[Frequency of skin reactivity to food allergens in allergic patients]. / Frecuencia de reactividad cutánea hacia alérgenos alimentarios en pacientes alérgicos.

BACKGROUND: Food allergy is deemed to have a worldwide prevalence ranging from 2 to 10 %. OBJECTIVE: To determine the frequency of skin reactivity to food allergens by age groups. METHODS: Cross-sectional, descriptive, prolective, observational study. Patients aged from 2 to 64 years with symptoms consistent with allergic disease were included. Skin prick tests were carried out with food allergens. Frequencies and percentages were estimated. RESULTS: One-hundred and ninety-one patients were included, out of which 63.4% were females. Mean age was 22.5 years; 19.3 % showed positive skin reactivity to at least one food. Distribution by age group was as follows: preschool children 13.5 %, schoolchildren 24.3 %, adolescents 2.7 % and adults 59.5 %. Diagnoses included allergic rhinitis in 84.3 %, asthma in 19.4 %, urticaria in 14.1 % and atopic dermatitis in 8.4 %. Positive skin reactivity frequency distribution in descending order was: soybeans with 5.2 %, peach with 4.7 %, grapes, orange and apple with 3.6 %, nuts with 3.1 %, pineapple, avocado, tomato and tuna with 2.6 %. CONCLUSION: The frequency of skin reactivity to food allergens was similar to that reported in the national and Latin American literature, but sensitization to each specific allergen varied for each age group.

Antecedentes: Se considera que la alergia alimentaria tiene una prevalencia mundial de 2 a 10 %. Objetivo: Determinar la frecuencia de reactividad cutánea hacia alérgenos alimentarios por grupos de edad. Métodos: Estudio observacional, descriptivo, transversal y prolectivo. Se incluyeron pacientes de 2 a 64 años de edad con cuadro compatible de enfermedad alérgica. Se efectuaron pruebas por punción cutánea con alérgenos alimentarios. Se estimaron frecuencias y porcentajes. Resultados: Se incluyeron 191 pacientes, 63.4 % fue del sexo femenino. La edad promedio fue 22.5 años; 19.3 % mostró reactividad cutánea positiva al menos a un alimento. La distribución por grupo etario fue la siguiente: preescolares 13.5 %, escolares 24.3 %, adolescentes 2.7 % y adultos 59.5 %. Los diagnósticos fueron rinitis alérgica 84.3 %, asma 19.4 %, urticaria 14.1 % y dermatitis atópica 8.4 %. La distribución de la frecuencia de reactividad cutánea positiva en orden descendente fue 5.2 % a soya, 4.7 % a durazno, 3.6 % a uva, naranja y manzana, 3.1 % a nuez y 2.6 % a piña, aguacate, tomate y atún. Conclusión: La frecuencia de reactividad cutánea para alérgenos alimentarios fue similar a la informada en la literatura nacional y latinoamericana, pero la sensibilización para cada alérgeno específico varió en cada grupo etario.

[Skin reactivity frequency to aeroallergens in patients with clinical symptoms of allergic disease]. / Frecuencia de reactividad cutánea hacia antígenos inhalables en pacientes con cuadro clínico de enfermedad alérgica.

BACKGROUND: Allergic diseases diagnosis must be based on adequate allergological anamnesis and an immunological sensitization test; the most sensitive and specific is the skin prick test. OBJECTIVE: To determine the frequency of skin reactivity to aeroallergens, by age groups, in patients of the Department of Allergy and Clinical Immunology of the Hospital Universitario de Puebla, in Mexico. METHODS: A cross-sectional study was conducted that included patients aged 2 to 64 years with symptoms suggestive of allergic disease, in which skin prick tests with aeroallergens were performed; the diagnostic criteria were those of international guidelines. Frequencies, percentages and dispersion measures were calculated. RESULTS: Of 173 patients, 63 % were females. Mean age was 22.3 years. The frequency of skin reactivity for Quercus sp. was 12.72 %, for Periplaneta americana, 9.83 %, for Dermatophagoides farinae, 9.25 %, for Cynodon dactylon, 8.09 %, for Blatella germanica, 8.09 %, for Holcus halepensis, 6.94 %, for Dermatophagoides pteronyssinus, 6.36 %, for Schinus molle, 5.78 %, for Fraxinus uhdei, 5.20 %, for Lolium perenne, 5.20 %, for Ambrosia eliator, 5.20 % and for Artemisa tridentata, 4.62 %. CONCLUSION: Although Dermatophagoides are the most frequently reported aeroallergens, the most common aeroallergen in this study was pollen, probably owing to geographical and environmental factors, although this was not observed in the analysis by age groups.

