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1.
Cytokine ; 143: 155524, 2021 07.
Article in English | MEDLINE | ID: mdl-33849767

ABSTRACT

INTRODUCTION: Asthma is a heterogeneous disease characterized by multiples respiratory symptoms; this is a polygenic entity that involves a complex interaction of environmental factors and inherent to the individual. To understand the development of asthma, some phenotypes have been proposed. OBJECTIVE: This work's purpose was to explore different molecules related to asthma development and to define each phenotype's specific characteristics. MATERIAL AND METHODS: 96 adult patients diagnosed with asthma before any treatment were enrolled in the protocol. Spirometric parameters, circulating leukocytes, serum IgE, body mass index, exhaled nitric oxide (FENO), and leukotrienes (LTB4) in urine were determined in each patient. The presence of asthma phenotypes proposed by the Global Initiative for Asthma (GINA) were explored: A) Allergic asthma, B) Non-allergic asthma, C) Late-onset asthma, D) Asthma with persistent airflow limitation, and E) Asthma with overweight and obesity. RESULTS: In the cohort analyzed, we found four of phenotypes proposed by GINA; however, these phenotypes overlapped, due to this, 4 groups were integrated with allergic, non-allergic and obese patients, which were the main phenotypes. The main overlap was that of patients not-obese allergic, and was characterized by earlier onset, elevated levels of IgE, LTB4 and inflammasome related cytokines. Non-allergic patients had a significant association between interleukin (IL)-18 and IL-18 binding protein (BP) with narrow ratio between these cytokines. Finally, LTB4 had remarkable capacity to discriminate between allergic and not allergic patients. CONCLUSIONS: Asthmatic phenotypes exist as interrelated characteristics and not as discrete entities. High levels of leukotrienes and IgE are hallmarks in the allergic phenotype of asthma.


Subject(s)
Asthma/genetics , Asthma/pathology , Adult , Age of Onset , Asthma/blood , Asthma/diagnosis , Biomarkers/blood , Cytokines/blood , Eosinophils/metabolism , Female , Humans , Hypersensitivity/blood , Hypersensitivity/complications , Immunoglobulin E/blood , Inflammasomes/blood , Inflammation Mediators/metabolism , Intercellular Signaling Peptides and Proteins/blood , Interleukin-18/blood , Interleukin-8/blood , Leukotrienes/urine , Male , Middle Aged , Overweight , Phenotype , Transforming Growth Factor beta/blood
2.
Rev Alerg Mex ; 65(3): 310-315, 2018.
Article in Spanish | MEDLINE | ID: mdl-30176210

ABSTRACT

BACKGROUND: Rhinitis is the leading cause for consultation in the allergy department. It consists in chronic inflammation of the nasal mucosa. Non-allergic rhinitis with eosinophilic syndrome is characterized by chronic inflammation of the nasal mucosa (> 20% of eosinophils in nasal cytology) in the absence of demonstrable allergy (negative in vivo and in vitro tests); often it is accompanied by other sinonasal conditions (nasal polyposis, chronic rhinosinusitis), and it constitutes a risk factor for the development of obstructive sleep apnea. CASE REPORT: Seven-year old girl with rhinorrhea, nasal obstruction, nasopalatine itching, and severe sneezing that limited sleep and school activities. This condition had a seasonal pattern, with important blood (800 eosinophils/µL) and nasal (30%) eosinophilia and absence of demonstrable allergy (negative skin tests, negative specific nasal challenge tests); the non-allergic rhinitis with eosinophilic syndrome diagnosis was verified. CONCLUSIONS: Non-allergic rhinitis with eosinophilic syndrome is considered to be a highly underdiagnosed disease owing to the lack of in vivo nasal tests' performance; to this underestimation, incorrect nasal etiology and lack of local in vivo tests (nasal specific IgE) are added, which warrants a high degree of diagnostic suspicion by the specialist physician.


Antecedentes: La rinitis es la primera causa de consulta en el servicio de alergia. Se trata de una inflamación crónica de la mucosa nasal. La rinitis no alérgica con síndrome eosinofílico se caracteriza por eosinofilia crónica (> 20 % de eosinófilos en citología nasal) sin que pueda comprobarse la existencia de alergia (pruebas in vivo e in vitro negativas); frecuentemente se acompaña de otras enfermedades sinonasales (poliposis nasal, rinosinusitis crónica) y constituye un factor de riesgo para desarrollar apnea obstructiva del sueño. Caso clínico: Niña de siete años de edad con rinorrea, obstrucción nasal, prurito nasopalatino y estornudos de intensidad severa que limitaban sueño y actividades escolares, de patrón estacional con importante eosinofilia sanguínea (800 eosinófilos/µL) y nasal (30 %), sin alergia demostrable (pruebas cutáneas negativas y pruebas de provocación nasal específicas negativas); se comprobó el diagnóstico de rinitis no alérgica con síndrome eosinofílico. Conclusiones: La rinitis no alérgica con síndrome eosinofílico se considera una enfermedad altamente infradiagnosticada debido a la falta de realización de pruebas nasales in vivo. A la infravaloración se suma la incorrecta etiología nasal y la inexistencia de pruebas in vitro locales (IgE nasal específica), por lo que amerita un alto grado de sospecha diagnóstica por parte del médico especialista.


