Low percentages of regulatory T cells in common variable immunodeficiency (CVID) patients with autoimmune diseases and its association with increased numbers of CD4+CD45RO+ T and CD21low B cells.

BACKGROUND: Common variable immunodeficiency (CVID) is a heterogeneous group of primary antibody deficiencies defined by marked reductions in serum IgG, IgA and/or IgM levels and recurrent bacterial infections. Some patients are associated with defects in T cells and regulatory T cells (Tregs), resulting in recurrent viral infections and early-onset autoimmune disease. METHODS: We analyzed whether there is an association between Tregs cells (CD4+CD25+CD127low and CD4+CD25+FoxP3+); memory T cells (CD4+CD45RO+); memory B cells (CD19+CD27-IgD-); and CD21low B cells (CD19+CD38lowCD21low); as well as autoimmune manifestations in 36 patients with CVID (25 women and 11 men, mean age 24 years), all by flow cytometry. RESULTS: Fourteen patients presented with autoimmune diseases (AI) (39%), including 11 with autoimmune thrombocytopenia (ITP) (31%); two with vitiligo (6%); one with systemic lupus erythematosus (LES) (3%); and one with multiple sclerosis (MS) (3%). CVID patients with AI had a reduced proportion of Tregs (both CD4+CD25+CD127low and FoxP3+ cells) compared with healthy controls. CVID patients with AI had expanded CD21low B cell populations compared with patients who did not have AI. A correlation between increased CD4+CD45RO T cell populations and reduced Tregs was also observed. CONCLUSIONS: Our results showed that 39% of patients with CVID had AI and reduced Tregs populations. Research in this area might provide noteworthy data to better understand immune dysfunction and dysregulation related to CVID.

Clinical and mutational features of X-linked agammaglobulinemia in Mexico.

X-linked agammaglobulinemia (XLA) is caused by BTK mutations, patients typically show <2% of peripheral B cells and reduced levels of all immunoglobulins; they suffer from recurrent infections of bacterial origin; however, viral infections, autoimmune-like diseases, and an increased risk of developing gastric cancer are also reported. In this work, we report the BTK mutations and clinical features of 12 patients diagnosed with XLA. Furthermore, a clinical revision is also presented for an additional cohort of previously reported patients with XLA. Four novel mutations were identified, one of these located in the previously reported mutation refractory SH3 domain. Clinical data support previous reports accounting for frequent respiratory, gastrointestinal tract infections and other symptoms such as the occurrence of reactive arthritis in 19.2% of the patients. An equal proportion of patients developed septic arthritis; missense mutations and mutations in SH1, SH2 and PH domains predominated in patients who developed arthritis.

[Reactive airway dysfunction syndrome. Clinical case]. / Síndrome de disfunción reactiva de las vías respiratorias. Caso clínico.

The reactive airway dysfunction syndrome (RADS) is a type of occupational asthma without any period of latency and induced by irritants of low molecular weight. It is a clinical illness diagnosed with scarce information of prevalence in our medical service, that is why it receives a deficient treatment with more morbidity. A clinical case of a 60 year old patient is reported with a sudden, intense and long exposure to clorhidric acid and the consequent development of RADS. We performed a complete study of her signs and symptoms as well as some diagnostic tests, such as respiratory function tests and a positive test to the clorhidric acid. Once the diagnosis was confirmed, the patient was treated with high doses of corticosteroids and bronchodilators of long action for a period of three months. She had complete remission of symptoms, with normal respiratory tests and return to her every day work activities. It is important to consider that this illness in patients with respiratory symptoms and exposed to irritants should receive an appropriate treatment, which makes a better prognosis of it.

[Clinical and spirometric correlation with home allergens and with pollutants]. / Correlación clínica y espirométrica con alergenos intradomiciliarios y con contaminantes.

