Reacciones adversas de los diez fármacos más notificados. Matanzas 2014 al 2017 / Adverse reactions to the ten most reported drugs in Matanzas 2014-2017

RESUMEN Introducción: la toxicidad de los fármacos es compleja y difícilmente valorable, por la cantidad de factores que intervienen en su producción, como modo de aparición, duración y gravedad de las reacciones adversas. La importancia de estas reacciones está dada por la frecuencia y gravedad con que un fármaco o familia de fármacos las producen. Objetivo: caracterizar las principales reacciones adversas que provocan los medicamentos, los grupos de edades con más riesgos, los sistemas de órganos que se afectan, la frecuencia, imputabilidad y la intensidad de las mismas. Materiales y métodos: estudio observacional, descriptivo, de serie de casos en farmacovigilancia. El universo fue las reacciones adversas de los 10 fármacos más notificados por la Unidad Coordinadora Provincial de Farmacovigilancia en Matanzas, en el periodo 2014-2017. Se estudiaron las variables: medicamentos, grupo farmacológico, datos demográficos, nivel de atención, tipo de efecto adverso, intensidad, imputabilidad y frecuencia. Resultados: se notificaron 10 fármacos con 2 216 reacciones. La vacuna pentavalente fue la más notificada, con un 17,6 %, seguido por la amoxicilina y las penicilinas. Predominó el sexo femenino con 1 279 reportes, (59,1 %) y los adultos, con 1 010 notificaciones, (46,6 %). La atención primaria de salud fue la de mayor número de notificaciones, 2 082 reportes, (96,1 %). Las principales reacciones fueron: la erupción cutánea, la fiebre y la urticaria. Predominaron reacciones moderadas; 1 972 reportes, (91,1 %), aquellas clasificadas como probables, 1 887 reportes, (87,1 %) y las frecuentes con 1 284 reportes, (59,2 %). Conclusiones: el sistema de farmacovigilancia en la provincia proporcionó sistemáticamente información sobre la seguridad de los medicamentos, lo que permitió el conocimiento de la relación beneficio-riesgo de los medicamentos presentes en el mercado, así como los más usados.

ABSTRACT Introduction: drugs toxicity is complex and of difficult assessment, due to the quantity of factors intervening in its production, like emergency way, duration, and seriousness of the adverse reactions. The importance of these reactions is given by the frequency and seriousness a drug or a drug family produces them. Objective: to characterize the main adverse reactions caused by medicines, the age groups having higher risk, the most affec6ted systems of organs, frequency, imputability and intensity. Material and methods: descriptive, observational study of a series of cases in pharmacovigilance. The universe was the adverse reactions of the ten drugs most reported by the Provincial Coordinating Unit of Pharmacovigilance in the period 2014-2017. The studied variables were: drugs, pharmacological group, demographic data, health care level, kind of adverse effect, intensity, imputability and frequency. Results: ten drugs were reported with 2 216 reactions. The pentavalent vaccine was the most reported one, with 17.6 %, followed by amoxicillin and penicillin. There was a predominance of the female sex with 1 279 reports (59.1 %), and adult people with 1 010 reports (46.6 %). The highest number of reports was made by the primary health care, 2 082 (96.1 %). The main reactions were skin rash, fever and urticaria. There was a predominance of mild reactions: 1 972 reports (91.1 %); reactions classified as probable: 1 887 reports (87.1 %): ands frequent ones: 1 284 reports (59.2 %). Conclusions: the pharmacovigilance system in the province systematically provided information on drugs´ safeness that allowed knowing the benefit-risk relation of the medicines that are in the market, and also which are the most used ones.

Incapacitating solar urticaria: successful treatment with omalizumab

Abstract: Solar urticaria is a rare form of physical urticaria mediated by immunoglobulin E. The lesions appear immediately after the sun exposure, interfering with the patient's normal daily life. Omalizumab, a monoclonal anti-IgE antibody, has been recently approved for the treatment of chronic spontaneous urticaria, and the latest reports support its role also in the treatment of solar urticaria. Hereby, we report a case of solar urticaria refractory to conventional treatment strategies, with an excellent response to treatment with omalizumab and phototesting normalization.

Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology

Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.

