[Recommendations for the management of latex allergy in pediatrics]. / Recomendaciones para el manejo de la alergia al látex en pediatría.

Latex allergy, or natural rubber latex allergy (NRLA), is a global health concern, even among the pediatric population, with symptoms varying in severity from mild to potentially life-threatening. Latex is derived from the Hevea Brasiliensis tree, producing twelve million tons annually for use in various everyday and medical products. Despite efforts to mitigate NRLA, its prevalence remains high, especially in at- risk groups such as children with spina bifida. Clinical manifestations include immediate and delayed symptoms, even anaphylactic reactions. Diagnosis involves a detailed medical history and specific tests. Prevention focuses on avoiding exposure, especially in medical and educational settings. Treatment, including immunotherapy, exhibits variable efficacy. NRLA has a strong negative impact on children's quality of life. The objective of this publication is to provide updated information and practical tools for the pediatrician's and allergist's practice.

La alergia al látex del caucho natural (ALCN) es un problema de salud global, incluso en población pediátrica, con síntomas de gravedad variable, desde leves hasta potencialmente mortales. El látex se obtiene del árbol Hevea brasiliensis; se producen doce millones de toneladas anuales que se utilizan en diversos productos cotidianos y médicos. A pesar de los esfuerzos para mitigar la ALCN, su prevalencia sigue siendo alta, especialmente en grupos de riesgo, como niños con espina bífida. Las manifestaciones clínicas incluyen síntomas inmediatos y retardados, hasta reacciones anafilácticas. El diagnóstico requiere una historia clínica detallada y pruebas específicas. La prevención se centra en evitar la exposición, especialmente en entornos médicos y escolares. El tratamiento, incluida la inmunoterapia, muestra eficacia variable. La ALCN tiene un fuerte impacto negativo en la calidad de vida. El objetivo de esta publicación es proveer información actualizada y herramientas prácticas para el consultorio del pediatra y el alergólogo.

Rinitis alérgica en pediatría: recomendaciones para su diagnóstico y tratamiento / Allergic rhinitis in pediatrics: recommendations for diagnosis and treatment

La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.

Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations

[Allergic rhinitis in pediatrics: recommendations for diagnosis and treatment]. / Rinitis alérgica en pediatría: recomendaciones para su diagnóstico y tratamiento.

Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations.

La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.

La Comunicación de Riesgos en el Contexto de la Pandemia COVID-19 en Chile

RESUMEN: La propuesta se enmarca dentro de la perspectiva teórica de la sociedad del riesgo, como marco propio de la modernidad, y es en este contexto que adquiere interés la comunicación de riesgos como mecanismo de interacción frente a situaciones de peligro para la seguridad y salud de la población; como es el caso de la pandemia COVID-19 declarada en el año 2020 -donde se generaron espacios de una mayor necesidad de información a la población y por tanto la generación de cambios en las dinámicas de comportamientos de la misma- la percepción de los riesgos para la salud y la modificación en los hábitos de cuidado y autocuidado de la población, conllevando a una nueva configuración de la temática de la salud pública y la cotidianidad las personas en Chile y en el mundo entero.

ABSTRACT: The proposal is framed within the theoretical perspective of the risk society as a reference framework typical of modernity, and in this context the communication of risks as a mechanism of interaction in the face of situations of danger to the safety and health of the population acquires interest. As is the case of the COVID-19 pandemic declared in 2020, where spaces were generated for a greater need for information to the population and therefore the generation of changes in the dynamics of behaviors of the same. The perception of health risks and the modification in the habits of care and self-care of the population led to a new configuration of the theme of public health and the everyday life of people in Chile and the world.

