Etiology of chronic urticaria: the Ecuadorian experience.

BACKGROUND: The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association between the etiology and its treatment. METHODS: We performed a retrospective study involving 112 patients diagnosed with CU using a Checklist for a complete chronic urticaria medical history. Demographic and clinical variables were collected. The etiology of CU was classified using the EAACI/GA2LEN/EDF/WAO guideline. Descriptive analyses were performed for demographical and clinical variables. Chi square tests were applied to analyze the fit of distribution and the independence of variables. P values less than 0.05 were considered significant. RESULTS: Among all the patients, 76.8% were diagnosed with chronic spontaneous urticaria (CSU), of which 22.3% had a known etiology or possible exacerbating condition. Food allergy was identified as the most common accompanying condition in patients with CSU (10.7%) (p < 0.01).. On the other hand, 23.2% inducible urticarias (CIndU) were indentified; dermographism was the most common (10.7%) (p < 0.01).Regarding treatment regimens, sg-H1-antihistamines alone represented the highest proportion (44.6%). The combination of any H1-antihistamine plus other drug was a close second (42.0%) (p < 0.01). Almost 48% of CSUs of unknown etiology were treated with any antihistamine plus another drug. In patients with known etiology, sg-antihistamines alone (44.0%) was the most common management. In addition, 53.8% of CIndUs were treated with sg-antihistamines alone. Though, these associations were not statistically significant. CONCLUSION: CSU is the most frequent subtype of CU. Modern non-sedating antihistamines in licensed doses are the drug of choice. Nevertheless, a great proportion of patients require the addition of another type of medication.

Loratadine versus cetirizine: assessment of somnolence and motivation during the workday.

OBJECTIVE: This parallel-group, double-blind study compared the somnolence and motivation profiles of 2 second-generation antihistamines, loratadine and cetirizine, in patients with allergic rhinitis. BACKGROUND: Second-generation antihistamines were developed to provide symptomatic relief from allergic disorders without the unwanted side effects of first-generation antihistamines, including somnolence. Recent research has indicated that not all second-generation antihistamines are comparable with respect to somnolence and other cognitive processes. METHODS: Patients aged > or = 12 years and actively exhibiting symptoms of allergic rhinitis were randomized to 2 treatment groups to receive 10 mg loratadine or 10 mg cetirizine daily at 8:00 AM for 1 week. After patients took the medication, their somnolence and degree of motivation to perform activities were recorded in an electronic diary using a visual analog scale 4 times during the workday (8:00 AM, 10:00 AM, noon, and 3:00 PM). RESULTS: Sixty patients (31 men, 29 women) were randomized to treatment. Somnolence scores were similar for both groups at baseline and at the time of dosing (8:00 AM). However, there was a statistically significant difference in somnolence scores between the loratadine and cetirizine groups at 10:00 AM (P = 0.008), noon (P = 0.001), and 3:00 PM (P < 0.001), with the cetirizine group showing a greater degree of somnolence. The scores on motivation to perform activities were similar for both groups at the baseline and 8:00-AM measurements. In parallel with the somnolence scores, there were statistically significant differences in motivation scores between the loratadine and cetirizine groups at 10:00 AM (P = 0.014), noon (P = 0.001), and 3:00 PM (P < 0.001), indicating that patients taking loratadine were relatively more motivated during the workday. CONCLUSION: The results of this study demonstrate that in patients aged > or = 12 years who had allergic rhinitis, cetirizine use promoted somnolence and decreased motivation to perform activities during the workday compared with loratadine.

Doxepin incorporated into a dermatologic cream: an assessment of both doxepin antipruritic action and doxepin action as an inhibitor of papules, in allergen and histamine-caused pruritus.

