Revisión retrospectiva del melanoma conjuntival: presentación, tratamiento y evolución / A retrospective review of conjunctival melanoma: Presentation, treatment and evolution

Objetivo: Describir las características clínicas y la evolución de los pacientes diagnosticados y tratados de melanoma conjuntival en la Unidad de Tumores del Hospital Clínico Universitario de Valladolid. Métodos: Estudio retrospectivo; se incluyeron pacientes diagnosticados consecutivamente de melanoma conjuntival desde enero de 1992 hasta diciembre de 2017. La información demográfica y las características del tumor fueron registradas en una base de datos en Microsoft Access. Resultados: De un total de 462 pacientes con diagnóstico de tumor conjuntival, 252 casos (54,5%) fueron de origen melanocítico, y de estos, 27 casos fueron melanomas de conjuntiva. La edad media fue de 59,2 (16-88) años; 41% hombres y 59% mujeres, con un seguimiento medio de 6,1 ± 6,8años. Según el origen del melanoma conjuntival, 16 casos (59%) surgieron a partir de melanosis adquirida primaria, el 26% de nevus y el 15% de novo. Se realizó biopsia incisional o escisional en todos los pacientes, quimioterapia local adyuvante en 15 casos (56%) y braquiterapia en 5 pacientes (18%). La supervivencia media fue de 18 años (IC95%) y la probabilidad de supervivencia a los 5 y 10 años fue del 89 y del 69%, respectivamente. Conclusiones: El melanoma conjuntival es una enfermedad rara que se suele infravalorar en estadios iniciales, lo que lleva a un tratamiento insuficiente y tardío. El diagnóstico y el tratamiento precoces son esenciales para prevenir las recurrencias y la extensión sistémica y para preservar la visión y la vida del paciente

Objective: The purpose of the present study is to describe the clinical characteristics and outcomes of patients diagnosed and treated for conjunctival melanoma in the Ocular Oncology Unit of the University Hospital Clinic of Valladolid. Methods: A retrospective observational case series study was conducted on patients diagnosed with conjunctival melanoma in the Ocular Oncology Unit of University Hospital Clinic of Valladolid, from January 1992 to December 2017. Demographic information and tumour features were recorded in a Microsoft Access database. Results: Among a total of 462 consecutive patients, the tumour was classified as melanocytic in 252 cases (54.5%), with 27 patients having the pathological diagnosis of conjunctival melanoma. The mean age at diagnosis was 59.2 years (16-88), and there were 41% males and 59% females, with a mean follow-up of 6.1 ± 6.8 years. As regards the origin of conjunctival melanoma, 16 cases (59%) arose from primary acquired melanosis, 26% from nevus, and 15% developed de novo. The treatment performed was incisional or excisional biopsy in all patients, local adjuvant chemotherapy in 15 cases (56%) and brachytherapy in 5 patients (18%). The median survival was 18 years and the probability of survival at 5 and 10 years was 89% and 69%, respectively. Conclusions: Conjunctival melanoma is a rare disease, usually undervalued by the patient as well as being underdiagnosed, leading to insufficient and delayed treatment. Early diagnosis and treatment are essential to prevent recurrences and systemic extension, as well as to preserve vision and life

Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP)

BACKGROUND: In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life. One treatment option in such cases is oral immunotherapy (OIT) with foods. METHODS: We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT. RESULTS: The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE specific of egg white titer was 38.5 kU/l. A double-blind placebo-controlled food challenge with cooked egg white was performed, and if the test proved positive, it was repeated with pasteurized raw egg white. The mean symptoms-provoking dose was 1.26 g and 0.55 g for cooked egg white and raw egg white, respectively. An IgE specific of ovomucoid titer of <2.045 kU/l differentiated those patients that tolerated cooked egg white. CONCLUSIONS: OIT with egg is regarded as an option in patients with persistent egg allergy. In the previous challenge test, an IgE specific of ovomucoid titer of <2.045 kU/l differentiates those patients that tolerate cooked egg white

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Position document: IgE-mediated cow's milk allergy

The present document offers an update on the recommendations for managing patients with cow's milk allergy - a disorder that manifests in the first year of life, with an estimated prevalence of 1.6-3% in this paediatric age group. The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis. The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk. Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice. Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy

