[Adverse reactions to vaccines]. / Reacciones adversas a vacunas.

Vaccination is one of the medicine's achievements to control and/or eradicate certain infectious diseases. Vaccines contain antigenic doses derived from microorganisms and/or its toxins, besides they are composed of other substances such as aluminum, gelatin, egg proteins, mercury components (as thimerosal), and antibiotics; therefore, these substances can produce hypersensitivity reactions. The above-mentioned reactions can be evidenced with itch, edema, hives, asthmatic crisis, hypotension and even anaphylactic shock. Due to the importance of vaccination, especially in childhood, it is essential to know the benefits of vaccines, their impact in morbidity and mortality decrease of certain infected-contagious diseases, as well as the adverse effects and the allergic reactions to their application. As immunizations prevent natural infections, they might contribute to a free infectious environment that would allow atopic response. This paper reviews the allergic reactions to vaccines and their influence on the development of atopic disease.

A comparative study of bronchodilator reversibility with albuterol, between asthma symptomatic and asymptomatic children according to ISAAC questionnaire in Mexico City.

BACKGROUND: Asthma is an important childhood disease. Recent surveys of the International Study of Asthma and Allergies in Childhood (ISAAC) suggest that the prevalence of asthma is increasing but these surveys do not include any pulmonary tests to confirm the possible diagnosis of asthma. OBJECTIVE: To compare bronchodilator reversibility with the albuterol test in symptomatic and asymptomatic 6-7-year-old children with asthma participating in the ISAAC survey and living in Mexico City. PATIENTS AND METHODS: We performed an observational, descriptive, comparative, cross sectional study in children participating in phase 3b of the ISAAC study. According to the ISAAC questionnaire children were classified as asthma symptomatic or asymptomatic. Both groups had bronchodilator reversibility with the albuterol test, using the guidelines of the American Thoracic Society to confirm or rule out the diagnosis of asthma. RESULTS: The asymptomatic group had a baseline FEV1 of 1.70 +/- 0.34 l/sec (mean +/- SD) and an endpoint FEV1 of 1.76 +/- 0.42 l/sec; in the symptomatic group the respective values were 1.51 +/- 0.41 l/sec and 1.57 +/- 0.44 l/sec (p < 0.05). A positive reversibility test was found in 13/136 (9.6 %) children in the asymptomatic group and in 22/112 (19.6 %) children in the symptomatic group (p < 0.05). CONCLUSION: Because of its low sensitivity, bronchodilator reversibility cannot be considered a diagnostic tool to confirm diagnosis of asthma.

[Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus]. / Desensibilización a insulina DNA recombinante humana en una adolescente con diabetes mellitus insulinodependiente.

BACKGROUND: Adverse reactions to drugs have increased in the last years, about 15% of all side effects are thought to be immune mediated according to the Coombs and Gell classification they can be type I (immediate) hypersensitivity, type II (cytotoxic) type III (immune complex mediated) or type IV (delay). Allergy to insulin is defined as an immunological response type I, and type II or III to exogenous insulin solutions occurring the 0.1% and 0.2% of the patients. PATIENTS: A 13 year old female with a 4-year history of insulin-dependent diabetes mellitus who presented hypersensitivity against recombinant DNA (rDNA) insulin manifested with urticaria and itching. We used a premedication therapy without good response and impossibility to use alternative therapy for her metabolic control, so she needed desensitization with insulin. METHODS: Skin prick testing with rapid insulin preparations 1:10 W/V dilution were positive. IgE antibodies to insulin weren't presented. IgE serum values were normal. We began the desensitization with a rapid 1:1000 UI insulin solution by intradermal route, than by subcutaneous route until reaching the accumulated doses necessary per day. During the process it appeared a papular rash and itching which were treated with an intravenous antihistaminic without troubles. RESULTS: The patient tolerated the desensitization procedure very well. For the past 14 months she has been treated uneventfully by subcutaneous administration of rDNA insulin. DISCUSSION: The desensitization against drugs is not a frequently process it only has to be used when it is impossible to substitute the treatment. Our patient showed probably hypersensitivity type 1 to insulin. However, we have to take into account the cytotoxic reaction caused by IgG or IgM antibodies or by immune complex. The desensitization finally was tolerated, 14 months after our patient accepts correctly her daily dose of human recombinant insulin.

[Procedure for bronchodynamic tests with inhaled allergens]. / Procedimiento para realizar pruebas broncodinámicas con alergenos inhalados.

The asthma is one of the most frequent chronic illnesses in the children. It is characterized by hyperreactivity from the air roads to inspecific stimuli (metacholin and histamin) and specific (allergens). The broncodynamics tests determines the broncolability asthmatic boy's and they help to settle down the I diagnose functional. They should be carried out with antigenic extracts of high quality, lyophilized watery and standardized; you can use an open or closed circuit and a dosimeter, the initial dose of the allergen it is lower than with the one that the positive cutaneous reactivity was obtained, carrying out successive increments until the VEF-1 descend 15% or more. The patient's security is fundamental, they should be carried out for specialized personnel.

