[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.

[Association of obesity in adults with allergic asthma]. / Asociación de obesidad y asma alérgica en adultos.

BACKGROUND: Obesity and asthma are diseases of high prevalence around the world. The increment in their incidence constitutes a challenge to public health. Asthma can be worse in patients with obesity. OBJECTIVE: To know the prevalence of obesity in a group of Mexican allergic asthmatic adults. METHODS: A study about the prevalence of obesity in 158 adult asthmatic allergic patients in the years 2010 and 2011 was performed, according to the body mass index (BMI) obtained from their clinical files. In addition, skin tests with allergens were done and the total serum level of IgE was determined in each one of the individuals. RESULTS: According to the BMI, 112 (70.9%) patients had a weight above normal; 76 (67.9%) were women and 36 (32.1%) were men. The highest number of patients with weight above normal corresponded to the overweight group. Mild persistent asthma presented in two-thirds of the patients with overweight and obesity. Women with overweight and obesity showed a higher severity of asthma than men. Women had more positive skin tests than men. Half of the patients had IgE levels above normal. CONCLUSIONS: We found an increased prevalence of asthmatic adults with associated obesity. Asthmatic women presented more overweight and obesity than men, as well as increased severity of asthma and more positive skin tests with allergens.

[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.

[Allergy to materials used in dental procedures]. / Alergia a materiales utilizados en procedimientos dentales.

OBJECTIVE: To provide a review of the literature regarding the pathological effects of material used in clinical dentistry. DATA SOURCES: PubMed search was performed using the key words: dental biomaterial, odontologic toxicity, odontologic allergy, dental allergens, dental resins. STUDY SELECTION: Articles were selected based on their relevance to this topic. RESULTS: The biomaterials used in orthodontic or dental treatment may lead to alterations of greater biological importance in susceptible or sensitized individuals, and may be able to alter the functions of cells in the mouth, including dentinogenesis and tissue repair; toxicity and mutagenicity have been observed. Some of them release potential antigens or allergens capable of inducing immune or immediate and delayed allergic reactions of diverse severity and extension, which may include extraoral damage. CONCLUSIONS: The number of patients with pathology originated by dental materials has increased. The scarce knowledge about it delays diagnosis. The study of biomaterials used in odontologic procedures and its harmful effect must be encouraged, as well as its pathological manifestations which require more clinical investigation and diffusion, with the aim to give more and better information to dentists, family and allergy physicians so that they can provide prompt and successful care.

[First centenary of Whipple's disease]. / Cumple su primer centenario la enfermedad de Whipple.

Whipple's disease is an infrequent multisystemic infection caused by a gram-positive bacterium: Tropheryma whippelii, which after several studies has been characterized as an actinomiceto por 16Sr RNA. It occurs with multiple symptoms, the principal of which are diarrhea, weight loss, stomach pain and arthralgias. Arthritis or artralgia may appear as an isolated symptom and eventually through the years additional digestive, cardiovascular and/or neurological symptoms arise. Diverse immunological abnormalities usually present before or after clinical symptoms are first discovered. Currently there are cabinet, endoscopic, radiological, tomographic and laboratory studies which can help to make a definitive diagnosis, such as the duodenal biopsy submitted to the Schiff test, to the polimerasa chain or an electronic microscopy in order to see the intracellular bacteria in the macrophage and for immunohistochemistry to see specific antibodies to Whipple's disease. Treatment is trimetoprim/sulfametoxazol, it is suggested transfer factor too.

[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.

Maize (Zea mays): allergen or toleragen? Participation of the cereal in allergic disease and positivity incidence in cutaneous tests.

BACKGROUND: The maize (zea mays) is considered one of the fundamental nutrients in the diet of the Mexican population. It can cause allergic reactions, according to reports from countries other than Mexico. OBJECTIVE: To know the participation of maize in the etiology of allergic disease and the incidence of positivity to its antigens by cutaneous tests, in Mexican patients. METHODS: Six hundred sixty-one patients were studied. There were obtained a complete clinical history and samples for laboratory tests, as well as the results of cutaneous tests. RESULTS: Of 661 patients, 56 (8.5%) manifested allergic symptoms attributable to maize, which correlated (p < 0.0001) with a positive cutaneous response to its antigens. Fifty (88%) of them worked with maize and had a significant relative risk value (RR=102). The remaining six patients did not work with maize, four of them were included in the group who had a positive response for both allergens (n = 25), and two in that one with positive response for only one of these allergens (n = 100). CONCLUSIONS: The low frequency (8.5%) to which the allergic disease was attributed to maize, and the strong association (88%) with workers of maize induce us to consider the influence of some differences concerning to the cereal, such as physical characteristics, years and frequency to contact with, and specially to its entrance route. In fact, it plays an important role in the development of either toleragenic or immunogenic response to an antigen.

Uso de metotrexato en el asma esteroideo-resistente / Use of methothrexate in steroid-resistant asthma

Existen pacientes con asma bronquial resistentes a la terapia habitual denominados esteroideo-resistentes. En el tratamiento de estos enfermos se han usado fármacos alternativos para mejorar su calidad de vida y supervivencia, así como para disminuir los efectos adversos de los corticoides. Realizamos un estudio prospectivo, longitudinal y observacional en 10 pacientes con asma esteroideo-resistente en el Servicio de Alergia e Inmunología Clínica del Hospital General de México. A estos sujetos les fueron administrados 7.5 mg de metotrexato semanales durante 40 semanas. Los pacientes lograron, en promedio, una elevación del volumen espiratorio forzado (FEV1) del 15.2 por ciento, un aumento de la capacidad vital de 7.2 por ciento y una disminución del volumen residual de 81.7 por ciento; también presentaron una elevación de la capacidad pulmonar total de 28.2 por ciento y un mínimo de efectos adversos. De esta manera se abre una línea de investigación, para el uso de fármacos alternativos en el asma bronquial esteroideo-resistente.

Sensibilización a distancia: dermatofítides / Sensibilization at distance: dermatophytides

El mecanismo de producción de la hiposensibilización a distancia (ID o IDE), cualquiera que sea su origen, ha sido difícil de dilucidar, lo cual ha sido el motivo para realizar esta revisión. La mayor parte de los hongos poseen una estructura compleja compuesta por La N-acetil glucosamina, la cual es fundamental en la producción de IDES, debido a que: es el antígeno de superficie de los dermatofitos que va a producir la formación de dichas IDES, ya que es semejante a la colágena tipo I de la piel y los glucosamin-glicanos que se utilizan para su conservación. Cuando se monta una respuesta inmunitaria contra la glucosamina de los dermatofitos se hace una reacción cruzada contra la colágena tipo I de la piel