Giardia lamblia e alergia respiratória: estudo em uma amostra de crianças de área urbana com frequência elevada da protozoose / Giardia lamblia and respiratory allergies: a study of children from an urban area with a high incidence of protozoan infections

OBJETIVO: Uma elevada incidência de enteroparasitoses é encontrada em regiões urbanas do nordeste brasileiro. As infecções por Giardia lamblia têm sido relacionadas com aumento da prevalência de alergias cutâneas e gastrointestinais. Contudo, ainda existe pouca informação sobre a associação entre a giardíase e doenças alérgicas das vias aéreas. Diante disso, o presente estudo se propôs a verificar a relação entre a infecção por G. lamblia em crianças de área urbana e reatividade alérgica respiratória. MÉTODOS: O estudo incluiu 110 pacientes, de ambos os sexos e idades, entre 5 e 15 anos. Os pacientes foram submetidos a questionários de avaliação dos sintomas clínicos, testes cutâneos de leitura imediata e exames coproparasitológicos e sorológicos. RESULTADOS: Foi verificada uma frequência elevada de crianças infectadas por G. lamblia (45%, 50/110). A infecção pelo protozoário não foi associada com maior risco de alergias respiratórias (p = 0,075), elevação de IgE total (p = 0,701), IgE específica (p = 0,250) ou teste cutâneo positivo para diferentes alérgenos ambientais (p = 0,239). CONCLUSÃO: O estudo demonstrou que a presença dos sintomas de asma, atopia cutânea e marcadores sorológicos não foram associados com a presença de infecção pela G. lamblia nessa amostra de crianças.

OBJECTIVES: There is a high incidence of intestinal parasite infection in urban areas in the Northeast of Brazil. Giardia lamblia infections have been associated with increased prevalence of cutaneous allergies and gastrointestinal disorders. However, little is known about the relationship between giardiasis and allergic diseases of the airways. The present study aimed to investigate the possible association between respiratory allergic diseases and infections by G. lamblia in children from urban areas. METHODS: This study recruited 110 patients of both sexes aged 5-15 years. Patients were administered a questionnaire evaluating clinical symptoms and were given skin tests, parasite tests and serum tests. RESULTS: A high incidence of G. lamblia was observed (45%, 50/110). Infections by this protozoan were not associated with increased risk of respiratory allergy (p = 0.075), high total IgE levels (p = 0.701), positive specific IgE tests (p = 0.250), or positive skin tests for a range of environmental allergens (p = 0.239). CONCLUSION: This study demonstrated that symptoms of asthma, skin allergy and serum markers were not associated with G. lamblia infections in this sample of children from urban areas.

Alergia, pólenes y medio ambiente / Allergy, pollen and the environment

Las enfermedades respiratorias como el asma y la rinitis, de origen predominantemente alérgico, constituyen un problema de salud pública para México, ya que son causas importantes de morbilidad hospitalaria y de ingresos a urgencias pediátricas. Los pólenes son transportados por el viento y se impactan en las vías aéreas causando enfermedad respiratoria alérgica en personas susceptibles. Estudios aerobiológicos en México muestran que en la temporada de secas se encuentra una mayor abundancia y diversidad de pólenes, siendo los árboles la fuente principal. Los tipos polínicos de árboles que sobresalen por su abundancia son Pinus, Fraxinus, Cupressaseae, Alnus, Liquidambar, Callistemon y Casuarina. Interesantemente, el polen de malezas y pastos alcanza su pico máximo de producción durante la temporada de lluvias. Los taxa de malezas y pastos que han sido encontrados de manera más numerosa son Compositae, Cheno-Am, Ambrosia y Gramineae, correspondiendo los primeros tres a malezas y el último a pastos. En la ciudad de México, la contaminación es un factor que exacerba la alergenicidad de los pólenes, ya que los contaminantes causan un efecto directo sobre el propio grano al liberar sus antígenos. En el mundo, el calentamiento global ha favorecido el desarrollo de alergias respiratorias debido a que las etapas de floración son más prolongadas. Todo esto en conjunto representa una amenaza para la salud de los pacientes alérgicos.

