Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study.

BACKGROUND: Global Asthma Network (GAN) was established in 2012 as a development to the International Study of Asthma and Allergies in Childhood to improve asthma care globally. OBJECTIVE: To survey asthma, allergic rhinitis and atopic dermatitis in primary and secondary school children and to investigate and evaluate its prevalence, severity, management and risk factors in Mexico. METHODS: GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016-2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by parents of 6-7-year-old primary school pupils (school children) and by 13-14-year-old adolescents. RESULTS: A total of 35 780 school children and 41 399 adolescents participated. Wheezing ever prevalence was 26.2% (95% CI 25.8% to 26.7%) in school children and 23.9% (95% CI 23.4% to 24.3%) in adolescents. The corresponding frequencies for current wheeze were 10.2% (95% CI 9.9% to 10.5%) and 11.6% (95% CI 11.2% to 11.9%). In school children, the risk factors for current wheeze were rhinitis (OR 4.484; 95% CI 3.915% to 5.134%) and rash symptoms (OR 1.735; 95% CI 1.461% to 2.059%). For adolescents, rhinitis symptoms (OR 3.492; 95% CI 3.188% to 3.825%) and allergic rhinitis diagnosis (OR 2.144; 95% CI 1.787% to 2.572%) were the most significant. For both groups, there was a negative relation with centres' sea level altitude higher than 1500 m above mean sea level (p<0.005). CONCLUSIONS: The most important risk factors for asthma symptoms in both age groups were the presence of rhinitis and rash symptoms or diagnosis. On the other hand, sea level altitude higher than 1500 metres was a protective factor.

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines.

BACKGROUND: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. METHODS: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. RESULTS: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. CONCLUSIONS: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]. / GUIMIT 2019, Guía Mexicana de Inmunoterapia. Guía de diagnóstico de alergia mediada por IgE e inmunoterapia aplicando el método ADAPTE.

BACKGROUND: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.

Antecedentes: En México, la inmunoterapia con alérgenos (ITA) y con veneno de himenópteros (VIT) se practica tradicionalmente combinando criterios de las escuelas europea y estadounidense; los dos tipos de extractos están comercialmente disponibles en México. Para una ITA adecuada es crucial un diagnóstico oportuno. Objetivo: Presentar GUIMIT 2019, Guía Mexicana de Inmunoterapia 2019, de base amplia, actualizada, que abarca temas de diagnóstico, indicaciones, dosificación, mecanismos, efectos adversos de la ITA y expectativas con esta modalidad de tratamiento. Método: Con la participación de múltiples grupos mexicanos de alergólogos, que incluían los centros formadores universitarios en alergia e inmunología, se desarrolló el documento de la guía según la metodología ADAPTE. Las guías de inmunoterapia de la European Academy of Allergy and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology, German Society for Allergology and Clinical Immunology y del American College of Allergy, Asthma, and Immunology se seleccionaron como guías fuente, ya que recibieron la puntuación AGREE-II más alta entre las guías internacionales disponibles; su evidencia conforma la base científica de GUIMIT 2019. Resultados: En GUIMIT 2019 se emiten recomendaciones fuertes o débiles (sugerencias) acerca de temas directamente relacionados con el diagnóstico in vivo o in vitro de las enfermedades alérgicas mediadas por IgE, la preparación y aplicación de ITA o VIT y sus efectos adversos; se incluye la revisión de las modalidades de ITA para el futuro. Todos los argumentos que se exponen fueron discutidos y votados con > 80 % de aprobación. Conclusión: Un grupo amplio y diverso de expertos en ITA y VIT emitió recomendaciones transculturizadas basadas en evidencia, que alcanzaron consenso; con ellas se pretende mejorar y homologar la práctica de la inmunoterapia en México.

[The role of acupuncture in asthma]. / El papel de la acupuntura en el asma.

