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Introducción: La azelastina es un antihistamínico tópico nasal, exento de los molestos efectos sistémicos, la cual asociada con fluticasona, ha mostrado excelentes resultados en el control de la rinitis alérgica. Objetivo: Evaluar los resultados del tratamiento del spray nasal de azelastina y fluticasona. Diseño: Observacional descriptivo prospectivo. Materiales y métodos: Se evaluaron 76 pacientes de ambos sexos, con edades entre los 12 y 59 años, con diagnóstico de rinitis alérgica en el que se midieron los síntomas: obstrucción, prurito, estornudos y rinorrea. La severidad de los síntomas fue valorada por el propio paciente de 0 a 10 pretratamiento, a la semana, dos, tres y cuatro semanas de iniciado el tratamiento, el cual fue igual para todos los pacientes, con control ambiental y la atomización de 2 puff en cada fosa nasal del spray de azelastina y fluticasona. Se hizo seguimiento de los síntomas nasales y la aparición de efectos colaterales. Resultados: Se observó una diferencia estadísticamente significativa entre el puntaje obtenido previo al tratamiento y en la evaluación posterior desde la primera semana de uso y hasta el momento del seguimiento final a la cuarta semana (p<0,0001 Friedman F). Conclusiones: El spray nasal de azelastina y fluticasona, es muy útil en el control de los síntomas de rinitis alérgica, mostrando además un adecuado perfil de seguridad.

Introduction: Azelastine, is a topical nasal antihistamine free of systemic effects, the quality associated with fluticasone, has been excellent in the control of allergic rhinitis. Objective: To evaluate the results of the treatment of the nasal spray of azelastine and fluticasone. Design: Prospective and descriptive study. Methods: 76 patients of both sexes, aged between 12 and 59 years, with a diagnosis of allergic rhinitis in which the symptoms were measured: obstruction, pruritus, sneezing and rhinorrhea. The severity of each symptom was assessed by the patient from 0 to 10 before and after a week, two, three and four weeks, which was the same for all patients, with environmental control and the atomization of 2 puffs in each nostril of the azelastine and fluticasone spray. A follow-up of nasal symptoms and the appearance of side effects. Results: A statistically significant difference was observed between the score obtained before the treatment and in the subsequent evaluation from the first week until the time of the final follow-up at the fourth week (p <0.0001 Friedman F). Conclusion: The nasal spray of azelastine and fluticasone is very useful in the control of the symptoms of allergic rhinitis.

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La incidencia y prevalencia de las enfermedades alérgicas en la infancia han aumentado considerablemente en los países desarrollados en los últimos 20-30 años. Se ha demostrado el papel de los alergenos inhalantes en la exacerbación de las alergias respiratorias. Son los ácaros del polvo doméstico los principales agentes causales. La contaminación ambiental y los cambios climáticos, entre otros factores, han contribuido al incremento de estas enfermedades, dentro de las cuales las más frecuentes en pediatría son las alergias respiratorias y a su vez dentro de estas últimas la rinitis alérgica y el asma bronquial. En este artículo se realiza una revisión sobre rinitis alérgica, asma bronquial y valores de IgE en niños, con énfasis en la epidemiología y factores desencadenantes.

Incidence and prevalence of allergic diseases during childhood have significantly increased in developed countries over the last 20 to 30 years. The role of the inhalant allergens in exacerbating respiratory allergies has been demonstrated. House dust mites are the main causative agents. Environmental pollution and climate changes, along with other factors, have contributed to the increase of these diseases. Among such conditions the most frequent in children are respiratory allergies, particularly allergic rhinitis and bronchial asthma. The current article presents a review on allergic rhinitis, bronchial asthma and IgE levels in children, emphasizing on epidemiology and trigger factors.

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OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood. .