Allergic respiratory diseases such asthma and allergic rhinitis are a health problem throughout the world. In Mexico City, pollens are an important cause of allergic respiratory disease. Both, the geographic location- and the vegetation surrounding this City favor the distribution of pollens leading to respiratory disease in susceptible patients. Aerobiological studies have shown that during the mild dry winter there is a large amount of pollens in the environment with tree pollens being the most abundant of all. The most frequent tree pollens found in Mexico City include Fraxinus, Cupressaseae, Alnus, Liquidambar, Callistemon, Pinus, and Casuarina. In contrast, grass- and weed pollens predominate during the summer (rainy season) including Compositae, Cheno-Am, Ambrosia and Gramineae. An additional health problem in Mexico City is the air pollution that exerts a direct effect on individuals. This in turn increases pollen allergenicity by disrupting them leading to the release of their particles which then penetrate the human airways causing disease. Thus, the polluted environment along with global warming which is also known to increase pollen quantities by inducing longer pollen seasons may represent a health risk to Mexico City inhabitants.

The role of interferon-gamma on immune and allergic responses

Allergic diseases have been closely related to Th2 immune responses, which are characterized by high levels of interleukin (IL) IL-4, IL-5, IL-9 and IL-13. These cytokines orchestrate the recruitment and activation of different effector cells, such as eosinophils and mast cells. These cells along with Th2 cytokines are key players on the development of chronic allergic inflammatory disorders, usually characterized by airway hyperresponsiveness, reversible airway obstruction, and airway inflammation. Accumulating evidences have shown that altering cytokine-producing profile of Th2 cells by inducing Th1 responses may be protective against Th2-related diseases such as asthma and allergy. Interferon-gamma (IFN-gamma), the principal Th1 effector cytokine, has shown to be crucial for the resolution of allergic-related immunopathologies. In fact, reduced production of this cytokine has been correlated with severe asthma. In this review, we will discuss the role of IFN-gamma during the generation of immune responses and its influence on allergic inflammation models, emphasizing its biologic properties during the different aspects of allergic responses.

Selective suppression of leukocyte recruitment in allergic inflammation

Allergic diseases result in a considerable socioeconomic burden. The incidence of allergic diseases, notably allergic asthma, has risen to high levels for reasons that are not entirely understood. With an increasing knowledge of underlying mechanisms, there is now more potential to target the inflammatory process rather than the overt symptoms. This focuses attention on the role of leukocytes especially Th2 lymphocytes that regulate allergic inflammation and effector cells where eosinophils have received much attention. Eosinophils are thought to be important based on the high numbers that are recruited to sites of allergic inflammation and the potential of these cells to effect both tissue injury and remodelling. It is hoped that future therapy will be directed towards specific leukocyte types, without overtly compromising essential host defence responses. One obvious target is leukocyte recruitment. This necessitates a detailed understanding of underlying mechanisms, particularly those involving soluble che-moattractants signals and cell-cell adhesion molecules.

Sensibilização a alérgenos inalantes e alimentares em crianças brasileiras atópicas, pela determinação in vitro de IgE total e específica: Projeto Alergia (PROAL) / Sensitization to inhalant and food allergens in Brazilian atopic children by in vitro total and specific IgE assay: Allergy Project - PROAL

OBJETIVO: Determinar a freqüência de sensibilização a alérgenos inalantes e alimentares em crianças atendidas em serviços brasileiros de alergia. PACIENTES E MÉTODOS: IgE sérica total e específica (RAST) a alérgenos inalantes e alimentares (UniCAP® - Pharmacia) foram determinados em 457 crianças acompanhadas em serviços de alergia pediátrica e em um grupo de controles (n = 62). Resultados classe igual ou maior que 1 foram considerados positivos (R+). RESULTADOS: A freqüência de R+ foi significantemente maior entre os atópicos (361/457, 79 por cento) quando comparados aos controles (16/62, 25,8 por cento). Não houve diferenças quanto ao sexo. A prevalência de R+ entre os atópicos foi significantemente maior para todos os alérgenos avaliados. Os níveis séricos de IgE total foram significantemente mais elevados entre os atópicos com R+ quando comparados aos com R-. Comparando-se atópicos e controles, a freqüência de R+ para os principais alérgenos inalantes foi como segue: D. pteronyssinus = 66,7 versus 14,5 por cento (p < 0,05), D. farinae = 64,5 versus 17,8 por cento (p < 0,05), B. tropicalis = 55,2 versus 19,4 por cento (p < 0,05), barata = 32,8 versus 9,7 por cento (p < 0,05) e gato = 12 versus 8,1 por cento. Com os alimentos, observou-se: peixe = 29,5 versus 11,3 por cento (p < 0,05), ovo = 24,4 versus 4,8 por cento (p < 0,05), leite de vaca = 23,1 versus 3,2 por cento (p < 0,05), trigo = 20 versus 8,1 por cento (p < 0,05), amendoim = 14 versus 4,8 por cento (p < 0,05), soja = 11,8 versus 4,8 por cento (p < 0,05) e milho = 10,6 versus 4,8 por cento (p < 0,05). Segundo a idade, os R+ aos alimentares predominaram entre as crianças mais jovens, e o inverso ocorreu com os inalantes. CONCLUSÕES: Nesta população, predominou a sensibilização aos aeroalérgenos, sobretudo aos ácaros domiciliares, e os alimentos foram importantes em crianças mais jovens.

