Sibilancia recurrente en pediatría

Introducción: los episodios de obstrucción bronquial a temprana edad constituyen un problema frecuente en pediatría. Se realizó un estudio descriptivo, longitudinal, retrospectivo. Objetivo: caracterizar el comportamiento de la sibilancia recurrente en los niños menores de 5 años pertenecientes al municipio Bayamo, del Hospital Provincial Pediátrico Docente "General Milanés "en el año 2019. Métodos: la muestra fue de 63 pacientes y se estudiaron las variables edad, sexo, lactancia materna, ingresos previos, procedencia, género de vida y posibles factores de riesgo. El análisis estadístico se realizó a través de las estimaciones de las frecuencias absolutas y relativas. Resultados: predominaron los niños de 1 a 5 años con 52 casos (82.6%) y el sexo masculino, 29 de ellos pertenecieron a este grupo etáreo ( 80.6%); los ingresos previos de menos de 3 días en 37 casos (66.1%) y 56 casos no recibieron lactancia materna exclusiva, 37 de ellos representó el 66.1%; 44 casos tuvieron un género de vida malo ( 69.8%) y de los 43 casos que procedían de la zona urbana 28 pertenecían a ese género de vida(65.1%); los antecedentes patológicos familiares de alergia o asma y la atopia fueron los más significativos con 63 y 52 casos(100 y 82.5%) respectivamente. Conclusiones: se comprobó que la edad de 1 a 5 años, el sexo masculino, los ingresos de menos de tres días, sin lactancia materna , el género de vida malo, la procedencia urbana fueron los que predominaron en el estudio, así como los antecedentes patológicos familiares y la atopia como factores de riesgo que exacerbaron la enfermedad.

Introduction: episodes of bronchial obstruction at an early age are a frequent problem in pediatrics. A descriptive, longitudinal, retrospective study was conducted. Objective: to characterize the behavior of recurrent wheezing in children under 5 years of age belonging to the Bayamo municipality, of the "General Milanés" Teaching Pediatric Provincial Hospital in 2019. Methods: the sample consisted of 63 patients and the variables age, sex, breastfeeding, previous income, origin, gender of life and possible risk factors were studied. Statistical analysis was performed through estimates of absolute and relative frequencies. Results: there was a predominance of children aged 1 to 5 years with 52 cases (82.6%) and males, 29 of them belonged to this age group (80.6%); previous admissions of less than 3 days in 37 cases (66.1%) and 56 cases did not receive exclusive breastfeeding, 37 of them accounted for 66.1%; 44 cases had a bad lifestyle (69.8%) and of the 43 cases that came from the urban area, 28 belonged to that kind of life (65.1%); Family pathological history of allergy or asthma and atopy were the most significant wit. Conclusions: it was found that age from 1 to 5 years, male sex, income of less than three days, without breastfeeding, poor lifestyle, urban origin were those that predominated in the study, as well as family pathological history and atopy as risk factors that exacerbated the disease.

Introdução: episódios de obstrução brônquica em idade precoce são um problema frequente em pediatria. Trata-se de um estudo descritivo, longitudinal e retrospectivo. Objetivo: caracterizar o comportamento da sibilância recorrente em crianças menores de 5 anos pertencentes ao município de Bayamo, do Hospital Provincial Pediátrico Universitário "General Milanés", em 2019. Métodos: a amostra foi composta por 63 pacientes e estudadas as variáveis idade, sexo, aleitamento materno, renda prévia, procedência, sexo de vida e possíveis fatores de risco. A análise estatística foi realizada por meio de estimativas de frequências absolutas e relativas. Resultados: houve predomínio de crianças de 1 a 5 anos com 52 casos (82,6%) e do sexo masculino, sendo que 29 deles pertenciam a essa faixa etária (80,6%); internações anteriores inferiores a 3 dias em 37 casos (66,1%) e 56 casos não receberam aleitamento materno exclusivo, sendo que 37 deles corresponderam a 66,1%; 44 casos tinham estilo de vida ruim (69,8%) e dos 43 casos provenientes da zona urbana, 28 pertenciam a esse tipo de vida (65,1%); História anatomopatológica familiar de alergia ou asma e atopia foram as mais significativas, com 63 e 52 casos (100 e 82,5%), respectivamente. Conclusões: verificou-se que idade de 1 a 5 anos, sexo masculino, renda inferior a três dias, ausência de aleitamento materno, estilo de vida ruim, origem urbana foram os que predominaram no estudo, assim como história patológica familiar e atopia como fatores de risco que exacerbaram a doença.

