RESUMO
The term food intolerance has been used non-specifically to define a wide range of disorders related to food intake. Recently, the use of the term "non-immunological adverse reactions to foods" (RANIAs) was recommended as a more correct clinical definition. The pathophysiological mechanisms can be diverse, sometimes unknown, and there are no validated diagnostic tests, making it difficult to obtain accurate data. The clinical manifestations of non-immunological adverse reactions to foods affect more than one organ or system; and gastrointestinal symptoms (pain, abdominal distension, flatulence, and diarrhea) are the most common. Non-immunological adverse reactions to foods are divided into independent and dependent on host factors. Foods may contain chemicals with pharmacological activity and be present naturally, such as vasoactive amines (histamine) and salicylates, or added for preservation, to improve appearance or flavor (monosodium glutamate, tartrazine, sulfites, and benzoates). In some cases, these types of reactions may be like to hypersensitivity reactions. Concomitant alcohol consumption may worsen symptoms by inhibiting histamine breakdown and increasing intestinal permeability. In patients diagnosed with non-immunological adverse reactions to foods, it is important to rule out some psychological problems: aversions or eating disorders.
El término intolerancia alimentaria se ha utilizado de manera inespecífica para definir una amplia gama de trastornos relacionados con la ingesta de alimentos. Recientemente se recomendó el uso de la expresión "reacciones adversas no inmunológicas a alimentos" (RANIAs) como una definición clínica más correcta. Los mecanismos fisiopatológicos pueden ser diversos, a veces desconocidos, y no existen pruebas diagnósticas validadas, por lo que es difícil obtener datos certeros. Las manifestaciones clínicas de las reacciones adversas no inmunológicas a alimentos afectan a más de un órgano o sistema; y los síntomas gastrointestinales (dolor, distensión abdominal, flatulencias y diarrea) son los más frecuentes. Las reacciones adversas no inmunológicas a alimentos se dividen en independientes y dependientes de factores del huésped. Los alimentos pueden contener productos químicos con actividad farmacológica y estar presentes en forma natural, como las aminas vasoactivas (histamina) y los salicilatos, o añadirse para su conservación, mejorar la apariencia o el sabor (glutamato monosódico, tartrazina, sulfitos y benzoatos). En algunos casos, este tipo de reacciones pueden ser similares, desde el punto de vista clínico, a las reacciones de hipersensibilidad. El consumo de alcohol concomitante puede empeorar los síntomas, al inhibir la degradación de la histamina y aumentar la permeabilidad intestinal. En pacientes con diagnóstico de reacciones adversas no inmunológicas por alimentos es importante descartar algunos problemas de índole psicológica: aversiones o trastornos de la conducta alimentaria.
Assuntos
Intolerância Alimentar , Histamina , Humanos , Intolerância Alimentar/diagnóstico , Intolerância Alimentar/etiologia , Histamina/efeitos adversos , Aminas , Benzoatos , DiarreiaAssuntos
Humanos , Adulto , Dermatite Atópica/epidemiologia , Eczema , Prevalência , Estudos TransversaisAssuntos
Dermatite Atópica , Eczema , Adulto , Estudos Transversais , Dermatite Atópica/epidemiologia , Humanos , PrevalênciaRESUMO
INTRODUCTION: Hereditary angioedema is an infrequent genetic disorder; which mainly manifests with cutaneous and mucosal swelling. Minor trauma may trigger potentially life-threatening events. In type I and II hereditary angioedema, plasma-derived C1-inhibitor concentrate can be used as short-term prophylaxis. For hereditary angioedema, prophylaxis is not yet standardized, but normal C1 inhibitor could be beneficial. CASE REPORT: A 69-year-old woman, with a genetic diagnosis of hereditary angioedema with normal C1 inhibitor, who needed multiple dental extractions. The surgical procedure was performed under general anesthesia, using 1000 U of plasma-derived C1-inhibitor concentrate as prophylaxis an hour before. The patient was admitted in the ICU for postsurgical care and the outcome was good. CONCLUSION: We highlight the possibility of successfully using plasma-derived C1-inhibitor concentrate as prophylaxis in patients with hereditary angioedema with normal C1 inhibitor.
Introducción: El angioedema hereditario es una enfermedad genética poco frecuente, que se manifiesta principalmente con edema cutáneo o mucoso. Pequeños traumas pueden producir eventos potencialmente fatales. En angioedema hereditario tipos I y II se puede llevar a cabo profilaxis a corto plazo con concentrado plasmático de inhibidor de C1. La profilaxis aún no está estandarizada, pero el concentrado de inhibidor de C1 normal podría ser beneficioso. Reporte de caso: Mujer de 69 años, con diagnóstico genético de angioedema hereditario con inhibidor de C1 normal, quien necesitaba exodoncias dentarias múltiples. El procedimiento quirúrgico se realizó bajo anestesia general, utilizando como profilaxis 1000 U de concentrado de inhibidor de C1 derivado del plasma una hora antes. Cursó el posoperatorio en terapia intensiva con buena evolución. Conclusión: Resaltamos la posibilidad de utilizar con éxito el concentrado de inhibidor de C1 derivado del plasma como profilaxis en pacientes con angioedema hereditario con inhibidor de C1 normal.