Phadiatop® no diagnóstico de alergia respiratória em crianças: Projeto Alergia (PROAL) / Phadiatop® in the diagnosis of respiratory allergy in children: Allergy Project - PROAL

OBJETIVO: Avaliar a positividade do Phadiatop® em crianças acompanhadas em serviços brasileiros de alergologia e compará-la aos resultados de IgE sérica específica a alérgenos inalantes e alimentares. CASUíSTICA E MÉTODO: Em 457 crianças acompanhadas em serviços de alergia pediátrica e um grupo de crianças controle não-alérgicas (n = 62), distribuídas em cinco faixas etárias, foram determinados em amostra de soro: Phadiatop® e IgE específica (RAST) a alérgenos inalantes e alimentares (UniCAP - Pharmacia®). RESULTADOS: O Phadiatop® foi positivo em 305 crianças atópicas (67,6 por cento) e em 25,8 por cento das controles (p < 0,001). Entre as crianças atópicas, a distribuição de positividade variou de acordo com a faixa etária: 7,9 por cento (24/305) entre as abaixo de 2 anos, 15,4 por cento (47/305) nas de 2 a 3 anos, 22,0 por cento (67/305) nas de 3 a 4 anos, 19,3 por cento (59/305) nas de 4 a 5 anos e 35,4 por cento (108/305) nas de 5 a 12 anos. Não houve concordância entre os alérgenos alimentares e a presença de Phadiatop® positivo. O estudo da relação entre os RAST positivos para alérgenos inalados e o Phadiatop® positivo mostrou melhores índices com os ácaros domiciliares (D. pteronyssinus, D. farinae e Blomia tropicalis). CONCLUSÕES: O Phadiatop®é método útil no diagnóstico de alergia aos ácaros domiciliares.

Allergy to house dust mites and asthma

House dust mites have been shown to be important sources of indoor allergens associated with asthma and other allergic conditions. Asthma is a chronic respiratory disease that affects millions of people worldwide, and numerous scientific studies have shown that the prevalence of asthma is increasing. The most common dust mite species around the world include Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), Euroglyphus maynei (Em) and Blomia tropicalis (Bt). Over the past three decades, many important allergens from these species have been identified and characterized at the molecular level. The biological function of several house dust mite allergens has been elucidated, with many of them showing enzymatic activity. However, Bt allergens remain the least studied, even though this mite is very common in tropical and subtropical regions of the world, including Puerto Rico. Therefore, it is very important to include Bt in diagnostic and therapeutic strategies for house dust mite induced allergy and asthma, particularly in areas where Bt exposure and sensitization is high. Recombinant DNA technology, as well as other molecular biology and immunological techniques, have played a fundamental role in advances towards a better understanding of the biology of house dust mites and their role in allergic diseases. This kind of study also contributes to the understanding of the complex immunologic mechanisms involved in allergic reactions. The development of effective diagnostic and therapeutic approaches depends on the continuity of research of house dust mite allergens. The objectives of this review are to describe the most important aspects of house dust mite allergy and to acquaint the scientific community with the latest findings pertaining to house dust mite allergens, particularly those derived from Bt.

Role of allergy in the therapeutic response of nasal polyps.