OBJETIVO: Determinar a prevalência de atopia e avaliar o perfil clínico, laboratorial e radiológico de pacientes com DPOC. MÉTODOS: Estudo de corte transversal com pacientes ambulatoriais portadores de DPOC estável (definida pela história clínica e relação VEF1/CVF < 70% do previsto após broncodilatador). Os pacientes responderam um questionário clínico e de atopia e foram submetidos a citologia de lavado nasal, teste cutâneo de alergia, radiografia de tórax, hemogasometria arterial e dosagem de IgE total. RESULTADOS: Dos 149 indivíduos avaliados, 53 (35,6%), 49 (32,8%) e 88 (59,1%), respectivamente, apresentavam eosinofilia no lavado nasal, teste cutâneo positivo e sintomas de rinite alérgica. A análise de correspondência confirmou esses achados, evidenciando dois perfis distintos de doença: a presença de atopia em pacientes com estágios mais leves de DPOC, e a ausência de características de atopia em pacientes com aspectos de doença mais grave (VEF1 reduzido e hiperinsuflação). Houve uma associação estatisticamente significante entre eosinofilia no lavado nasal e prova farmacodinâmica positiva. CONCLUSÕES: Este estudo identificou uma alta frequência de atopia em pacientes com DPOC, utilizando ferramentas simples e reprodutíveis. A monitorização inflamatória de vias aéreas parece ser uma ferramenta útil para avaliar as doenças respiratórias em idosos, assim como em pacientes com sobreposição de asma e DPOC, entidade clínica ainda pouco compreendida. .

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Realizar revisão sobre uso de Probióticos emartigos originais no Pubmed. Resultados: Foram selecionadosartigos que abordavam as características gerais dosprobióticos, bem como seu uso na imunomodulação. Osprobióticos estão indicados na prevenção de diarréias,causadas por antibióticos e rotavírus, mas também emdoenças atópicas, auto-imunes e câncer. O efeito terapêutico,na literatura, foi observado com doses variáveis de 106 a109 UFC e embora seu mecanismo de ação não estejatotalmente estabelecido, o probiótico deve estar viável quandoconsumido, permanecer vivo após contato com suco gástricoe bile, aderir-se à mucosa intestinal e competir commicrorganismos patogênicos, promovendo ação satisfatóriana modulação de inflamação e imunidade. Conclusão: Asbactérias ácidas lácticas promovem melhoria nofuncionamento do organismo, devendo-se realizar maioresestudos, para que sua utilização seja mais ampla em Medicina...

To perform a literature review on probiotics usefrom articles published in Pubmed. Results: Were selectedarticles that addressed general characteristics of probioticsand their use in immunomodulation. Probiotics have beenindicated for the prevention of diarrhea caused by rotavirusand antibiotics, and also atopic diseases, autoimmunediseases and cancer. Therapeutic effect, in literature, wasobserved at doses varying from 106 to 109 CFU, and althoughits mechanism of action has not been fully established, to bebeneficial probiotics must be viable when consumed, remainalive after contact with gastric and bile juice, adhere to theintestinal mucosa and compete with pathogenicmicroorganisms, promoting a satisfactory action in themodulation of inflammation and immunity. Conclusion: Lacticacid bacteria promote improvement in the body’s function.Further studies must be carried out so that probiotics usemay be broadened in medicine...

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Background: Allergic rhinitis and sinusitis are common diseases that affect quality of life of pediatric and adult patients. Aim: To adapt and validate the Sino-Nasal Outcome Test 20 indicators (SNOT-20) survey in Chilean subjects. Material and Methods: In a psychometric validation study, an adapted version of the SNOT-20 adapted version was applied to 181 volunteers on two different occasions, three weeks apart. Feasibility (response time and perceived difficulty), reliability (internal consistency and test-retest) and validity (concurrent validity, correlating results with an independent instrument; predictive validity assessing its sensitivity to detect changes and discriminate validity, assessing receiver operating characteristic (ROC) curves), were assessed. An exploratory factor analysis was performed to confirm the presence of previously described underlying constructs. Results: Eighty percent of participants considered SNOT-20 easy to complete. This task was completed in less than 5 minutes. Cronbach's alpha was 0.946. Temporal stability on a healthy subgroup was strong with an intraclass correlation coefficient of0.92. SNOT-20 had a correlation coefficient of0.82 with an independent instrument and its score significantly decreased after 3 weeks of treatment (p = 0.003). The area under ROC curve was 0.895. Factor analysis identified four principal components which possessed identical structure as previously described. Conclusions: SNOT-20 survey was valid, reliable and easy to implement among Chilean subjects.