Clinical analysis of allergen reactivity and atopic disease history in 168 patients with chronic inducible urticaria / 中华皮肤科杂志

Objective:To analyze the relationship between allergen reactivity, atopic disease history and clinical features in patients with chronic inducible urticaria (CIndU) .Methods:A retrospective analysis was conducted on clinical data and follow-up results from 168 patients with CIndU in the Department of Dermatology, Southwest Hospital of Army Medical University from June 2014 to June 2015. Associations were analyzed between allergen reactivity, atopic disease history and clinical characteristics (including patient global assessment [PGA] scores, pruritus intensity, dermatology life quality index [DLQI], proportions of cases with complicated angioedema, natural course, etc.) in patients with different CIndU subtypes. Chi-square test, Mann-Whitney U test and Kaplan-Meier survival analysis were used for statistical analysis. Results:Among the 168 patients with CIndU, 117 were diagnosed with symptomatic dermographism (SD) , 32 with cold contact urticaria (CCU) , 5 with heat contact urticaria (HCU) , and 14 with cholinergic urticaria (CholU) ; there were 46 (39.3%) , 14 (43.8%) , 3, and 9 patients with positive skin prick test (SPT) among the patients with SD, CCU, HCU and CholU respectively, and no significant difference was observed in the positive rate of SPT among patients with different CIndU subtypes ( χ2 = 3.86, P = 0.283) . The SPT-positive CIndU patients showed significantly increased PGA scores, pruritus scores, DLQI scores and proportions of cases with complicated angioedema compared with the SPT-negative patients (all P<0.05) ; the CIndU patients with a personal or family history of atopic diseases also showed significantly increased PGA and DLQI scores compared with those without (both P < 0.05) . For different CIndU subtypes, the pruritus scores, PGA scores, DLQI scores, and proportions of cases with complicated angioedema were significantly higher in the SPT-positive SD patients than in the SPT-negative SD patients (all P < 0.05) ; the DLQI scores were significantly higher in the SPT-positive CholU patients than in the SPT-negative CholU patients ( Z = -2.28, P = 0.019) ; the pruritus scores were significantly higher in the CCU patients with a personal or family history of atopic diseases than in those without ( Z =-2.41, P = 0.022) . Conclusion:The allergen reactivity and atopic disease history of CIndU patients were associated with disease severity, pruritus intensity, quality of life, and the proportion of cases with complicated angioedema, but their relationship with the natural course of CIndU needs to be confirmed by further studies.

Allergic sensitization in low-income urban children: relationship with current symptoms of asthma and rhinitis / Sensibilización alérgica en niños urbanos de escasos recursos: relación con síntomas actuales de asma y rinitis

Abstract Background: Recent information on the prevalence of allergic sensitization (AS) in children from low-income urban areas is limited. Methods: We conducted a cross-sectional, randomized, population-based study to determine the prevalence of AS, and its relationship with asthma and rhinitis in low-income schoolchildren in Santiago, Chile. The parents answered a standardized questionnaire on respiratory symptoms, and a skin prick test (SPT) for common aeroallergens was performed on all children. Results: In the 545 schoolchildren studied (mean age 8.3 ± 0.9 years), the prevalence of positive SPT was 25.5%. The current prevalence of asthma, rhinitis, and rhinoconjunctivitis was 20%, 43.4%, and 27.8%, respectively. SPT was positive in 30.6%, 32.8%, and 38.0% of children with current asthma, rhinitis, and rhinoconjunctivitis, respectively. Positive SPT was significantly associated with rhinitis and rhinoconjunctivitis (p < 0.001) but not with asthma. Breastfeeding for at least 4 months was significantly protective against AS (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.26-0.78; p = 0.008); no other factor studied was associated with AS. Conclusions: The prevalence of AS was low; less than 40% of children with current asthma, rhinitis, or rhinoconjunctivitis symptoms evidenced AS. The prevalence of non-atopic asthma and rhinitis is consistent with previous findings in children from low-income urban areas. Other environmental factors, such as the high burden of respiratory infections and environmental pollution, might be more critical than atopy for developing asthma and rhinitis in schoolchildren from deprived urban areas.