The objective of this study was to determine whether the allergy factor affects therapeutic response of nasal polyps. A total of 68 patients were enrolled between 1 October 1999 and 1 January 2002 at the Allergy and Rhinology Clinic, Faculty of Medicine, Songklanagarind Hospital. Allergy skin prick test was performed in order to divide patients into a positive skin test group and a negative skin test group. Their medical history was recorded including age, sex, nasal symptoms, concomitant diseases and medications. Patients in both groups were treated over a 6 week period with Budesonide nasal spray. Nasal symptoms, polyp size, nasal and oral expiratory peak flow were evaluated at each visit. Overall assessment of treatment efficacy was evaluated by patients at 3 and 6 weeks after treatment. The mean value of these variables during treatment and a baseline period were compared within and between groups. After 3 and 6 weeks of treatment of nasal polyps with topical Budesonide nasal spray, nasal symptoms, polyp size, nasal and oral expiratory peak flow index and overall response to treatment were improved within both groups. Comparing the two groups, there were greater improvements in the negative skin test group compared to the positive skin test group in all variables. These differences in variable scores between groups showed a tendency to increase overtime after treatment was terminated. The results demonstrate that nasal polyps with positive allergen skin test had less improvement compared to nasal polyps with negative allergen skin test in all nasal signs and symptoms and these differences in improvement showed a tendency to increase over time after treatment.

Common environmental allergens causing respiratory allergy in India.

Respiratory allergy affects all age groups but the children are the worst affected by the respiratory allergy. Bioparticles from different biological sources are the main cause of allergy. Pollen grains, fungal spores, insect and other materials of biological origin form the most important allergen load in the air. For the efficient diagnosis of the allergy and its effective treatment it is very important to know about the prevalence, seasonal and annual variations of aeroallergens of the area. India being the climatically diversed country, there is diversity in the flora and fauna of different parts of the country. Atmospheric surveys carried out in different parts of India reveal that, Alanus nitida, Amarantus spinosus, Argemone mexicana Cocos nucifera, Betula utilis, Borasus flabellifer, Caraica papaya, Cedrus deodara, Cassia fistula, Parthenium, Chenopodium album, Dodonaea viscosa, Malotus phillipensis, Plantago ovata, Prosopis juliflora, Ricinus communis, Holoptelea intergifolia are the allergenically important pollens of the country. Among the fungal aeroallergens, Alternaria, Candida aibieans, Aspergillus versicolor, Aspergillus terreus, Aspergillus japonicus, Cladosporium cladosporoides, Fusarium roseum, Ganoderma lucidum,Neurospora sitophila Helminthosporium, Ustilago trtici, Uromyses are important allergens. Dust mites D. farinae, D.pteronyssinus are also important source of inhalant allergens particularly in the coastal areas of the country. Cockroaches, beetles, weevils, mosquitoes, house flies also contribute towards the aeroallergen load and are allergenically implicated. Avoidance of the indoor and outdoor aeroallergens is recommended for better management of respiratory allergy.

Histamine induced decrease of lecithin levels in broncho-alveolar lavage fluid of rats is mediated by H2 receptor.

Lecithin, a major surface active substance of the surfactant system of the lung, was estimated in broncho-alveolar lavage (BAL) fluid in four groups of healthy adult male albino rats. Rats from group I were not administered any drug and acted as controls. Group II were administered histamine diphosphate. Group III were given H1 blocker (pyrilamine maleate) followed by histamine diphosphate. Group IV received H2 blocker (ranitidine hydrochloride) followed by histamine diphosphate. Lecithin content of BAL fluid in the control group was compared with that in the other three groups. A significant decrease in lecithin content was observed in the rats that received either histamine diphosphate or H1 blocker followed by histamine diphosphate. However, compared to control rats no significant difference in lecithin content was seen in rats that received H2 blocker followed by histamine diphosphate. The results clearly indicate that the decrease in surface active lecithin content in BAL fluid following administration of histamine diphosphate was unaffected by prior administration of H1 blocker, but was blocked by prior administration of H2 blocker. It was concluded that histamine induced decrease in lecithin content of BAL fluid is mediated through H2 receptors. Since the predominant source of intra-alveolar lecithin are Type II cells of the alveolar epithelium, It is possible that Type II cells have H2 receptors, stimulation of which resulted in decreased intraalveolar lecithin.