INTRODUCTION: Environmental contamination causes an increase in respiratory symptoms, especially in patients with asthma. The severity of allergic asthma in children is associated with the presence of intradomicilliary aeroallergens and intramural contaminants. OBJECTIVE: Correlation to clinical abnormalities, spyrometryand skin test with the intradomiciliary pollution. MATERIALS AND METHODS: Children who participated ranged in age from 6 to 15 years, attended public schools, and were classified as healthy and asthmatic. A questionnaire was applied to them, as well as a clinical history, spirometry, skin tests, and an environmental study at home. RESULTS: Fifty-seven children were studied, of 10 years of age (+/- 3). Group 1 (23 healthy children): Positive skin tests, dust 66.6%, cockroaches 66.6%, mites 33.3%, cat 33.3%, dog 4.3%. Principal clinical symptoms were cough 91.3%, wheezing 78.3%, respiratory difficulty 39.1% with a morning predominance of 78.3%. Spirometry showed an obstructive pattern in 30.5%. Group 2 (34 asthmatic children): Positive skin tests, mites 52.1%, dust 47.8%, cockroach 21.7%, cat 21.7%, dog 4.3%, passive exposure to tobacco smoke 79.5%. Principal clinical symptoms were cough 91.3%, respiratory 82.3%, wheezing 79.4%, predominantly at night 70.5%. Spirometry showed obstructive pattern in 67.7%. CONCLUSIONS: Children with asthma present great contact and sensitivity for intradomicilliary allergens such as mites in household dust, proteins from cat, dog, and cockroach feces, in addition to greater frequency of passive smoking. It is important to point out that these factors can be modifiable at low cost, thus presenting the conditions for a better quality of life for the patient and diminishing costs of medical attention.

[Results of an education program for adult asthmatics]. / Resultados de un programa educativo para adultos asmáticos.

Bronchial asthma is a chronically disease with huge social economical consequences. Educational programs, which have been design for asthmatic patients and diminish asthma mobility and reduce medical cost. They also improve the patients quality of life. We show the results of our educational programs for asthmatic adults which were evaluated through a questionnaire applied to these patient one year after the program was introduced. The results show decreased of medicine required asthmatic crisis.

[Criteria for the diagnosis and treatment of chronic rhino-sinusitis in family medicine, otorhinolaryngology, and allergy services]. / Criterios de diagnóstico y tratamiento de la rinosinusitis crónica en servicios de medicina familiar, de otorrinolaringología y de alergia.

BACKGROUND: Rhinosinusitis is an inflammatory response affecting mucosa membrane of nasal cavity of one or more paranasal sinus. Its prevalence is of 14 and 5-13% in adults and children, respectively. Rhinosinusitis causes high rate of scholar and labor absenteeism. OBJECTIVE: To know diagnostic and treatment criteria of rhinosinusitis in units of familial medicine, otolaryngology and allergy. MATERIAL AND METHODS: A series of 25 patients randomly obtained from familial medicine units 21 and 28 of the IMSS, was studied. Diagnosis was assessed according to 1998 Consensus and computed tomography was considered the gold standard. It was performed to all patients and evaluated by a study-blind radiologist. RESULTS: Diagnosis of rhinosinusitis was done by familial medicine unit in 68%, otolaryngology service in 40% and allergy service in 64%. Clinical criteria most used were nasal congestion and anterior and posterior nasal discharge. The more requested examination was computed tomography (38.7%) and in 30% of cases, medical treatment was not prescribed. CONCLUSIONS: Familial physicians, otolaryngologists and allergists use, with low frequency, international criteria for diagnosis and treatment of chronic rhinosinusitis. Otolaryngologists perform other differential diagnosis.

[Hyper-IgE syndrome treated with interferon alpha 2 beta. Report of a case]. / Síndrome de hiper IgE con tratamiento de interferón alfa 2 beta. Reporte de un caso.