Resumen Introducción: La información reciente sobre la prevalencia de sensibilización alérgica (SA) en niños de áreas urbanas de bajos recursos es limitada. Métodos: Se realizó un estudio transversal, aleatorio, a nivel poblacional, para determinar la prevalencia de SA y su relación con asma y rinitis en escolares de bajos recursos en Santiago de Chile. Los padres respondieron un cuestionario estandarizado de síntomas respiratorios y se realizaron pruebas cutáneas (PC) para alérgenos comunes en los niños. Resultados: En los 545 escolares estudiados (media de edad 8.3 ± 0.9 años) la prevalencia de PC positivas fue del 25.5%. La prevalencia actual de asma, rinitis y rinoconjuntivitis fue del 20%, 43.4% y 27.8%, respectivamente. Las PC fueron positivas en el 30.6%, 32.8% y 38.0% de los niños con síntomas actuales de asma, rinitis y rinoconjuntivitis, respectivamente. La rinitis y la rinoconjuntivitis se asociaron significativamente con PC positiva (p < 0.001), pero no el asma. La lactancia materna por al menos cuatro meses protegió significativamente contra SA (razón de momios [RM] 0.48, intervalo de confianza [IC] 95% 0.26-0.78; p = 0.008); ningún otro factor estudiado se asoció con SA. Conclusiones: La prevalencia de SA fue baja; menos del 40% de los niños con síntomas actuales de asma, rinitis o rinoconjuntivitis evidenció SA. La alta prevalencia de asma y rinitis no atópicas concuerda con hallazgos previos en niños de áreas urbanas de bajos ingresos. Otros factores ambientales como la alta carga de infecciones respiratorias y contaminación ambiental podrían ser más importantes que la atopia para el desarrollo de asma y rinitis en escolares de áreas urbanas desfavorecidas.

Characterization of allergic manifestations in dental professionals / Caracterización de manifestaciones alérgicas de profesionales en Odontología

Abstract The aim was to determine the prevalence and types of the allergies present among dental professionals in Costa Rica. We performed a cross-sectional study on 664 dentists who completed a self-reported questionnaire. A descriptive cross-sectional study with inferential analysis was carried out. Dentists reported allergies prior to studying dentistry in 39% of cases, 36% reported chronic illnesses, and 61% of the dentists reported first-degree relatives with some type of allergic reaction. Different allergies had a similar prevalence among the dental professionals (ranging between 19%-26%), all allergic manifestations occurred within the first 120 minutes after exposure. The average time of exposure to dentistry-related environments was 16 years (95% CI) among all the dentists surveyed. There is a positive correlation between the presence of a chronic illness and the predisposition to develop allergic reactions among dentists. In addition, there is a directly proportional relationship between age, time of exposure to dental environments, and the risk of developing allergic conditions to dental materials. The main adverse reactions reported due to exposure to dental materials, medicines and/or food were gastrointestinal, skin, and respiratory problems.

Resumen El objetivo del estudio fue determinar la prevalencia y tipo de alergias presentes entre los odontólogos en Costa Rica. Se realizó un estudio transversal descriptivo en 664 dentistas que completaron un cuestionario, utilizando análisis inferencial para el procesamiento de los resultados. Los odontólogos reportaron alergias previo a estudiar odontología en un 39% de los casos, el 36% informó enfermedades crónicas y el 61% de los dentistas mencionó tener familiares en primer grado que habían presentado algún tipo de reacción alérgica. Diferentes tipos de alergias tuvieron una prevalencia similar entre los odontólogos (oscilando entre el 19% y el 26%), todas las manifestaciones alérgicas ocurrieron dentro de los primeros 120 minutos después de la exposición al alergeno. El tiempo medio de exposición a entornos relacionados con la odontología fue de 16 años (IC del 95%) entre todos los dentistas encuestados. Existe una correlación positiva entre la presencia de una enfermedad crónica y la predisposición a desarrollar reacciones alérgicas entre los dentistas. Además, existe una relación directamente proporcional entre edad, tiempo de exposición a entornos dentales, y el riesgo de desarrollar reacciones alérgicas a los materiales dentales. Las principales reacciones adversas notificadas posterior a la exposición a materiales dentales, medicamentos y/o alimentos fueron problemas gastrointestinales, cutáneos y respiratorios.

