ABSTRACT
Background: Recent data about clinical features, triggers and management of anaphylaxis in Latin America is lacking. Objective: To provide updated and extended data on anaphylaxis in this region. Method: An online questionnaire was used, with 67 allergy units involved from 12 Latin-American countries and Spain. Among data recorded, demographic information, clinical features, severity, triggering agents, and treatment were received. Results: Eight hundred and seventeen anaphylactic reactions were recorded. No difference in severity, regardless of pre-existing allergy or asthma history was found. Drug induced anaphylaxis (DIA) was most frequent (40.6%), followed by food induced anaphylaxis (FIA) (32.9%) and venom induced anaphylaxis (VIA) (12%). FIA and VIA were more common in children-adolescents. Non-steroidal anti-inflammatory drugs (NSAIDs) and beta-lactam antibiotics (BLA) were the most frequent drugs involved. Milk (61.1% of FIA) and egg (15.4% of FIA) in children, and shellfish (25.5% of FIA), fresh fruits (14.2% of FIA), and fish (11.3% of FIA) in adults were the most common FIA triggers. Fire ants were the most frequent insect triggers, and they induced more severe reactions than triggers of FIA and DIA (p < 0.0001). Epinephrine was used in 43.8% of anaphylaxis episodes. After Emergency Department treatment, epinephrine was prescribed to 13% of patients. Conclusions: Drugs (NSAIDs and BLA), foods (milk and egg in children and shellfish, fruits and fish in adults) and fire ants were the most common inducers of anaphylaxis. Epinephrine was used in less than half of the episodes emphasizing the urgent need to improve dissemination and implementation of anaphylaxis guidelines.
ABSTRACT
BACKGROUND: Diet might influence the risk of allergic diseases. Evidence from developing countries with high prevalence of childhood asthma is scant. METHODS: Information on wheeze, rhinitis, and eczema was collected from 3209 children aged 6-7 years in 2005, who were taking part in the International Study on Asthma and Allergy in Children (ISAAC) in Colombia. Intake frequency of twelve food groups was assessed. Associations between each food group and current wheeze, rhino-conjunctivitis, and eczema were investigated with multiple logistic regressions, adjusting for potential confounders. Simes' procedure was used to test for multiple comparisons. RESULTS: 14.9% of children reported wheeze in the last 12 months, 16% rhino-conjunctivitis, and 22% eczema. Eczema was negatively associated with consumption of fresh fruits and pulses three or more times per week (adjusted Odds ratio (aOR): 0.64; 95% Confidence Interval (CI): 0.49 to 0.83; p value = 0.004; and aOR: 0.62, 95% CI: 0.47 to 0.80; p value < 0.001, respectively). Current wheeze was negatively associated with intake of potatoes (aOR: 0.44, 95% CI: 0.31 to 0.62, p value = 0.005), whilst this outcome was positively associated with consumption of fast food (aOR: 1.76, 95% CI: 1.32 to 2.35, p value = 0.001). These associations remained statistically significant after controlling for multiple comparisons. CONCLUSIONS: A traditional diet might have a protective effect against eczema and wheeze in Colombian children, whilst intake of fast foods increases this risk.
Subject(s)
Conjunctivitis, Allergic/etiology , Dermatitis, Atopic/etiology , Diet , Fast Foods/adverse effects , Respiratory Sounds/etiology , Rhinitis, Allergic/etiology , Child , Colombia/epidemiology , Conjunctivitis, Allergic/epidemiology , Dermatitis, Atopic/epidemiology , Diet/adverse effects , Diet Surveys , Female , Fruit , Humans , Logistic Models , Male , Odds Ratio , Prevalence , Rhinitis, Allergic/epidemiology , Risk Factors , Risk Reduction Behavior , Solanum tuberosumABSTRACT
Allergic rhinitis and asthma represent global problems of public health affecting all age groups; asthma and allergic rhinitis frequently coexist in the same patients. In Latin American prevalence of allergic rhinitis, although variable, is very high. Allergic rhinitis and its Impact on Asthma (ARIA) started during a workshop of the World Health Organization performed in 1999 and was published in 2001. ARIA proposed a new classification of allergic rhinitis in intermittent or persistent and mild or moderate-severe. This approach of classification reflects more nearly the impact of allergic rhinitis in patients. In its review of 2010 ARIA developed guidelines for diagnosis and treatment of allergic rhinitis and of clinical practices for management of comorbidities of allergic rhinitis and asthma based on GRADE (Grading of Recommendations, Development and Evaluation). ARIA has been spread and implemented in more than 50 countries. In Latin American an intense activity has been developed to spread these recommendations in almost all the countries of the region and it is important to record the obtained goals in the diffusion and implementation of ARIA, as well as to identify the unsatisfied needs from the clinical, research and implementation points of view. Final objective is to reinforce the priority that allergy and asthma should have, especially in children, in the programs of public health, as they have been prioritized in European Union in 2011.
La rinitis alérgica y el asma representan problemas globales de salud pública que afectan a todos los grupos etarios; el asma y la rinitis alérgica frecuentemente coexisten en los mismos pacientes. En América Latina la prevalencia de rinitis alérgica, aunque variable, es muy elevada. La iniciativa Rinitis Alérgica y su Impacto en Asma (globalmente conocida como ARIA, de su nombre en inglés Allergic Rhinitis and its Impact on Asthma) comenzó durante un taller de la Organización Mundial de la Salud (OMS) realizado en 1999 que se publicó en el año 2001. ARIA propuso una nueva clasificación de rinitis alérgica en intermitente o persistente y leve o moderada-severa. Este esquema de clasificación refleja más estrechamente el impacto de la rinitis alérgica en los pacientes. En su revisión de 2010, la guía ARIA desarrolló pautas para el diagnóstico y tratamiento de la rinitis alérgica y de prácticas clínicas para el manejo de las comorbilidades de la rinitis alérgica y el asma basadas en GRADE (Gradación de Recomendaciones, Desarrollo y Evaluación). ARIA se ha diseminado e implantado en más de 50 países. En América Latina se ha desarrollado una intensa actividad para diseminar estas recomendaciones en casi todos los países de la región y es importante llevar un registro de los logros obtenidos en la difusión e implantación de ARIA, además de identificar las necesidades insatisfechas desde el punto de vista clínico, de la investigación y de la implantación. El objetivo final es reforzar la prioridad que deben tener la alergia y el asma especialmente en niños en los programas de Salud Pública, tal como los priorizó la Unión Europea en 2011.
