Rhinomanometry in young patients with perennial allergic rhinitis with/without recent exposure to tobacco smoke.

OBJECTIVE: To assess the influence of environmental exposure to tobacco smoke on the nasal symptoms and nasal resistance of young patients with perennial allergic rhinitis. DESIGN: Cross-sectional study. SETTING: Tertiary referral centre. PARTICIPANTS: Fifty patients were evaluated (aged 10-19 years old): 25 patients with and 25 patients without recent exposure to tobacco smoke (confirmed by cotinine/creatinine ratio). MAIN OUTCOMES MEASURES: After a clinical evaluation, all the patients replied to a validated questionnaire of the severity of the nasal symptoms. Then total nasal airway resistance was recorded by active anterior rhinomanometry. RESULTS: Patients with exposure to tobacco smoke had a larger total resistance than patients without exposure (t-test, P < 0.01). No significant correlation was observed between the total score of the questionnaire of nasal symptoms and the nasal resistance. CONCLUSIONS: In young patients with perennial allergic rhinitis, exposure to tobacco smoke can be related to increased nasal resistance, which may not be recognised by the report of nasal symptoms.

CD4+ CD30+ T cells perpetuate IL-5 production in Dermatophagoides pteronyssinus allergic patients.

BACKGROUND: Airway allergic diseases are regulated by interleukin (IL)-5, which causes infiltration of eosinophils into the bronchial epithelium, and by IL-4 which increases serum immunoglobulin E (IgE) production and promotes CD30 expression on Th cells. CD30 generates a costimulatory signal involved in apoptosis or cell proliferation, depending on the microenvironment. Our aims were: (i) to analyze if CD4+ CD30+ T cells from allergic patients proliferate in response to Dermatophagoides pteronyssinus, and (ii) if upon stimulation this cell population produces IL-4 and IL-5. METHODS: Peripheral blood mononuclear cell (PBMC) from 17 allergic rhinitis and mild allergic asthma patients and 12 healthy nonallergic individuals were stimulated with allergen in the presence or absence of anti-IL-4, anti-IL-5 or anti-IL-4Ralpha monoclonal antibodies (mAbs). TdT-mediated dUTP nick end-labeling (TUNEL) assay, 7-aminoactinomycin-D (7-AAD) intercalation, and flow cytometry were used to determine the CD4+ CD30+ blasts percentage, cell proliferation, apoptosis, and intracellular cytokines after 7 culture days. RESULTS: Cell proliferation induced with allergen showed that 90% of the allergen-stimulated blasts were CD4+, 50% of which were CD30+. Allergen-stimulated PBMC showed a progressive increase (mean: from 7% to 23%) of CD4+ CD30+IFN-gamma+ and CD4+ CD30+IL-4+ blasts which diminished (mean: 6%) after 5 culture days. In contrast, CD4+ CD30+IL-5+ blasts showed a continuous progression (from 12% to 24%) that maintained after 7 culture days. The vast majority of CD4+ CD30+ blasts were negative to 7-AAD or TUNEL. Additionally, a significant decrease (34%) was observed in the number of CD4+ CD30+ blasts when IL-4 was neutralized. CONCLUSIONS: These data suggest that specific allergen stimulation of PBMC isolated from allergic patients generates a nonapoptotic CD4+ CD30+ blast subset that produces IL-5.

[Prevalence of hiatal hernia and chronic esophagitis in adult asthmatic patients]. / Prevalencia de hernia hiatal y esofagitis crónica en pacientes asmáticos adultos.

BACKGROUND: The association among asthma, hiatus hernia, oesophagitis and gastro-oesophageal reflux has been reported as etiologic factor that alters the clinical evolution of the asthma. MATERIAL AND METHODS: Prospective, longitudinal and comparative study was developed. 90 patients were incoming with persistent light and moderate asthma, of allergic etiology. By the 6 months of immune-allergic treatment the clinical answer was valued being classified in two groups: Group A: 40 patients with intermittent light asthma and group B: 50 patients with persistent severe moderate asthma. In both groups they were submitted to an endoscopy for the diagnosis of esophageal pathology, with biopsies in the 3 esophageal thirds. They registered symptoms of gastro-oesophageal reflux. RESULTS: 72 women and 28 men, age average 35.9 years. There was hiatus hernia in 33 patients, 12 of the group A and 21 of the B. Upper oesophagitis in 21 patients, 8 of the group A and 13 of the B. Symptoms of gastro-oesophageal reflux in 71 patients, 29 of the group A and 42 of the B. The association among hiatus hernia, oesophagitis and gastro-oesophageal reflux was observed in 12 patients, 2 of the group A and 10 of the B (p < 0.05). CONCLUSIONS: The association of symptoms among gastro-oesophageal reflux, hiatus hernia and upper oesophagitis, is bigger in the patients with bad answer to the anti-asthmatic treatment; they are justified to endoscopy study and biopsies of the upper oesophagus (in the group of patients with bad response and symptoms of gastro-oesophageal reflux) when 24 hours pH-monitoring is not available.