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Uso del cuestionario Hospital Anxiety and Depression Scale (HADS) para evaluar la ansiedad y la depresión en pacientes con fibromialgia / Use of the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression in fibromyalgia patients

Introducción:El cuestionario HADS es ampliamente utilizado en la evaluación de la ansiedad y depresión, sin embargo no hay datos sobre su utilización en pacientes de fibromialgia. El objetivo de este estudio es conocer la utilidad del HADS para evaluar los aspectos emocionales presentes en los pacientes de fibromialgia. Método:Se estudia a una muestra de 301 pacientes de fibromialgia. Se analiza la bondad científica del cuestionario y su estructura que es comparada mediante análisis factorial confirmatorio con la obtenida en otras investigaciones. Se utilizan dos índices externos de severidad: número de puntos dolorosos y situación laboral. Resultados:Se obtienen altos niveles de ansiedad, mayores que en otros trastornos. La fiabilidad es adecuada y un modelo de 3 factores es el que mejor se ajusta a los datos, no obstante, dicha estructura no parece ser más útil que la de 2 factores, considerando los criterios externos utilizados. Conclusión:El HADS se ha mostrado útil para explorar la presencia de ansiedad y depresión en pacientes de fibromialgia. El número de puntos dolorosos no parece estar relacionado con la severidad de los aspectos psicológicos evaluados por el HADS, sin embargo sí parece haber una correspondencia entre estos y la situación laboral de las pacientes(AU)

Introduction:The HADS is a questionnaire widely used to evaluate anxiety and depression, although its use in fibromyalgia patients has not yet been reported. The aim of this study is to know the usefulness of the HADS to evaluate the emotional aspects related to fibromyalgia patients. Methods:This paper studies a sample of 301 fibromyalgia patients. The scientific goodness of the questionnaire is analyzed, and its structure is compared with other models by confirmatory factor analysis. Two external severity indices are used, number of tender points and patient's employment situation. Results:The results show higher levels of anxiety than in other disorders, adequate reliability and a three-factor model with better statistical fit. Nevertheless, this structure was not shown more useful than the two-factor structure for the external criteria studied. Conclusions:The HADS has been shown to be a useful tool for exploring the presence of anxiety and depression in fibromyalgia patients and that the number of tender points does not seem to be related to the severity of the psychological aspects measured by the HADS in our sample, while there does seem to be a correspondence between psychological condition and absence from work.AU)

Cambio de tratamiento en pacientes con esclerosis múltiple y sus consecuencias en la práctica clínica / Change of treatment in patients with multiple sclerosis and its consequences in clinical practice

Introducción. El 30% de los pacientes con esclerosis múltiple (EM) presenta respuesta subóptima al tratamiento en los primeros años. El impacto real del cambio de tratamiento no está bien establecido. Objetivos. Describir nuestra práctica clínica sobre el cambio de tratamiento en los pacientes con EM con respuesta subóptima y analizar la evolución en función de nuestras decisiones terapéuticas. Pacientes y métodos. Estudio observacional y retrospectivo. Se incluyeron pacientes con EM remitente recurrente con al menos un brote después de instaurado el tratamiento inmunomodulador. Se tuvieron en cuenta la intención de cambio de tratamiento y los retrasos hasta el momento real del cambio. Las consecuencias teóricas de estas estrategias se midieron por los cambios en la curva esperada de la Multiple Sclerosis Severity Scale (MSSS). Resultados. Los pacientes que cambiaron de inmunomodulador mejoraron la curva esperada de la MSSS (p > 0,05) respecto a los que no (64,3% frente a 35,3%). Los pacientes que mejoraron esa curva habían cambiado de tratamiento antes que los que no mejoraron (1,9 meses frente a 6 meses), aunque las diferencias no fueron significativas. El tiempo transcurrido entre el planteamiento y el cambio real de tratamiento tuvo una media de 2,70 ± 3,55 meses. Conclusiones. A pesar de las limitaciones por el tamaño de la muestra, los pacientes con respuesta subóptima que cambian de tratamiento precozmente podrían beneficiarse de una mejoría en su evolución esperada por la MSSS (AU)