Alergia e intolerancia a antiinflamatorios no esteroideos en pediatría / Allergy and intolerance to nonsteroidal anti-inflammatory drugs in children

Los antiinflamatorios no esteroideos son ampliamente recetados en niños. Constituyen la segunda causa de reacciones a medicamentos en pediatría después de los antibióticos betalactámicos; sin embargo, solo una parte de estas son reacciones de hipersensibilidad. La prevalencia de dichas reacciones a antiinflamatorios no esteroideos en niños es del 0,3 % y aumenta al 5 % en asmáticos.Los mecanismos fisiopatológicos involucrados (inhibición de la ciclooxigenasa, hipersensibilidad mediada por inmunoglobulina E, linfocitos T reactivos y/o afectación de la inmunidad innata) darán lugar a diferentes entidades clínicas con sintomatología dispar.La confusión con síntomas propios de procesos virales y la variabilidad clínica hacen del diagnóstico de certeza un verdadero desafío. Una historia clínica detallada, análisis de laboratorio, pruebas cutáneas y de provocación controlada permitirán definir estrategias para cada paciente en particular sin etiquetar como alérgico a un niño que no lo es ni exponer a riesgos innecesarios a quien está sensibilizado.

Nonsteroidal anti-inflammatory drugs are widely prescribed in children. They are the second cause of drug ́s reactions in pediatrics after beta-lactam antibiotics, however only a part of them are hypersensitivity reactions. The prevalence of these reactions to nonsteroidal anti-inflammatory drugs in children is 0.3 %, increasing to 5 % in asthmatics.The different physiopathological mechanisms involved (inhibition of cyclooxygenase, immunoglobulin E-mediated hypersensitivity, reactive T lymphocytes and/or disturbance of innate immunity) will cause different clinical entities with diverse symptoms.The confusion between the common symptoms of a viral infection and a hypersensitivity reaction, and the variability of the clinical presentations make diagnosis a real challenge.A detailed clinical history, laboratory, skin and controlled provocation tests will provide strategies for each patient, without labeling a child who is not an allergic one, or taking unnecessary risks with those who are sensitized.

[Recommendations for the management of the child with allergic diseases at school]. / Recomendaciones para el manejo del niño con enfermedades alérgicas en la escuela.

Allergic diseases cause great impact on the health related quality of life in children and adolescents, resulting in increased school absenteeism and deficiencies in school performance. Although the bibliographic framework on allergic diseases is wide, in our country, there are no guidelines for proper management of the allergic child at school. It is necessary to establish guidelines for coordinated action among the educational community, the families, the pediatrician, the health team and governmental and non-governmental authorities. This position paper aims to provide information about the impact of allergic diseases on school activities, establish standards of competence of the various stakeholders at school and consider the legal framework for the intervention of the school staff about the child with allergies at school.

Aeroallergen sensitization in wheezing children from rosario, Argentina.

BACKGROUND: Wheezing is a highly frequent symptom in infants and children. Its major causes are respiratory infections and bronchial asthma. In this context, allergen sensitization plays an important role, and it can be detected by a skin prick test, a safe and effective technique that can be easily performed on any age-group. To assess the prevalence of aeroallergen sensitization in a pediatric population with recurrent episodes of wheezing. MATERIALS AND METHODS: Cross-sectional study that evaluated 100 patients, 50 (50%) girls and 50 (50%) boys, from 6 months to 10 years. These children had consulted frequently at the Allergy and Immunology Division of the Eva Perón School Hospital due to recurrent episodes of wheezing. Skin prick test were performed on all of them and also on 20 healthy children. RESULTS: Overall, 58% of the patients presented sensitization to dust mite, 13% to pollen, 9% to epithelium, 8% to fungi, 6% to cockroach, and 1% to soybean hull. Overall, 60% of the patients were positive to at least one of the extracts, and we observed a significant and gradual increase in the frequency of sensitization in older age-groups (P < 0.005). This increase persisted when analyzing separately the dust mite group and the pollen group. None of the cases presented any adverse local or systemic reaction during the procedure or the following 24 hours after the procedure. The 20 individuals in the control group turned out negative when tested. CONCLUSIONS: This study found high aeroallergen sensitization prevalence in a pediatric population with recurrent episodes of wheezing examined in the Allergy and Immunology Division of the Eva Perón School Hospital, which is in the southern area of the province of Santa Fe in Argentina.