Assuntos
Angioedemas Hereditários , Idoso , Angioedemas Hereditários/tratamento farmacológico , Angioedemas Hereditários/genética , Feminino , HumanosRESUMO
Allergic rhinitis (AR) is the most frequent allergic disease. Prevalence in children and teenagers in Argentina ranges between 22.3% and 34.9%. Given this situation, members of the scientific committees of Pediatrics and Rhinitis of the Argentinian Association of Allergy and Clinical Immunology (AAAeIC) have reviewed scientific evidence in order to update the therapeutic regulations of this pathology in the pediatric population. The classification and categorization of AR are currently in full review all around the world. It is necessary to make a differential diagnosis with other non-allergic types of rhinitis in children, and to confirm AR based on the clinical history, physical examination, determination of bio-markers, and/or skin tests. Non-pharmacological treatment includes education and guidelines of environmental control for allergens such as dust mites, anemophilous fungi, animal epithelium, and pollens. Step pharmacological therapy is proposed according to the control of the disease. Second-generation, non-sedating anti-histamines are the first line of therapy. The association with oral decongestants is not recommended in children under 4 years of age. Inhaled corticosteroids are the first choice for both moderate and severe forms. This document warns pediatricians about the importance of an early diagnosis, the rational use of step pharmacological therapy, and specific immunotherapy in children.
La rinitis alérgica (RA) es la enfermedad alérgica más frecuente. La prevalencia en niños y adolescentes de Argentina oscila entre 22.3 y 34.9 %. Ante esto, integrantes de los comités científicos de pediatría y rinitis de la Asociación Argentina de Alergia e Inmunología Clínica (AAAeIC) revisaron evidencia científica para actualizar las normativas terapéuticas de esta patología en la población pediátrica. La clasificación y categorización de la RA se encuentra actualmente en plena revisión en todo el orbe. Es necesario realizar un diagnóstico diferencial con otras rinitis no alérgicas en los niños, y confirmar la RA con base en la historia clínica, el examen físico, la determinación de biomarcadores o pruebas cutáneas. El tratamiento no farmacológico incluye la educación y pautas de control ambiental para alérgenos como ácaros, hongos anemófilos, epitelio de animales y pólenes. Se propone un tratamiento farmacológico escalonado de acuerdo con el control de la enfermedad. Los antihistamínicos de segunda generación no sedativos son la primera línea de tratamiento. La asociación con descongestivos orales no se recomienda en menores de cuatro años. Los corticoides nasales inhalados son de primera elección en formas moderadas y graves. El presente documento alerta a los pediatras sobre la importancia del diagnóstico precoz, el uso racional del tratamiento farmacológico escalonado y la inmunoterapia específica en niños.
Assuntos
Rinite Alérgica/terapia , Adolescente , Corticosteroides/uso terapêutico , Alérgenos , Antialérgicos/uso terapêutico , Argentina/epidemiologia , Criança , Pré-Escolar , Terapia Combinada , Dessensibilização Imunológica , Diagnóstico Diferencial , Humanos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Prevalência , Rinite Alérgica/diagnóstico , Rinite Alérgica/tratamento farmacológico , Rinite Alérgica/epidemiologia , Testes CutâneosRESUMO
BACKGROUND: Asthma is a chronic disease with a great impact on public health and on the patients' quality of life. In Latin America, there are scarce epidemiological studies. OBJECTIVE: To describe the prevalence of asthma and the clinical-demographic characteristics in an adult population from a private health system in the City of Buenos Aires. METHODS: A cross-sectional study of adults who were enrolled in the medical program of a private health system in Buenos Aires between January 1st, 2017, and January 1st, 2018. All the patients that were included in the study had been diagnosed with asthma. RESULTS: The prevalence of asthma in the adult patients of a prepaid health system in the City of Buenos Aires was of 6 % (n = 66, IC 95 % = 5-7), and the prevalence of severe asthma among the same group was of 5 % (n = 3, IC 95 % = 1-13). Most patients had intermittent and mild asthma. CONCLUSION: This study provides new data about the epidemiology of asthma in the region.
Antecedentes: El asma es una enfermedad crónica de gran impacto en la salud pública y en la calidad de vida de los pacientes. En Latinoamérica existen escasos estudios epidemiológicos Objetivo: Describir la prevalencia del asma y las características clínico-demográficas en una población adulta de un sistema de salud privado de la ciudad de Buenos Aires. Métodos: Estudio de corte transversal de adultos afiliados al programa médico de un sistema de salud privado de Buenos Aires, entre el 1 de enero de 2017 y 1 de enero de 2018, con diagnóstico médico de asma. Resultados: La prevalencia de asma en pacientes adultos de un sistema de salud prepago en la ciudad de Buenos Aires fue de 6 % (n = 66, IC 95 % = 5-7) y de asma grave de 5 % (n = 3 IC 95 % = 1-13) La mayoría de los pacientes presentaron asma intermitente y leve. Conclusión: El estudio aporta nuevos datos sobre la epidemiología del asma en la región.