Guía clínica chilena de urticaria crónica espontánea / Chilean guidelines for chronic urticaria

Chronic urticaria (CU) is characterized by itchy wheals, angioedema or both lasting six weeks or more. It is classified as spontaneous (CSU) and inducible urticaria (CIndU), depending whether there is an identifiable trigger or not. CSU is the predominant form, affecting more than 75% of patients, although overlaps often occur. The prevalence of CSU throughout life is around 1.8% and predominates in women at a ratio of 2:1. The higher incidence of CSU is between 20 and 40 years of age and lasts between one to five years. However, in up to 20% of patients the disease may last longer. CSU not only hampers quality of life, but also affect performance at work and school. The diagnosis of CSU is mainly clinical, and laboratory tests are required depending on the clinical history of the patient. Extensive laboratory tests are usually unnecessary. Second generation anti-histamines are used as first line treatment for CSU treatment. In refractory patients, systemic treatments, such as cyclosporine or omalizumab are suggested. We herein report the first Chilean CSU guidelines.

Edema agudo hemorrágico de la infancia: Lesiones alarmantes de un cuadro benigno. Reporte de caso / Acute hemorrhagic edema of infancy: alarming lesions of a benign condition. Case report

Se reporta un caso de edema agudo hemorrágico de la infancia, en un lactante de 18 meses, después de un episodio de otitis media. El cuadro comenzó con máculas eritematosas en los muslos, seguidas de lesiones purpúricas en los brazos, las piernas y edema en los tobillos. Se interpretó, inicialmente, como urticaria, por lo que recibió esteroides. Sin embargo, las características clínicas fueron de edema agudo hemorrágico de la infancia, una vasculitis leucocitoclástica benigna que se presenta en niños de entre 4 y 24 meses y que se caracteriza por fiebre, máculas y lesiones purpúricas. Estas se ubican, principalmente, en la cara, los lóbulos de las orejas y las extremidades, y se asocian, muchas veces, a edema. Los diagnósticos diferenciales son eritema multiforme, urticaria, vasculitis inducida por droga, enfermedad de Kawasaki, eccema infectado, meningococcemia y maltrato infantil, algunas de ellas, con riesgo de mortalidad. El manejo es conservador, sin embargo, los esteroides podrían ser una opción terapéutica.

We report a case of acute hemorrhagic edema of infancy in an 18-month-old boy after an episode of otitis media. The clinical presentation begins with skin erythematous macules on the thighs, followed by purpuric lesions in arms, legs, and ankle edema. It was initially interpreted as urticaria, whereby steroids were indicated. However, the clinical feature was acute hemorrhagic edema of infancy, a benign leukocytoclastic vasculitis that occurs in children between 4 and 24 months of age and is characterized by fever, large purpuric palpable target-like skin lesions affecting the face, lobes of the ears, limbs and frequently associated with edema. Differential diagnosis includes erythema multiforme, hemorrhagic urticaria, drug-induced vasculitis, Kawasaki disease, infected eczema, sepsis (either meningococcal or non-meningococcal) and child abuse. Some of them have risk of mortality. Management is conservative, however, steroids may be a therapeutic option.

Basophil Activation Test for Chronic Urticaria

No abstract available.

The Potential Utility of Iodinated Contrast Media (ICM) Skin Testing in Patients with ICM Hypersensitivity

Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM.

Utilidad del fototest para el diagnóstico de urticaria solar / Usefulness of the fototest for the diagnosis of solar urticaria

INTRODUCCIÓN: Aunque las manifestaciones clínicas son de gran ayuda para el diagnóstico de urticaria solar, se plantea el uso del fototest como una herramienta útil para la confirmación de la entidad. OBJETIVO: Realizar una revisión, apreciación crítica y síntesis de la evidencia disponible sobre la validez y utilidad del fototest para el diagnóstico de urticaria solar. METODOLOGÍA: : la evaluación fue realizada de acuerdo con un protocolo definido a priori por el grupo desarrollador. Se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, LILACS y Google, sin restricciones de idioma, fecha de publicación y tipo de estudio. Las búsquedas electrónicas fueron hechas en septiembre de 2014 y se complementaron mediante búsqueda manual en bola de nieve y una consulta con expertos temáticos. La tamización de referencias se realizó por dos revisores de forma independiente y los desacuerdos fueron resueltos por consenso. La selección de estudios fue realizada mediante la revisión en texto completo de las referencias preseleccionadas, verificando los criterios de elegibilidad predefinidos. Las características y hallazgos de los estudios fueron extraídos a partir de las publicaciones originales. Se realizó un análisis estadístico descriptivo. RESULTADOS: No se identificó evidencia respecto a la validez diagnóstica del fototest comparado con el diagnóstico clínico para la confirmación de urticaria solar en pacientes con sospecha de la entidad. En pacientes con sospecha o diagnóstico clínico de urticaria solar, el fototest fue positivo (anormal) en el 91.04% y negativo (normal) en un 8.95% (estimaciones basadas en una muestra de 346 pacientes de 17 series de casos). CONCLUSIONES: el fototest es una prueba útil para confirmar el diagnóstico de urticaria solar en pacientes con sospecha clínica de la entidad, también para inducir en condiciones de laboratorio las lesiones urticarianas en aquellos pacientes con diagnóstico clínico de urticaria solar. La calidad de la evidencia es limitada por el diseño de los estudios.(AU)