Antecedentes: El diagnóstico de las enfermedades alérgicas debe basarse en la historia clínica alergológica adecuada y en una prueba inmunológica de sensibilización; la de mayor sensibilidad y especificidad es la prueba cutánea por punción. Objetivo: Determinar la frecuencia de la reactividad cutánea hacia aeroalérgenos, por grupos etarios, en pacientes del Servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla, México. Métodos: Se realizó estudio transversal que incluyó a pacientes de 2 a 64 años de edad, con síntomas sugestivos de enfermedad alérgica, en quienes se realizaron pruebas cutáneas con aeroalérgenos; los criterios diagnósticos fueron los de las guías internacionales. Se calcularon frecuencias, porcentajes y medidas de dispersión. Resultados: De 173 pacientes, 63 % fue del sexo femenino. La edad media fue de 22.3 años. La frecuencia de la reactividad cutánea para Quercus sp. fue 12.72 %, Periplaneta americana 9.83 %, Dermatophagoides farinae 9.25 %, Cynodon dactylon 8.09 %, Blatella germanica 8.09 %, Holcus halepensis 6.94 %, Dermatophagoides pteronyssinus 6.36 %, Schinus molle 5.78 %, Fraxinus uhdei 5.20 %, Lolium perenne 5.20 %, Ambrosia eliator 5.20 % y Artemisa tridentata 4.62 %. Conclusión: Los Dermatophagoides son los aeroalérgenos más identificados, pero en el presente estudio fue más común un polen, probablemente debido a factores geográficos-medioambientales, aunque no fue así en el análisis por grupos etarios.

[Correlation between the magnitude of skin prick test reactivity and pollen-specific serum IgE levels in patients with respiratory allergy]. / Correlación entre la magnitud de la reactividad cutánea por punción y las concentraciones de IgE sérica específica a pólenes en pacientes con alergia respiratoria.

BACKGROUND: For the etiological diagnosis of allergic respiratory diseases skin tests or specific serum IgE determination are used. OBJECTIVE: To determine the correlation between the extent of reactivity to cutaneous prick tests and the levels of pollen specific serum IgE in patients with respiratory allergy. PATIENTS AND METHODS: A prolective, descriptive and transversal study was done with patients of both genders, aged 2 to 60 years, who attended for the first time at the service of Allergy and Clinical Immunology of University Hospital of Puebla, Mexico, with presumptive diagnosis of respiratory allergy. All patients underwent clinical history, skin prick tests with standardized allergenic extracts and quantification of pollen specific serum IgE by chemiluminescence method. We estimated the correlation index r using the statistical method Pearson product-moment correlation coefficient; a value r equal to or higher than 0.70 was considered a significant relationship or a high correlation. RESULTS: Nine-one patients were included, of whom 58.2% were female. The diagnoses were: allergic rhinitis (79.1%), asthma and allergic rhinitis (16.5%) and only asthma (4.4%). Only significant correlation was found in patients with allergic rhinitis for Rumex crispus (r = 0.702) and in patients with asthma and rhinitis for Ambrosia trifida (r = 1). CONCLUSION: Only for Rumex crispus and Ambrosia trifida, the skin prick tests or the determination of specific serum IgE levels are comparable diagnostic methods of allergic respiratory diseases.

