[Asthma and pregnancy]. / Asma y embarazo.

Asthma is among the diseases that may complicate pregnancy. Asthma affects up to 4% of the pregnant women. Uncontrolled asthma may impair the proper oxygenation of both mother and child. According to asthma severity clinical manifestations may be unapparent or apparent requiring hospital treatment. It is necessary that pregnant asthmatic woman check daily the peak-flow by portable peak-flow meters. The asthma pharmacological treatment should consider the changes in the physiology of the pregnancy, such as low albumin and carrier proteins for the drugs inducing high levels of free active drugs. This point is important for theophylline, besides the low drug clearance. Bronchodilator should be used as they are required, using the inhaled forms, as well as short term corticoid courses. The goal of the treatment is to control the symptoms, avoid relapse and keep the ventilatory function close to the normal, in order to achieve a satisfactory state of the mother and the children.

Double-blind comparison of cetirizine and loratadine in children ages 2 to 6 years with perennial allergic rhinitis.

Antihistamines are the pharmacologic cornerstone of treatment for allergic rhinitis. The comparative effects of the newer, more specific H (1) -antagonists cetirizine and loratadine among younger patients are not well characterized. The efficacy and safety of cetirizine and loratadine were compared in a prospective, randomized, double-blind, longitudinal, parallel-group study of 80 children, 2 to 6 years of age, with perennial allergic rhinitis caused by house dust mites or plant pollens (verified by a radioallergosorbent or skin test). Patients received cetirizine or loratadine at 0.2 mg/kg once daily in the morning for 28 days. Histamine skin tests and eosinophil counts from nasal smears were performed at baseline and at the end of treatment. Individual rhinitis symptoms were assessed by the investigator at baseline and on day 28 and by parents at baseline and daily in symptom diaries. Global assessments were made by using a visual analog scale at baseline and at the end of treatment. Cetirizine produced significantly greater inhibition of the wheal response compared with loratadine (P <.0001). Eosinophil counts were improved to a comparable degree with both agents. Cetirizine and loratadine produced comparable improvements in symptoms and according to a global evaluation as assessed by the investigator at the end of treatment. Both agents produced substantial symptomatic relief according to patients' daily diary assessments; however, cetirizine was more effective than loratadine in relieving the symptoms of rhinorrhea, sneezing, nasal obstruction, and nasal pruritus (P <. 0001). Both treatments were well tolerated; two patients receiving cetirizine were dropped from the study because of adverse events. Cetirizine and loratadine provided effective, well-tolerated relief of the symptoms of perennial allergic rhinitis in small children. Cetirizine was more effective than loratadine in inhibiting the wheal response to histamine challenge and afforded greater reductions in most individual symptoms assessed daily by the parent.

Metabolic and electrocardiographic effects of albuterol in pediatric asthmatic patients treated in an emergency room setting.

beta 2 agonists are first election drugs for the treatment of asthma exacerbations. However, rates of complications derived from this asthma therapy like cardiovascular effects have addressed question marks on a possible paradoxical condition, leading to an increased mortality rate. The study was open label, non controlled and aimed to assess the effect of albuterol nebulizations on serum potassium levels, arterial oxygen saturation and electrocardiographic changes in asthma exacerbation in pediatric patients. Albuterol was administered at a dose of 150 mcg/kg/course for 10 minutes in two occasions. Thirty children with mild to moderate asthmatic exacerbation, admitted to emergency room, were included in the study. Bronchodilators administration in the previous 24 hours and history of cardiac or metabolic disease were considered exclusion criteria. Drugs affecting serum potassium were not allowed. Severity of exacerbation was rated by the Wood-Downes criteria. Average sample age was 7.4 +/- 1 years, heart rate increased from 111 +/- 23.23 to 130.0 +/- 22.14 beats/minute, with no clinical significance; serum potassium levels decreased from 4.47 +/- 0.52 to 3.73 +/- 0.49 mEq/L between baseline and final visits, respectively; QTc interval was significantly enlarged from 0.397 to 0.418 milliseconds between initial and final records (p < 0.001), but had no clinical meaning. No arrhythmias were recorded. Pulse oxymetry did not show significant changes (90.6 +/- 3.0% and 92.1 +/- 3.2 at baseline and final visits). The most common reported adverse event was distal tremor, which was present in 80% of the cases. Neither serum potassium decrement nor prolonged QTc after albuterol had clinical significance. Albuterol is a safe drug for the treatment of mild to moderate asthma exacerbations in pediatric patients.

Association analysis of polymorphisms in the interleukin-4 receptor (alpha) gene with atopic asthma in patients from western Mexico.

We undertook an association analysis between the ile50val, glu375ala, cys406arg, and ser761pro polymorphisms of the IL-4Ralpha gene and atopic asthma, total IgE levels and IL-4 serum levels in a population from western Mexico. We found that the ser761pro polymorphism was monomorphic for ser761, while there was no association between any of the other polymorphisms and the three phenotypes analysed.

[Antihistaminics]. / Antihistamínicos.

The antihistamines are drugs who compete for the histamine receptor H-1, blocking the liberation of autacoid mediators, that is the reason for their action in allergic diseases. It's important to know the pharmacodynamics and pharmacokinetics of these drugs in order to choose the best one for the patient, looking for the ones who have less side effects and work better. We show a summary of the principal antihistamines, their actions and side effects.

[Asthma physiopathology]. / Fisiopatología del asma.

Bronchial asthma is a very common disease but often the diagnosis and treatment is not done correctly. The physiopathology is very complex in which are involved neuroimmune mechanism with imbalance between sympatic-parasympatic system, and the other pathways including non adrenergic non colinergic and neuropeptide factors. The immunologic participation with a high level of IgE and the activation of the interleukins, all these together with very active participation of the adhesives, are the responsible for the activations and action of the chemical substances who are the origin of the bronchospasm and inflammation.

[Mastocytosis in children. Report of 3 cases]. / Mastocitosis en la edad pediátrica. Comunicación de tres casos.

The mastocytosis is a disease characterized by an increase in mast cell number, and may present in childhood. It is classified as cutaneous or systemic mastocytosis. Cutaneous mastocytosis generally is selected in childhood. It is important to be aware of systemic complications. Systemic mastocytosis is adult-onset and its clinical presentations is caused by histamine, leucotrienes, prostaglandins and other mediators' release. The treatment is directed at symptomatic relief. Several cases are reported at Hospital Infantil de México Federico Gómez. Only 3 cases are presented of these benign child-onset diseases.

[Comparison of 2 skin test methods for the diagnosis of allergic diseases]. / Comparación de dos métodos de pruebas cutáneas para el diagnóstico de enfermedades alérgicas.

Diagnosis of allergic diseases is realized by clinical history and cutaneous tests to determine the causative allergen. As several cutaneous test exist we consider necessary evaluate sensibility and specificity of epicutaneous (EP) and intradermic (ID) test. All open, prospective transversal study was carried out. The study included 45 patients suffering asthma, allergic rhinitis or both. The patients underwent both kind of test, with 10 allergens: Dermatophagoides pteronyssinus, Fraxinus, Ligustrum, Quereus, Schinus, Phleum, Amaranthus, Ambrosia, Artemisa. Alternaria and Hormodendrum. The mean age was 12 years. No difference was found comparing positive results for tree, grass, weed and molds allergens using both test. Instead for Dermatophagoides pt EP had 92.5% of sensibility and 100% of specificity, mean while ID has 100% of sensibility and 96.6% of specificity. We conclude that ID test have greater sensibility and EP have greater specificity, we recommend use EP for first instance.