Seroprevalence of dengue virus antibodies in asymptomatic Costa Rican children, 2002-2003: a pilot study.

OBJECTIVES: Since 1993 dengue has become more frequent in Costa Rica. Adults have been the most affected population, while children have remained virtually unharmed. So far no studies have investigated how many asymptomatic children have been affected by this virus. This pilot study documents the seroprevalence, measured as the presence of IgG antibodies, of dengue virus in asymptomatic children from two different geographical areas. METHODS: This descriptive, prospective epidemiologic study compared the presence of antibodies in children who live in a coastal region of a tropical country where dengue is endemic, and an inland area where dengue is not endemic. An enzyme-linked immunosorbent assay was used to test the serum for dengue virus IgG antibodies. None of the children had a prior history of dengue, fever, immunosuppressive therapy or underlying disease. RESULTS: During the period from July 2002 to July 2003, 103 children were recruited from each area. In the costal region we found a seroprevalence of 36.9%. In the inland area seroprevalence was 2.9%. CONCLUSIONS: We found a substantial number of asymptomatic infections in Costa Rican children. This greatly increases the risk of dengue hemorrhagic fever or dengue shock syndrome in these children, in whom previous dengue infection had gone undetected. Preventive efforts should be targeted at the costal region due to the higher prevalence in this area.

Seroprevalence of dengue virus antibodies in asymptomatic Costa Rican children, 2002-2003: a pilot study / La seroprevalencia de anticuerpos contra el virus del dengue en niños costarricenses asintomáticos, 2002-2003: estudio piloto

OBJECTIVES: Since 1993 dengue has become more frequent in Costa Rica. Adults have been the most affected population, while children have remained virtually unharmed. So far no studies have investigated how many asymptomatic children have been affected by this virus. This pilot study documents the seroprevalence, measured as the presence of IgG antibodies, of dengue virus in asymptomatic children from two different geographical areas. METHODS: This descriptive, prospective epidemiologic study compared the presence of antibodies in children who live in a coastal region of a tropical country where dengue is endemic, and an inland area where dengue is not endemic. An enzyme-linked immunosorbent assay was used to test the serum for dengue virus IgG antibodies. None of the children had a prior history of dengue, fever, immunosuppressive therapy or underlying disease. RESULTS: During the period from July 2002 to July 2003, 103 children were recruited from each area. In the costal region we found a seroprevalence of 36.9 percent. In the inland area seroprevalence was 2.9 percent CONCLUSIONS: We found a substantial number of asymptomatic infections in Costa Rican children. This greatly increases the risk of dengue hemorrhagic fever or dengue shock syndrome in these children, in whom previous dengue infection had gone undetected. Preventive efforts should be targeted at the costal region due to the higher prevalence in this area.

OBJETIVOS: Desde 1993, la frecuencia de dengue en Costa Rica ha venido aumentando. La población de adultos ha sido la más afectada, mientras que en los niños apenas se han presentado casos. Hasta el momento no se han realizado estudios para determinar cuántos niños asintomáticos se han visto afectados por el virus de la enfermedad. Este estudio piloto documenta la seroprevalencia de anticuerpos de tipo IgG contra el virus del dengue en niños asintomáticos procedentes de dos zonas geográficas distintas. MÉTODOS: En este estudio epidemiológico descriptivo y prospectivo se comparó la presencia de anticuerpos en niños que vivían en la zona costera de un país tropical donde el dengue es endémico, y en una zona del interior donde no lo es. Se usó inmunoadsorción enzimática para detectar IgG en el suero. Ninguno de los niños tenía antecedentes de dengue, enfermedad febril, tratamiento inmunosupresor o enfermedad subyacente. RESULTADOS: Durante el período transcurrido desde julio de 2003 hasta julio de 2003, se reunió a 103 niños de cada área. En la zona costera encontramos una seroprevalencia de IgG de 36,9 por ciento; en el interior, de 2,9 por ciento. CONCLUSIONES: Encontramos muchos casos de infección asintomática por el virus del dengue en niños costarricenses. Esto conlleva un riesgo elevado de fiebre hemorrágica del dengue o de síndrome de choque por dengue en estos niños en quienes la infección había pasado inadvertida. Es necesario tomar medidas preventivas en la región del litoral debido a la mayor prevalencia de la enfermedad en ella.

