Immediate and nonimmediate reactions induced by contrast media: incidence, severity and risk factors.

BACKGROUND: The pattern of the contrast media-induced adverse reactions has not been investigated extensively in Mexico. OBJECTIVE: To estimate the incidence and the degree of severity of the adverse reactions to contrast media, administered for the first time, in hospitalized subjects. METHODS: We studied 99 patients longitudinally on whom computed tomography with contrast media (iopamidol) was carried out. The adverse reactions were identified by clinical examination; subsequently, they were classified as mild, moderate and severe, following the Manual on Contrast Media version 9 guides, and as immediate and nonimmediate. In addition, the vital functions, oxygen saturation, serum creatinine levels and the total number of eosinophils were measured before and after the procedure. RESULTS: The incidence of immediate and nonimmediate adverse reactions was of 26.3% and 10.1%, respectively. The mild immediate reactions were 18 (69.2%), the most common being the sensation of warmth, nausea and pruritus; among the more delayed reactions, nephrotoxicity stood out (5.1%). The serum creatinine median showed no difference either before or after the intravenous injection of contrast media (p = 0.13); in contrast, there was a significant difference in the total number of eosinophils (p ≤ 0.001). The values of high baseline systolic blood pressure and the diminished baseline amounts in pulse oximetry were significantly related with any type of the adverse reactions to contrast media. CONCLUSION: The incidence of the adverse reactions to contrast media was greater with respect to previous reports; the majority of these reactions were of the immediate type and of a mild nature. The risk factors that have mostly been implicated in the adverse reactions to contrast media could not be identified in our cohort.

[Prevalence of Sensitization to the Most Common allergens in Elderly Patients from the Western of Mexico]. / Prevalencias de sensibilizaciÛn a alÈrgenos m·s comunes en adultos mayores del occidente de México.

BACKGROUND: Allergic diseases affect a great proportion of seniors. OBJECTIVE: To determine the prevalence of allergen sensitization in this age group in the western of Mexico. METHODS: A retrolective study related to skin prick tests with a common allergen panel was performed on the first consultation in elderly patients during a period of three years in Guadalajara, Mexico. RESULTS: We included 60 subjects, with an average of 67.7 years old; 83.3% were women. Diagnosis of allergic rhinitis was present in 60%, allergic rhinitis plus asthma in 30%, and asthma alone in 10%. Non atopic comorbidities were present in 56.7% of the cases. Median serum IgE was 124.95 UI/ml, the average of positive skin prick tests was 4 (1 to 21); 13.3% were sensitized to just 1 aeroallergen, and 55% were to more than three aeroallergens. Sensitization to pollens was predominant, even more to tree pollens. One by one, house dust mite, Fraxinus sp and Amaranthus palmeri were the most commonly found. Diabetes was associated to a lower positive prick test (p = 0.021). CONCLUSIONS: The most common sensitizing allergens are similar for other age groups from the same area. Elderly patients with diabetes had lower positive allergen skin tests. Itís recommended to identify the allergen sensitization in seniors with allergic disease symptoms, as part of their clinical evaluation.

[Allergen sensitization in Mexican adults with asthma: Experience at a teaching hospital]. / Sensibilización a alergenos en adultos mexicanos con asma; la experiencia en un hospital escuela.

INTRODUCTION: Cutaneous test practice to identify atopy is recommended in persons who suffer persistent asthma. OBJECTIVE: To estimate the prevalence of allergen sensitization in a group of adult asthma patients; plus, to investigate about the differences that exist between atopic and non-atopic asthmatic persons. METHODS: Consecutive asthmatic outpatients were evaluated for the first time in an Allergology Service. They were analyzed through clinical history, physical examination, and allergic cutaneous reactivity to any of 38- allergen panel. IgE serum levels were quantified too. RESULTS: One hundred eighty one asthmatic patients were included. Mean age was 40 years; 75.1% were women; in 59.9%, asthma was accompanied by allergic rhinitis; 81.2% fulfilled the atopy criteria. On average, each patient had 7.2 positive skin tests, corresponding to house-dust mite the highest frequency, followed by cockroach. Subjects age correlated negatively with the amount of positive cutaneous test and IgE serum levels, and positively with severity of asthma. IgE serum level higher than 100UI/ml was identified as a predictive factor for atopic asthma (OR = 3.1, p = 0.03). CONCLUSIONS: A substancial amount of asthmatic patients were atopic. The most highly sensitizing allergens were house-dust mite and cockroach. Differences between atopic and non-atopic asthmatics depended on their age and IgE serum levels.

[Spontaneus pneumomediastinum associated with exacerbation of asthma during the epidemic of influenza A H1N1: Inform of four cases]. / Neumomediastino espontáneo asociado a exacerbación del asma durante la epidemia de influenza A H1N1; informe de cuatro casos.

Spontaneus pneumomediastinum (SP) is an infrequent but usually benign pathology. Its main clinical manifestations are thoracic pain, dyspnea and subcutaneous emphysema. We describe the clinical findings of 4 SP patients, identified in the context of an A H1N1 influenza virus epidemic. All the patients were young and all of them required initial medical attention for asthma exacerbation. The most frequent symptoms and signs to detect SP were cervical pain and subcutaneous emphysema; chest radiography helped to confirm the diagnosis. Concomitant A H1N1 influenza virus infection was documented in two patients. The treatment was focused in the basic pathology; two patients were placed on oseltamivir, whereas the two others just had expectant management.

[Sensitization to aeroallergens in subjects with allergic rhinitis who live in the metropolitan zone of Guadalajara, Jalisco]. / Sensibilización a aeroalergenos en sujetos con rinitis alérgica que viven en la zona metropolitana de guadalajara, México.

BACKGROUND: allergic rhinitis is the most common allergic disease worldwide. Aeroallergens are compromise in its presentation and its prevalence varies in different parts of the world. Aeroallergen sensitization in the Guadalajara metropolitan area is not yet documented. OBJECTIVE: to determine by means of skin prick test the sensitization prevalence to aeroallergens in patients with allergic rhinitis. PATIENTS AND METHODS: We retrospective evaluated the results of skin prick test to different aeroallergens and their prevalence by age group in patients with allergic rhinitis referred to our allergy department. RESULTS: the complete data of 965 subjects were available, 78% of these had positive skin prick tests, the age range of the patients was 16 to 78 years, 74.9% of which were women; 9% were sensitized to one allergen and 11.5% had more than 15 positive skin prick test. The most frequent interior allergens were house dust mites and outdoor allergens Quercus sp and Fraxinus sp. Males showed the highest reaction frequency to aeroallergens. The age range from 21 to 40 years presented the highest frequency of positive skin prick test. CONCLUSION: our data demonstrate that house dust mites followed by tree pollens are the most frequent aeroallergens in patient with allergic rhinitis. Positive skin prick test frequency was age associated.