Beyond eosinophilia: inflammatory patterns in patients with asthma.

Background: Recently, inflammatory cell ratios have gained importance as useful indicators in the categorization of asthma.Objective: We compared the concentration of white blood cells in peripheral blood, as well as their respective inflammatory cell ratios, between patients with asthma and a healthy control group.Methods: We performed cross-sectional analyses of the data obtained from 53 adult patients with asthma and 109 adult controls. In our study, we estimated and compared the following inflammatory cell ratios: Neutrophil-Lymphocyte Ratio (NLR), Eosinophil-Lymphocyte Ratio (ELR), Eosinophil-Neutrophil Ratio (ENR), Eosinophil-Monocyte Ratio (EMR), and Platelet-Lymphocyte Ratio (PLR). The magnitude of association was quantified with the odds ratio.Results: In both groups, the average age was 33 years. In asthmatic patients, we obtained the following results: eosinophils ≥ 400 cells/µl, accounted for 37.7%; basophils ≥ 110 cells/µl, comprised 37.7%; and monocytes < 320 cells/µl, reached 11.3%. In the control group, the results were as follows: 4.6%, 9.2% and 0.9%, respectively. When compared to the control group, asthmatic patients had higher odds of eosinophils ≥ 400 cells/µl (OR = 12.61, p < 0.0001); higher odds of basophils ≥ 110 cells/µl (OR = 6.00, p < 0.0001); and increased odds of monocytes < 320 cells/µl (OR = 13.79, p = 0.017). NLR did not differ between our two groups; however, ELR, ENR, EMR and PLR were significantly higher in the asthma group.Conclusions: Overall, patients with asthma have a higher concentration of eosinophils and basophils, fewer monocytes in their blood, and higher ratios of increased chronic inflammation.

Prevalence of allergic sensitization to Platanus occidentalis among adults with allergic rhinitis: A multicenter study.

Background: In the Americas there are few studies that have evaluated the frequency of allergic sensitization to Platanus occidentalis or sycamore pollen in adult patients with allergic rhinitis (AR). Objective: To determine the prevalence of allergic sensitization to P. occidentalis and to identify factors associated with its presentation. Methods: A cross-sectional study was carried out in 3 centers distributed in the northwest, west, and southeast of Mexico. Allergic sensitization to P. occidentalis was determined with a skin prick test. Prevalence and 95% confidence intervals (CI) were estimated. Results: A total of 404 patients were included, women were 233 (57.7%); the age mean was 33.8 ± 12.9 years. The overall prevalence of sensitization to P. occidentalis was 20.8% (95% CI, 17.1%-25.0%); in the northwestern: 15.9% (95% CI, 9.6%-25.1%); in the western: 21.8% (95% CI, 15.4%-29.9%); and in the southeastern: 22.4% (95% CI, 17.1%-38.8%). Multivariate analysis showed to the following allergens as factors associated with sycamore allergic sensitization: tree pollens (OR, 3.19; P = 0.001), weeds (OR, 2.49; P = 0.004), fungi (OR, 1.96; P = 0.014), and dog or cat epitheliums (OR, 1.88; P = 0.018). Conclusion: Allergic sensitization to P. occidentalis pollen in AR patients is not an infrequent event; consequently, we recommend doing the challenge test in all patients with this allergen, especially in those regions where the tree is present.

[Prevalence of asthma in patients hospitalized for pneumonia associated to SARS-CoV-2 infection]. / Prevalencia de asma en pacientes hospitalizados por neumonía asociada a infección por SARS-CoV-2.

BACKGROUND: The association between asthma and COVID-19 remains controversial. Objective. To establish the prevalence of asthma in a sample of patients with COVID-19-associated pneumonia; furthermore, to describe the clinical characteristics of patients with asthma compared to patients without asthma. METHODS: Clinical data corresponding to 120 patients hospitalized for pneumonia associated with SARS-CoV-2 infection were analyzed. Patients with and without asthma were compared based on COVID-19 severity. RESULTS: The prevalence of asthma in patients with COVID-19 pneumonia was 3.5% (95% CI: 2.0% to 5.1%). When comparing the severity of COVID-19 among asthma patients with non-asthma patients, it did not differ based on symptoms, comorbidity, duration of symptoms, need for assisted mechanical ventilation, biomarkers of inflammation, and the occurrence of death. Patients with asthma and COVID-19 showed a high T2 phenotype, poor respiratory function, and no regular treatment for asthma control. CONCLUSIONS: No significant differences in the frequency of assisted mechanical ventilation or death were observed between patients hospitalized for COVID-19-associated pneumonia with and without a history of asthma.