Introduction. Thirty per cent of patients with multiple sclerosis (MS) present a suboptimal response to treatment in the first few years. The real impact of the change of treatment has still not been well established. Aims. To describe our clinical practice with regard to the change of treatment in MS patients with a suboptimal response and to analyse their progress depending on our therapeutic decisions. Patients and methods. The study is observation-based and retrospective. The sample was made up of patients with relapsingremitting MS and at least one event after establishing immunomodulatory treatment. Both the intention to change treatment and the delays until the actual change took place were taken into account. The theoretical consequences of these strategies were measured by the changes in the expected curve of the Multiple Sclerosis Severity Scale (MSSS). Results. A comparison of those who changed immunomodulator with those that did not showed that 64.3% versus 35.3%, respectively, improved on the expected curve of the MSSS (p > 0.05). Patients who improved the expected curve of the MSSS had changed treatment before those who did not improve (1.9 months versus 6 months), although the differences were not significant. The mean time that elapsed between taking the decision to change and actually changing the treatment was 2.70 ± 3.55 months. Conclusions. Despite limitations due to the size of the sample, the patients with a suboptimal response who changed treatment early could benefit from an improvement in their expected progression on the MSSS (AU)

Mobbing: una propuesta exploratoria de intervención / Mobbing: An exploratory proposal for intervention

Mobbing or harassment at work, is a continued and incremental process that undergoes the person because reiterated negative conducts by his/her superiors or equal ones in the labour environment. The effects, which are produced on the person both emotional and psychosomatic levels, are not detected in the beginning, causing a deterioration of the person well-being in the long term. Indeed, when mobbing appears, processes of absenteeism, losses and turn over begin to take place, these issues could have palliate effects in the beginning, but in the long run if they are not abashed and confronted, could end in a deep malaise situation. This labour environmental upheaval must be undertaken with the aim to provide protocols of prevention, detection and treatment that minimize the costs they produce not only in the management but also in the personal level. In the present work it has been developed and applied a registered group program (9 sessions), which has obtained positive results, equipping the subjects for mechanisms in the recovery of their personal well-being, improving their levels of anxiety, depression, modifying their negative thoughts and carrying out a positive problem facing (AU)

El mobbing o “acoso moral en el trabajo”, es un proceso continuado e incremental que sufre la persona ante las conductas negativas reiteradas por parte de sus superiores o iguales en el entorno laboral. Los efectos que produce en la persona tanto a nivel emocional como psicosomático, no son detectados al inicio, es más, se van acumulando provocando un deterioro del bienestar de la persona a largo plazo. Además, cuando aparece el mobbing, comienzan a producirse procesos de absentismo, bajas laborales y rotaciones, que en principio pueden paliar los efectos, pero a la larga si no se atajan y afrontan, puede acabar en una situación de profundo malestar. Este trastorno que sucede en el entorno laboral, debe ser acometido con el fin de proporcionar protocolos de prevención, detección y tratamiento que minimecen los costes producidos tanto a nivel empresarial como personal. En el presente trabajo se ha desarrollado y aplicado un programa grupal protocolizado (9 sesiones), que ha obtenido resultados positivos al dotar a los sujetos de mecanismos para la recuperación de su bienestar personal, mejorando sus niveles de ansiedad, depresión, modificando los pensamientos negativos y realizando un afrontamiento positivo de los problemas (AU)

Estudio multicéntrico retrospectivo sobre trasplante de limbo / Limbal transplantation: multicenter retrospective case series analysis