Urticaria vasculitis / Urticaria vasculitis

En la práctica diaria, y dentro de los diagnósticos diferenciales de la urticaria crónica idiopática(UCI), se debería tener presente a la urticaria vasculitis (UV), debido a su pronóstico menos benigno. En un alto porcentaje de los casos, únicamente se distinguen por la histología ya que la presentación clínica es similar, Se ofrece una actualización de esta enfermedad haciendo hincapié en la importancia del complemento sérico como factor pronóstico y en las novedades en el tratamiento, en extremo dificultoso, con respuestas disímiles e individuales

Systemic host inflammatory and coagulation response in the Dengue virus primo-infection.

BACKGROUND: Dengue virus infection has been rising in tropical countries. Clinical manifestations range from fever and general malaise to hemorrhagic manifestations and death. The role of endothelial damage and cytokines has not been well established for dengue infection. OBJECTIVE: Determine the profile of the pro-inflammatory cytokines and several markers of coagulopathy of dengue infection. METHODS: Patients admitted between September 2000 and April 2001, who met the WHO dengue diagnosis criteria, were enrolled. Blood samples were collected at 0, 6, 12, 24, 48, 72 h and 5 and 7 days after hospitalization. Profile of pro-inflammatory cytokines, markers of coagulopathy, protein C, protein S, d-dimer, prothrombin time, activated partial thromboplastin time, fibrinogen and activated protein C levels were determined. RESULTS: Thirty-three patients were enrolled. Median (range) age was 31 (13-70) years; 51.5% (17/33) were female. Ten of 33 (30%) presented with hemorrhagic manifestations. Patients were classified: Grade 1: 23/33 (70%), Grade II: 10/33 (30%). At study entry IL-6 was the most elevated, followed by IL-8 and TNF alpha. IL-10 was not elevated. No significant differences (P < 0.05) were demonstrated in the levels of any of the haemostatic or cytokine markers by disease severity (Grade I versus Grade II patients). CONCLUSION: The systemic host inflammatory and coagulation activation response occurs early in patients with dengue viral infection in the absence of severe hemorrhagic manifestations, and provides the basis for considering future clinical study in the use of recombinant human activated protein C to treat patients with severe sepsis from dengue infection.

Ganciclovir therapy in cytomegalovirus (CMV) infection in immunocompetent pediatric patients.

OBJECTIVES: To evaluate the outcome of immunocompetent pediatric patients who had positive cytomegalovirus (CMV) antigenemia and received ganciclovir. METHODS: A retrospective review was done of patients who had a CMV infection based on positive antigenemia. Medical charts were reviewed for the following information: age, sex, underlying disease, symptoms and signs, laboratory results, complementary diagnostic procedures, duration and dose of ganciclovir therapy, concomitant medications, complications, and outcome. RESULTS: Sixty-four patients with positive CMV antigenemia were identified; 15 patients were excluded from the study because of their underlying diseases. Of the remaining 49 patients, 26 (53%) were female; the median age was 11.5 months (range 0.3-132 months). Sixty-one percent (30/49) of these patients received ganciclovir (5-10 mg/kg/day) for a median of 14 days (range 7-42 days). Clinical findings included: fever, anemia, hepatomegaly, failure to thrive, elevated liver enzymes, splenomegaly, seizures, and thrombocytopenia. Sixty-three percent (19/30) of the treated patients had negative antigenemia at the end of therapy. CMV antigenemia remained positive in six (20%) patients. Nine patients received a second course of ganciclovir. CONCLUSIONS: Ganciclovir was effective in 80% of patients, as determined by negative antigenemia at the end of therapy.