ANTECEDENTES: La asociación el asma con la COVID-19 continúa siendo controversial. Objetivo: establecer la prevalencia de asma en una muestra de pacientes con neumonía asociada COVID-19; además, describir las características clínicas de los pacientes con asma en comparación con los pacientes sin asma. MÉTODOS: La asociación el asma con la COVID-19 continúa siendo controversial. Objetivo: establecer la prevalencia de asma en una muestra de pacientes con neumonía asociada COVID-19; además, describir las características clínicas de los pacientes con asma en comparación con los pacientes sin asma. RESULTADOS: La prevalencia de asma en los pacientes con neumonía por COVID-19 fue del 3.5% (IC 95%: 1.5% a 9.6%). Al comparar la gravedad de la COVID-19 entre los pacientes con asma con los pacientes sin asma, ésta no difirió en función de los síntomas, la comorbilidad, la duración de los síntomas, la necesidad de ventilación mecánica asistida, los biomarcadores de inflamación y la ocurrencia de muerte. Los pacientes con asma y COVID-19 mostraron un fenotipo T2 alto, con pobre función respiratoria y sin uso de tratamiento regular para el control del asma. CONCLUSIONES: No se observaron diferencias significativas en la frecuencia de la ventilación mecánica asistida o de la muerte entre los pacientes hospitalizados por neumonía asociada con COVID-19 con y sin historia de asma.

[Geographical variation of asthma prevalence among Mexican children during the COVID-19 pandemic]. / Variación geográfica en la prevalencia de asma en niños mexicanos durante la pandemia de la COVID-19.

OBJECTIVE: The purpose of this study was to analyze the geographic variation in the prevalence of asthma in children, according to their place of residence in Mexico. METHODS: A cross-sectional analysis of the epidemiological surveillance system dataset for respiratory diseases in Mexico carried on. From 27 February to 5 November 2020, a total of 1,048,576 subjects were screened for SARS-CoV2 infection, of which 35,899 were children under 18 years of age. The strength of the association was estimated by odds ratio (OR). RESULTS: Of 1,048,576 patients who attended for SARS-CoV2 infection detection, 35,899 corresponded to pediatric patients who met the study criteria. The estimated national prevalence of asthma was 3.9% (95% CI: 3.7-4.1%). The nationwide prevalence of asthma was 3.9% (95% CI: 3.7% - 4.1%); the minimum was 2.8% (Southeast region) and the maximum 6.8% (Southeast region). Compared to the South-West Region that presented the minimum prevalence at the national level, the Northwest (OR = 2.41) and Southeast (OR = 1.33) regions showed the highest risk of asthma in pediatric population. CONCLUSIONS: The prevalence of asthma in children differed markedly among the different regions of Mexico; two regions, Northwest and Southeast, stood out. This study puts into context the role of the environment on the prevalence of asthma in children.

OBJECTIVO: Estimar la prevalencia de asma en pacientes pediátricos, según su lugar de residencia en la República Mexicana, durante la pandemia por SARS-CoV-2. MÉTODOS: Estudio transversal, llevado a cabo a partir de la revisión de datos del Sistema de Vigilancia Epidemiológica para Enfermedades Respiratorias en México, analizados del 27 febrero al 5 de noviembre de 2020. Criterios de inclusión: pacientes que acudieron a la detección de infección por SARS-CoV2, menores de 18 años. La fuerza de asociación se estimó con la razón de momios. RESULTADOS: De 1,048,576 pacientes que acudieron a la detección de infección de SARS-CoV2, 35,899 correspondieron a pacientes pediátricos que cumplieron con los criterios del estudio. La prevalencia nacional de asma estimada fue de 3.9% (IC95%: 3.7-4.1%); la prevalencia mínima se observó en la región Suroeste (2.8%) y la máxima en el Sureste (6.8%); comparada con la región Suroeste, que registró la prevalencia mínima a nivel nacional, y la Noroeste (RM = 2.41) y Sureste (RM = 1.33) mostraron el mayor riesgo de asma en la población pediátrica. CONCLUSIONES: La prevalencia de asma en niños mexicanos difirió notoriamente en los diferentes estados de la República Mexicana; sobresalieron las regiones Noroeste y Sureste. Este estudio pone de manifiesto el papel del medio ambiente en la prevalencia del asma en pacientes pediátricos mexicanos.