"Doxederm", a 5% doxepin hydrochloride ("doxepin") cream, has been used for assessments on patients' response to histamine and allergens by means of a prick test. Parameters selected papule diameters, and pruritus intensity. Doxederm was applied: (a) immediately before tests, (b) 10 minutes after tests, and (c) 72 hours before tests. All test reactions have been compared to similar tests that had been performed with a placebo cream. Tests yielded the following findings: (1) a remarkable remission of pruritus when doxederm was applied according to above mentioned (a), (b), and (c) schedules; (2) no inhibition of papule size --should either antigens or histamine be administered, could be observed when doxederm was applied immediately before tests or 10 minutes after tests had been performed (p > 0.10 vs placebo); (3) an evident remission of papules when doxederm had been applied 72 hours before tests were performed. No difference, however, could be detected with patients forearms placebo cream had been applied whereon (difference among previously observed papules, and papules observed 72 after doxederm application: p > 0.005. Difference between doxederm and placebo: p > 0.10). Pursuant to the above mentioned observations, it can be suggested that doxederm evidences a highly siwft response on pruritus. Doxederm local effect, however, does not alter histaminic responses. Responses, however, are likely to be altered after a doxederm percutaneous absorption.

Delta pico flujo espiratorio, hiperreactividad bronquial y proteína catiónica del eosinófilo en asmáticos tratados con diferentes dosis de budesonida / Delta peak flow expiratoryhyperreactivity bronchial and cationic protein of the eosinophil in asthmatic treatmentwith different dose of Budesonide

Objetivo: Determinar la acción de distintas dosis de budesonida (BUD) sobre la evolución clínica del asma, la hiperreactividad bronquial (HRB) al aire frío y la proteína catiónica eosinofílica (PCE) sérica en un grupo de pacientes asmáticos atópicos, versus un grupo control tratado sólo con ß2 a demanda. Material y métodos: Se estudiaron 30 pacientes (p) con asma moderada persistente, edad X=25,5 años. Se les determinó: espirometría basal, HRB con aire frío, niveles séricos de PCE (valores normales: 2,6 a 16 mg/l) y monitoreo del pico flujo espiratorio (PFE) matinal y vespertino durante los distintos regímenes terapéuticos. Se los dividió en dos grupos: grupo 1 (23 p): se los medicó con BUD 800 mg/día durante 3 semanas; y grupo 2 (7 p): recibieron solamente ß2 a demanda por 3 semanas. al cabo de las mismas se volvieron a evaluar los mismos parámetros a los fines de determinar diferencias entre los dos tratamientos. Seguidamente al grupo 1 se redujo la dosis de BUD a 400 mg/día durante 2 semanas y a 200 mg/día otras dos semanas, evaluando HRB y valores de delta PEF (PEF) al final de cada tratamiento. Resultados: 1 a) La HRB al aire frío disminuyó en el grupo 1 (BUD) de una PD inicial X=16,4 a una PD X=7,62 luego de 3 semanas de tratamiento con 800 mg/d, mientras que en el grupo 2 (ß2) la PD inicial fue de X=15,8 y la PD final de X=15 (diferencia BUD vs. ß2: p<0,005). 1 b) El promedio semanal de  PFE diarios mayores al 10 por ciento en el grupo 1 fue de X=2,91 al inicio y de X=2 luego de las 3 semanas, mientras que en el grupo 2 subió de X=2,91 al inicio a X=5 al final del tratamiento (p<0,005). 1 c) La PCE sérica en el grupo 1 fue de X=32,5 µg/l al inicio y de X=23 µg/l al final, disminuyendo en 16/23 pacientes, mientras en el grupo 2 fue de X=28 µg/l al inicio y de X=21,2 µg/l al final de las 3 semanas (p<0,18). 2 a) En el grupo 1, la HRB durante el tratamiento con 400 µg/día bajó de una PD X=7,62 a una PD X=3,57 (p<0,005), aumentado nuevamente a una PD X=4,67 al disminuir la dosis a 200 µg/día. 2 b) Los  PEF mayores al 10 por ciento, durante el tratamiento con 400 µg/día bajaron de un X=2 a un X=1,74, volviendo a aumentar a X=2,2 con 200 µg/día. Conclusiones: Al disminuir la dosis del fármaco, este efecto se mantiene hasta una dosis de 400 µg/día, disminuyendo al utilizar 200 µg/día.