ANTECEDENTES: para el diagnóstico etiológico de las enfermedades alérgicas respiratorias se realizan pruebas cutáneas o determinación de IgE sérica específica. OBJETIVO: determinar la correlación entre la magnitud de la reactividad a las pruebas cutáneas por punción y las concentraciones de IgE séricaespecífica para pólenes en pacientes con alergia respiratoria. PACIENTES Y MÉTODOS: estudio prolectivo, descriptivo y transversal efectuado en pacientes de uno y otro sexo, con edades de 2 a 60 años, que acudieron por primera vez al servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla con diagnóstico presuntivo de alergia respiratoria. A todos los pacientes se les realizó historia clínica, pruebas cutáneas por punción con extractos alergénicos estandarizados y cuantificación de IgE sérica específica para pólenes por método de quimioluminiscencia. Se estimó el índice de correlación r con el método estadístico coeficiente de correlación producto-momento de Pearson, un valor de r igual o mayor de 0.70 se consideró una relación notable o una correlación elevada. RESULTADOS: se incluyeron 91 pacientes, 58.2% eran mujeres. Los diagnósticos fueron: rinitis alérgica (79.1%), asma y rinitis (16.5%) y únicamente asma (4.4%). Sólo se encontró una correlación significativa en pacientes con rinitis alérgica para Rumex crispus (r = 0.702) y en pacientes con asma y rinitis para Ambrosia trifida (r = 1). CONCLUSIÓN: sólo para Rumex crispus y Ambrosia trifida, las pruebas epicutáneas o la determinación de las concentraciones de IgE sérica específica son métodos equiparables en el diagnóstico etiológico de la alérgica respiratoria.

[Prevalence of Cutaneous Reactivity to an Allergenic Extract of Mus musculus in Patients with Allergic Rhinitis and Asthma]. / Prevalencia de reactividad cutánea a un extracto alergénico de Mus musculus en pacientes con rinitis alérgica y asma.

BACKGROUND: A high prevalence of sensitization to antigen Mus musculus (mouse) in patients with allergic respiratory diseases has been reported worldwide. OBJETIVE: To determine the prevalence of skin reactivity to the Mus musculus antigen in patients with asthma and allergic rhinitis in the Department of Allergy and Clinical Immunology, Hospital Universitario de Puebla. METHODS: We conducted a cross-sectional, observational, prospective and descriptive study in patients of both genders, from 2 to 58 years old. All patients were attending the hospital for the first time, in a period of 6 months with the diagnoses of asthma, allergic rhinitis, or both. Each patient underwent skin prick test with epithelial antigen Mus musculus. Data were analyzed with SPSS-Statistics software, version 18. RESULTS: We included 110 patients, 50% were women, mean age was 24.1 years (SD 16.2); 92.7% were from urban areas and the rest from rural areas. The overall prevalence of skin reactivity to the antigen tested was 1.8%; corresponding to patients with allergic rhinitis 2.4% and the remaining subgroups showed no reactivity. One of the three patients with positive skin tests worked in an animal laboratory, exposed to Mus musculus. CONCLUSIONS: We found a low prevalence of positive skin tests with mouse antigen. However, in patients with respiratory allergy symptoms and a strong exposure to mice or rodents we suggest to perform skin tests with mice allergen extracts.

[Correlation of cutaneous reactivity between allergenic extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae with Blomis tropicalis in patients with allergic rinitis and asthma]. / Correlación de reactividad cutánea entre extractos alergénicos de Dermatophagoides pteronyssinus y Dermatophagoides farinae, con Blomia tropicalis en pacientes con rinitis alérgica y asma.

BACKGROUND: There are documented molecular homologies between mites from the same group, but intergroup characteristics are not. Although mites share the same taxonomic order, there are species antigenically distinct. At the present we dont know clearly the differences in cutaneous reactivity among several house dust mites species. OBJETIVE: to estimate the correlation of skin reactivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae antigens with that of Blomia tropicalis in patients with allergic rhinitis and asthma. METHODS: a cross sectional, observational, prolective and interpretive study was performed in patients of both genders, aged 2 to 58 with allergic rhinitis and asthma. All patients underwent skin prick tests with allergenic extracts. RESULTS: One hundred and ten patients were included, with an age average of 24.1 years; 50% were males. There were positive skin tests with mites in 59% of the patients, 24.5% for Blomia t; 10% for D. pteronyssinus plus Blomia t. and 7.29% for D. farinae plus Blomia t. The correlation of the skin reactivity between Dermatophagoides pteronyssinus and Blomia tropicalis (r= 0.36) and between Dermatophagoides farinae and Blomia tropicalis (r= 0.27), was not significant in both cases. CONCLUSIONS: We found that most patients with allergic rhinitis and asthma showed positive skin tests with the mite extracts tested. There is a weak correlation between both species of Dermatophagoides and Blomia tropicalis.