Severe and Difficult Asthma: Diagnosis and Management—Challenges for a Low-Resource Environment

Severe and difcult asthma in a low- and middle-income country (LMIC) can relate to (a) lack of availability of basic medications; (b) potentially reversible factors such as poor adherence or comorbidities such as obesity inhibiting a good response to treatment; and (c) (rarely) true severe, therapy-resistant asthma. However, defnitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The frst assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-efects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.

Recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca en población pediátrica colombiana - Posición de expertos / Expert recommendations for diagnosis and treatment of cow's milk protein allergy in the Colombian pediatric population

Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.

Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.

Esofagite eosinofílica numa consulta de alergia alimentar: caracterização e comparação entre idade pediátrica e idade adulta / Eosinophilic esophagitis at a food allergy appointment: characterization and comparison between pediatric and adult ages

Introdução: Esofagite eosinofílica (EoE) é uma doença inflamatória crônica do esôfago, mediada imunologicamente e caracterizada por sintomas relacionados com disfunção esofágica e infiltração da mucosa esofágica por eosinófilos (Eo). Os objetivos foram caracterizar os doentes com diagnóstico de EoE e analisar as diferenças entre doentes com diagnóstico em idade pediátrica (Cr, < 18 anos) e adulta (Ad, ≥ 18 anos). Métodos: Estudo observacional retrospetivo dos doentes seguidos no serviço de Imunoalergologia, no período de Fev/2009 a Jul/2017, com diagnóstico de EoE. Foram divididos em dois grupos, Cr e Ad, caracterizados de acordo com dados demográficos, história de atopia, sintomas, sensibilizações alimentares, IgE Total, eosinofilia, achados na endoscopia digestiva alta e biópsias. Avaliou-se a correlação entre sensibilização alimentar, clínica grave (ClinG), ou seja, idas ao serviço de urgência ou internamento por complicações de EoE ou histologia grave (HistG), biópsia com Eo > 50 e/ou microabcessos. Resultados: 74 pacientes (81% sexo masculino, média de idades 27±17 anos), 36 Cr e 38 Ad. Os sintomas mais frequentemente reportados foram, no grupo Cr disfagia (73%) e refluxo gastroesofágico (46%), enquanto no grupo Ad impactação (85%) e disfagia (56%). Foram referidos antecedentes de atopia em 96% das Cr, e 67% dos Ad. Em 77% das Cr e 69% dos Ad havia sensibilização alimentar. Os achados endoscópicos mais frequentes no grupo Cr foram estriação (65%) e placas brancas (50%), enquanto que no grupo Ad foram placas brancas (42%) e anéis esofágicos (35%). HistG (46%) associou-se a ClinG (35%), p = 0,001, nas Cr, mas o mesmo não foi objetivado no grupo Ad [ClinG (22%) e HistG (17%), p = 0,5]. Conclusão: Os nossos resultados estão de acordo com o descrito na literatura, observando-se um predomínio do sexo masculino e uma maior frequência de história de atopia e sensibilização alimentar no grupo Cr. As situações graves de impactação e estenose esofágica foram mais frequentes nos Ad, e objetivou-se uma associação de histologia grave com clínica grave, apenas nas Cr.

Background: Eosinophilic esophagitis (EoE) is an immunologically mediated chronic inflammatory disease of the esophagus characterized by symptoms related to esophageal dysfunction and eosinophilic infiltration in the esophageal mucosa. This study aimed to characterize patients with a diagnosis of EoE and analyze differences between patients with EoE diagnosed at pediatric age (Ch, <18 years) and at adult age (Ad, ≥18 years). Methods: This was a retrospective study of patients with a diagnosis of EoE who were followed in the immunoallergology department from February 2009 to July 2017. Patients were divided into Ch and Ad groups and characterized according to demographic data, history of atopy, symptoms, food sensitization, total IgE, eosinophils (Eo), upper digestive endoscopy (UDE) findings, and biopsy findings. Correlations were assessed between food sensitization, clinical severity (SClin; determined by number of ER visits or hospital admissions for EoE complications), and severe histology (SHist; defined as biopsy with Eo >50 and/or microabscesses). Results: 74 patients (81% male, mean age 27±17 years), 36 Ch and 38 Ad. The most commonly reported symptoms were dysphagia (73%) and gastroesophageal reflux (46%) in the Ch group, and impaction (85%) and dysphagia (56%) in the Ad group. History of atopy was reported in 96% of Ch vs 67% of Ad. Food sensitization was found in 77% of Ch vs 69% of Ad. The most common UDE findings were striation (65%) and white plaques (50%) in the Ch group, and white plaques (42%) and esophageal rings (35%) in the Ad group. SHist (46%) was associated with SClin (35%) in Ch (p=0.001), but not in Ad (SClin [22%] and SHist [17%], p=0.5). Conclusion: Our results are consistent with those reported in the literature, with a male predominance and a higher prevalence of atopy and food sensitization in Ch. Severe impaction and esophageal stenosis were more frequent in Ad, but an association between SHist and SClin was found only in Ch.

