[Atopic dermatitis. Allergological characteristics and association with respiratory disease]. / Dermatitis atópica: características alergológicas y asociación a patología respiratoria.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease that frequently precedes the development of asthma or other respiratory allergies. The aim of this study was to review allergen sensitization, type of feeding in infancy, and development of asthma or rhinitis in a group of patients with AD. METHODOLOGY: One hundred children with AD were selected. All patients underwent skin prick and patch tests to foodstuffs and inhalant allergens, total and specific IgE determination, and oral challenge tests. RESULTS: The study included 57 boys and 43 girls. The mean age at consultation was 3.77 +/- 2.81 years and mean age at onset of of AD was 1.09 +/- 1.69 years. Twenty-eight percent of the children were exclusively sensitized to food allergens, 20% to inhalant allergens and 22% to both food and inhalant allergens. Mean serum IgE levels were higher in children sensitized to Dermatophagoides pteronyssinus (DPT) (346.86 +/- 430.43 U/ml) than in non-sensitized children (78.24 +/- 132.93 U/m) (p < 0.001). Total IgE levels were also higher in patients with respiratory symptoms (283.77 +/- 336.53 U/ml) than in children without respiratory disease (124.62 +/- 285.21 U/ml) (p = 0.021). Thirty-five percent of the children developed some kind of respiratory allergic disease (asthma and/or rhinitis) in a mean interval of 2.55 years after the onset of dermatitis. Of the children sensitized to inhalant allergens (DPT), 55.26 % developed respiratory symptoms compared with 22.58 % of the non-sensitized children (p < 0.001). The odds ratio of developing respiratory allergy if the patient showed sensitization to DPT was 4.235 (95 % CI 1.768-0.147, p = 0.002). CONCLUSIONS: Children with AD that develops in the first year of life, associated with high IgE levels and early sensitization, independently of the kind of feeding, develop respiratory allergic disease more frequently than children without these factors.

Dermatitis atópica: características alergológicas y asociación a patología respiratoria / Atopic dermatitis. Allergological characteristics and association with respiratory disease

Objetivos: La dermatitis atópica (DA) es una enfermedad inflamatoria crónica de la piel que frecuentemente precede el desarrollo de asma u otra alergopatía respiratoria, por lo que el objetivo de nuestro estudio fue revisar las características de un grupo de pacientes con DA, sus sensibilizaciones, el tipo de lactancia recibido y la asociación a enfermedades respiratorias.Metodología: Seleccionamos a 100 niños diagnosticados de DA y les realizamos a todos ellos pruebas cutáneas (prick test y epicutáneas) a alimentos e inhalantes, determinación de inmunoglobulina E (IgE) total y específica y pruebas de provocación oral a alimentos.Resultados: El estudio incluyó a 57 niños y 43 niñas. La edad de inicio de la dermatitis atópica fue de 1,09 ñ 1,69 años y la media de edad en el momento de la consulta de 3,77 ñ 2,81 años. El 28 por ciento de los niños estaba sensibilizado exclusivamente a alimentos, el 20 por ciento a inhalantes y el 22 por ciento a alimentos más inhalantes.En los niños sensibilizados a Dermatophagoides pteronysinuss (DPT) encontramos un valor medio de IgE superior (346,86 ñ 430,43 U/ml), al del grupo de niños no sensibilizados (78,24 ñ 132,93 U/ml) (p < 0,001). Así mismo, la cifra de IgE total también fue más elevada en el grupo de pacientes con sintomatología respiratoria (283,77 ñ 336,53), que en los niños sin clínica respiratoria (124,62 ñ 285,21) (p = 0,021). El 35 por ciento de los niños desarrolló algún tipo de patología respiratoria (asma y/o rinitis), en un tiempo medio de 2,55 años desde el inicio de la DA. De los niños sensibilizados a neumoalergenos (DPT) el 55,26 por ciento presentaron patología respiratoria, frente al 22,58 por ciento de los no sensibilizados (p < 0,001). La OR del desarrollo de alergia respiratoria si el paciente presentaba sensibilización a DPT fue de 4,235 (95 por ciento IC 1,768-0,147, p = 0,002).Conclusiones: Los niños con dermatitis atópica de aparición durante el primer año de vida, asociada a la existencia de niveles elevados de IgE y la presencia de sensibilización precoz, independientemente del tipo de lactancia recibida, tienen más riesgo de acabar desarrollando patología respiratoria alérgica que los niños con dermatitis atópica sin la asociación de todos estos factores (AU)

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that frequently precedes the development of asthma or other respiratory allergies. The aim of this study was to review allergen sensitization, type of feeding in infancy, and development of asthma or rhinitis in a group of patients with AD. Methodology: One hundred children with AD were selected. All patients underwent skin prick and patch tests to foodstuffs and inhalant allergens, total and specific IgE determination, and oral challenge tests. Results: The study included 57 boys and 43 girls. The mean age at consultation was 3.77 ± 2.81 years and mean age at onset of of AD was 1.09 ± 1.69 years. Twenty-eight percent of the children were exclusively sensitized to food allergens, 20 % to inhalant allergens and 22 % to both food and inhalant allergens. Mean serum IgE levels were higher in children sensitized to Dermatophagoides pteronyssinus (DPT) (346.86 ± 430.43 U/ml) than in non-sensitized children (78.24 ± 132.93 U/m) (p < 0.001). Total IgE levels were also higher in patients with respiratory symptoms (283.77 ± 336.53 U/ml) than in children without respiratory disease (124.62 ± 285.21 U/ml) (p = 0.021). Thirty-five percent of the children developed some kind of respiratory allergic disease (asthma and/or rhinitis) in a mean interval of 2.55 years after the onset of dermatitis. Of the children sensitized to inhalant allergens (DPT), 55.26 % developed respiratory symptoms compared with 22.58 % of the non-sensitized children (p < 0.001). The odds ratio of developing respiratory allergy if the patient showed sensitization to DPT was 4.235 (95 % CI 1.768-0.147, p = 0.002). Conclusions: Children with AD that develops in the first year of life, associated with high IgE levels and early sensitization, independently of the kind of feeding, develop respiratory allergic disease more frequently than children without these factors (AU)

[Treatment of status asthmaticus. Experience of intravenous beta-adrenergic bronchodilator therapy in 71 cases]. / Tratamiento del estado asmático. Experiencia del tratamiento broncodilatador beta-adrenérgico EV sobre 71 casos.

A retrospective study of the patients admitted during the last 8 years with status asthmaticus is reported. We compare the requirement of mechanical ventilation with the beta-agonist therapy received and the type of asthma. About 71 patients admitted, 67% were IgE dependent asthmatic (EDA) children and 31% no-IgE dependent asthmatic (nEDA) ones. They needed intermittent positive pressure ventilation (IPPV) in 20 instances; no difference was found between both types of asthma. We studied the ventilatory parameters used. The 33% of EDA children was treated using a continuous IV infusion of hexoprenalina, requiring IPPV in 5 (31%) of them. The rest received a continuous IV of isoproterenol, and only the 16% required IPPV. We found isoproterenol to be more effective than hexoprenalina in the treatment of status asthmaticus. Similar results were obtained with the nEDA group. The Downes score was showed to be a good predictor-index scoring system in many cases.