Acciones de diversos fármacos sobre la hiperreactividad bronquial y el asma: consideraciones fisiopatogénicas y terapéuticas / Actions of different drugs on the bronchial hyperreactivity and the asthma: considerations physiopathogenic and therapy

En 48 pacientes asmáticos atópicos leves o moderados se investigó la respuesta a diversos fármacos. Luego de una semana de tratamiento con dipropionato de beclometasona (BECLO) o terfenadina (TER) o cetirizina (CET) o cromoglicato disódico (CGDS) o nedocromil sódico (NED), se evaluó: a)la evolución espirográfica tomando como parámetros VEF y FM antes y después de cada uno de los tratamientos. En el cotejo de los resultados obtenidos con cada fármaco se encontró que, tomando los promedios de ambos parámetros, el CGDDS, con el 50 por ciento, es el fármaco que mejor actua; luego siguen en orden decreciente, TER 38 por ciento, BECLO 35 por ciento, CET 29 por ciento y NED 7 por ciento. Las diferencias son estadísticamente significativas entre CGDS vs. NED, p<0,05. b) La capacidad de protección de cada uno de esos fármacos sobre la hiperreactividad bronquial con aire frío (HRB). Aquí el orden de protección para la broncoobstrucción, si se toman ambos parámetros(VEF y FM) es para la CET, del 65 por ciento, BECLO 50 por ciento, CGDS 46 por ciento y TER 8 por ciento. Si en lugar de considerar los promedios para ambos parámetros, se toma el número de evaluaciones espirográficas que son protegidas más del 10 por ciento ante la estimulación con aire frío, se observa que a la CET le corresponde el 90 por ciento de protección, al CGDS al 61,5 por ciento, a la BECLO el 60 por ciento a la TER el 28,6 por ciento y al NED el 12.5 por ciento. Estadísdicamente la CET es superior a TER y NED (P<0,02) y CGDS también vs. TER y NED p<0,02. Se concluye que si bien la HRB es una expresión del asma, en ésta se suma a la inflamación basal y broncoobstrucción, donde la histamina tiene un papel más importante que en las respuestas de HRB. Y que en la HRB por aire frío la acción antiinflamatoria de los fármacos u otras acciones, como anti PAF, puedan ofrecer mejores resultados, por lo que habría que elaborar criterios terapéuticos individuales de acuerdo con la mejor acción preventiva para cada una de las situaciones

Acción de la cetirizina y otros fármacos en la protección de la hiperreactividad bronquial (HRB) con aire frio / Action of the cetirizine and other drug in the bronchial hiperreactivy protection with cold air

Hemos estudiado 48 pacientes (p) con media y moderada asma, según Scheffer y Taggart (1). Todos los pacientes son atópicos, con elevadas cantidades de IgE sérica, con eosinofília sanguínea y con test cutáneos positivos. Los pacientes son evaluados pro y post la provocación broquial con la inhalación de aire frio (-10,-20) por 3 minutos. Previo y posterior a la utilización de distintos fármacos por una semana. Consideramos resultados positivos cuando disminuyen la caida espirográficas más de un 10 por ciento luego de la utilización de algún fármaco. Encomtramos los siguientes resultados: Cetirizina (Cet.) 10p. dosis de 20 mg/d, mejoran en la HRG sus VEF1 y FM 25-75 por ciento, un 65 por ciento. Cromoglicato Disódico (CGDS) 13p, 40mg/d, mejoran ambos parámetros el 46 por ciento. Beclometaosna (Beclo) 10p. 400 mcg/d, ambos parámetros mejoran un 50 por ciento, Terfenadina (Terf) 6p mejoran ambos parámetros el 8 por ciento, Placebo (Pla) 19p mejoran 5,5 por ciento. Esto establece las siguientes relaciones estadísticas: entre Cet vs Terf y Pla p<0,02. La protección con Cet es mayor que Beclo, CGDS y Terf. Debido a esto nosotros pensamos que la Cet tiene una buena protección no tanto por su actividad anti H1 sino probablemente por sus otras propiedades antiinflamatorias especialmente por su acción inhibidora de la quimiotaxis de los eosinofilos

Plasmaféresis en el tratamiento de la dermatitis atópica generalizada / Plasmaphoresis in the treatment of the generalized atopic dermatitis

Cuatro pacientes con Dermatitis Atópica generalizada fueron tratados con plasmaférisis. La enfermedad fue clasificada en cuatro estadios: l) lesiones diseminadas en áreas flexurales, ll) lesiones en zonas flexurales y cara, lll) amplio compromiso cutáneo con liquenificación y severo prurito, lV) dermatitis generalizada abarcando toda la superficie corporal y cuero cabelludo con xerosis y/o ictiosis, liquenificación, sudoración profusa, impétigo, severo prurito y corticoideo dependencia. La Plasmaférisis ...

