and cardiovascular abnormalities and the immunological investigation revealed hypogammaglobulinemia, deficiency of the cell, CD4 and CD8 decreased and with inverted relation. Chest X ray showed cardiomegaly grade II, and no thymus was seen. The diagnosis of the complete DiGeorge syndrome was based on the abnormalities found.
Assuntos
Síndrome de DiGeorge/imunologia , Anormalidades Múltiplas , Síndrome de DiGeorge/sangue , Síndrome de DiGeorge/diagnóstico , Síndrome de DiGeorge/genética , Face/anormalidades , Evolução Fatal , Humanos , Lactente , Cariotipagem , Masculino , Linfócitos T/patologia , Timo/anormalidadesRESUMO
An investigation was done to know specificity and sensitivity of one in vitro test useful for diagnosis of allergy in pediatric age (Phadiatop paediatric), in 65 children in two groups. Group 1 (35 children) with diagnosis of respiratory allergy (asthma, rhinitis, or both) based on clinical history, eosinophils, IgE and skin tests; and group 2 (control) with no allergy diagnosis. In both groups IgE was measured and Phadiatop test was done. In group 1, Phadiatop paediatric was positive in 28 children (80%) while in group 2 was positive in 2 children (6.6%) that means a 67.5% sensitivity and 88.0% specificity, for this test.
Assuntos
Imunoglobulina E/sangue , Teste de Radioalergoadsorção , Kit de Reagentes para Diagnóstico , Hipersensibilidade Respiratória/diagnóstico , Alérgenos/classificação , Alérgenos/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
A prospective, comparative, random study was conducted with 40 patients treated with ebastine vs. terfenadine. The purpose of the study was to evaluate the efficacy of both as second generation antihistamines used in the treatment of allergic rhinitis. Ten milligrams of ebastine was administered once a day before breakfast (fasting), in 5 and 10 year old children and 20 mg in 11 to 15 year olds. Ebastine was more efficient in the control of symptoms (rhinorrhea, nasal obstruction, sneezing, eye and nose itching) than terfenadine from the seventh day on, (p 0.05). Tolerance to ebastine was good, although a small number of patients (1.5%) suffered collateral symptoms: sleepiness, headaches and nausea. The two doses of ebastine (10 or 20 mg depending on the patients age) had overall efficacy rates better than terfenadine (p 0.05%).