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O objetivo desta revisão foi apresentar evidências da relação entre rinite alérgica e redução da qualidade de vida. As fontes de dados foram artigos originais, revisões e consensos indexados nos bancos de dados Medline e LILACS entre 1997 e 2008. As palavras de busca foram "rinite alérgica", "qualidade de vida" e "distúrbios do sono". Os pacientes com rinite alérgica frequentemente têm redução na qualidade de vida causada pelos sintomas clássicos da doença (espirros, prurido, coriza e obstrução). Além disso, a fisiopatologia da rinite alérgica, com frequência, interrompe o sono, ocasionando fadiga, irritabilidade, déficits de memória, sonolência diurna e depressão. A carga total da doença recai não apenas no funcionamento social e físico prejudicados, mas também no impacto financeiro, que se torna maior quando se consideram as evidências de que a rinite alérgica é um possível fator casual de comorbidades, tais como a asma e a sinusite. A obstrução nasal, o mais proeminente dos sintomas, está associada a eventos respiratórios relacionados aos distúrbios do sono, uma condição que tem profundo efeito sobre a saúde mental, o aprendizado, o comportamento e a atenção. Finalmente, a rinite alérgica - doença crônica que afeta crianças, adolescentes e adultos - frequentemente é subdiagnosticada ou inadequadamente tratada. O impacto deletério dos distúrbios do sono associados à rinite alérgica sobre a habilidade para realizar as atividades de vida diária dos pacientes é um importante componente da morbidade da doença. Com um diagnóstico acurado, existem vários tratamentos disponíveis que podem reduzir a carga associada à rinite alérgica.

The objective of this review was to present evidence of the relationship between allergic rhinitis and impairment of quality of life. The data sources were original articles, reviews and consensus statements entered into the Medline and LILACS databases between 1997 and 2008. The following search terms were used: "allergic rhinitis"; "quality of life"; and "sleep disorders". Quality of life is often impaired in patients with allergic rhinitis, due to the classic symptoms of the disease (sneezing, pruritus, rhinorrhea and nasal obstruction). In addition, the pathophysiology of allergic rhinitis often disrupts sleep, leading to fatigue, irritability, memory deficits, daytime sleepiness and depression. The total burden of this disease goes beyond impairment of physical and social functioning. It has also a financial impact, which becomes greater when we consider the evidence that allergic rhinitis is a possible causal factor of comorbidities, such as asthma and sinusitis. Nasal obstruction, the most prominent symptom, is associated with sleep disorders, which can have a profound effect on mental health, learning, behavior and attention. Finally, allergic rhinitis-a chronic condition that affects adults, adolescents and children-is often underdiagnosed or inadequately treated. The deleterious impact that allergic rhinitis-related sleep disorders have on patient capacity to perform activities of daily living is an important component of the morbidity of the disease. With an accurate diagnosis, there are various available treatments that can reduce the burden of allergic rhinitis.

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Objetivo. Comparar la bioequivalencia de tres formulas farmacéuticas nasales de propionato de fluticasona administradoscon un rociador nasal. Materiales y métodos. Ensayo clínico aleatorizado, abierto, de dosis única, cruzado a tresbrazos en 60 voluntarios sanos de ambos sexos entre 18 y 55 años de edad. El tratamiento consistió en una dosis nasalúnica (800 mcg) de rociador nasal de propionato de fluticasona (RNF), Flonase®, y Flixonase® en cinco visitas: una visita de selección, tres visitas de administración del medicamento y una de evaluación final. Se obtuvo muestras desangre a intervalos apropiados para análisis farmacocinético. El parámetro primario para determinar la bioequivalencia de las fórmulas farmacéuticas estudiadas fue el área bajo la curva de concentración-tiempo (AUC0-t). Como parámetro secundario se consideró la concentración máxima de la droga (Cmax). RNF se comparó separadamente a Flonase® y Flixonase®. Resultados. Se demostró bioequivalencia entre RNF y Flonase® (n=55) utilizando la transformación logarítmica invertida de AUC0-t (relación RNF a Flonase® = 1,021; IC90 por ciento, 0,88 a 1,19), y Cmax (relación = 0,995; IC90 por ciento, 0,92 a 1,07). Ambas medidas se encuentran dentro del rango aceptable de bioequivalencia (0,80 a 1,25). También se demostró la bioequivalencia entre RNF y Flixonase® (n=54) para AUC0-t (relación = 0,949; IC 90 por ciento 0,81 a 1,10) y Cmax (relación = 0,939, IC90 por ciento, 0,87 a 1,02). Se encontró que los tres tratamientos presentaron relativamente pocos efectos adversos. Conclusiones. RNF a una dosis de 800 mcg es bioequivalente tanto a Flonase® como Flixonase® administradas a voluntarios sanos. El perfil de seguridad de RNF es consistente con los de Flonase® y Flixonase®.