[Nasal allergenic provocation test]. / Prueba de provocación alergénica nasal.

This is a method to evaluate both specific sensitivity to allergens in the nasal mucosa, IgE-mediated hypersensitivity, and antiinflammatory and antiallergic drugs efficacy, whose objectives are for research in diagnosis and treatment. The method is based in allergen extracts delivery in the nasal mucosa and the post-challenge measurement of rhinitis symptoms, vasoactive mediators release quantification and nasal obstruction degree evaluated by rhinomanometry. Nasal allergen challenge is a procedure of diagnostic and therapeutic evaluation usefulness, that must be performed in selected patients, in adequate facilities, by experts physicians, with standardised allergen dosages, in an specific nasal area, with objective measurements (rhinomanometry, mediators and secretions of the allergic response) and symptoms scoring that allow get reliable results in patients with allergic rhinitis under study.

[Leukocyte adhesion deficiency syndrome: case report]. / Síndrome de adhesión leucocitaria deficiente: informe de un caso.

INTRODUCTION: Leukocyte adhesion deficiency syndrome (LAD) is an altered phagocytic disorder characterised by the deficiency of one or several integrins which are included within the adhesion molecules group and cell surface receptors superfamily. OBJECTIVE: To describe the clinical features of a rare primary immunodeficiency case. CLINICAL CASE: A nineteen days-old male newborn was referred to the pediatrics infectology service because a 15 days clinical course characterised by delayed cord detachment; fever and skin lesions in several arcas that evolved to, cellulitis and dermal necrosis: Then he was admitted with the diagnosis of septicemia secondary to omphalitis. There were a partial response to antimicrobial treatment. Thereafter he had recurrent respiratory and gastrointestinal fungal and bacterial infections. Then he suffered psychomotor impairment and severe malnutrition. The patient died because septicemia at 5 months-old. WBC counts showed persistent leukocytosis between 42,000 and 133,000 cells/mm3, mostly neutrophils (64%-88%). We also found defective neutrophil quimiotaxis. By flow cytometer it was detected CDII/18 adhesins deficiency. Otherwise immunological, bone marrow biopsy and viral tests were, normal. CONCLUSIONS: Although its prevalence is rare, leukocyte adhesion defects must be considered in those patients with delayed cord detachment, recurrent severe infections and both persistent and elevated neutrophilia and with other primary and secondary immunodeficiencies previously discarded.

[Prevalence on acute asthma in children]. / Prevalencia de asma aguda en niños.

OBJECTIVE: In this descriptive study we considered age, sex, and admission's month of children under 15 years-old admitted to the emergency room for acute asthma between January 94 to july 95. MATERIAL AND METHOD: There were 594 boys and 421 girls. Male to female mean ratio was 1.4:1. We found a greater and significative admission's number in boys than in girls (x2: p < 0.001). Odds ratio was greater in boys. 1.18 (CI 95%: 1.04-1.35) than in girls, 0.85 (CI 95%: 0.750.96). RESULTS: The acute asthma admissions monthly trend was in third place (median) and second place (mode) when compared with other children's admission diagnoses. Total monthly admissions amount did not show a significative differences when compared the first seven months of 1994 and 1995 (Mann-Whitney's U: p > 0.05). CONCLUSIONS: The acute asthma admissions are currently predominant in boys over girls, and that bronchial asthma is one of the more frequent emergency admission's causes in children.

[Incidence of allergic diseases and atopic markers in a tertiary hospital]. / Incidencia de enfermedades alérgicas y marcadores atópicos en un hospital de tercer nivel.

With the aim to know both the distribution and features of allergic disorders in a third level hospital at Mexico city we performed a descriptive study throughout one year, patients data were obtained from their clinical records at initial evaluation. We attended 1486 patients, 744 females (50.1%) and 742 males (49.9%). Children under 10 years-old were the main ages group (46.8%). Forty-four percent of the patients had at least one atopic relative, one brother or sister in 19.5%. White blood cells results showed peripheral cosinophilia in 57.6% patients and nasal cosinophilia in 58.1%. We found S. aureus, coagulase positive in 55% of 192 positive throat cultures. The more frequent diagnoses were rhinitis and asthma (46.3%), rhinitis (20.7%) and asthma (14.1%). We consider that the more prominent findings were the high index of S. aureus, higher atopic family history in brothers and the association between cosinophilia and allergic disorders.