Guía Argentina de urticaria y angioedema

Se actualiza el diagnóstico de la urticaria crónica (UC) y los conceptos, definiciones y sugerencias basados en la evidencia para su tratamiento. La urticaria ocurre en al menos 20% de la población en algún momento de la vida. Su etiología difiere en la forma aguda (menos de 6 semanas), y en la crónica. No es posible pronosticar si las formas agudas evolucionarán a UC, ya que todas son agudas al comienzo. La UC ocurre como espontánea (UCE) o inducible (UCI). El diagnóstico es sencillo, pero incluye un minucioso estudio para descartar diagnósticos diferenciales; para UCI son útiles las pruebas de provocación en la caracterización y manejo. Los estudios complementarios se deben limitar y orientar según sospecha clínica. El tratamiento se divide en tres enfoques: evitación, eliminación o tratamiento del estímulo desencadenante o de la causa, y tratamiento farmacológico. Recientemente éste se modificó, con empleo de antihistamínicos de segunda generación como primera línea y aumento de dosis de antihistamínicos H1 no sedantes, hasta 4 veces, como segunda línea. Los antihistamínicos son fundamentales para tratar la UC; sin embargo, un 40% de los pacientes no logra un buen control pese al aumento de dosis y requiere otro medicamento adicional. La evidencia más reciente considera que un grupo de fármacos puede utilizarse como tercera línea en estos casos, para mejorar la calidad de vida y limitar la toxicidad por el uso frecuente o crónico de esteroides sistémicos. Se recomiendan para esta tercera línea solo 3 fármacos: omalizumab, ciclosporina A o antileucotrienos.

This interdisciplinary paper summarizes the news in the diagnosis and treatment of chronic urticaria (CU), and provides concepts, definitions and evidence-based suggestions for its management. Urticaria occurs in at least 20% of the population at some point in their lives. Acute urticaria (less than 6 weeks' duration), differs from CU in its etiology, but the onset of this disease is always acute. CU may occur as spontaneous (SCU) or induced (ICU). The diagnosis is simple, although a careful evaluation is necessary for differential diagnosis. ICU´s diagnosis is mainly clinical, even if provocation tests can be useful. Supplementary studies should be limited and based on the clinical suspicion. Treatment may be divided into three approaches: avoidance, elimination or treatment of the cause, and pharmacological treatment. Recently treatment has been modified with the use of second-generation antihistamines as first-line and increased doses of nonsedating H1 antihistamines, up to 4 times, as second line. Antihistamines are essential to treat CU; however, 40% of patients do not achieve good control despite increased doses and require additional treatment. The most recent evidence indicates a group of drugs to be used as third line in these cases, to improve quality of life and to limit toxicity from frequent or chronic use of systemic steroids. Only 3 drugs are recommended as third line: omalizumab, cyclosporin A or anti-leukotrienes.

Urticaria acuagénica: presentación de un caso / Aquagenic urticaria: a case presentation

FUNDAMENTO: la urticaria acuagénica es una rara forma de presentación de las urticarias físicas. OBJETIVO: describir el cuadro clínico y conducta a seguir de la urticaria acuagénica en una lactante. CASO CLÍNICO: lactante blanca, femenina de siete meses. Refieren los padres que desde su nacimiento comenzó la aparición de pequeñas ronchas en el tronco, brazos y piernas, que coincidían con el horario del baño, desaparecían a los 30-60 minutos posterior al mismo. A pesar de modificar el tipo de jabón y la temperatura del agua se mantenía el cuadro. Señalan que no le aparecen las lesiones de piel con el baño de mar. Los antecedentes atópicos familiares son positivos. Al bañarse la niña se comprueba la aparición de las lesiones de piel. Se diagnosticó la presencia de urticaria acuagénica y se prescribió tratamiento con antihistamínicos con una buena evolución del cuadro. CONCLUSIONES: la urticaria acuagénica es poco frecuente en lactantes, de su correcto diagnóstico y tratamiento, depende la buena evolución, así como la vida del paciente que puede verse comprometida por acompañarse esta de manifestaciones extracutáneas.

