[Failure of allergen-based immunotherapy in adults with allergic asthma]. / Fracaso de la inmunoterapia con alergenos en pacientes adultos con asma alérgica.

BACKGROUND: The allergic asthma is the reversible chronic inflammatory process at the airways, secondary to exaggerate reply to the allergens exposition, its treatment includes: avoiding the exposure to allergens, pharmacology therapy and the specific immunotherapy with allergens (ITA), which is based on the growing dosages of the extract allergenic; the objectives are to modify the immune response and to improve the allergic disease. The ITA can fail due to causes attributable to the patient, vaccine-inherent causes and/or factors related to the allergic disease. OBJECTIVE: To determine the main causes of specific immunotherapy with allergens' failure in our hospital. MATERIAL AND METHODS: In the present study 126 records of patients with allergic asthma treated in the extern consultation service of the clinical immunology and allergy department of the CMN 20 de Noviembre, ISSSTE, were reviewed from January 1996 to December 2001. RESULTS: It was found that specific immunotherapy with allergens, failed in 32 (23%) patients. Main causes of failure were: 1) withdrawal in the vaccine application in 19 (59%) patients; 2) high serum levels of IgE. The co-morbidities that contribute to poor responses to the treatment were: obesity, gastroesofageal reflux and chronic rhynosinusitis. CONCLUSIONS: Specific immunotherapy with allergens is an alternative method of allergic asthma's treatment which has been approved by national and international medical consensus. Main causes of failure in our hospital are the abandon of treatment and high serum levels of IgE, as well as the existence of other conditions.

[Quality of life evaluation in the patient with allergic rhinits]. / Evaluación de la calidad de vida del paciente con rinitis alérgica.

BACKGROUND: The introduction of the evaluation tools, such as the quality of life-questionnaires, allows to assess how functional alterations due to an illness affect the patient's life. OBJECTIVE: To know the emotional, social and occupational state of allergic rhinitis patients. MATERIAL AND METHODS: Quality of life questionnaires were applied once to a group of 50 patients with allergic rhinitis diagnosis from the clinic immunology and allergy service, from May to August 2002. RESULTS: Female sex was the predominant (64%), with ages from 8 to 74 years (average of 36.9 years). In women severe rhinitis was observed in 37.5%, and in men mild rhinitis was found in 61%. The main occupations were: student (20%), administrative (20%) and teacher (18%). Nasal symptoms appeared when doing the following activities: housework in 18 cases (36%), reading in 10 cases (20%) and house maintenance in 5 cases (10%). In the analysis done to know the usefulness of the questionnaire a sensitivity of 90% and a specificity of 85% were found. CONCLUSIONS: The quality of life was found to be altered, affected and closely related to the presentation of nasal symptoms when doing different daily-life activities, which produces dissatisfaction in patients.

[Allergic asthma and interleukins 2, 4, 5, 6 and 12 and gamma interferon levels]. / Asma alérgica y concentraciones de interleucinas 2, 4, 5, 6 y 12 e interferón gamma.

BACKGROUND: Asthma is an inflammatory chronic illness, in which mastocyt cells, basophils, T lymphocytes, eosinophils and cytokines play a role. Its association with the production of TH2 cytokines is not well known, but it is considered an aberrant immune response, yielding the activation and recruitment of a number of effector cells (mastocyts/eosinophils) and the appearance of clinical symptoms. OBJECTIVE: To determine the serum values of the interleukins 2, 4, 5, 6 and 12 and gamma interferon in relation to the severity degree of asthma and the time of immunotherapy in patients with stable chronic allergic bronchial asthma. MATERIAL AND METHODS: Clinical records of allergic asthmatic patients from the external consultation at Servicio de Alergia e Immunología Clínica were reviewed in a period of 12 months (1st January 2002 to 1st January 2003) and those of healthy volunteers, forming three groups: Group 1, allergic asthmatics with immunotherapy less than 24 months; Group 2, allergic asthmatics with more than 24 months of immunotherapy, and Group 3, healthy volunteers (control group). Previous informed consent, a serum sample was taken of all subjects. RESULTS: Ninety-two subjects were included: 41 (45%) allergic asthmatics and 51 (55%) healthy volunteers. Significant differences were found in interleukins 2, 4, 5, 6 and 12 levels between healthy volunteers and asthmatics without relating the immunotherapy time. In the total group gamma interferon levels were not found. A relation of interleukins Th2 levels with the severity degree of asthma was not found. Differences of serum interleukins Th1 and Th2 in allergic patients related to immunotherapy time were not significant; even though, irrespective of immunotherapy time, IgG levels were always high. CONCLUSIONS: Patients with allergic asthma have a predominance of serum interleukins Th2 and, despite of the immunotherapy, in the maintaining phase, these continue high, which may be due to an immune system dysregulation maybe including other factors. Immunotherapy continues being one of the most useful specific treatments in allergic diseases, demonstrated by its satisfactory clinical response, reduced drugs' use and modification in severity and evolution of the disease.