[Effects of levamisole in the treatment of a group of patients with atopic asthma and depression cellular immunity]. / Efectos del levamisol en el tratamiento de un grupo de pacientes con asma atópica y depresión de la inmunidad celular.

We investigated the possibility of decreased cellular immunity (C.I.) in a substantial group of atopic asthmatic patients with respiratory tract infections during autumn and winter. Two-hundred and ten atopic asthmatic patients were selected, and the following tests for cellular immunity were performed. Skin tests with 11 bacterial and fungal antigens. Normal average value of the skin reactions is 2.5 mm. E rosettes with sheep erythrocytes. Normal value for patients of this age is 60 +/- 8%. Immunoglobulins A, G and M and complement fractions C3 and C4 were determined by radial immunodiffusion. IgE was determined using PRIST (Phadebas, Pharmacia). IgE was elevated in all except two of the patients. IgG, IgA and IgM, C3 and C4 were normal. Twenty five of the 85 patients had some depression in cellular immunity (decreased E rosettes and/or decreased skin reactions). Patients with depressed cellular immunity were given 2.5 mg Levamisol three times a week for three months. Their progress was evaluated clinically and immunologically and a positive correlation was found between clinical improvement and increased C.I. in 18 of the 25 patients. We consider Levamisol to be useful in approximately 8.5% of all asthmatic patients.

Research on a new type of antiinsulin antibody in a diabetic female patient: the cytotoxic antibody. antiinsulin cytotoxic antibody.

A study was carried out on a diabetic patient showing allergy to insulin, with urticaria and Quincke's edema, apparently owing to sensitization with IgE antibodies. By means of a hyposensitizing treatment her allergy improved due to the building up of IgG protecting antibodies, but at the same time she showed resistance to insulin, probably owing to IgG antibodies as well. This suggest that caution should be exerted before applying hyposensitization with insulin on diabetic patients allergic to the hormone. We were able to describe on the same patient a type II sensitization caused by a cytotoxic antibody against insulin. It was shown that this antibody agglutinates leukocytes which had been previously incubated with insulin and damage occurred when complement was present. Those effects could be especifically inhibited when the antigen (insulin) was added to the medium. The antibody belongs to the IgG group and it acts both in vivo and in vitro. In the case under study, the cytotoxic antibody disappeared as soon as treatment with insulin was discontinued for a year, and reappeared when renewed. It does not seem to occur very frequently, for it was not found in 20 consecutive diabetic patients under insulin treatment.

[Immunological studies on patients with mycosis fungoides]. / Estudios immunológicos efectuados en pacientes con micosis fungoide

Recently, much has been published on the immunological status of patients affected with various lymphomas. In the particular case of Mycosis fungoide, there was no general agreement on the immunological status of the corresponding patients. In fact, López Borrasca et al, found severe depression of cellular immunity in such patients. On the contrary, Blaylock and Clendenning found very little change in cellular immunity, but a very high serum-IgA. We want to offer our experience on this problem with the immunological survey of four patients with the Alibert-Bazin-form of Mycosis fungoide. The following tests were performed on each patient: a) Intracutaneous test with candidina, PPD and other bacterial antigens. b) Sensitization to a concentrate solution of dinitrochlorobencene (DNCB). c) Lymphocyte Transformation Test (LTT), with phytohemagglutinin as mitogen. d) Quantitative determination of IgG, IgM, IgA and beta1C, with the radial immunodiffusion technique (Mancini et al.). e) Agar immunoelectrophoresis. The following results were obtained: 1) The cellular immunity was markedly depressed in the four patients when any of a, b or c-test was performed. 2) All the patients showed very high levels of serum IgA, 150% higher than control. The reason for this is unknown. On the contrary, IgG in serum was less elevated and IgM and beta1C serum levels were normal. 3) No monoclonal bands were found in any case (immunoelectrophoresis). 4) No definite conclusions could be reached due to the limited number of cases, but the uniformity of results should encourage to carry this work further.