Objective: Comparison of the bioequivalence of three pharmaceutical formulations of fluticasone propionate nasal administered with a nasal spray (FANS). Materials y Methods: A randomized, open-label, single-dose, three-way crossover study in 60 healthy volunteers of both sexes between 18 and 55 years old. Subjects received a single intranasal dose (800 mcg) of FANS, Flonase®, and Flixonase® in 5 visits: screening, 3 dosing visits, and end of study. Forty-eight hours to 7 days were allowed between dosing visits. Blood was drawn for pharmacokinetics analysis at appropriate intervals. The primary pharmacokinetic parameter for determination of bioequivalence of the formulations was the areaunder the plasma concentration-time curve (AUC0-t). Secondary parameters included the maximum plasma concentration (Cmax). FANS was compared to Flonase® and to Flixonase® separately. Results: Bioequivalence between FANS and Flonase® (n=55) was demonstrated by the inverse log transformed AUC0-t (ratio FANS to Flonase® = 1.021; 90 per cent CI, 0.88 to 1.19), and Cmax, (ratio = 0.995; 90 per cent CI, 0.92 to 1.07), which are within the acceptable range of 0.80 to 1.25. Bioequivalence between FANS and Flixonase® (n=54) was also demonstrated for AUC0-t (ratio = 0.949; 90 per cent CI 0.81 to 1.10) and Cmax (ratio = 0.939, 90 per cent CI, 0.87 to 1.02). Active treatments were well tolerated and there were relatively few adverse events. Conclusions: A single dose of FANS 800 mcg is pharmacokinetically bioequivalent to both Flonase® and Flixonase® when administered to healthy subjects. The safety profile of FANS was consistent with that noted for Flonase® and Flixonase®.

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OBJETIVOS: Determinar la prevalencia de síntomas de rinitis alérgica en escolares de Mexicali, Baja California, México, y evaluar la influencia del medio ambiente rural sobre esta afección. MÉTODOS: Estudio transversal poblacional mediante la aplicación de un cuestionario estandarizado en una muestra aleatoria de 2 087 escolares de 6 a 7 años (1 078 niñas y 1 009 niños) residentes en la ciudad de Mexicali, Baja California, México. Se evaluó la asociación entre variables de exposición y antecedentes clínicos personales y familiares, y dos variables dependientes: síntomas nasales y síntomas nasales y oculares, en ausencia de catarro o gripe, con sus razones de posibilidades (OR, odds ratios) e intervalos de confianza de 95 por ciento (IC95 por ciento). El estudio, realizado entre febrero y julio de 2004, utilizó la metodología del Estudio Internacional de Asma y Alergia en la Infancia (ISAAC). RESULTADOS: Las prevalencias generales de síntomas nasales y síntomas nasales y oculares fueron de 25,0 por ciento y 10,5 por ciento, respectivamente. Los niños y las niñas que habían vivido en el campo o zona rural en algún momento presentaron menor probabilidad de padecer síntomas nasales (OR = 0,43; IC95 por ciento: 0,24 a 0,77) y síntomas nasales y oculares (OR = 0,39; IC95 por ciento: 0,16 a 0,93), después de ajustar por factores de confusión. CONCLUSIONES: El contacto con el medio rural en los primeros años de vida disminuyó el riesgo de presentar rinitis alérgica en la población estudiada, independientemente de los antecedentes familiares de asma.

OBJECTIVES: To assess the prevalence of allergic rhinitis symptoms among schoolchildren in Mexicali, Baja California, Mexico, and determine what impact a rural environment might have on this condition. METHODS: A population-based, cross-sectional study using a standardized questionnaire administered to a random sample of 2 087 schoolchildren 6-7 years of age (1 078 girls and 1 009 boys) living in the city of Mexicali, Baja California, Mexico. The study analyzed associations between exposure variables and personal and family health history, and two dependent variables-nasal symptoms and nasal and ocular symptoms, in the absence of a cold or flu-using odd ratios (OR) and 95 percent Confidence Intervals (95 percentCI). The study took place in February-July 2004 and followed the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: The general prevalence of nasal symptoms and nasal and ocular symptoms was 25.0 percent and 10.5 percent, respectively. The boys and girls who had ever lived on a farm or in a rural area had a lower probability, adjusted for confounding variables, of presenting nasal symptoms (OR = 0.43; 95 percentCI: 0.24-0.77), or nasal and ocular symptoms (OR = 0.39; 95 percentCI: 0.16-0.93). CONCLUSIONS: In the study population, exposure to a rural environment in early childhood decreased the risk of developing allergic rhinitis, regardless of a family history of asthma.

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