Usefulness of bronchodilator response as an index of asthma control in children

PURPOSE: Assessing asthma control is important for proper management, and various indices for objective assessment of asthma control, such as fractional exhaled nitric oxide (FeNO) and asthma control test (ACT) score have been proposed. Recently, bronchodilator response (BDR) was reported as a marker of poor asthma control in adults. This study aimed to assess the usefulness of BDR as a biomarker for childhood asthma. METHODS: A total of 305 children diagnosed with asthma were included. Spirometry with bronchodilator test was done at the time of diagnosis and about 14 months after asthma treatment. All children were evaluated by childhood asthma control test (c-ACT) and FeNO after asthma treatment. The patients were divided into 2 groups according to BDR results: the positive and negative BDR groups. Various biomarkers for asthma control, such as c-ACT, FeNO and changes of forced expiratory volume in 1 second (FEV1), were compared between the 2 groups. RESULTS: Of the 305 patients, 143 (46.9%) were positive and 162 (53.1%) were negative for BDR. The BDR-positive group showed lower FEV1. In the BDR positive group, FEV1 was significantly increased after asthma treatment, especially in children with airflow limitation which was defined as below 80% of FEV1 or atopy. In atopic children, BDR showed a significant negative correlation with c-ACT and a positive correlation with FeNO. CONCLUSION: In asthmatic children with airflow limitation at the time of diagnosis, BDR can be a useful index for predicting improvement in lung function by asthma maintenance treatment. BDR could be a reliable marker for the assessment of asthma control in atopic children.

Atopy and susceptibility to respiratory infections in children / 中华实用儿科临床杂志

There is a close relationship between atopy and respiratory infections.Respiratory infections are regarded as one of the most important factors during allergic diseases development from atopy.Children with atopic diseases are not only predisposition to respiratory infections, but also display server symptom and long-lasting course during respiratory infections.Defection in innate immunity characterized by compromised epithelial barrier and low interferon response to virus infection and dysregulation of adaptive immunity characterized by predominant T-helper (Th)2 immune response are the potential causes.Children with a topic diseases such as asthma usually have abnormal microbe colonization or latent infection.Those factors maybe response for predisposition to respiratory infections in atopic children.On the other hand, children with atopic diseases are usually invoked with both infective inflammation and allergic inflammation during respiratory infections.Therefore, antiallergic inflammation therapy should be emphasized in the treatment of respiratory tract infections in atopic children.

Atopy and susceptibility to respiratory infections in children / 中华实用儿科临床杂志

There is a close relationship between atopy and respiratory infections.Respiratory infections are regarded as one of the most important factors during allergic diseases development from atopy.Children with atopic diseases are not only predisposition to respiratory infections,but also display server symptom and long-lasting course during respiratory infections.Defection in innate immunity characterized by compromised epithelial barrier and low interferon response to virus infection and dysregulation of adaptive immunity characterized by predominant T-helper (Th) 2 immune response are the potential causes.Children with a topic diseases such as asthma usually have abnormal microbe colonization or latent infection.Those factors maybe response for predisposition to respiratory infections in atopic children.On the other hand,children with atopic diseases are usually invoked with both infective inflammation and allergic inflammation during respiratory infections.Therefore,antiallergic inflammation therapy should be emphasized in the treatment of respiratory tract infections in atopic children.