BACKGROUND: aquagenic urticaria is an uncommon presentation of physical urticaria. OBJECTIVE: to describe the clinical manifestations and the behavior to follow in an infant. CLINICAL CASE: a seven-months-old, white, female infant. The parents said that since she was born, some little wheals started to appear in the trunk, arms and legs that coincided with the bath time and disappeared 30-60 minutes later. In spite of changing soaps and the water temperature the manifestations remained. The parents also said that the lesions in the skin did not appear when taking a bathe in the sea. Family atopic antecedents were positive. When the baby is given a bath, the appearance of the lesions in the skin could be verified. The presence of aquagenic urticaria was diagnosed and antihistamines were prescribed for the treatment. The patient condition had a good progress. CONCLUSIONS: aquagenic urticaria is not frequent in infants. The good progress and the life of the patient, which could be affected by the disease since extracutaneous manifestations come with it, depend on the correct diagnosis and treatment.

Guía argentina de urticaria y angioedema / Argentine guidelines for urticaria and angioedema

This interdisciplinary paper summarizes the news in the diagnosis and treatment of chronic urticaria (CU), and provides concepts, definitions and evidence-based suggestions for its management. Urticaria occurs in at least 20

of the population at some point in their lives. Acute urticaria (less than 6 weeks’ duration), differs from CU in its etiology, but the onset of this disease is always acute. CU may occur as spontaneous (SCU) or induced (ICU). The diagnosis is simple, although a careful evaluation is necessary for differential diagnosis. ICU’s diagnosis is mainly clinical, even if provocation tests can be useful. Supplementary studies should be limited and based on the clinical suspicion. Treatment may be divided into three approaches: avoidance, elimination or treatment of the cause, and pharmacological treatment. Recently treatment has been modified with the use of second-generation antihistamines as first-line and increased doses of nonsedating H1 antihistamines, up to 4 times, as second line. Antihistamines are essential to treat CU; however, 40

of patients do not achieve good control despite increased doses and require additional treatment. The most recent evidence indicates a group of drugs to be used as third line in these cases, to improve quality of life and to limit toxicity from frequent or chronic use of systemic steroids. Only 3 drugs are recommended as third line: omalizumab, cyclosporin A or anti-leukotrienes.

A Case of Recurrent Abdominal Pain with Fever and Urticarial Eruption / 대한소화기학회지

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent episodes of fever and serosal, synovial, or cutaneous inflammation, caused by a dysfunction of pyrin as a result of mutation within the MEFV gene. It occurs mainly among Mediterranean and Middle Eastern populations, including Jews, Arabs, and Turks. However, FMF cases have been reported outside the Mediterranean and Middle Eastern countries in recent years. Although FMF has been relatively rare in Korea until now, proper recognition of FMF might lead to more frequent diagnoses of FMF. We experienced an interesting case, a 31-year-old Korean man who presented with recurrent abdominal pain with fever and urticarial eruption for 10 years. DNA analysis showed complex mutations (p.Leu110Pro, p.Glu148Gln) in the MEFV gene. To date, three cases have been reported, and this case of FMF with skin conditions is the first case in Korea.

Urticaria crónica / Chronic urticaria

La urticaria crónica (VC), es una variante común de la urticaria que se define como un síndrome reactivo de la piel y mucosas caracterizado por la presencia de placas eritematosas, habones o ronchas edematosas y pruriginosas que se prolonga durante más de seis semanas. La etiología de la VC no es muy clara en la mayoría de los casos, multitud de causas se han implicado. La patogenia es compleja. El conocimiento y estudio de cada uno de los factores celulares y solubles, su interacción dinámica, vías efectoras y trama de citoquinas conducirá al logro de una terapéutica efectiva y racional de la urticaria crónica.