Subject(s)
Eosinophilia/complications , Rhinitis/complications , Child , Eosinophilia/diagnosis , Female , Humans , Rhinitis/diagnosis , Syndrome
3.
Allergy Rhinol (Providence) ; 9: 2152656718783618, 2018.
Article in English | MEDLINE | ID: mdl-30083412

ABSTRACT

Tolerance induction and desensitization in Stevens-Johnson syndrome (SJS) or in toxic epidermal necrolysis (TEN) have been described as an absolute contraindication by some authors, but there are cases where there is no treatment alternative. Tuberculosis (TB) remains a leading cause of morbidity and mortality in developing countries and ranks alongside HIV as a leading cause of death worldwide. Severe drug reactions, such as SJS and TEN, occurring in these individuals are lifethreatening. Since alternative therapies for TB are limited, the role of desensitization and reintroduction becomes essential. We describe a case of tolerance induction to anti-TB drugs in a patient with SJS/TEN overlap syndrome using a specifically designed premedication, comedication, and desensitization protocol.

4.
Rev Alerg Mex ; 65(2): 128-139, 2018.
Article in Spanish | MEDLINE | ID: mdl-29983010

ABSTRACT

BACKGROUND: The prevalence of latex allergy ranges from 0.8 to 6.5% and is the second cause of perioperative anaphylaxis. The main risk factors are being a health worker or latex producer, hours of latex gloves or products usage, exposure to other hand irritants, history of atopy, neural tube closure defects or numerous surgeries at early age. OBJECTIVE: To determine the frequency of latex sensitization in resident physicians of the Hospital General de México surgical area. METHODS: Prospective, cross-sectional, descriptive study where skin prick tests were applied to residents of the surgical area of the Hospital General de México, which depends on the Ministry of Health and is located in Mexico City. RESULTS: Ninety-two subjects were included and had skin tests practiced, with 11 surgical specialties participating. Latex sensitization in this population was 11.9%, whereas the presence of latex allergy was 10.8%. CONCLUSIONS: A high frequency of latex sensitization and allergy was demonstrated in Hospital General de Mexico surgery residents, which indicates the need for policies and procedures to be developed for health workers with latex allergy, as well as continuous training of employees on latex allergy.


Antecedentes: La prevalencia de alergia al látex oscila entre 0.8 y 6.5 % y es la segunda causa de anafilaxia perioperatoria. Los principales factores de riesgo son ser trabajador de la salud o productor de látex, horas de utilización de guantes o productos de látex, exposición a otros irritantes de manos, antecedente de atopia, defectos del cierre del tubo neural o numerosas cirugías a edad temprana. Objetivo: Determinar la frecuencia de sensibilización al látex en médicos residentes del área quirúrgica del Hospital General de México. Métodos: Estudio clínico prospectivo, transversal, descriptivo, mediante la realización de prueba de punción cutánea a residentes del área quirúrgica del Hospital General de México, Secretaría de Salud, Ciudad de México. Resultados: Se incluyeron 92 sujetos a los cuales se les realizó pruebas cutáneas, participando 11 especialidades quirúrgicas. La sensibilización al látex en esta población fue de 11.9 % y la presencia de alergia al látex de 10.8 %. Conclusiones: Se demuestró alta frecuencia de sensibilización y alergia al látex en los residentes quirúrgicos del Hospital General de México, lo que indica la necesidad de desarrollar políticas y procedimientos para los trabajadores de salud con alergia al látex y la capacitación continua de empleados sobre alergia al látex.


Subject(s)
Internship and Residency , Latex Hypersensitivity/epidemiology , Adult , Cross-Sectional Studies , Female , Hospitals, General , Humans , Hypersensitivity/epidemiology , Latex Hypersensitivity/physiopathology , Latex Hypersensitivity/therapy , Male , Mexico , Prospective Studies , Young Adult
5.
Rev Alerg Mex ; 65(1): 103-107, 2018.
Article in Spanish | MEDLINE | ID: mdl-29723946

ABSTRACT

BACKGROUND: Psyllium is a derivative of Plantago ovata ground seed and husk that is used as bulk-forming laxatives owing to its hydrocolloid properties. CASE REPORT: 43-year-old female nurse with previous diagnosis of drug allergy and allergic rhinitis who, after the preparation and administration of a laxative, developed rhinoconjunctivitis symptoms, urticarial syndrome, angioedema and bronchospasm, which led to conclude that she had an anaphylactic reaction. She was treated with adrenaline, corticosteroids and antihistamines. After symptom resolution, with in vivo tests by means of the skin prick technique and by in vitro assay (specific IgE), hypersensitivity to plantago psyllium was determined. DISCUSSION: Most cases of anaphylaxis have been reported with psyllium ingestion, since, through that route, antigenic burden is higher. It should be noted that, even when exposure in the described patient was only by inhalation, manifestations were life-threatening.