[Presence of anti-Helicobacter pylori, antithyroid, and high-affinity IgE receptor antibodies in patients with chronic urticaria]. / Presencia de anticuerpos anti-Helicobacter pylori, antitiroideos y antirreceptor de alta afinidad de la inmunoglobulina E en pacientes con urticaria crónica.

BACKGROUND: Chronic urticaria is characterized by erythematous wheals during more than 6 weeks. In 47% of the patients it is associated to Helicobacter pylori infection; in 50%, to antibodies (Abs) against the high affinity receptor of the IgE, and in 12 to 20% to antithyroid's antibodies (antithyroglobuline, mychrosomals) and, from these, 25% have alterations of the thyroid function. OBJECTIVE: To determine the presence of the anti-Helicobacter pylori and anttihyroids antibodies and the high affinity anti-receptor of the IgE in healthy subjects and patients with chronic urticaria. MATERIAL AND METHODS: Eighty subjects were included: 40 healthy subjects and 40 patients whit diagnosis of chronic urticaria. In all of them a blood sample was extracted to the determination of the antibodies and skin test applications with autologous serum to determine the antibody of the high affinity anti-receptor of IgE. For the analysis of the results descriptive statistics was used (central tendency measures, frequencies, means, averages and percentages), as well as multiple correlations and inferential analyses. RESULTS: Anti-Helicobacter pylori, antithyroid (antithyroglobulin, microsomal) antibodies and the skin test with autologous serum (antibody of the high affinity anti-receptor of IgE) were negative in the healthy group (mean age: 41 years, 36 women, 90%). Of the 40 patients with chronic urticaria (mean age: 42 years, 36 women, 90%), the frequency of the antibody of high affinity anti-receptor of the IgE was: 5 patients with negative skin test (12.5%), 1 (2.5%)+, 7 (17.5%)++, 9 (22.5%)+++, 18 (45%)++++. The anti-Helicobacter pylori antibodies were positive in 30 (75%) patients and negative in 10 (25%). The antithyroid's antibodies were as follows: antithyroglobulin: 4 (10%) positive, microsomal: 4 (10%) positive. The concomitant diseases found were: hypothyroidism (3, 7.5%) mixed rhinitis (2.5%) and autoimmunity 2 (5%). CONCLUSION: The test skin with autologous serum to determine the IgG antibody against the high affinity receptor of IgE is a simple and low-cost procedure leading to determine the cause of the idiopathic chronic urticaria in a high percentage of patients. As reported in literature, the Helicobacter pylori infection documented by the detection of the IgM antibodies against Helicobacter pylori is frequent in patients with chronic urticaria, which is important due to it could be implied in the diagnosis and treatment.

[Preeclampsia-eclampsia: a change in utero-placental microcirculation. Immunologic, histologic, and biochemical features]. / Preeclampsia-eclampsia: una alteración en la microcirculación útero-placentaria. Aspectos inmunológicos, histológicos y bioquímicos.

BACKGROUND: To know the alterations in the microcirculation of the placenta, umbilical cord, as well as the immune and hemorrheologic disorders in preeclampsia-eclampsia. MATERIAL AND METHODS: Two groups were conformed, 30 patients each, all of them with pregnancy of more than 24-week gestation. Group A included patients with preeclampsia-eclampsia and group B (control group) included women with normal pregnancy. In all patients determinations of levels of platelets, fibrinogen, antinuclear antibodies, IgG and IgM anticardiolipin, VDRL were made; clotting times were determined, and histopathologic analyses (placenta, umbilical cord and uterus-placenta membranes) were performed. RESULTS: Platelet levels in the group A were normal in 40% and low in 60%. In group B they were normal in 83.3% and low in 16.7%. with p < 0.05. In group A fibrinogen was normal in 10% and high in 90%; in the group B it was normal in 62.1% and high 37.9%, with p < 0.05. In group A prothrombin time (PT) was normal in 40% and high in 60%; in group B it was normal in 76.7% and low in 23.3%, with p < 0.05. in group TPT was normal in 36.7% and high in 62.1%, with p > 0.05. VDRL was negative in the 100% of the women of group A and positive in the 3.3% of the controls with p > 0.05. The antinuclear antibodies were positive in 6.7% in group A, and in 23.3% in group B, p < 0.05. IgG anticardiolipin antibodies were negatives in the 100% in both groups and IgM antibodies were negative in 96.7% in the group B and 3.3% in group A, p > 0.05. Analysis of histopathologic and immune changes did not show statistic significance when comparing both groups. CONCLUSIONS: Statistical and clinical significance was observed only in the hemorrheologic changes (PT, TPT, fibrinogen and platelets) and in the newborn weight.