[Prevalence of cow´s milk allergy and lactose intolerance among Mexican late adolescents]. / Prevalencia de alergia a la leche de vaca e intolerancia a la lactosa en adolescentes tardíos mexicanos.

OBJECTIVE: To determine the prevalence of cow´s milk allergy and lactose intolerance in a sample of late adolescents. METHODS: Through a population-based study, data corresponding to students with aged 15 to 18 years were analyzed. RESULTS: A total of 1992 adolescents was analized. The prevalence of cow´s milk allergy was 1.4% (95% CI: 0.2% to 0.8%) and the prevalence of lactose intolerance was 0.5% (95% CI: 0.2% to 0.8%). Adolescents with cow´s milk allergy had fewer gastrointestinal symptoms (p = 0.036), but more skin (p < 0.001) and respiratory (p = 0.028) ailments than adolescents with lactose intolerance. CONCLUSIONS: The manifestations associated with cow's milk consumption in late adolescents seem to correspond mainly to cow´s milk allergy than to lactose intolerance.

OBJECTIVO: Determinar la prevalencia de alergia a la proteína de la leche de vaca e intolerancia a la lactosa en una muestra de adolescentes tardíos. MÉTODOS: Estudio transversal con base poblacional, en el que se analizaron los datos de pacientes adolescentes de 15 a 18 años. RESULTADOS: Se registraron 1992 estudiantes. La prevalencia de alergia a la proteína de la leche de vaca fue de 1.4% (IC95%: 0.9% a 2.0%) y de intolerancia a la lactosa de 0.5% (IC95%: 0.2% a 0.8%). Los adolescentes con alergia a la proteína de la leche de vaca tuvieron menos síntomas gastrointestinales (p = 0.036), pero más molestias cutáneas (p < 0.001) y respiratorias (p = 0.028) que los adolescentes con intolerancia a la lactosa. CONCLUSIONES: Las manifestaciones asociadas con el consumo de leche de vaca en adolescentes tardíos corresponden, principalmente, a la alergia de la proteína de la leche de vaca que a la intolerancia a la lactosa.

Serum Vitamin D Is Inversely Associated with Blood Eosinophil Count Among Adults with Allergic Asthma.

OBJECTIVE: To evaluate the role that serum vitamin D concentration plays in the number of eosinophils in peripheral blood in adults with allergic asthma. MATERIAL AND METHODS: A total of 142 patients were categorized based on different cutoff points for eosinophils: ≥200, ≥300, ≥400, and ≥500 cells/mL. The vitamin D concentration was stratified into <20 and ≥20 ng/mL. The association between vitamin D (independent variable) and eosinophils (dependent variable) was explored using multivariate analysis. RESULTS: The average number of eosinophils in the included patients was 418 cells/mL, and 33.8% of the included patients had vita- min D concentrations ≥20 ng/mL. Asthmatic patients with vitamin D< 20 ng/mL had a higher mean concentration of eosinophils than did asthmatic patients with vitamin D ≥20 ng/mL (464 ± 377.7 eosinophils/mL vs. 327.8 ± 247.2 eosinophils/mL, P = .025). We also observed that vitamin D was inversely correlated with eosinophil count (rho = 0.244, P = .003). In the multivariate analysis, vitamin D <20 ng/mL showed a significant inverse association with each cutoff value for eosinophilia (odds ratio >1). CONCLUSION: Vitamin D concentrations <20 ng/mL are associated with a significant increase in the number of eosinophils in blood. Studies that analyze the use of vitamin D supplements as complementary therapy for the treatment of asthma are needed.

[Allergy to cow's milk protein, or lactose intolerance: a cross-sectional study in university students]. / Alergia a la proteína de la leche de vaca o intolerancia a lactosa: un estudio transversal en estudiantes universitarios.

BACKGROUND: Factors like ethnic origin and geographical area affect the frequency of cow's milk protein allergy (CMPA) and lactose intolerance (LI). Epidemiological information about the non-pediatric population is still missing. OBJECTIVE: To determine the prevalence of CMPA and LI in university students. METHODS: A cross-sectional study of 1200 students of 18 to 25-year-old. A structured questionnaire was applied in order to identify the clinical manifestations triggered by the intake of cow's milk (CM), and these were categorized as linked to CMPA or linked to LI. RESULTS: Thirty students met the criteria for CMPA (prevalence of 2.5 %; CI 95 % = 1.7-3.6 %) and 128 for LI (prevalence of 10.7 %, CI 95 % = : 9.0 % - 12.5 %). The frequency of personal history of food allergy and dust mite allergy was higher in students with CMPA than in students with LI. Oral pruritus, skin and respiratory discomforts were predominant in CMPA. Abdominal cramps and flatulence were predominant in LI. CONCLUSIONS: IL is more frequent than CMPA; which frequency was one in every 10 students; and the frequency of CMPA was one in 400.