Role of specific IgE, IgG and IgG4 antibodies to corn dust in exposed workers

BACKGROUND AND METHODS: To evaluate the role of specific antibodies to corn dust (CD) and their relationship to respiratory dysfunction, we detected serum specific IgE(slgE) and IgG4(slgG4) antibodies by ELISA in 42 employees working in the animal feed industry and 27 unexposed controls. RESULTS: Our survey revealed that 15 (34.9%) subjects had work-related respiratory dysfunction associated with or without nasal symptoms. Among these subjects, eight had airway hyper-responsiveness to methacholine. Significant differences were noted in slgE and slgG4 between exposed and unexposed groups (p = 0.04, p = 0.00 respectively), but no difference was noted in slgG (p = 0.1). Although there was no significant differences in the prevalence of specific IgE antibody between symptomatic (29%) and asymptomatic groups (19%, p = 0.55), the specific IgE levels were significantly higher in symptomatic workers than in asymptomatic workers (p = 0.03). Specific IgG antibody was detected in 1 (6%) symptomatic and 4 (15%) asymptomatic workers (p = 0.46). Specific IgG4 antibody was detected in 11 (73%) of symptomatic and 21 (78%) of asymptomatic workers (p = 0.90). The higher prevalence of slgG4 antibody was noted in workers with slgE antibody (p = 0.001). The correlation between slgG and exposure duration was significant (r = 0.36, p = 0.02). There was no association between the prevalence of slgE, slgG, and slgG4 to exposure intensity, smoking or atopic status. CONCLUSION: These results suggested that the existence of slgG and slgG4 might represent a response to CD exposure, and that some unexposed subjects had slgG to CD. Specific IgE might play a role in the development of respiratory symptoms.

Immune responses of IL-5 transgenic mice to parasites and aeroallergens

Eosinophils have long been thought to be effectors of immunity to helminth but have also been implicated in the pathogenesis of asthma. Patterns of cytokine production in the host may influence the pathogenesis of these diseases by regulating the activities of eosinophils and other components of the immune response. Mice which constitutively over-express IL-5 have profound and life-long eosinophilia in a restricted number of tissues. Although eosinophils from IL-5 transgenics are funtionally competent for a number of parameters considered to be important in inflammation, untreated animals are overtly normal and free of disease. In addition, the responses of these animals when exposed to aeroallergens and helminth present a number of apparent paradoxes. Eosinophil accumulation in tissue adjacent to major airways is rapid and extensive in transgenics exposed to the aeroallergen, but even after treatment with antigen over many months these mice show no evidence of respiratory distress or pathology. Helminth-infected IL-5 transgenics and their non-transgenic littermates develop similar inflammatory responses at mucosal sites and are comparable for a number of T cell and antibody responses, but they differ considerably in their ability to clear some parasite species. The life-cycle of Nippostrongylus brasilensis is significantly inhibited in IL-5 transgenics, but that of Toxocara canis is not. Our results suggest that eosinophilia and/or over-expression of IL-5 may actually impair host resistance to Schistosoma mansoni and Trichinella spiralis. The pathogenesis of diseases in which eosinophils are involved may therefore be more complex than previously thought.

Interleukin-4 and interleukin-5 as targets for inhibition of eosinophilic inflammation and allergic airways hyperreactivity

Clinical and experimental investigations suggest that allergen-specific CD4+ T-cells, IgE and the cytokines IL-4 and IL-5 play central roles in initiating and sustaining an asthmatic response by regulating the recruitment and/or activation of airways mast cells and eosinophils. IL-5 plays a unique role in eosinophil development and activation and has been strongly implicated in the aetiology of asthma. The present paper summarizes our recent investigations on the role of these cytokines using cytokines knockout mice and a mouse aeroallergen model. Investigations in IL-5-/- mice indicate that this cytokines is critical for regulating aeroallergen-induced eosinophilia, the onset of lung damage and airways hyperreactivity during allergic airways inflammation. While IL-4 and allergen-specific IgE play important roles in the regulation of allergic disease, recent investigations in IL-4-/- mice suggest that allergic airways inflammation can occur via pathways which operate independently of these molecules. Activation of these IL-4 independent pathways are also intimately associated with CDA+ T-cells, IL-5 signal transduction and eosinophilic inflammation. Such IL-5 regulated pathways may also play a substantive role in the aetiology of asthma. Thus, evidence is now emerging that allergic airways disease is regulated by humoral and cell mediated pocesses. The central role of IL-5 in both components of allergic disease highlights the requirements for highly specific therapeutic agents which inhibit the production or action of this cytokines.