Uso de vacuna bacteriana de Staphylococcus en pacientes pediátricos con sinusitis crónica / Use of Staphylococcus bacterial vaccine in pediatric patients with chronic synusitis

Introducción. Los extractos antigénicos de vacuna bacteriana (Staphylococcus aureus) incrementan la fagocitosis, las concentraciones de inmunologlobulinas y ayudan en la respuesta inmunológica. Objetivo. Determinar la eficacia de la vacuna bacteriana en pacientes pediátricos con sinusitis crónica. Material y método. A través de un estudio prospectivo, observacional, descriptivo y longitudinal se estudiaron 50 pacientes con diagnóstico clínico y radiológico de sinusititis crónica en el periodo de mayo de 1997 a julio de 1998; se trataron con tres esquemas de antibióticos, se les efectuaron estudios de citología hemática, de moco, exudado faríngeo y determinación de inmunoglobulinas y radiografías de senos paranasales. Se aplicó el extracto de 0.1 ml hasta 0.5 ml dos veces por semana, vía subcutánea durante ocho meses, con seguimiento de seis meses y control de citología hemática, así como determinación de inmunoglobulinas. Resultados. 82 por ciento (41) de los pacientes mejoraron y nueve (18 por ciento) persistieron con síntomas, de éstos cinco requirieron la prescripción de antimicrobianos, tres amigdalectomía. Hubo un incremento de inmunoglobulina, principalmente de la IgA e IgG en 38 (76 por ciento) pacientes

Evaluación clínica del cromoglicato de sodio en solución nasal al 2 por ciento en el tratamiento de la rinitis alérgica / Clinic evaluation of the 2 per cent cromoglycate sodium chomoglycate nasal solution in the allergic rhinitis

Resultados de un estudio doble ciego donde 30 pacientes con síntomas de rinitis alérgica y edades de 6 a 50 años fueron asignados aleatoriamente para recibir solución activa con CGS al 2 por ciento, un disparo en cada narina cada seis horas o solución con placebo. Todos los individuos recibieron astemizol 10 mg en ayunas diariamente e hiposensibilización durante un periodo de seis meses a dos años. Se revisaron los diarios en donde se anotaban los síntomas de los pacientes cada dos semanas durante siete visitas y se les efectuó exploración física. Ambos grupos tuvieron promedio de agudización de síntomas de rinitis comparable al inicio del estudio. Después de 45 días de tratamiento y en el seguimiento a tres meses, los promedios de síntomas indicaron superioridad del CGS en solución nasal para reducir la gravedad de la rinorrea, obstrucción nasal y estornudos; así como disminución de la secreción nasal y edema de cornetes (p<0.001). Los pacientes con CGS mejoraron significativamente según la valoración global hecha por el investigador (p<0.05). No hubo efectos secundarios en ninguno de los grupos

Efectividad del cromoglicato de sodio en la reducción de las dosis de broncodilatadores en pacientes asmáticos / Effectivity of the sodium chromoglycate in the decrease in the use of bronchial dilators in asthmatic patients

Se estudiaron 30 asmáticos con límite de edad entre seis y 72 años, a quienes se hizo una evaluación clínica con duración de 14 semanas en las que se investigó gravedad de disnea, tos, expectoración y sibilancias. El cromoglicato de sodio (CGS) se administró en forma de aerosol inhalado a partir de la segunda semana y el esquema de reducción de broncodilatadores se puso en práctica a partir de la semana cuatro, reduciendo 25 porciento de la dosis total establecida inicialmente, cada dos semanas. En el estudio, el CGS demostró ser útil para disminuir los síntomas provocados por la hiperreactividad bronquial y en 70 porciento la necesidad de uso de broncodilatadores en los asmáticos en quienes se desencadenaron síntomas con un solo factor de riesgo (frío, el más frecuente).

Vasculitis e infección viral / Vasculitis and viral infection

A 17 pacientes con diagnóstico de vasculitis primaria idiopática se les realizó valoración inmunitaria y de anticuerpos antivirales. Se comparó su biometría hemática y sus anticuerpos antivirales con 25 testigos sanos. Todos los pacientes y testigos HIV y HBV resultaron negativos. Se demostró actividad viral por IgM en ocho pacientes: cinco con púrpura vascular, una con enfermedad de Takayazu, una con poliarteritis nodosa y la otra con eritema nodoso. Ningún testigo tuvo IgM positiva. Se detectaron 14 anormalidades en la biometría hemática de los pacientes y en cuatro testigos. Los pacientes exhibieron respuestas de anticuerpos IgG menores que los testigos, alteraciones en subpoblaciones linfocitarias y complejos inmunitarios circulantes. El 47 por ciento de los pacientes tenía infección viral activa, pero la característica predominante fue una respuesta inmunitaria anormal en 82 por ciento

Esclerosis múltiple / Multiple sclerosis

La esclerosis múltiple es un padecimiento neurológico con participación de mecanismos fisiopatológicos de autoinmunidad e inmunodeficiencia, con rasgos variables de respuesta inmunitaria. Estos rasgos pueden generalizarse en tres grandes subgrupos: Tipo I: defecto específico de la respuesta inmunitaria: Tipo II: inmunodefíciencia que desencadena respuestas autoinmunitarias; Tipo III: respuestas mixtas, autoinmunidad concomitante con un defecto de la respuesta inmunitaria con citotoxicidad aumentada. De la comprensión de estos mecanismos de respuesta surge una explicación racional en relación con los diversos cambios inmunológicos que cursan los pacientes con esclerosis múltiple y, considerando estas hipótesis de tipo de respuesta es factible orientar la terapéutica para el logro de una mayor eficacia de la misma