Objetivo: Revisar el resultado de los trasplantes de limbo (TL) realizado en pacientes con Síndrome de insuficiencia límbica (SIL) en el contexto de varias enfermedades de la superficie ocular. Materiales y métodos: Se realizó un estudio retrospectivo y multicéntrico (cinco centros) de los TL realizados entre 1996 y 2004. Los datos fueron recogidos por el mismo investigador, en una base de datos especialmente diseñada para el estudio. Se consideró como «éxito» del TL a la ausencia de: defectos epiteliales, inflamación y recurrencia del pterigión cuando éste fue la causa del TL. Resultados: Se analizaron un total de 72 TL realizados en 61 pacientes (65 ojos) con tiempo de seguimiento de 20,8 meses (DS 23,5; rango, 3-115).Hubo 33 hombres y 28 mujeres, con una media de55,8 años (DS: 15,6; rango, 20-89). Se realizaron58 (80.6%) TL autólogos (40 pterigión, 12 causticaciones, tres iatrogénicas, dos infecciones virales, una neoplasia) y 14 (19,4%) TL alogénicos de donante cadáver (siete inflamaciones inmunes, seis causticaciones, uno iatrogénico). Todos los pacientes a los que se les realizó TL alogénicos recibieron inmunosupresión sistémica. Al final del seguimiento,48 (66,7%) TL se consideraron un éxito. Este porcentaje fue del 81,0% (47/58) en los TL autólogos y del 7,1% (1/14) en los TL alogénicos. El porcentaje de éxito también dependió de la etiología, siendo alto en los casos de pterigión (80,0%) y menor en las patologías inmunológicas (14,3%).Conclusiones: El TL autólogo es preferible al alogénico, pues la tasa de fracasos disminuye notablemente y, además, se evita el uso de inmunosupresión oral mantenida. Además, el pronóstico es siempre peor en los casos de patología inflamatoria inmune. El TL autólogo parece ser una buena elección para el tratamiento del pterigión recurrente, aunque se necesitan estudios prospectivos que corroboren estos resultados

Purpose: To report the results of limbal transplantation (LT) in patients with limbal stem cell deficiency (LSCD) in the context of ocular surface diseases. Materials and methods: A multicenter (5 centers) retrospective case series analysis of patients who underwent LT between 1996 and 2004 was performed. Data were collected by the same researcher using a customized database. Success was defined by the absence of a persistent corneal epithelial defect, on-going inflammation or recurrence of a pterygium. Results: Data from 72 LT performed in 61 patients(65 eyes) with a mean follow-up of 20.8 months(SD 23.5; range, 3-115) were analyzed. There were33 males and 28 females with a mean age of 55.8years (SD: 15.6; range, 20-89). Fifty-eight (80.6%)LT were autografts (40 pterygia, 12 alkali burns, 3iatrogenic cases, 2 viral infections, 1 neoplasiacase) and 14 (19.4%) were allografts from cadaveric donors (7 immune-based disorders, 6 alkali burns, 1 iatrogenic case); all patients receiving allografts also received systemic immunosuppression. Of the total number of LT, 48 (66.7%) were successful. This proportion increased to 81.0% (47/58)when autografts were used. However, only 7.1%(1/14) of all allografts were successful. The success rate was higher (80.0%) when performed for apterygium and lower when done for immune-based inflammation (14.3%).Conclusion: Autograft tissue for LT is always preferable to allografts to surgically treat LSCD, as clinical success is significantly higher, and systemic immunosuppression is avoided. As expected, immune-based disorders are the most difficult casesto treat. LT has been shown to be an excellent option for recurrent pterygium, although prospective studies need to be performed to further corroborate these results

Exercise-induced asthma in asthmatic children. Predisposing factors

Background: Exercise-induced bronchoconstriction (EIB) has a high prevalence in children with asthma, and this is a common problem, even in case of controlled asthma, because of the high levels of physical activity in the childhood. Objectives: The aim of our study was to identify factors associated with the development of EIB in children with controlled asthma. Methods: We studied children evaluated for asthma. A personal and familiar history was collected from each patient to estimate asthma severity, precipitating factors, exercise ability, immunotherapy treatment and atopic familiar disorders. Skin prick tests for inhalant allergens, pulmonary function tests (PFTs) and exercise challenge test (ECT) measurements were realized in every patient. We used the Chi Squared test to compare qualitative variables, the Student's-t test for quantitative variables and a logistic regression analysis to estimate the independent effect of the variables. Results: We evaluated 132 asthmatic patients. Eighty-two, 6 to 14 years old (average 110 ± 36.9 months), were included in the study. Forty one have coughing or wheezing with exercise at least three months ago, in addition to a positive ECT; 9 of these children had solitary EIB (group A), and 32 (group B) had controlled chronic asthma, 27 intermittent and 5 moderately persistent. Forty one controlled asthmatic children, 39 intermittent, 1 mildly persistent and 1 moderately persistent (group C) had a good tolerance for exercise with a negative ECT. No differences were found in familiar history, asthma severity or evolution time in B vs C group. We found that 35 patients (42,68 %) patients were sensitized to indoor allergens: 24 (58,53 %) were patients suffering EIB and 11 (26,8 %) allowed to group C. Precipitating factors of asthma were in group B: respiratory infections in 19 cases, pollen in 20 and in 10 indoor allergens exposure. In group C: 14 patients had asthmatic symptoms with viral respiratory infections, 32 with pollen and 2 with indoor allergens exposure. A patient from group A had allergy rhinitis after exposure to cats. Allergy to indoor allergens demonstrated an direct association to EIB suffering (p = 0,026). Twenty six patients with allergic asthma followed pollen immunotherapy treatment, 7 of group B (33,3 %) and 19 (59,3 %) of group C. This treatment was inversely associated with EIB suffering (p = 0,048). A logistic regression analysis confirmed the independence of both variables as predisposing and protecting factors in EIB suffering. Conclusions: Allergy to indoor allergens might be considered a risk factor for EIB. Immunotherapy treatment could be a protective factor against the development of EIB in children with allergic asthma