Antecedentes: El origen étnico y la zona geográfica influyen en la frecuencia de la alergia a la proteína de leche de vaca (APLV) y de intolerancia a la lactosa. Faltan datos epidemiológicos en población no pediátrica.Objetivo: Determinar la prevalencia de APLV e intolerancia a la lactosa en estudiantes universitarios.Métodos: Estudio transversal de 1200 estudiantes de 18 a 25 años. Se aplicó cuestionario estructurado para identificar manifestaciones clínicas desencadenadas por la ingesta de leche de vaca y fueron categorizadas como relacionadas con APLV o intolerancia a la lactosa.Resultados: 30 estudiantes cubrieron criterios para APLV (prevalencia de 2.5 %; IC 95 % = 1.7-3.6) y 128 para intolerancia a la lactosa (prevalencia de 10.7 %, IC 95 % = 9.0-12.5). Los estudiantes con APLV tuvieron mayor frecuencia de historia personal de alergia a alimentos y alergia a ácaros del polvo casero, comparados con los estudiantes con intolerancia a la lactosa. El prurito oral y las molestias cutáneas y respiratorias predominaron en la APLV. El cólico abdominal y las flatulencias predominaron en la intolerancia a la lactosa.Conclusiones: La intolerancia a la lactosa fue más frecuente que la APLV; se observó en uno de cada 10 estudiantes y la APLV en uno de cada 400.

Peanut allergy among Mexican adults with allergic respiratory diseases: prevalence and clinical manifestations.

BACKGROUND: Peanut allergy among adults with respiratory diseases has seldom been studied within Mexico. OBJECTIVE: To establish the prevalence of peanut allergy among adults that have been diagnosed with either asthma or allergic rhinitis; we will also be describing the symptoms that are associated with peanut allergy. METHODS: We carried out a cross-sectional study through which we analyzed the corresponding data of 257 patients with allergic respiratory diseases, asthma or allergic rhinitis, all participants were 16 years of age or older, and were recruited in a consecutive manner. Peanut allergy was established by testing positive to a peanut skin-prick test; we also conducted a standard interview with each patient. RESULTS: From our sample of 257 patients, 18 tested positive to peanut sensitization, (7.0%; 95% CI = 3.9% to 10.1%); among these 18 participants, 7 were considered to be allergic to peanuts (2.7%; 95% IC: 0.7% to 4.7%). Predominant symptoms were oral, primarily affecting the pharynx and the palate, followed by swelling of the lips. When it came to respiratory discomfort, sneezing and rhinorrhea stood out, and lastly there were cutaneous symptoms. We did not detect any systemic reactions to the peanut. CONCLUSION: In our study, peanut allergy among adults with allergic respiratory diseases is not an uncommon occurrence.

Antecedentes: La alergia al cacahuate en adultos con enfermedades respiratorias alérgicas pocas veces ha sido estudiada en México. Objetivo: Establecer la prevalencia de alergia al cacahuate en un grupo de adultos con asma o rinitis alérgica; también se describen los síntomas asociados con la alergia al cacahuate. Métodos: Se realizó estudio transversal en el que analizaron los datos correspondientes a 257 pacientes con enfermedades respiratorias alérgicas, asma o rinitis alérgica, con edad igual o mayor a 16 años; los pacientes fueron reclutados consecutivamente. La alergia al cacahuate se determinó por una prueba cutánea positiva al cacahuate y a través de una entrevista estandarizada. Se estimaron intervalos de confianza (IC) a 95 % para proporciones. Resultados: De los pacientes incluidos, 18 estuvieron sensibilizados al cacahuate (7.0 %, IC 95 % = 4.4-10.9), siete de ellos fueron considerados alérgicos al cacahuate, para una prevalencia de 2.7% (IC 95%: 1.2% - 5.6%). En los pacientes con alergia al cacahuate, los síntomas predominantes fueron los orales, principalmente el prurito en la faringe y en el paladar, seguidos de edema de los labios; entre las molestias respiratorias sobresalieron los estornudos y la rinorrea y, al final, los síntomas cutáneos. No se documentaron reacciones sistémicas al cacahuate. Conclusión: En nuestro estudio, la alergia al cacahuate en adultos con enfermedades respiratorias alérgicas no fue infrecuente.