[Impact of the integral allergological treatment on quality of life of patients with allergic rhinitis at the University Hospital of Puebla]. / Impacto del tratamiento alergológico integral en la calidad de vida de los pacientes con rinitis alérgica del Hospital Universitario de Puebla.

BACKGROUND: In order to determine the impact of allergic rhinitis on the quality of life of the patients, standardized and validated questionnaires have been developed. The quality of life is the perception of the patient of the functional effects of his illness and its therapeutics consequences. OBJECTIVE: To determine the modification of index the quality of life on the patients with allergic rhinitis attended at the external consultation of the service of allergy and clinical immunology of the Hospital Universitario de Puebla when they were submitted to integral allergologic treatment. PATIENTS AND METHODS: It was carried out a longitudinal, prospective, experimental and prolective study in patients of both sexes, older than 18 years with diagnosis of allergic rhinitis, a validated and standardized questionnaire was applied to assess the quality of life index every 14 days during 6 months. It was measured severity degree at the beginning and the end of the study. It was assessed the sample size considering a reasonable size of the effect 1 and a variability of 0.8 for usual techniques. The severity degree was compared with RIDIT analysis and the mean with variance, a value of p smaller than 0.05 was considered significant. RESULTS: Sixteen patients were included, 75% were women. The average age was 34.2 years old. When the severity degrees were compared it was an average RIDIT of 0.014 with a "z" of -5.0 that implicated a value of p < 0.001. The comparison among the initial quality of life and the subsequently visits mean was significantly different since third visit. CONCLUSION: The integral allergologic treatment modifies the quality of life and the severity degree in the patients with allergic rhinitis.

[Prevalence of seropositividad to antibodies IgG and IgM against Helicobacter pylori in the medical residents of the University Hospital of Puebla]. / Prevalencia de seropositividad a anticuerpos IgG e IgM contra Helicobacter pylori en el personal médico residente del Hospital Universitario de Puebla.

BACKGROUND: Helicobacter pylori is a gram-negative, curved, microaerophilic, oxidase, catalase and urease positive bacillus. It lives in the gastric mucosa, and is the main etiological agent of peptic ulcer, and of atrophic and multifocal gastritis. It is associated with extraintestinal, vascular, autoimmune and cutaneous diseases. The infection by this bacteria causes a chronic inflammatory process related with the sensibilization of mast cells, which increases the incidence of allergic diseases. OBJECTIVE: To estimate the seropositivity prevalence of IgG and IgM antibodies against Helicobacter pylori in medical resident personnel. PATIENTS AND METHOD: A transversal, descriptive and observational study was carried out in medical residents of the Hospital Universitario de Puebla. Serum levels of IgG and IgM antibodies against Helicobacter pylori were determined by chemiluminescence. Data were analyzed applying descriptive statistics, such as: frequency, central tendency and dispersion measures. RESULTS: 57 residents were included, 54.4% were men. The mean age was 28.4 (SD 2.9). Seropositivity prevalence of IgG and IgM antibodies was 24.6 and 33.3%, respectively. Combined seropositivity prevalence of IgG and IgM was of 43.9%. CONCLUSION: Seropositivity prevalence of IgG and IgM antibodies against Helicobacter pylori in the medical resident personnel of the Hospital Universitario de Puebla was similar to the reported in the general population. This estimation might be considered a reference to other epidemiological and clinical studies such as those pretending to evaluate and demonstrate the relationship between infection by Helicobacter pylori and other entities, even allergies.

[Frequency of Helicobacter pylori infection in patients with chronic urticaria of Puebla University Hospital]. / Frecuencia de infección por Helicobacter pylori en pacientes con urticaria crónica del Hospital Universitario de Puebla.

