[Mexican clinical practice guidelines of immunotherapy 2011]. / Guía Mexicana de Práctica Clínica de Inmunoterapia 2011.

BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. OBJECTIVES: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. METHODS: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE. RESULTS: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions. CONCLUSIONS: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence. KEYWORDS: Allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, skin testing, allergy diagnosis, rhinitis, asthma, atopic dermatitis, house dust mite, pollens, anaphylaxis, adrenaline, Mexico.

Asma / Asthma

El asma es una enfermedad inflamatoria crónica de las vías aéreas en la cual muchas células y productos celulares juegan un papel importante. La inflamación crónica produce un incremento en la reactividad de la vía aérea y episodios recurrentes de sibilancias, dificultad respiratoria, tiraje intercostal, tos y opresión torácica, especialmente en la noche y en la mañana. Estos episodios se asocian con obstrucción del flujo aéreo, reversible espontáneamente o con tratamiento. La inflamación también causa un aumento en la respuesta bronquial a una gran variedad de estímulos. Es la enfermedad crónica más común en la infancia, los estudios epidemiológicos en América Latina han revelado diferencias en prevalencia del asma con cifras de 5.7 a 16.5% en la población pediátrica. En los últimos años se han realizado estudios en la Ciudad de México aplicando la metodología del ISAAC, determinando que la prevalencia es de 8 a 12%. Varios factores de riesgo se asocian con el desarrollo de esta enfermedad, a continuación se exponen éstos, así como la fisiopatología de la enfermedad, manifestaciones clínicas, estrategias de diagnóstico y opciones terapéuticas.

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment. It is the most common respiratory disease in childhood, epidemiologic studies in Latin America report prevalence varying from 5.7 to 16.5%. Recent studies using ISAAC methodology in Mexico City have reported prevalence from 8 to 12%. Numerous risk factors have been associated with this disease. This factors, physiopathology, clinical presentation, diagnosis and therapeutics options are reviewed.

[Status asthmaticus vs transtracheal membrane and cyclic neutropenia: a report of a case]. / Estado de mal asmático vs membrana transtraqueal y neutropenia cíclica: comunicación de un caso.

INTRODUCTION: Acute episodes of asthma are one of the most common respiratory emergencies, and status asthmaticus is the most severe respiratory impairment. Because "not all the wheezes are manifestations of asthma", the clinician needs to consider non asthmatic causes of wheezing in the differential diagnosis such as tracheal stenosis. CLINICAL CASE: 7 years old male, hispanic, non atopic background, with two previous cases of acute asthma. Current condition: 15 days of cough, dyspnea and wheezes, without fever. The physical examination revealed nasal flutter, use of accessory muscles of respiration, fatigue and bibasal hypoventilation. Mitomycin was applied during nasolaryngoscopy. He was discharged 17 days after with tracheal stenosis diagnosis. Biopsy reported respiratory epithelium with chronic inflammation and fibrosis. Six dilatations were performed because of persistent stenosis and he is being evaluated by infectologist and hematologist for repeated upper airway infections associated with cyclic neutropenia.