Evaluation of multiple allergen simultaneous (sIgE) testing compared to intradermal testing in the etiological diagnosis of atopic dermatitis in horses

Although intradermal testing (IDT) is commonly used in the etiological diagnosis of allergies, in vitro testing for specific IgE (sIgE) is an attractive alternative. Currently, new laboratory techniques in veterinary allergological practice, including multiple allergen simultaneous tests (MASTs), gradually supersede in vivo tests. Both, serological (sIgE) and IDTs in fourteen atopic Malopolski horses were performed. Correlation and agreement between test results were evaluated. Receiver operating characteristic analysis showed that sIgE to Acarus siro had the best diagnostic performance (Area under the ROC curve [AUC] = 0.969), followed by Dermatophagoides pteronyssinus (AUC = 0.844), Dermatophagoides farinae (AUC = 0.813) and Tyrophagus putrescentiae (AUC = 0.803). A significant positive correlation between IDT and MAST was found for A. siro (r(S) = 0.870; p = 0.00005), and D. farinae (r(S) = 0.657; p = 0.011). There was significant moderate agreement for 2 of 5 allergens, A. siro (κ = 0.569) and D. farinae (κ = 0.485) in semiquantitative assessment and significant fair to substantial agreement for 3 of 5 allergens, D. pteronyssinus (κ = 0.689), A. siro (κ = 0.569), D. farinae (κ = 0.432) in dichotomic assessment. Sensitivity ranged from 44% to 89%, depending on the allergen, while specificity was significantly higher for all allergens in MAST (60%–100%); the mean accuracy was 73% (manufacturer cut-off) and 77.4% (optimal cut-off) based on the Youden index. Compared with IDT, serological MAST showed good detection performance for 60% allergen sIgE in dichotomic assessment with substantial diagnostic capability, but careful clinical interpretation is needed for some allergens.

Re-evaluation of the diagnostic value of fractional exhaled nitric oxide & its impact in patients with asthma

Background & objectives: The diagnostic value of fractional exhaled nitric oxide (FeNO) in patients with asthma remains controversial. This study was aimed to re-evaluate the diagnostic value of FeNO in specific groups with asthma and identify potential factors associated with FeNO. Methods: FeNO measurement and bronchial provocation test (BPT) or bronchodilator test (BDT) were performed in patients with suggestive symptoms for asthma. Correlation analysis was performed, and receiver-operating characteristic (ROC) curves and area under the curve (AUC) were calculated to evaluate the accuracy of FeNO in diagnosis. Results: A total of 265 (66.3%) patients with asthma were identified in 400 individuals suspected to have asthma from October 2014 to June 2015. Positive correlations of gender (r=0.138, P=0.005), atopy (r=0.598, P <0.001) and rhinitis (r=0.485, P <0.001) but negative correlations of age (r=?0.220, P <0.001) and the cumulative methacholine dosage with a 20 per cent decrease in forced expiratory volume in one second (r=?0.197, P <0.001) with FeNO were found. AUC of FeNO in whole population and patients with atopy and rhinitis was 0.728 [95% confidence interval (CI) 0.675-0.781, P <0.001] and 0.752 (95% CI 0.640-0.865, P <0.001), while the cut-offs were 23.5 and 44.5 parts per billion (ppb), respectively, rendering sensitivities, specificities, positive predictive value and negative predictive value of 79.9, 54.7, 77.9, 58.1 and 78.7, 67.9, 89.2 and 48.7 per cent, respectively. The cut-off of FeNO with specificity of 90 per cent (FeNO90) for all patients and a sub-group of patients with atopy and rhinitis was 59.5 and 90.5 ppb, respectively, while FeNO90decreased by 12 ppb with every 10 years. Interpretation & conclusions: Our findings show that the diagnostic value of FeNO varies in different groups of patients with asthma, thus, the cut-off point should be adjusted in different asthmatic sub-populations. A cut-off point of FeNO with a specificity >90 per cent could decrease the false-positive rate.

Anafilaxia: estado del arte / Anaphylaxis: state of the art

RESUMEN La anafilaxia se define como una reacción de hipersensibilidad, sistémica, de instauración rápida y potencialmente fatal, con manifestaciones clínicas y severidad variable, que resulta de la liberación súbita de mediadores de mastocitos y basófilos. El diagnóstico de esta entidad es fundamentalmente clínico, basándose en los patrones de manifestación y la exposición a un posible detonante. Actualmente varios estudios indican deficiencias en la identificación y manejo de esta enfermedad, lo que genera un riesgo elevado de mortalidad. En esta revisión presentamos puntos prácticos del manejo e identificamos las principales consideraciones a tener en cuenta en el primer nivel de atención.