BACKGROUND: Chronic urticaria may be continuous or recurrent according to its form of appearance. Within the diseases associated to chronic urticaria there are mycosis, parasitism and bacterial infections where Helicobacter pylori stands out. This has been related to the allergic diseases promoting a Th2 response. OBJECTIVE: To determine the frequency of infection caused by Helicobacter pylori in patients with chronic urticaria of the allergic and clinical immunology service of the Puebla University Hospital. PATIENTS AND METHODS: A descriptive, cross-sectional, prolective and observational study was made in adult patients, between 18 and 60 years old, with diagnosis of chronic urticaria. Inhalated and food skin prick test were made to all the patients. The infection by Helicobacter pylori was documented by serology, fecal antigen, endoscopy with fast test of urease and histological study. Descriptive statistics was implemented such as frequency, percentage, central tendency and dispersion measures. RESULTS: 30 patients were included; 83.3% were women. The average age was 37.8 years (SD 13.2). The most frequent type of chronic urticaria was the persistent one, representing 56.7%. The frequency of positivism of IgG antibodies against Helicobacter pylori represented the 60.0%, for IgM 33.3% and for fecal antigen 60.0%, the combined IgG, IgM, fecal antigen, fast test of ureasa and histological study was of 83%. CONCLUSION: The high frequency of infection caused by Helicobacter pylori in the patient with chronic urticaria suggests a possible role in its etiopathogeny, extending the therapeutic possibilities.

[Impact of integrated asthma treatment on the patients' quality of life]. / Impacto del tratamiento integral del asma sobre la calidad de vida de los pacientes.

BACKGROUND: Patient's perception about the effect of disease's manifestations on daily activities is called health-related quality of life, and it is used to evaluate the individual response to treatment. At present, there are some questionnaires designed to evaluate it. OBJECTIVE: To evaluate the effect of integral treatment dosage on quality of life in asthmatic adults. MATERIAL AND METHODS: A prospective, longitudinal and experimental study was made. We included male and female adult patients, with allergic asthma. A standardized questionnaire of quality of life was applied to all of them in every visit, for eight times. The integral treatment was based on Global Initiative for Asthma judgments. RESULTS: Ten patients were included, 70% of them were women. The media age was 37.4 +/- 15.73 years old. The asthma was diagnosed as intermittent in 10% cases, mild persistent in 20%, moderate persistent in 20% and severe persistent in 50% patients. The group of age most frequently affected was that of 20 to 30 years old. The media index of quality of life was 2.43 +/- 0.91 at the first visit and it was 5.73 +/- 1.11 at eighth visit. It was found a significant difference. CONCLUSION: Integral treatment improves quality of life in asthmatic adults.

[Impact of integral allergic treatment in the quality life of patients with allergic rhinitis]. / Impacto del tratamiento alergológico integral en la calidad de vida de pacientes con rinitis alérgica.

BACKGROUND: The quality of life is the perception of a patient about functional effects of his illness and therapy. Recently, appropriate instruments were devised to evaluate the health related with the quality of life, as the standardized and validated questionnaires for rhino-conjunctivitis. OBJECTIVE: To determine the impact of integral allergological treatment upon the quality of life of patients with allergic rhinitis that were attended as outpatients at the Service of Allergy and Clinical Immunology of Hospital Universitario de Puebla. MATERIAL AND METHODS: It was carried out a longitudinal, prospective, experimental and prolective study in patients of both sexes, older than 18 years old, with diagnosis of allergic rhinitis; life quality was evaluated by means of the application of a validated and standardized questionnaire every 15 days during 4 months. After being included in the study, patients received the integral allergological treatment conformed by educational measures, environmental control, pharmacotherapy and specific immunotherapy. We determined frequency for qualitative variables and average for quantitative variables. The averages were compared by means of variance analysis. The significance value was established down in 0.05. RESULTS: Thirteen patients were included, 61.5% of them were male. The average age was 33.2 (SD 17.0). There was a significative difference in quality of life index when patient was included in comparison with the indexes in subsequent visits. The most frequent allergic rhinitis was the moderate-severe persistent type, with a 76.9% rate. CONCLUSION: Integral allergological treatment improves quality of life of patients with allergic rhinitis.