Chronic urticaria (VC) is a common variant of urticaria which is defined as a reactive skin and mucous membranes syndrome characterized by the presence of plaques erythematous, wheals, or swollen and itchy hives that lasts more than six weeks. The etiology of the VC is not very clear in the majority of cases, multitude of causes have been implicated. The pathogenesis is complex. Knowledge and study of each cell and soluble factors, their dynamic interaction, effector pathways and cytokines plot will lead to the achievement of an effective and rational therapy of chronic urticaria.

Recidiva de urticária crônica decorrente de reinfecção por Helicobacter pylori / Recurrence of chronic urticaria caused by reinfection by Helicobacter pylori / Recidiva de urticaria crónica decurrente de reinfección por Helicobacter pylori

OBJETIVO: Descrever, em uma adolescente do sexo feminino, o caso clínico de urticária crônica associado à infecção por Helicobacter pylori confirmado em dois momentos distintos, com melhora após a terapêutica antibacteriana. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 13 anos, procurou atendimento médico com urticária crônica e dores epigástricas sem resposta ao tratamento medicamentoso. Os exames solicitados para investigação complementar apresentaram-se normais, exceto a endoscopia digestiva alta com biópsia, que evidenciou gastrite crônica ativa moderada associada ao Helicobacter pylori. Foi iniciado o tratamento adequado para a bactéria em questão e a paciente apresentou remissão dos sintomas. Nova endoscopia digestiva alta para controlar o tratamento após nove meses estava normal. Cinco anos depois, a paciente procurou novamente o ambulatório queixando-se de retorno do quadro de urticária e dores epigástricas. Ela se encontrava em uso de anti-histamínico, sem melhora. Foi novamente submetida a protocolo de exames para investigar urticária crônica, com resultados dentro da normalidade. Foi submetida à endoscopia digestiva alta, que apresentou teste da urease positivo. Iniciou-se então novo tratamento para Helicobacter pylori por sete dias, com desaparecimento da urticária crônica e das dores epigástricas. COMENTÁRIOS: O caso relatado sugere relação causal entre o diagnóstico positivo para o Helicobacter pylori e a ocorrência do quadro de urticária crônica, com instituição de terapêutica eficaz para tal bactéria e remissão dos sintomas. A urticária crônica é uma doença de etiopatogenia complexa e, apesar das controvérsias, as evidências do envolvimento do Helicobacter pylori com doenças extraintestinais vêm crescendo, entre elas a urticária crônica.

OBJECTIVE: To describe a case of chronic urticaria in a female adolescent associated with Helicobacter pylori infection, confirmed in two different occasions, with improvement of urticaria after the antibacterial treatment. CASE DESCRIPTION: A 13-year-old female patient sought medical care with chronic urticaria and epigastric pain unresponsive to medical treatment. Laboratorial tests for further investigation were normal except for the upper gastrointestinal endoscopy with biopsy showing moderate chronic active gastritis associated with Helicobacter pylori. After specific and appropriate treatment, the patient had remission of the symptoms. A new upper gastrointestinal endoscopy to control the treatment after nine months was normal. After five years, the patient returned with recurrence of urticaria and epigastric pain. She was taking antihistamines, without any improvement. It was again submitted to screening protocol for chronic urticaria with normal results. She was submitted to upper gastrointestinal endoscopy, which showed positive urease test. The patient started a new treatment for Helicobacter pylori with disappearance of chronic urticaria and epigastric pain within seven days. COMMENTS: The reported case suggests a causal relationship between the positive diagnosis of Helicobacter pylori and the occurrence of chronic urticaria, showing the remission of symptoms after the institution of effective therapy for this agent. Chronic urticaria is a disease of complex etiology, and although controversial, there is growing evidence of Helicobacter pylori involvement with extraintestinal diseases, including chronic urticaria.