The hyper IgE syndrome is characterized by recurrent abscess on the skin, and airways and itching dermatitis. The data acquired in the lab is hypergammaglobulinemy, eosinophil in blood, tissue, sputum, with fagocitos, and quimiotaxis defect. Since 1972 it has been reported 150 cases in the world without no geographic difference and 2:1 relation with the masculine gender. The therapeutic ways are even controversial. The therapy with interferon alpha 2 beta is the alternative treatment so diminish the dermis inflammation as the seric IgE reduction. This case shows a patient with the classic clinic data and seric IgE levels who didn't present response to the habitual therapy, because of this. He was the switch to the interferon alpha 2 beta. Later on the therapy it wasesented clinical changes over the symptomatology with reduction in the over seric IgE.

[Aeroallergens, skin tests and allergic diseases in 1091 patients]. / Aeroalergenos, pruebas cutáneas y enfermedad alérgica en 1091 pacientes.

To know the frequency of positively of several skin tests, data cards from patients, of the Allergy and Clinic Immunology Service of the Hospital de Especialidades del Centro Medico Nacional Siglo XXI (Mexico City), between January, 1989 and March, 1995, were reviewed. Aqueous extracts manufactures by our laboratory were applied, in a dilution of 1:1000 weight-volume. 1091 from 5,651 skin tests patients were positive. Asthma and rhinitis were diagnosed in 492, allergic rhinitis in 289, allergic asthma in 111, and other diagnosis in 199 cases. The most frequent inhalable aeroallergens were house dust and perennial Dermatophagoides p and f1 with predominance in the rainy season, followed by pollens from Fraxinus a. Quercus a and Capriola, with predominance in the rainy season. The most frequent fungi were Candida and Fusarium, with predominance in the dry season.

[Exposure to pollutants and allergens in the asthmatic child compared with the healthy child]. / Exposición a contaminantes y alergenos en el niño asmático en comparación con el niño sano.

To assess the frequency of exposure to allergens and indoor pollutants of school age asthmatic children at the time of their first visit to the specialist, we studied 14 cases with the diagnosis of asthma according to international criteria, and 21 healthy controls. The parents of the children filed a questionnaire asking about socio-economic level, family history of asthma, exposure to allergens or indoor pollutants, and clinical severity of the disease. Questionnaires with less than 80% of the responses were excluded from analysis. Asthmatic patients had higher frequency of exposure to tobacco smoke (42.8% vs 38%), moisture in the home walls (42.9% vs 19%), and to dust reservoirs (71.4% vs 52.4%). A high proportion of the asthmatic patients did not apply adequate environmental control measures. Education for the patients and their primary care physicians must be increased, to reduce the morbidity of the diseases.

[Epidemiologic aspects of bronchial asthma in the Mexican Republic]. / Los aspectos epidemiológicos del asma bronquial en la República Mexicana.

This work was done to determine the mortality and morbidity rates secondary to asthma in Mexico, for age, gender, state of the country and time. Data were obtained from the Instituto Nacional de Estadística. Geografía e Informática. We calculated morbidity and mortality rates adjusting for age, by a direct method. In the results, there was a reduction in mortality rate in both genders, from 1960 to 1987. Age groups up to 4 years and older than 50 were the mainly affected. From 1960 to the present time, the state with highest mortality is Tlaxcala. The states with highest hospitalization rates were Morelos, Baja California Sur, Nuevo León, Durango and Tamaulipas. In conclusion, mortality rates secondary to asthma in Mexico show a decreasing trend, with a considerable rise in morbidity, especially in the adolescent group.

[Asthma mortality trends in Mexico]. / Tendencia de la mortalidad por asma en México.