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Medida del tamaño de las lesiones con cápsula endoscópica: un problema por resolver / No disponible

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Creatinina sérica y aclaramiento de creatinina para la valoración de la función renal en hipertensos esenciales / Serum creatinine and creatinine clearance for renal function evaluation

La creatinina plasmática puede subestimar el filtrado glomerular. Los pacientespueden tener una disminución significativa del filtrado glomerular conun valor de creatinina plasmática dentro de la normalidad, haciendo difícil ladetección precoz del deterioro de la función renal. En este trabajo se estimala función renal así como la prevalencia de la disfunción renal en pacientescon hipertensión arterial esencial, mediante la determinación de creatinina sérica,comparándolo con la medida del aclaramiento de creatinina, medida por4 fórmulas distintas; la fórmula habitual con recogida orina de 24 h, la fórmulade Cockcroft-Gault, MDRD abreviada y la fórmula habitual corregida porla superficie corporal. El estudio incluye 721 hipertensos esenciales, 319 hombres(44,2%), 402 mujeres (55,8%), con edad media 56,3 ± 13,9 (53,7 ±14,4 vs 58,3 ± 13,3). En todos ellos se determina la creatinina plasmática asícomo el aclaramiento de creatinina por las 4 fórmulas señaladas. Los pacientesfueron agrupados en función de la edad, en 4 grupos ( 76 años), la función renal fue calificado como normal cuando la creatininasérica es 60 ml/m en las cuatro fórmulas.La creatinina plasmática aumenta con la edad (1,01 ± 0,36 vs 1,3 ± 1,15en aquellos con edad menor de 40 y mayor de 70 años y el aclaramiento decreatinina disminuye con la edad según las 4 fórmulas (107,6; 92,8; 74,7,57,3 para la fórmula habitual); (117,7; 87,7; 65,9; 49,5 para la fórmula deCockroft-Gault); (87,4, 74,9, 66,5 y 61 para la fórmula MDRD abreviada) y(97, 85,3, 71,9; 57,3 para la fórmula de superficie corporal). Las 4 fórmulasson comparables para la medición de la función renal, con cualquiera deellas, el porcentaje de deterioro de la función renal fue mucho mayor (18,3-25,3% (CrCl < 60 ml/m) que el obtenido cuando se utiliza la creatinina plasmática(4%). Este estudio, demuestra la importancia de la determinación delaclaramiento de creatinina en hipertensos esenciales a la hora de valorar elfiltrado glomerular, detectando más precozmente el deterioro de la funciónrenal que cuando se utiliza la creatinina sérica

The shortcoming of serum creatinine (SCr) as an index of renal function is wellknown, patients can have significantly decreased glomerular filtration rates (GFR)with normal range SCr values, making the recognition of renal dysfunction moredifficult. This study was designed to estimate renal function and the prevalence ofrenal dysfunction in essential hypertensive patients, comparing SCr and 4 formulasused to measure the creatinine clearance (CrCl) (the urinary CrCl formula,Cockcroft-Gault, MDRD and body surface formula)The study included 721 essential hypertensive patients, 319 men (44.2%), 402women (55.8%), mean age 56.3 ± 13.9 (53.7 ± 14.4 vs 58.3 ± 13.3). In all subjectsSCr was measured and 24-h urine sample was collected to evaluate CrCl.Creatinine clereance was calculated by 4 formulas. Patients were grouped accordingto age ( 76) and renal function was classified asnormal when SCr 60 ml/m,respectively) within the above written formulas.SCr increases with age (1.01 ± 0.36 vs 1.3 ± 1.15) and CrCl decreases accordingto the 4 formulas (107,6; 92,8; 74,7 and 57,3 for the urinary SCr formula);(117,7; 87,7; 65,9 and 49,5 for the CG formula); (87,4, 74,9, 66,5 and 61 forthe MDRD formula) and (97, 85,3, 71,9 and 57,3 for the body suface formula).The 4 formulas are comparable markers of renal function in the overall population.With any formula the percentage of patients with impaired renal function wasmuch higher than indicated by the plasma creatinine alone (4% for SCr) vs 18,3-25,3% (CrCl < 60 ml/m) according to the 4 formulas. This study documents thesubstantial prevalence of abnormal renal function in essential hypertension. Estimationof GFR may help to facilitate the early identification of patients with renalimpairment

