[Allergic hypersensitivity to antiretroviral drugs: etravirine, raltegravir and darunavir]. / Hipersensibilidad alérgica a antirretrovirales: etravirina, raltegravir y darunavir.

All antiretroviral drugs can have both short-term and long-term adverse events. The risk of specific side effects varies from drug to drug, from drug class to drug class, and from patient to patient. A better understanding of the adverse effects of antiretroviral agents is of interest not only for HIV specialists, but also for other physicians who care allergy reactions in HIV-positive patients. Each antiretroviral medication is associated with its own specific adverse effects or may cause problems only in particular circumstances. In this article some adverse allergic effects of HAART therapy in the treatment of HIV from a patient are reviewed. Our aim is to gain a working knowledge of these adverse effects, promoting the early recognition and reversal of potentially serious adverse effects, and reducing the potential for adverse drug interactions.

Todos los fármacos antirretrovirales tienen efectos adversos que pueden manifestarse a corto o largo plazo. El riesgo de efectos secundarios específicos varía de un fármaco a otro, de una clase de medicamento a otra y de un paciente a otro. Una mejor comprensión de estos efectos es de interés no sólo para los especialistas en VIH, sino también para otros médicos que atendemos las reacciones alérgicas en los pacientes VIH-positivos. Cada fármaco antirretroviral se asocia con sus propios efectos adversos específicos o puede causar problemas sólo en circunstancias particulares. En este artículo se revisan algunos efectos alérgicos adversos del tratamiento antirretroviral de gran actividad (TARGA) en el tratamiento del VIH de un paciente. Nuestro objetivo es obtener un conocimiento práctico de estos efectos adversos, promoviendo el reconocimiento temprano y la reversión de los efectos adversos graves y reducir las interacciones farmacológicas adversas.

[Cutaneous necrotic loxoscelism. A case report]. / Loxoscelismo cutáneo necrótico. Informe de un caso.

Brown recluse (Loxosceles spp.) spiders are arachnid species known to cause necrotic arachnidism. The envenomation, described as loxoscelism, is associated with localized pain, erythema, and edema followed by the development of necrosis. However, the specific pathophysiological mechanisms by which Loxosceles venom exerts these noxious symptoms are multifactorial and not fully understood. The causative factor for production of necrotic lesions is generally considered to be the enzyme sphingomyelinase D (SMD), which cleaves sphingomyelin to form choline and ceramide 1-phosphate. Four active forms of SMD with molecular weight of 32 000 are found in L recluse. Sphingomyelinases of comparable size are also described in the venoms of Loxosceles intermedia, gaucho and laeta. Here we describe the case of a young male adult who suffered a spider bite on his left forearm which evolved into a necrotic lesion, and after a few days the injury healed completely. One week later the patient developed two similar lesions on his left leg. The diagnosis was established by clinical data and by biopsy findings. The patient did not developed systemic complications.

[Hypersensitivity to metals in patients with orthopedic implants]. / Hipersensibilidad a metales en pacientes con implantes ortopédicos.

All metals in contact with biological systems suffer corrosion, which is an electrochemical process that causes metallic ions formation, known as haptens, which link with endogenous or exogenous proteins, therefore inducing an immune response. A hypersensitivity response to an implanted material should be suspected when cutaneous lesions or inflammatory reactions occur proximal to or surrounding the site of the metallic orthopedic implant. At present there is no a reliable diagnostic test for the determination of hypersensitivity to implanted metallic devices. It has been shown that the products of corrosive degradation are associated with dermatitis, urticaria and vasculitis. Cutaneous lesions in patients with unsuccessful metallic implants are more frequent than in non-rejected implants or the general population. Although the cellular and humoral hypersensitivity response in metallic orthopedic implants has been clearly identified, the risk is very low. Nowadays the importance of hypersensitivity to metals as a contributing factor in the failure of implants is unknown.

[Immunology and BCG therapeutics]. / Inmunología y terapéutica de la vacuna BCG.

The importance in the study of bacillus of Calmette-Guérin or BCG is related to several functions derived from its influence on the immunological system, between which it is found the prevention of the dissemination of the tubercular bacillus, its utilization as immunomodulator in some oncologic illness (as vesical cancer) in order to avoid post-surgical recidiva or in some forms of immunotherapy, as the cytokine (interferon alpha and interleukin-2); in addition, BCG vaccine is supplied like an immunomodulator in treatment of melanoma. It is important to continue with the study of the BCG strains for its great utility in the treatment of various diseases, example of the previous is the Tice strain, which is used in the superficial cancer of bladder and in the production of new and more powerful vaccines for the protection of tuberculosis.

[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.