The objective of this cross-sectional study was to estimate mortality and morbidity from asthma in Mexico by federative entity (state) of residence, age, and sex during the period between 1960 and 1988. Statistics published by the National Institute of Statistics, Geography, and Information Science were reviewed, as were vital statistics and information from other sources. Data were selected on mortality, hospital admissions, and outpatient visits, as well as population by federative entity, age, and sex. Mortality and morbidity rates were adjusted for age using the direct method. From 1960 to 1987, mortality decreased for both sexes. The groups with the highest asthma mortality were those under 4 years of age and those over 50. From 1960 to the present, the state with the highest mortality was Tlaxcala. Hospitalizations increased from 10 to 140 per 100,000 population for the country as a whole. When both outpatient visits and hospitalizations were considered, the morbidity rates rose from 180 to 203.4 per 100,000 between 1960 and 1970. In 1970, hospital morbidity was higher among males than females. From 1960 up to the 1990s, the highest rates of hospitalization and outpatient visits were registered among those under 4 and those over 60. The states with the highest asthma hospitalization rates were Morelos, Baja California Sur, Nuevo León, Durango, and Tamaulipas. It is concluded that asthma mortality in Mexico is showing a downward trend, while morbidity is increasing considerably, especially among adolescents.

[Descriptive study of morbidity and mortality due to asthma at a Health Sector institution]. / Estudio descriptivo sobre la morbilidad y mortalidad debida a asma en una institución del Sector Salud.

The objective of this study was to determine the morbidity and mortality rate due to asthma from a Health Institution, which represents the majority of working population. Asthma data were obtained from the National Institute of Informatical, Geography and Statistics (INEGI), Mexican Health Secretary (SS) and Mexican Social Security Institute (IMSS). The underlying cause of death hospitalization or visit were obtained. Asthma was coded according to the International Classification of Disease (ninth revision). Asthma death rate was adjusted by age using direct method. In the IMSS, asthma death rate increased from 3.24/200,000 in 1980 to 12.76/100,000 in 1990. The asthma letality increased from 0.34 in 1980 to 1.23 in 1990. The average length of hospital stay was 3.96 days in 1990; there was noy significant differences by sex the most affected groups were children under 4 years of age and persons older than 65 years of age. In conclusion, from 1980 to 1990, the morbidity and mortality rate due to asthma in IMSS increased. It suggests that future health policy efforts should be focused to reduce the morbidity, mainly in high risk groups.

[Evaluation of eosinophils in nasal mucus from patients with perennial allergic rhinitis during nasal provocation tests]. / Evaluación de los eosinófilos en el moco nasal de pacientes con rinitis alérgica perenne durante la prueba de provocación nasal.

The purpose of this study was the evaluation of the behaviour of the eosinophils in the nasal mucous of patients with perennial allergic rhinitis in the moment of making a nasal initiation test 30 subjects were studied to which a nasal initiation test was applied with a 1:100 dilution of aqueous extracts, the samples were taken with a inferior nostril swab in basal form, in 30 minutes. Two and eight hours after the antigenic dare, the samples were tinged with the Wright technic, and the quantity of eosinophils and polymorphonuclear cells were determined. There were not adverse reaction during the procedure. The results showed eosinophils of 4.9% basal form, 13% at the 30 minutes, 19% at two hours and 28%, eight hours after the antigenic initiation, the percentage of polymorphonuclear cells was of 40.6%, 34.2%, 34.8% and 31.7% respectively. The obtained results are in accordance to the expectations in the different phases of the allergic response in rhinitis. We suggest for a correct evaluation of this nasal cytology test in patients with allergic rhinitis, the allergic response phase where the patient is, should be known.

[Clinical and laboratory features of 100 patients with perennial allergic rhinitis]. / Características clínicas y de laboratorio de 100 pacientes con rinitis alérgica perenne.

100 patient records were studied with a clinical diagnosis of perennial allergic rhinitis; they were 66 women and 34 men, with a range of 28.6 years old. The cutaneous tests were positive to pollens in 78% of the cases, fungus 39%, inhalables 39%, Dermatophagoides 19% and bacterial 7%. In the nasal mucous culture the following germs were isolated: S epidermidis 49%, S aureus 25%, Neisseria sp 15%, Corynebacterium 2%, P mirabilis 1% and E coli 1%. The nasal cytology was positive in 25% of the cases for the presence of eosinophils, and was negative in 75%. In only 27% of the patients eosinophil was found in the peripheric blood. The results are commented and the utility of the cultivation of nasal mucous and of the cytology of nasal mucous in patients with perennial allergic rhinitis is discussed.