Provocaciones nasales: puesta al día / Nasal provocation: an update

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[Nasal obstruction and its measurement]. / La obstrucción nasal y su medida.

Nasal obstruction is an important symptom of rhinitis. The present article presents the inflammatory mechanisms that lead to the clinical presentation of this symptom: conchal vasodilation, infiltration of mainly eosinophilic cells with activation of these cells and release of intracellular mediators. Given the importance of this symptom and its effects both on function and on quality of life, the various methods used to study it are discussed. Active anterior rhinometry (AAR), measurement of nasal peak inspiratory flow (NPIF), and acoustic rhinometry (AR) are discussed. The underlying principles, based on the trajectory of nasal air flow, techniques, and their advantages and disadvantages are presented. In conclusion, any of these methods can be used to evaluate nasal obstruction.

La obstrucción nasal y su medida / Nasal obstruction and its measurement

La obstrucción nasal es un síntoma importante en las rinitis. En el presente trabajo se exponen los mecanismos inflamatorios que conducen a la presentación clínica de dicho síntoma: dilatación de los vasos de capacitancia de los cornetes, infiltración celular de predominio eosinofílico, con activación de dichas células y liberación de los mediadores intracelulares. Dada la importancia del síntoma, de sus repercusiones tanto a nivel funcional, como en lo referente a la calidad de vida del paciente, se discuten los diferentes métodos para su estudio. Se analizan sucesivamente la rinomanometría anterior activa (AAR), la medición del flujo inspiratorio nasal (NPIF) y la rinometría acústica (AR). Se exponen: a) los fundamentos, basados en el recorrido del flujo aéreo nasal; b) las técnicas, y c) sus ventajas e inconvenientes. Como conclusión, cualquiera de estos métodos puede ser usado en la valoración de la obstrucción nasal (AU)

Nasal obstruction is an important symptom of rhinitis. The present article presents the inflammatory mechanisms that lead to the clinical presentation of this symptom: conchal vasodilation, infiltration of mainly eosinophilic cells with activation of these cells and release of intracellular mediators. Given the importance of this symptom and its effects both on function and on quality of life, the various methods used to study it are discussed. Active anterior rhinometry (AAR), measurement of nasal peak inspiratory flow (NPIF), and acoustic rhinometry (AR) are discussed. The underlying principles, based on the trajectory of nasal air flow, techniques, and their advantages and disadvantages are presented. In conclusion, any of these methods can be used to evaluate nasal obstruction (AU)

Validación de la determinación del flujo inspiratorio nasal / Validation of inspiratory nasal airflow measurement

El estudio de la obstrucción na al es útil tanto para el seguimiento terapéutico como para la provocación nasal con alérgenos, lo estudios de irreversibilidad de la obstrucción nasal y las pruebas de reactividad inespecífica. Antes de usarlo en estas circunstancias se intentó validar un medidor del flujo inspiratorio. Material y métodos: Se estudió a 30 pacientes (15 varones y 15 mujeres, con una edad media de 34,9 años) mediante rinomanometría anterior activa y se determinó la reproducibilidad de esta técnica; en la misma sesión se determinó el flujo inspiratorio máximo y la correlación entre los dos sistemas de medida. Resultados: Se realizaron tres determinaciones del flujo inspiratorio nasal máximo. La prueba de Student mostró la falta de diferencias estadísticamente significativas con un nivel de confianza P del 95%. Los coeficientes de correlación lineal entre los valores obtenidos con el medidor de flujo y el rinomanómetro oscilaron entre 0,40 y 0,53 (p < 0,01) según Ja presión diferencial estudiada. Conclusión: Es posible confiar en el uso de los medidores de flujo inspiratorio forzado nasal tanto para el diagnóstico como para el control terapéutico (AU)

Background: The study and assessment of nasal airflow obstruction is useful not only as a therapeutic follow-up too! but al o inna al allergen challenge tests, in the asessment of the irreversibility of nasal obstruction and in non-specific reactivity tests. Prior to using it in these circumstances, I have tried to validate an inspiratory airflow measurement device. Material and methods: Thirty patients ( 15 male and J 5 females, mean age 34.9 years) were studied with active anterior rhinomanometry and the reproducibility of the technique was a se sed; during the same study session the inspiratory nasal peak flow was measured and the correlation between the results of the two measurement systems was exarruned. Results: Three inspiratory nasal peak flow measurements were performed. The Student t-test disclosed absence of statistically significant difference at a 95% P confidence level. The linear correlation coefficients between the result achieved with the peak flow meter and the rhinomanometer ranged between 0.40 and 0.53 (p

[Risk factors in child asthma]. / Factores de riesgo en el asma infantil.