Effect of histamine on lecithin content in broncho-alveolar lavage fluid of rat.

Deficiency of surfactant in alveoli leads to increased resistance to breathing. Histamine is a mediator in allergic respiratory diseases. Though the bronchoconstrictor effect of histamine is well recognised, histamine may have additional actions that contribute to pathogenesis in these diseases. The present study aimed to observe the effect of histamine on lecithin, a major component of alveolar surfactant. Lecithin content in broncho-alveolar lavage (BAL) fluid of healthy adult male rats was estimated by enzymatic method using Boehringer-Mannheim kits. Lecithin content in these control animals was compared with that in three groups of healthy adult male rats following subcutaneous administration of 0.06 mg of histamine diphosphate at 10 minutes, 30 minutes and 60 minutes intervals, respectively. A significant reduction in lecithin levels in BAL fluid was observed up to one hour after administration of histamine. The results indicate a possible additional action of histamine in the pathogenesis of allergic respiratory diseases.

Multiple dust allergy in a semiurban environs.

Multiple dust allergy in a study of 100 patients of nasobronchial hypersensitivity has been demonstrated by skin testing in Chandigarh and successfully desensitised over a 3-year period. The results are discussed and the multiple factors involved postulated.

Skin reactivity and specific IgE antibody to two nonbiting midges in Korean respiratory allergy patients

To evaluate the significance of chironomid as a respiratory allergen, we performed skin prick tests with Chironomus plumosus (CP) and Tokunagayusurika akamusi (TA) extracts on 475 respiratory allergy patients, and their specific IgE antibodies were detected by enzyme-linked immunosorbent assay (ELISA) in 106 positive reactors to skin prick test and 30 negative controls. Ninety-seven (20.4%) showed more than 2+ of allergen to histamine ratio to CP and 98 (20.6%) to TA on skin prick test. Seventy-one (73.2%) of 97 positive reactors had increased specific IgE to CP, and 34 (34.7%) of 98 positive reactors, to TA. CP-specific IgE was detected in 14 (14.4%) non-atopic asthmatics and 6 (6.2%) non-allergic rhinitis patients. TA-specific IgE was detected in 17 (17.4%) non-atopic asthmatics and 6 (6.1%) non-allergic rhinitis patients. No association was noted between skin reactivity to Dermatophagoides farinae and the prevalence of specific IgE to CP or TA (p > 0.05). The correlation between total IgE level and specific IgE level to CP and TA was poor (r = 0.07, 0.04). ELISA inhibition test suggested specificity of IgE binding and cross-allergenicity between CP and TA. It is suggested that CP and TA can induce IgE-mediated reaction in exposed patients and should be considered as important causative allergens in respiratory allergy patients in Korea.

Serum IgE levels: correlation with skin test reactivity in Thai adults with respiratory allergy.

A history of respiratory allergic disorders was obtained in 68 patients. Allergic skin testing was performed with measurement of total IgE by enzyme immunoassay (EIA). The mean level of total IgE from the control group of 13 healthy adults with no history of allergic diseases was 24.7 IU per ml. The average serum IgE level among the allergic patients with positive skin tests was 97.6 IU per ml and it was significantly higher than that of the controls (p less than 0.005). It was also found that the positive skin test patients had significantly a higher mean serum IgE level than that of patients with negative skin test results (97.6 vs 33.6 IU per ml, p less than 0.01). Since 73.2% of the allergic patients with positive skin tests had serum IgE levels over 45 IU per ml while only 23.1% of the control group had IgE levels exceeding this figure, we consider that a patient with clinical symptoms and a serum IgE level over 45 IU per ml is likely to be suffering from allergic disease.

Aeroalargenos y alergia respiratoria en el estado de Oaxaca, México / Aeroallergens and respiratory allergy in the state of Oaxaca, Mexico

Se estudiaron 108 pacientes del estado de Oaxaca, M[exico., 75 hombres, 62 mujeres, con promedio de edad de 29 a;os, con diagnosticos de asma, rinitis y sinusitis, para determinar la frecuencia de aeroalargenos comprometidos. Se efectuaron pruebas de escarificacion con alergenos glicerinados 1:20 p/v Hollister S. Los resultados muestran al Dermaphagoides como principal alergeno, seguido de polvo casero y los polenes de capriola y lolium.