Assuntos
Asma , Qualidade de Vida , Adulto , Asma/epidemiologia , Cidades , Estudos Transversais , Humanos , PrevalênciaRESUMO
BACKGROUND: In spite of the frequency of chronic urticaria, there are no epidemiological studies on its prevalence in Argentina. OBJECTIVE: The objective of this study was to define the prevalence and epidemiological characteristics of chronic urticaria patients in Buenos Aires. METHODS: The population studied were the members of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in the urban areas around the Autonomous City of Buenos Aires, Argentina. All patients with diagnosis of chronic urticaria members of the Italian Hospital Medical Care Program, and with at least 12 months of follow up were included in the study. All medical records obtained between January 1st, 2012 and December 31, 2014 were analyzed. The prevalence ratio for chronic urticaria per 100,000 population with 95% CI for December 31, 2014 was calculated. The prevalence rate for the entire population and then discriminated for adults and pediatric patients (less than 18 years old at diagnosis) was assessed. RESULTS: 158,926 members were analyzed. A total of 463 cases of chronic urticaria were identified on prevalence date (68 in pediatrics, 395 in adults), yielding a crude point prevalence ratio of 0.29% (CI 95% 0.26-0.31%). The observed prevalence of chronic urticaria in the adult population was 0.34 % (95% CI 0.31-0.38%), while in pediatrics it was 0.15 % (95% CI 0.11-0.20%). STUDY LIMITATIONS: the main weakness is that the results were obtained from an HMO and therefore the possibility of selection bias. CONCLUSIONS: chronic urticaria is a global condition. Its prevalence in Buenos Aires is comparable with other countries.
Assuntos
Urticária/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Argentina/epidemiologia , Criança , Doença Crônica , Feminino , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
Abstract: Background: In spite of the frequency of chronic urticaria, there are no epidemiological studies on its prevalence in Argentina. Objective: The objective of this study was to define the prevalence and epidemiological characteristics of chronic urticaria patients in Buenos Aires. Methods: The population studied were the members of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in the urban areas around the Autonomous City of Buenos Aires, Argentina. All patients with diagnosis of chronic urticaria members of the Italian Hospital Medical Care Program, and with at least 12 months of follow up were included in the study. All medical records obtained between January 1st, 2012 and December 31, 2014 were analyzed. The prevalence ratio for chronic urticaria per 100,000 population with 95% CI for December 31, 2014 was calculated. The prevalence rate for the entire population and then discriminated for adults and pediatric patients (less than 18 years old at diagnosis) was assessed. Results: 158,926 members were analyzed. A total of 463 cases of chronic urticaria were identified on prevalence date (68 in pediatrics, 395 in adults), yielding a crude point prevalence ratio of 0.29% (CI 95% 0.26-0.31%). The observed prevalence of chronic urticaria in the adult population was 0.34 % (95% CI 0.31-0.38%), while in pediatrics it was 0.15 % (95% CI 0.11-0.20%). Study limitations: the main weakness is that the results were obtained from an HMO and therefore the possibility of selection bias. Conclusions: chronic urticaria is a global condition. Its prevalence in Buenos Aires is comparable with other countries.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Urticária/epidemiologia , Argentina/epidemiologia , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Doença Crônica , Prevalência , Estudos Retrospectivos , Distribuição por IdadeRESUMO
BACKGROUND: Scarce studies address the issue of resource consumption and direct health care costs of patients diagnosed with adult-onset chronic urticaria (CU). OBJECTIVES: To estimate medical resource consumption and direct health care costs of affected patients in a private health maintenance organization in Buenos Aires, Argentina. METHODS: Patients diagnosed with adult-onset CU (International Classification of Diseases, Ninth Revision, Clinical Modification code 708.1, 708.8, or 708.9) and who were members of the Italian Hospital Medical Care Program were included in the study. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. Third-quarter 2014 costs were obtained from the Italian Hospital Medical Care Program and converted into US dollars (using the November 2014 exchange rate). RESULTS: A total of 232 patients were included in the study. The mean age at diagnosis was 54.2 ± 20.0 years, and the mean disease duration was 5.4 ± 2.6 years (range, 2-22 years). Of the total number of patients, 75% had allergists as their usual source of care, 23% had dermatologists, 18% had internists, and 3% had rheumatologists. Only 7.8% of the patients had an emergency room admission to manage CU symptoms. To manage the disease, 57.8% of patients used antihistamines and 11.6% used oral corticosteroids. The most relevant source of cost was the medical treatment received, followed by physician visits. The average yearly direct cost per patient was US $1015 ± $752 (95% confidence interval 803-2003). CONCLUSIONS: This is the first Argentine study that evaluated the costs of CU considering the direct medical costs of the disease. The study provides information on resource utilization and the disease-related economic burden, which is valuable to better understand CU in the local setting. Future research that takes into consideration the direct and indirect costs of the disease will expand knowledge and improve management of the disease.