Antecedentes: El psyllium es un derivado de la semilla y cáscara pulverizada de Plantago ovata, que se usa como laxante de volumen debido a sus propiedades hidrocoloides. Reporte de caso: Mujer de 43 años, de profesión enfermera, con diagnóstico de alergia a fármacos y rinitis alérgica, quien posterior a la preparación y administración de un laxante presentó síntomas rinoconjuntivales, síndrome urticariforme, angioedema y broncoespasmo, por lo que se concluyó que presentaba anafilaxia. Fue tratada con adrenalina, corticoides y antihistamínicos. Después de la resolución del cuadro, por pruebas in vivo mediante técnica de punción cutánea y por estudio in vitro (IgE específica) se determinó hipersensibilidad a plantago psyllium. Discusión: La mayoría de los casos de anafilaxia se ha reportado por ingestión de psyllium debido a que por esa vía es mayor la carga antigénica. Llama la atención la paciente descrita, en quien la exposición fue únicamente por inhalación, sin embargo, las manifestaciones que presentó fueron potencialmente letales.


Subject(s)
Anaphylaxis/chemically induced , Cathartics/adverse effects , Psyllium/adverse effects , Adult , Female , Humans
6.
Rev Alerg Mex ; 65(4): 379-388, 2018.
Article in Spanish | MEDLINE | ID: mdl-30602208

ABSTRACT

BACKGROUND: Perioperative hypersensitivity reactions constitute a global health problem, with an estimated incidence of 1 per 100,000 procedures and a mortality rate of 0.1 to 9 %. Main risk factors are a history of allergy to other drugs, atopy, associated psychiatric disorders and previous surgeries. OBJECTIVES: To determine the frequency of sensitization and the type of drugs involved in perioperative allergy in a tertiary care hospital, over a 3-year period. METHODS: Retrospective, cross-sectional, descriptive study of perioperative allergy, corroborated by skin tests for each drug and latex, of patients treated at the Allergy and Clinical Immunology Department of Hospital General de Mexico. RESULTS: Twenty-eight patients diagnosed with perioperative allergy were included. Main triggers were neuromuscular blocking agents (46.42 %), latex (28.52 %) and propofol (14.28 %). The main risk factor was a history of previous surgeries (89.28 %). Most perioperative allergic reactions were mild (71.42 %) and occurred within the postoperative period (60.71 %). CONCLUSIONS: Initial diagnosis and Treatment should always be carried out by the anesthesiologist or surgeon, who should focus on the withdrawal of possible causative agents.


Antecedentes: Las reacciones de hipersensibilidad perioperatorias constituyen un problema de salud mundial, con una incidencia estimada de uno por cada 100 000 procedimientos y una tasa de mortalidad de 0.1 a 9 %. Los principales factores de riesgo son antecedentes de alergia a otros fármacos, atopia, trastornos psiquiátricos asociados y cirugías previas. Objetivos: Determinar la frecuencia de sensibilización y tipo de medicamentos implicados en la alergia perioperatoria en un hospital de tercer nivel, durante tres años. Método: Estudio retrospectivo, transversal, descriptivo de alergia perioperatoria corroborada mediante pruebas cutáneas a cada medicamento y al látex, de pacientes atendidos en el Servicio de Alergia e Inmunología Clínica del Hospital General de México. Resultados: Se incluyeron 28 pacientes con el diagnóstico de alergia perioperatoria. Los principales desencadenantes fueron los bloqueadores neuromusculares (46.42 %), el látex (28.52 %) y el propofol (14.28 %). El principal factor de riesgo fue el antecedente de cirugías previas (89.28 %). En su mayoría, las reacciones de alergia perioperatoria fueron leves (71.42 %) y se presentaron en el periodo posoperatorio (60.71 %). Conclusiones: El diagnóstico y tratamiento iniciales siempre deberán efectuarse por el médico anestesiólogo o el cirujano, enfocados en el retiro de los posibles agentes causales.


Subject(s)
Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/epidemiology , Latex Hypersensitivity/diagnosis , Latex Hypersensitivity/epidemiology , Cross-Sectional Studies , Drug Hypersensitivity/complications , Female , Humans , Latex Hypersensitivity/complications , Male , Middle Aged , Preoperative Period , Retrospective Studies , Time Factors
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