[Perioperative allergy. A 3-year experience]. / Alergia perioperatoria. Experiencia de tres años.

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.

[Effects of methimazole on the evolution of the allergic rhinitis of patients with Graves' disease]. / Efectos del metimazol en la evolución de la rinitis alérgica en pacientes con enfermedad de Graves.

BACKGROUND: The methimazole has long been used for treating Graves' disease to decrease thyroid hormone production and obtain a thyroid normofunction, but this drug has also immunosuppressive and immunomodulation effects. OBJECTIVE: To analyze in patients with Graves' disease treated with methimazole and allergic rhinitis, the clinical evolution of the allergic rhinitis with the immunosuppressive and immunomodulation effects of the methimazole. PATIENTS AND METHODS: A comparative and observational study was done in the Mexico's General Hospital, in twenty-six patients with Graves' disease treated with methimazole 10 mg, thyroid profile was done, and when subjects obtained a thyroid normofunction continued with the same doses of methimazole and received also 12.5 mcg/day of levothyroxine. All the patients were diagnosed with allergic rhinitis, and they were divided into two groups (11 females and 2 males each). Both groups continued with the same treatment of methimazole and levothyroxine, but group II was given also antihistamines H1 of second-generation (loratadine) daily, and specific immunotherapy during six months. We described and compared the clinical evolution of the allergic rhinitis of the two groups with the treatment. RESULTS: In the group I, changes in the clinical evolution of the allergic rhinitis after six months were not observed. In the group II, by week 10 the symptoms of the allergic rhinitis were controlled in 80% of the patients, and by week 14 all the patients of this group were asymptomatic. CONCLUSIONS: In patients with allergic rhinitis and Graves' diseases with methimazole-thyroid normofunction we observed that there is not influence of methimazole on clinical evolution of the allergic rhinitis.

[Peripheral anticholinergic syndrome]. / Sindrome anticolinérgico periférico.

This is a case report of a woman of 38 years old, studied and analyzed at the service of allergy and immunology with clinical manifestations of allergic rhinitis; studies of laboratory, cabinet and intradermal test were made to corroborate this diagnosis and the treatment with specific hyposensitization, oral antihistaminines and inhaled steroids was started. Two years later the patient referred urinary retention without important antecedents, so, a peripheral anticholinergic syndrome (PAS) was suspected, a urodynamic test study was carried out consisting in a uroflujometry, static and dynamic urethral profile, cystometry, flow pressure study and electromyography, which diagnosed low urinary obstruction (functional) and vesical sphincter pseudodysfunction, demonstrating the PAS associated with oral antihistamines.

[Allergy and neurotoxicity induced by bee sting. Case report and literature review]. / Alergia y neurotoxicidad inducida por piquete de abeja. Reporte de un caso y revisión bibliográfica.

Under the heading of this subject we deal with stings by arthropods, making of bees, commenting on the composition of the poisons and the different local and general reactions that are differences that exist between the stings The venom contains many biologically active components such as melitin, phospholipase A2, apamin, mast cell degranulation peptide, hyaluronidase, histamine, and dopamine. That neurotoxic venom secretory phospholipases A2 (sPLA2) have specific receptors in brain membranes called N-type receptors that are likely to play a role in the molecular events leading to neurotoxicity of these proteins. The sPLA2 found in honeybee venom is neurotoxic and binds to this receptor with high affinity. Poneratoxin is small neuropeptide found in the venom of arthropod (bee). It is stored in the venom reservoir as a inactive 25 residue peptide. Here we describe both chemically synthesized poneratoxin, insect larvae were paralyzed by injection of either of the purified toxins. These toxins are used in research as molecular probes, targeting with high affinity selected ion channel subtypes. As such, they are very useful for understanding the mechanism of synaptic transmission. Poneratoxin affects the voltage-dependent sodium channels and blocks the synaptic transmission in the insect central nervous system in a concentration-dependent manner; we think that in the human this is same.