SUMMARY Anaphylaxis is defined as a systemic, rapid onset, and potentially fatal hypersensitivity reaction, with variable clinical manifestations and severity resulting from the sudden reléase of mast cell and basophil mediators. The diagnosis of this entity is fundamentally clinical, based on the patterns of manifestation and the exposure to a possible trigger. Currently several studies indicate deficiencies in the identification and management of this disease, which generates an increase in mortality. In this review we present practical points of management and identify the main considerations to be taken into account in the first level care.

The relationship between atopy and neurological manifestations in HTLV-1 infection

Abstract INTRODUCTION: Human T-cell lymphotropic virus type 1 (HTLV-1)induces exaggerated Th1 responses, whereas atopy is associated with exacerbated Th2 responses. METHODS: Here, a cross-sectional study compared the prevalence of atopy in HTLV-1 carriers and HAM/TSP patients. It also compared the spontaneous cytokine production in HTLV-1-infected individuals. A retrospective cohort study evaluated the development of neurological manifestations in atopic and non-atopic carriers. RESULTS: Atopic HAM/TSP patients with high IFN-γ production exhibited higher IL-5 levels than non-atopic patients. Allergic rhinitis accelerated the development of Babinski signals and overactive bladders. CONCLUSIONS: Abnormal Th1 and Th2 responses coexist in HTLV-1-infected individuals and allergic diseases may worsen the clinical course of HTLV-1 infections.

Impact of Bacille Calmette-Guérin revaccination on serum IgE levels in a randomized controlled trial

Abstract INTRODUCTION: Bacille Calmette-Guérin (BCG) downmodulates allergen-specific IgE levels and prevents other atopic responses in experimental models but fails to protect against respiratory allergies. Human responsiveness to BCG is variable and may interfere with protection. METHODS: Multivariate models were evaluated to test the possible effect of responsiveness (assessed by IFN-γ production) to BCG revaccination on the modulation of total and allergen-specific serum IgE levels in healthy volunteers participating in a randomized controlled trial. RESULTS: Serum total or Derp-specific IgE levels did not change regardless of the increase in IFN-γ levels. CONCLUSIONS: BCG responsiveness does not affect protection against atopy.

The Incidence of Delayed-Type Hypersensitivity Reactions to Apples Among Patients Allergic to Birch Pollen

The major apple allergen Mal d 1 cross-reacts with the homologous birch pollen allergen Bet v 1 and causes immunoglobulin E (IgE)-mediated immediate-type allergic reactions. In some patients, delayed-type hypersensitivity to apples may develop within 72 hours without evidence of specific IgE or a positive skin prick test (SPT). The aim of the study was to evaluate the concomitance of delayed-type hypersensitivity reactions and immediate IgE-mediated reactions against high- and low-allergenic apple cultivars in patients with birch pollen allergy. Data were obtained from 45 adults with clinical symptoms of birch pollen allergy. Patients were exposed to apple pulp via atopy patch tests (APTs) and SPTs. Levels of IgE specific to Bet v 1 and Mal d 1 were measured with a radioallergosorbent test. Patients allergic to birch pollen showed the highest rate of positive SPT responses to Golden Delicious apples and the lowest rate to low-allergenic cultivar Grey French Reinette. Among these patients, 9% developed delayed hypersensitivity reactions to either Golden Delicious or Grey French Reinette apples; these reactions manifested clinically as erythema with papules (class ++). Fifty percent of APT-positive patients were concomitantly SPT-negative. Here, we show for the first time the clinical relevance of T cell-driven allergic reactions to apples. APTs may reveal type IV sensitization in patients who are negative for the corresponding type I sensitization tests. Thus, utilization of the APT procedure with fresh apple appears to be a valuable tool for the diagnosis of apple allergy and may improve the accuracy of food allergy diagnoses.

Trends in the Prevalence of Childhood Asthma in Seoul Metropolitan City, Korea: The Seoul Atopy ∙ Asthma-friendly School Project / 예방의학회지

OBJECTIVES: The project Seoul Atopy ∙ Asthma-friendly School investigated the current status of childhood asthma to enable formulation of a preventative policy. We evaluated the current prevalence of childhood asthma in Seoul and its trends and related factors. METHODS: The project was conducted annually from 2011 to 2016 and involved around 35 000 children aged 1-13 years. Based on the International Study of Asthma and Allergies in Childhood guidelines, the survey involved parents. The associations of the particulate matter (PM10) concentration, and the number of days on which the daily air quality guidance level was exceeded in the 25 districts of Seoul, with the prevalence of asthma were assessed. RESULTS: The age-standardized asthma prevalence in 2011 and 2016 was 6.74 and 4.02%, respectively. The prevalence of lifetime asthma treatment and treatment during the last 12 months tended to decrease from 2011 to 2016. Asthma treatment was significantly correlated with the number of days on which the daily air quality guidance level was exceeded, but not with the PM10 concentration. CONCLUSIONS: This study reports the prevalence of asthma among children in Seoul and confirmed the relationship between childhood asthma and known risk factors in a large-scale survey.