Eficacia de la inmunoterapia en el tratamiento del asma / Efficacy of immunotherapy in the treatment of asthma

La inmunoterapia específica consiste en la administración de extractos alergénicos a pacientes con enfermedad alérgica para alcanzar la tolerancia clínica a los alergenos causantes de la enfermedad. Constituye en la actualidad el único tratamiento etiológico de la alergia respiratoria. Un documento de opinión de la Organización Mundial de la Salud en 1997 define la inmunoterapia como "La única forma de tratamiento capaz de modificar el curso natural de las enfermedades alérgicas". En pacientes con rinitis alérgica, varios estudios sugieren que puede modificar la historia natural de la alergia respiratoria evitando la aparición de asma en niños con esta enfermedad. Numerosos estudios demuestran su eficacia en el tratamiento del asma alérgica, mediada por IgE, y en particular del asma leve-moderada. Cuando una total evitación del alergeno no es posible con medidas que permitan al paciente llevar a cabo una vida normal, el tratamiento farmacológico puede ayudar a controlar los síntomas, pero este control desaparece en forma inmediata tras su interrupción. Sin embargo, existe la posibilidad de mejorar el cuidado del asma con un tratamiento específico de alergeno, la inmunoterapia puede desviar la respuesta inmune desde el patrón alérgico hacia una respuesta más protectora con una mejoría persistente disminuyendo los síntomas y la necesidad de tratamiento farmacológico. Numerosos estudios comparativos, con inmunoterapia específica vs placebo o tratamiento farmacológico, demuestran la eficacia de este tratamiento y sus ventajas sobre el control de la enfermedad. La inmunoterapia específica induce modificaciones clínicas, biológicas y funcionales favorables en el curso del asma alérgica. Se ha demostrado una significativa mejoría de las manifestaciones clínicas aún con niveles de exposición a alergenos superiores a los del inicio del tratamiento. Esta mejoría se asocia a una disminución de las necesidades de tratamiento antiinflamatorio y broncodilatador ...(AU)

Specific immunotherapy consists of the administration of allergen extracts to patients with allergic disease to achieve clinical tolerance to the causative allergens. Currently, it is the only etiologic treatment for respiratory allergy. A World Health Organization opinion paper published in 1997 defines immunotherapy as "the only form of treatment able to modify the natural course of allergic diseases". In patients with allergic rhinitis, several studies suggest that immunotherapy can modify the natural history of respiratory allergy by preventing the development of asthma in children with this disease. Numerous studies demonstrate its efficacy in IgE-mediated asthma and particularly in mild-to-moderate asthma. When complete avoidance of the allergen cannot be achieved with measures that allow the patient to lead a normal life, pharmacological treatment can help to control symptoms, but symptoms immediately return when treatment is interrupted. However, asthma care can be improved by allergen-specific treatment; immunotherapy may shift the immune response from an allergic pattern toward a more protective response, producing persistent improvement with reduction of symptoms and the need for pharmacological treatment. Numerous comparative studies with specific immunotherapy vs. placebo or pharmacological treatment have demonstrated the efficacy of this treatment and its advantages in control of the disease. Specific immunotherapy induces favorable clinical, biological and functional modifications in the course of allergic asthma. Significant improvement in clinical manifestations has been demonstrated, even with levels of allergen exposure higher than those at the beginning of treatment. This improvement is associated with a reduced need for antiinflammatory and bronchodilator treatment ... (AU)