RESUMO
BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. OBJECTIVES: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. METHODS: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE. RESULTS: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions. CONCLUSIONS: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence. KEYWORDS: Allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, skin testing, allergy diagnosis, rhinitis, asthma, atopic dermatitis, house dust mite, pollens, anaphylaxis, adrenaline, Mexico.
Assuntos
Dessensibilização Imunológica , Hipersensibilidade , Alérgenos/uso terapêutico , Animais , Asma/terapia , Humanos , Pyroglyphidae/imunologia , Testes Cutâneos , Imunoterapia SublingualRESUMO
BACKGROUND: Cupressus pollen is one of the main causes of allergic respiratory disease in North America. In a previous study of pollen concentration in Monterrey, Cupressus occupied the 3rd place in frequency. OBJECTIVE: To know the sensitization to Cupressus in patients treated at our center. METHODS: We conducted an observational, cross-sectional and prospective study, with a questionnaire to assess potential exposure and allergic symptoms to pollen, skin tests with allergen extract of Cupressus 1:20 dilution, and skin tests with others 36 aeroallergens in our hospital. RESULTS: We did Cupressus skin test in 256 patients (136 women), 130 younger than 18 years old and 126 adults. The skin test was positive in 39 patients (15.2%). Of the 36 aeroallergens tested, Cupressus occupied the 7th place in frequency. Of the 130 under 18 years, only 10 (7.7%) had a positive skin test. Among the other 129 adults, 29 (22.5%) had a positive skin test (p = 0.001). Patients with a positive skin test Cupressus had at least one positive skin test to other aeroallergen in 97% of cases (p = 0.001). CONCLUSIONS: Cupressus sensitization in our study group was high (15.2%). The routine use of allergen extract of Cupressus should be considered in patients with respiratory allergy. However, it is necessary to determine precisely the prevalence of sensitization and its possible clinical implications.
Assuntos
Cupressus , Pólen , Estudos Transversais , Humanos , México/epidemiologia , Prevalência , Estudos ProspectivosRESUMO
Hereditary angioedema is an uncommon disorder mainly caused by defects of the gene for C1 inhibitor. These patients present recurrent edema episodes in the different regions of the body, including larynx edema in some cases. Low plasma levels of C1 inhibitor confirm the diagnosis. It is important to establish an early diagnosis and prompt treatment to this disorder due to its potential of fatal consequences and multiple alterations in the quality of life that have been associated with. The indicated treatment is substitutive therapy of C1 inhibitor concentrate. We present the case of a patient a 27 year-old female with a history of seven years of evolution, with daily periorbital, upper and lower extremities and labial edema episodes who was classified as C1 inhibitor deficiency type II. She began treatment with attenuated androgens in progressive increased doses with poor response, appearing torpid evolution without a favorable response. This case corresponds to a very atypical presentation of C1 inhibitor deficiency with daily symptoms, unlike the typical intermittent course of the classic disease.