OBJETIVO: Describir, en una adolescente del sexo femenino, el caso clínico de urticaria crónica asociado a la infección por Helicobacter pylori confirmado en dos momentos distintos, con mejora después de la terapéutica antibacteriana. DESCRIPCIÓN DEL CASO: Paciente del sexo femenino, 13 años, buscó atención médica con urticaria crónica y dolores epigástricas sin respuesta al tratamiento medicamentoso. Los exámenes solicitados para investigación complementar se presentaron normales, excepto por la endoscopía digestiva alta con biopsia, que evidenció gastritis crónica activa moderada asociada al Helicobacter pylori. Se inició el tratamiento adecuado para la bacteria en cuestión, y la paciente presentó remisión de los síntomas. Nueva endoscopía digestiva alta para controlar el tratamiento después de nueve meses estaba normal. Tras cinco años, la paciente buscó nuevamente el ambulatorio quejándose de retorno del cuadro de urticaria y dolores epigástricos. Ella estaba en uso de anti-histamínicos, sin mejoría. Fue nuevamente sometida al protocolo de exámenes para investigar urticaria crónica, con resultados dentro de la normalidad. Fue sometida a la endoscopía digestiva alta, que presentó prueba de ureasa positiva. Se inició entonces nuevo tratamiento para Helicobacter pylori por siete días, con desaparición de la urticaria crónica y de los dolores epigástricos. COMENTARIOS: El caso relatado sugiere relación causal entre el diagnóstico positivo para el Helicobacter pylori y la ocurrencia del cuadro de urticaria crónica, con institución de terapéutica eficaz para tal bacteria y remisión de los síntomas. La urticaria crónica es una enfermedad de etiopatogenía compleja y, a pesar de las controversias, las evidencias de la implicación del Helicobacter pylori con enfermedades extraintestinales vienen creciendo, entre ellas la urticaria crónica.

A propósito de un caso de urticaria vasculítica intermedia en un paciente pediátrico / A propos of a case of intermediate vasculitic urticaria in a pediatric patient

Se presenta un paciente de sexo masculino, de 2 años y siete meses de edad, con cuadro clínico compatible con urticaria vasculítica. La biopsia cutánea evidenció una vasculitis con infiltrado mononuclear. A diferencia del cuadro típico de urticaria vasculitis, en este paciente en la histopatología no se evidenció vasculitis leucicitoclástica, hecho que nos permite categorizarla como una forma intermedia de urticaria vasculitis.

We report a male patient, 2 years and seven months old, with clinical symptoms compatible with vasculitic urticaria. A skin biopsy showed vasculitis with mononuclear infiltrate. Unlike the typical picture of urticaria vasculitis in this patient, the histopathology did not reveal vasculitis leucicitoclástica, allowing us to categorize it as an intermediate form of urticaria vasculitis.

Urticária: diagnóstico e tratamento / Urticaria: diagnosis and treatment

A urticária apresenta-se com diversas formas clínicas e causas distintas. Constitui uma das dermatoses mais frequentes: 15% a 20% da população têm pelo menos um episódio agudo da doença em sua vida. A urticária é classificada do ponto de vista de duração da evolução temporal em aguda (inferior a seis semanas) ou crônica (superior a seis semanas). O tratamento da urticária pode compreender medidas não farmacológicas e intervenções medicamentosas, as quais são agrupadas em tratamentos de primeira (anti-histamínicos), segunda (corticosteróides e antileucotrienos) e terceira linha (medicamentos imunomoduladores). Essa entidade clínica acarreta importante perda na qualidade de vida e deve ser prontamente tratada pelo profissional de saúde.

The urticaria presents itself with diverse clinical forms and distinct causes. It is one of the most common dermatosis: 15% to 20% of the population has at least one acute episode of illness in their life. Urticaria is classified based on its temporal evolution as acute (less than 6 weeks) or chronic (more than 6 weeks). Management strategies may involve nonpharmacological measures and drug interventions, which are grouped into first-(antihistamines), second (corticosteroids and antileukotrienes) and third-line therapies (immunomodulators). This clinical entity has a major loss in quality of life and should be promptly treated by a health professional.

A Case of Combined Cholinergic and Cold Urticaria

No abstract available.

Urticaria crónica asociada a Helicobacter pylori / Chronic urticaria associated with Helycobacter pylori

Se efectuó un estudio descriptivo y prospectivo de 51 pacientes con diagnóstico de urticaria crónica, atendidos en la consulta de Dermatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el primer semestre del 2008, para identificar las causas de dicha afección. Se utilizó el porcentaje como medida de resumen y la prueba del Ji al cuadrado, considerando su significación cuando p <0,05. En la casuística predominó el sexo femenino y se encontró una positividad de Helicobacter pylori en las biopsias gástricas realizadas.

A descriptive and prospective study was carried out in 51 patients diagnosed with chronic urticaria, who were attended at the Outpatient Dermatology Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital of Santiago de Cuba during the first semester of 2008 to identify the etiology of this condition. The percentage as a summary measure and the chi-square test were used, considering their significance when p <0, 05. Female sex prevailed in the case material and Helicobacter pylori-positive gastric biopsies were found.