OBJECTIVE: To evaluate six risk factors in a population of low economic level. MATERIAL AND METHOD: 40 asthmatic children were studied, 21 masculine and 19 feminine, with a 9.3 years old half age +/- 3.22 years. A group control is included (22 children) without asthma and without allergic symptoms. RESULTS: I intragroup study. In the control group the tobacco atmosphere overcame the prospective frequency (p < 0.05), circumstance that didn't happen to the group of patient. Intragroup studies. There were not significant differences among the parameters studied in both groups, except for the frequency of family antecedents. CONCLUSIONS: The genetic factor is decisive for the initial asthma. The genotypic studies has found the chromosomic locus that regulate their expression. The environmental factors, particularly the tobacco pre and postnatal, they are decisive in the early precipitation of the beginning of the asthma.

Inmunoterapia específica en área básica: II. Estudio de su eficacia / Specific immunotherapy in basic area: II. Study of its efficiency

Introducción: la inmunoterapia específica es considerada por algunos especialistas como una técnica controvertida. El estudio se ha diseñado para conocer la eficacia de la IT en la práctica clínica. Material y métodos: veinticinco niños (edad media 10,09+/- 3 años, asmáticos, fueron tratados con IT durante 20 meses (18,96 +/- 3,7 meses) y un grupo control de niños con asma, tratados con corticoide inhalados o con Beta-2 (edad 10,87 +/ 2,1 años, tiempo 19,7 +/- 2,1 meses). Se controló el ahorro de medicación, la tolerancia al esfuerzo, las variaciones del FEM y los despertares nocturnos, así como una valoración global. Resultados: en todos los parámetros estudiados, los enfermos tratados con IT obtienen mejores resultados. Además las OR son significativas (p< 0,05) en todos y cada uno de los parámetros. El FEM se incrementó en los tratados con IT en un 28,46 por ciento. Conclusiones: la IT es un tratamiento esencial en el asma infantil (AU)

Factores de riesgo en el asma infantil (II). Factores perinatales y ambientales / Risk factors in childhood asthma (II). Perinatal and environmental factors

Mi objetivo es caracterizar, con la mayor precisión posible, los niños de alto riesgo de padecer asma dentro de los tres primeros años de vida. Material y métodos: mediante encuesta se estudian 30 niños cuyo asma se inició en los tres primeros años de vida y se comparan con 78 controles sanos. Se analizan los siguientes factores: peso bajo al nacer, parto distócico/anoxia, virasis respiratorias el primer año y animales de pelo en medio doméstico. Resultados: sólo la presencia de virasis (OR = 5,879) y el parto distócico/anoxia (OR = 4,3) son factores de riesgo. Conclusión: se consideran pacientes de alto riesgo los niños varones, con madres atópicas, parto distócico/anoxia y frecuentes virasis respiratorias el primer año de vida (AU)

Factores de riesgo en el asma infantil (I). Historia familiar y ambiente tabáquico / Risk factors in childhood asthma (I). Family history and smoking environment

Introducción: el asma es una enfermedad en constante incremento. Nuestro estudio se ha diseñado para conocer el riesgo de sufrir asma los niños con antecedentes familiares alérgicos o que estuvieron expuestos a ambiente tabáquico en periodo neonatal. Material y métodos: estudiamos 66 niños con asma 78 controles no asmáticos. Por cuestionario se conocieron los datos señalados anteriormente. Se estudian las frecuencias, odd ratio y razón de riesgo de sufrir asma.Resultados: podemos diferenciar dos grupos: El grupo A1 que inicia su asma antes de los 3 años, con madre con antecedentes atópicos, OD 7,44; RR 8. Más frecuente en niños 1,5:1. El grupo A2 de inicio después de los 3 años. Los antecedentes maternos presentan una OR 2,51. Los demás factores estudiados no difieren de los controles.Conclusión: sólo en niños varones, cuya asma empieza antes de los 3 años, el antecedente materno puede ser un factor de riesgo (AU)

Allergy during anaesthetic procedures.

Our purpose is to discover and discuss allergic accidents during the course of general anaesthesia. PRINCIPAL POINTS: We have discussed the mechanisms involved, the principal agents, their character as allergens and diagnostic means. EVALUATION: We highlight the role of plasmatic tryptase in immediate diagnosis and that of cutaneous tests for aetiological diagnosis. CONCLUSIONS: In accordance with the tests discussed, we propose a few lines of action to be taken.

Rhinitis and asthma: nasal provocation test in the diagnosis of asthma.