Analysis of Medical Treatment Interest Trend in Rural Environment by Big Data / 의료커뮤니케이션

BACKGROUND: In the rural environment, medicine treatment has analyzed the health behavior of some rural areas, but it is necessary to study and generalize trends of interest in the whole country. Therefore, The objective of this study is to analyze interest trends of rural health care services of rural residents in rural areas by Big Data.METHODS: Big medical data collection related to rural environment medicine treatment used portal site data of social networks. The Big Data was analyzed utilizing a Textom and Ucinet6 analysis tools.RESULTS: Among the major keywords of Big Data are ‘hospital’, ‘university’, ‘management’, ‘seat’, ‘improvement’, ‘residents’, ‘information’, ‘exercise’, ‘development’, ‘problem’, ‘Pain’, ‘Possibility’, ‘Post’, ‘Work’, ‘Relationship’ etc occupy a high rank in all analyzes such as frequency ranking, total network analysis, 4 centrality and CONCOR analysis. In rural environment medicine, the individual diseases of interest were skin, scars, atopy, acne, eyes, hyperlipidemia, stress and so on. It is also possible to find out whether the program, the longevity person, the cultivation, the village, the farm, the activity, the program, the education, the experience, etc.CONCLUSION: In the rural areas, they are interested in the folk medicine that can be used in the rural areas for the treatment of the diseases related to the rural areas.The lack of treatment for children and women indicated that professional information was needed, and they also expressed interest in food, life, and spatial location for long-lived villages. Specially, “atopy” and “earnestness” were included in the main words. The word ‘health center’, which is the subject of various health promotion projects, was not included in the 170 main words.

A clinician's reference guide for the management of atopic dermatitis in Asians

BACKGROUND: Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD. OBJECTIVE: The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians. METHODS: Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017. RESULTS: The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included. CONCLUSION: The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.

Papel de las infecciones virales en el asma / The role of viral infections in asthma

Respiratory viral infections have been implicated in the origin and exacerbation of asthma symptoms in a variety of ways. A growing body of evidence indicates that viral infections are closely linked to infantile wheezing and suggest that severe bronchiolitis in early infancy may predispose to chronic childhood asthma. Alternatively, it could represent a marker of susceptible individuals. In contrast, mild repetitive infections in early years may provide a protective role against the development of asthma or atopy by switching the immune system towards Th1 responses. However, evidence on this hypothesis is not consistent as far as viruses are concerned. On the other hand, in the presence of asthma, the role of viral infections on exacerbations is well established. Several factors, such as the presence of atopy, timing of the exposure and severity of the infections, interactively contribute to the asthma-infection relationship. In the present report, recent data on the involvement of viral infections in the development and progression of asthma are reviewed

Las infecciones virales respiratorias han sido involucradas en el origen y en las exacerbaciones de los síntomas del asma en una variedad de formas. Cada vez hay más indicios de que las infecciones virales están estrechamente relacionadas con sibilancias en la niñez y sugieren que la bronquiolitis grave en la primera infancia puede predisponer a asma crónica infantil; por otra parte, podría representar un marcador de individuos susceptibles. Por el contrario, las infecciones leves repetidas en los primeros años brindarían un efecto protector contra la aparición de asma o atopia mediante la desviación del sistema inmunitario hacia respuestas Th1. Sin embargo, la información relacionada con esta hipótesis no es firme en lo que a virus se refiere. Por otra parte, en presencia de asma, el papel de las infecciones virales sobre las exacerbaciones está bien establecido. Varios factores, como la presencia de atopia, el momento en el que se produce la exposición y la gravedad de las infecciones, interactúan en la relación entre asma e infección. En este artículo se revisan datos acerca de la participación de las infecciones virales en la aparición y progresión del asma