Correlación entre Blatella germanica y periplaneta americana en pacientes alérgicos / Correlation between Blatella germanica and Periplaneta americana in allergic patients

Antecedentes: se han identificado alergenos compartidos entre los cuerpos enteros de Blatella germanica y Periplaneta americana de los que se reporta la existencia de una correlación significativa entre la reactividad cutánea para ambas especies. Objetivo: estimar la correlación entre las pruebas cutáneas para las dos principales especies de cucarachas intradomiciliarias. Material y métodos: se incluyeron pacientes con sospecha clínica de enfermedad alérgica que acudieron a la consulta externa del servicio de alergia e inmunología clínica del Hospital Universitario de Puebla en un periodo de seis meses, en donde se les efectuaron pruebas cutáneas mediante la técnica de prick con extractos alergénicos estandarizados de Blatella germanica y Periplaneta americana. Resultados: se estudiaron 120 pacientes con edad promedio de 15.7 años, 54.2 por ciento mujeres y 45.8 por ciento hombres. El coeficiente de correlación entre cucaracha alemana y cucaracha americana fue de 0.49 y 0.40 para eritema y pápula, respectivamente. Conclusión: los resultados indican una correlación moderada o una relación considerable entre ambas cucarachas, tanto para pápula como para eritema. Con base en los resultados presentados se sugiere evaluar ambos antígenos con el objeto de mejorar la certeza diagnóstica.

Incidencia de reacciones adversas a la inmunoterapia en pacientes alérgicos del Hospital Universitario de Puebla / Adverse effects incidence associated with immunotherapy in patients allergic of Hospital Universitario de Puebla, Mexico

Antecedentes: la inmunoterapia específica ha evolucionado recientemente y se postula que las dosis altas son más efectivas, pero conllevan un incremento en las reacciones locales y sistémicas indeseables, que en su grado máximo producen anafilaxia. Material y método: estudio longitudinal, prospectivo y descriptivo en pacientes de la consulta externa del servicio de alergia e inmunología clínica del hospital Universitario de puebla efectuado en un periodo de 10 meses. Se determinó la edad, el sexo, el diagnóstico, el tipo de reacción adversa y el tiempo de presentación de la misma. La dosis inicial de inmunoterapia fue de 0.05 ml con antígenos de tratamiento (Laboratorios Aphi) a una dilución de 1:100 peso/volumen sin premedicaión a la misma. Se incluyeron 170 pacientes con edad promedio de 22.6 años (De 15.4), 56.5 por ciento del sexo femenino y 43.5 por ciento del masculino. Resultados: los padecimientos más frecuentes fueron asma y rinitis. La incidencia de reaciones adversas a la inmunoterapia específica fue de 2.4 por ciento, todas ellas de tipo inmediato y local. Conclusión: estos resultados están influidos por la concentración y dosis de los antígenos utilizados y pueden definir de otros estudios

Correlación entre la prueba cutánea de prick e intradérmica para detectar sensibilización al dermatofagoide / Correlation between the prick and intradermal cutaneous test to determinate the sensibilization to dermatophagoide

Material y método: se efectuó un estudio transversal, observacional y descriptivo con el propósito de conocer la correlación entre la prueba cutánea de prick y la intradérmica para determinar la sensibilización al dermatofagoide. Se incluyeron pacientes que acudieron a la consulta externa del servicio de alergia e inmunología clínica del Hospital Universitario de Puebla en un periodo de tres meses con edades de 6 a 54 años, de uno y otro sexo y enfermedad alérgica. Se efectuaron pruebas cutñáneas mediante las técnicas de prick e intradérmica con extracto alergénico de Dermatofagoide, control positivo y negativo. Resultados: se estudiaron 104 pacientes, con edad promedio de 23 años (DE 14). El coeficiente de correlación para pápula fue de 0.78 y para eritema de 0.80. Conclusión: la prueba de prick debe ser la técnica de primera elección y la intradérmica sólo en casos negativos con sospecha clínica