Our purpose was to determine if the study of rhinitis is useful in the diagnosis of asthma. We formulated the hypothesis that the inflammation of the upper airway reflects the inflammation of the lower airway. It was found that there are allergens that produce rhinitis more frequently than asthma, and vice versa. This can be explained by size. This explanation, however, is questionable as the allergic proteins are extracted from the carrying agent, and through the lymphatic route or the blood, reach the entire human organism. It was also found that with bronchoalveolar lavage in allergic asthma it is possible to obtain the same results for eosinophils as with a nasal wash or using Citospyn. However, the results in the late phase are questionable. In the immediate phase and in the late phase, eosinophil cationic protein (ECP) was detected in the blood (in asthma) and in nasal washes (in rhinitis). In the immediate response tryptase was detected from the mast cells. The role of leukotrienes in asthma and rhinitis is well established in the early and late response. The use of leukotriene inhibitors guarantee their importance in the airway. Platelet-activating factor (PAF) has been demonstrated to increase vascular permeability and the use of antagonists were the best nasal feature. The inhalation of histamine caused bronchospasm, while instillation of histamine in the nasal passages increased resistance. With this information it seems that our hypothesis has been confirmed. Rhinitis and BHR together are equivalent to asthma, although the PFER decreases during the course of nasal provocation test (NPT) in nonasthmatic patients. In pure rhinitis patients, however, we find decreases in PFER due to effort. All this suggests that the study of nasal inflammation is still unclear with regard to bronchial inflammation.

[Nasal provocation tests: dose-response relationship during D. pteronyssinus challenge]. / Test de provocación nasal: relación dosis-respuesta frente al D. pteronyssinus.

They are communicated the results of a study of the obtained responses as compared to D. pteronyssinus in function of the mcg/ml of antigen contents in an extract in the one which was characterized and quantified the allergen greater than represents 42% of the extracts. The interrelation analysis dose-response offers a value of r = 0.835, with a meaning level of 99% and the up spacing +/-28. The found regression equation was y = 0.235 x 9.047.

Diagnosis of allergy to cat epithelium in clinical practice. I. Value of skin tests.

Seventy atopic patients were studied. Pin-prick skin tests with cat epithelium extract (Ifidesa-Aríste-gui) were made. The results were compared by dividing the patients into a group with clinical manifestations of contact with cats and a group without clinical manifestations of contact with cats. Our results show that skin tests for cat epithelium, such as those carried out routinely in clinical practice, are not very sensitive or specific, and, therefore, are not suitable for diagnosis or prevalence studies.

Studies of nonsedative antihistamines. II. Assessment of its antihistaminic potency.

An analysis is made of the effectiveness of terfenadine at dosages of 60 and 120 mg, of cetirizine at a dose of 10 mg, and of loratadine and ebastine at a dose of 10 mg in inhibiting the papule induced by 20 mcg of intradermal histamine. Although all produced significant inhibition, cetirizine and terfenadine 120 mg showed a significantly greater inhibition coefficient than loratadine.

The nasal provocation test in the diagnosis of allergic rhinitis. Behaviour and dynamics of nasal flow during the test.

We analyzed the value of the (n) coefficient of nasal flow in the formula of nasal resistances in order to: (1) calculate nasal flow during the course of the nasal provocation test, and (2) try to find out whether nasal flow maintains the same characteristics during the test. Our results show that values vary between 1.6589 and 1.8801, with a weighted mean of 1.7645--suggesting that the flow is of a mixed character--without significant differences during the course of the test. At the same time we carried out an analysis of the dynamics of nasal flow during nasal provocation.

Study of the possible crossed reactivity between D. pteronyssinus and non pyroglyphide acarus. 1. Skin tests and FAST inhibition.

On 132 patients with case history of rhinitis and/or asthma in a domestic environment and with positive cutaneous tests contrasted with D. pteronyssinus, we have made cutaneous tests compared to said antigen and compared with D. farinae, L. destructor and A. siro, with extracts 5000 E/ml (Noon Units), as well as FAST inhibition, using D. pteronyssinus in its solid phase and all the above mentioned extracts in their liquid phase. Our results show that the frequency of D. pteronyssinus positivities in prick is greater than the other mites as well as the intensity of the response expressed in the size of the wheal showing significant differences between those found for D. pteronyssinus and those obtained with other mites. In turn those obtained with the D. farinae are significantly greater than those obtained with non-pyroglyphide mites. In FAST inhibition we only found a good correlation for D. pteronyssinus-D. pteronyssinus and D. pteronyssinus-D. farinae and there is no good correlation between the other mites. The correlation coefficients differ significantly except for those of the pyroglyphides, and the regression equations show a lack of parallelism in the regression lines. Consequently, on the basis of this study, we conclude that there is no crossed reactivity between D. peteronyssinus and non-pyroglyphide mites.