Asthma is a chronic inflammatory syndrome of airways, in which different cells and their mediators play a role originating damage clinically expressed by recurrent respiratory symptoms. Current therapy of asthma is focused to reduce airway inflammation, diminishing long-term bronchial hyperactivity and rescue treatment (when required). Unfortunately, the failure of current therapies of asthma has increased the number of patients searching for approximations in complementary and alternative medicine. Scientific evidence is still scarce for establishing that alternative medicine is more effective than placebo in asthma. However, this does not mean that it is ineffective, maybe more multicentric clinical assays are needed, with methodological rigor, to establish final conclusions of efficacy and safety of complementary medicine. Thus, until such results are available, it is better to be skeptical and not to recommend acupuncture for asthma treatment.

[Comparative meta-analysis of immunoestimulant agents used in pediatric patients in Mexico]. / Metaanálisis comparativo de los inmunoestimulantes utilizados en pediatría en México.

OBJECTIVES: To gather basic information of the double-blinded, placebo controlled studies about the use of immunostimulant agents to prevent acute respiratory infections in children and to make a meta-analysis of each one of them after six months of treatment. MATERIAL AND METHODS: Articles related to immunostimulant agents were looked up in Medline and EMBASE, and the ones referring to controlled studies were selected. Average data and the dispersion of the number of acute respiratory infections were extracted and combined as average differences considering the random-effect model for each one of the immunostimulant agents. RESULTS: Only D53, LW50020, OM-85, pidotimod, and RU41740 had controlled studies. It was only possible to calculate the combined effects of D53, OM-85, pidotimod, and RU41740. The effects in the reduction of the number of acute respiratory infections were: global D53 -0.92 (-1.46, -0.39), average difference (confidence interval 95%) (p < 0.05); global OM-85 -1.20 (-1.70, -0.69) (p < 0.05), OM-85 in Mexico City -1.55 (-2.00, -1.10) (p < 0.05); global pidotimod -0.82 (-1.84, +0.21) (p > 0.05); global RU41740 -0.81 (-2.24, +0.62) (p > 0.05), RU41740 in Mexico City -1.20 (-4.33, +1.94) (p > 0.05). Effects in the reduction of acute respiratory infections as percentages were: global D53 31.86% (-34.32, -29.40) (p < 0.05); global OM-85 -39.28% (-52.58, -25.98) (p < 0.05), OM-85 in Mexico City -46.85% (-54.98, -38.72) (p < 0.05); global pidotimod -31.26% (-42.51, -20.01) (p < 0.05); global RU41740 -27.60 (-73.88, +18.69) (p > 0.05), RU41740 in Mexico City -27.89 (-104.11, +48.33) (p > 0.05). DISCUSSION: Only D53 and OM-85 proved to have significant effect in the prevention of acute respiratory infections in children. Only OM-85 showed significant efficacy in Mexico City. LW50020, pidotimod, and RU41740 have some evidence of their efficacy, contrary to other immunostimulant agents that do not have it.

Dermatitis atópica; un nuevo enfoque: experiencia en el Hospital Infantil de México Federico Gómez / Atopic dermatitis. experience in Hospital Infantil de Mexico Federico Gomez

La dermatitis atópica afecta del 10 al 15 por ciento de la población general; aproximadamente el 80 por ciento de los casos se manifiestan antes del año de edad y el 95 por ciento a los 5 años. La IgE así como los linfocitos T tienen un papel importante en el procesamiento de antígenos relacionados con la fisiopatología de esta enfermedad. Las manifestaciones clínicas dependen de la edad de presentación y del estadio de las lesiones. El manejo es en forma integral, principalmente evitando los factores precipitantes y manteniendo una piel lubricada

Anafilaxia potencialmente mortal: comunicación de tres casos / Fatal anaphylectic: cases clinics

Los casos de anafilaxia potencialmente mortal causada por alimentos son raros; sin embargo, se identificaron tres casos pediátricos en el servicio de alergia del Hospital Infantil de México Federico Gómez y se logró detectar los alimentos implicados y se capacitó a los familiares para identificar las manifestaciones clínicas de anafilaxia, así como su tratamiento, basado en la administración oportuna de adrenalina. Además, se realizó una revisión amplia de la literatura respecto a estas afecciones y se encontró semejanza con nuestra comunicación