[Effect of heating on FEV-1 in children with asthma challenged with exercise]. / Efecto del calentamiento sobre el VEF-1 en niños con asma sometidos a reto por ejercicio.

AIMS: The exercise-induced bronchoespasm, also called asthma for exercise, it corresponds to a frequent clinical entity that commonly accompanies the asthmatic patient. Their frequency is of around the 80 to 90% for the patients with asthma; it is presented among 40 to 50% of the children with allergic rhinitis, in the athletes 14% and in the population's 12% in general. OBJECTIVE: To determine the effectiveness of a heating routine like preventive agent of the exercise-induced bronchoespasm. METHOD: 30 patients were included of between 10 and 16 years of age, asthmatic and with exercise-induced bronchoespasm by diagnosed by means of challenge test to the exercise. All the patients carried out an exercise routine with duration of 20 minutes during which movements of elasticity, calisthenics and light activity were made directed to the exercise to develop, taking as objective parameter 60% of the frequency heart submax. Did all the patients carry out challenge at once, again to the exercise, in which a band numberless was used, with speeds that were increased progressively from 1 to 8 km/h and with inclination of 0? 10 0. The spirometrics registrations was made before the challenge and at the 2, 5, 10, 15, 20, 25, 30 and 60 minutes after the same one. RESULTS: The average of the patient's age was of 12.8 +/- 2 years with size of 157 +/- 10 cm. CONCLUSION: The heating in children with broncoespasmo induced by exercise acts as a protective agent against the decrement of the VEF-1. Although the heating can be a good control method in the asthmatic patient, it is necessary to keep in mind that not all the patients have a benefit of this protection. This can only be used in patient with programmed physical activity, since in the preschoolers it is not possible to implant a heating routine for the characteristics characteristic of their activity.

[Degree and duration of bronchodilatation with an agonist beta 2 administered alone versus an agonist beta 2 administered with ipratropium bromide in children with acute asthma]. / Grado y duración de la broncodilatación mediante la administración de un agonista beta 2 solo vs un agonista beta 2 más bromuro de ipratropio en niños con asma aguda.

BACKGROUND: The asthma is the chronic illness of the most frequent respiratory tract of the pediatric age. MATERIAL AND METHOD: Prospective study, longitudinal, double blind, at random with 40 patient (split into two groups) with asthmatic crisis with ages of 8 to 15 years. To all was them accomplished tests of effected pulmonary function of basal way and subsequent to the inhalation of the medication. The medication were administered in two inhalations by three steps and with intervals of 10 minutes between each dose. It was considered that the treatment was effective if the improvement of the pulmonary function tests (VEF1) were presenting an increase of the 15% of their initial value. RESULTS: For each one of the tests accomplished in the different times were found meaningful increases in VEF1 (p < 0.05) in both groups compared with the basal and stayed meaningful until eight hours after the administration of both therapeutic plans. CONCLUSION: The bronchodilator effect of the salbutamol alone and in combination with bromide of ipratropio is similar in intensity and in action time demonstrated by the VEF1.

[Air flow measurement in children with mite allergies before and after skin prick test]. / Medición de la flujimetría en niños alérgicos a ácaros antes y después del reto con pruebas por prick.

OBJECTIVE: To determine the obstruction of the air flow by flujimetry subsequent to the application of tests cutaneous specific (Dermatophagoides pteronisinnus) in sensitive children. MATERIAL AND METHODS: They were studied 44 patient of one and other sex with diagnostic of asthma and antecedent of sensibility to the mite Dermatophagoides pteronisinnus through tests cutaneous for prick, with an average age of 6 to 16 years, captured of the external consult of the allergy service of the Hospital Infantil de Mexico Federico Gómez. It is a longitudinal study, prospective, blind, cross, in the one which previously was made a challenge test with antigen standardized of Dermatophagoides pteronisinnus or glycerine, previous reading of flujimetry. RESULTS: Of the patients challenged with antigen in 23 there was decrease of the respiratory maximum flow, with a p < 0.05, but without clinical meaning. When they were challenged with placebo only it reduced in patient seven the respiratory maximum flow, also significative statistically, but without clinic relevancy. CONCLUSION: The cutaneous tests are a useful tool in allergy and sure, since almost they do not produce serious systemic reactions.

[Wheezing in infants]. / Sibilancias en el lactante.

The wheeze are a common symptom in nursing, especially when suffer infections of the respiratory tract. They are common in 75 to 85% of the children, who have wheezes during some stage of their development between 2 to 5 years old. They can be related to smoking motherly during the pregnancy, exposition to the smoke of the tobacco to the subsequent stage to the birth, exposition to environmental and certain factor infections veers them. The wheezes in patient with atopy maybe they are related to a IgE two standard deviations up above of what is normal and persist as asthma in late stages. The wheeze is an affection syndromatic therefore it is obligatory to seek the factor unfetter you to arrive to a definitive diagnosis.