Do immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies have distinct implications in children with acute lymphoblastic leukemia? A cross-sectional study.

BACKGROUND: l-Asparaginase is essential in the treatment of childhood acute lymphoblastic leukemia. If immunoglobulin G anti-l-asparaginase antibodies develop, they can lead to faster plasma clearance and reduced efficiency as well as to hypersensitivity reactions, in which immunoglobulin E can also participate. This study investigated the presence of immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies and their clinical associations. METHODS: Under 16-year-old patients at diagnosis of B-cell acute lymphoblastic leukemia confirmed by flow cytometry and treated with a uniform l-asparaginase and chemotherapy protocol were studied. Immunoglobulin G anti-l-asparaginase antibodies were measured using an enzyme-linked immunosorbent assay. Intradermal and prick skin testing was performed to establish the presence of specific immunoglobulin E anti-l-asparaginase antibodies in vivo. Statistical analysis was used to investigate associations of these antibodies with relevant clinical events and outcomes. RESULTS: Fifty-one children were studied with 42 (82.35%) having anti-l-asparaginase antibodies. In this group immunoglobulin G antibodies alone were documented in 10 (23.8%) compared to immunoglobulin E alone in 18 (42.8%) patients. Immunoglobulin G together with immunoglobulin E were simultaneously present in 14 patients. Children who produced exclusively immunoglobulin G or no antibodies had a lower event-free survival (p-value=0.024). Eighteen children (35.3%) relapsed with five of nine of this group who had negative skin tests suffering additional relapses (range: 2-4), compared to none of the nine children who relapsed who had positive skin tests (p-value<0.001). CONCLUSION: Children with acute lymphoblastic leukemia and isolated immunoglobulin G anti-l-asparaginase antibodies had a higher relapse rate, whereas no additional relapses developed in children with immunoglobulin E anti-l-asparaginase antibodies after the first relapse.

[Evaluation of functional capacity by 6-minute walk test in children with asthma]. / Evaluación de la capacidad funcional mediante prueba de marcha de 6 minutos en niños con asma.

BACKGROUND: Asthma patients show lower exercise tolerance. OBJECTIVE: Assessment of functional capacity in children with asthma. METHODS: Girls and boys from 6 to 17 years old were included in two groups: asthmatic patients and healthy subjects. PSPQ was applied and vital signs, peak expiratory flow and Modified Borg Dyspnea Scale were measured at the beginning and the end of 6MWD. RESULTS: Participants included 58 subjects, including 32 asthmatic patients, and 55.2 % male subjects. Mean age: 10.6 years ± 3.1. Asthmatic group: mean distance covered in meters 456.04 ± 54.05, meters covered by gender 456.31 ± 48.73 male and 455.74 ± 61.29 female (p = 0.28). Control group: the mean was 468.28 ± 54.52 meters, meters covered by gender 465.98 ± 58.04 male, 471.44 ± 51.95 female (p = 0.35). The difference between asthmatic group and control group was 12.24 meters in favor of control group (p = 0.378). There was no association between body mass index (BMI) and distance covered (p = 0.53), but a Pearson correlation p = -0.445. In the male gender, CF was positively associated with self-perception in CAF variables: physical condition, physical attractiveness, strength (p = 0.04) and physical self-concept in general (p = 0.02). CONCLUSIONS: There was no significant difference in the distance covered between the two groups. The main impact factor was the body mass index with an inverse relation to the distance. Males had better physical self-perception, which is positively associated with CF.

Antecedentes: los pacientes con asma muestran menor tolerancia al ejercicio. Objetivo: evaluar la capacidad funcional en niños con asma. Métodos: se incluyeron pacientes con asma de 6 a 17 años y un grupo control sano. Se registraron signos vitales, flujometría, escala de disnea y fatiga de Borg antes y después de prueba de marcha de seis minutos; se aplicó el Cuestionario de Autopercepción Física. Resultados: participaron 58 sujetos, 32 con asma, 55.2 % del sexo masculino. La edad fue de 10.6 años ± 3.1 años. En el grupo con asma, la distancia media recorrida fue de 456.04 ± 54.05 m; en los hombres de 456.31 ± 48.73 m y en las mujeres de 455.74 ± 61.29 m (p = 0.28). En el grupo control, la distancia media fue de 468.28 ± 54.52 m; en niños de 465.98 ± 58.04 m y en las niñas de 471.44 ± 51.95 m (p = 0.35). La diferencia entre los grupos con asma y control fue de 12.24 m, a favor del control (p = 0.378). No hubo asociación entre el índice de masa corporal y la distancia recorrida (p = 0.53). En el sexo masculino, la capacidad funcional se asoció positivamente con la condición física, atractivo físico, fuerza (p = 0.04) y autoconcepto físico en general (p = 0.02) del Cuestionario. Conclusiones: no hubo diferencia significativa entre los grupos en la distancia recorrida. El principal factor de impacto fue el índice de masa corporal, con una relación inversa a la distancia recorrida. El sexo masculino tuvo mejor autopercepción física, asociada positivamente con la capacidad funcional.

A High Level of Soluble CD40L Is Associated with P. aeruginosa Infection in Patients with Cystic Fibrosis.

OBJECTIVE: The aim of this study was to evaluate whether the concentration of sCD40L, a product of platelet activation, correlates with the presence of Pseudomonas aeruginosa in the airway of patients with cystic fibrosis (CF) and to determine its possible clinical association. METHODS: Sixty patients with CF, ranging in age from 2 months to 36 years, were studied. The demographics, cystic fibrosis transmembrane conductance regulator (CFTR) genotype, spirometry measurements, radiographic and tomographic scans, platelet count in peripheral blood, sCD40L, IL-6, TNF-α and ICAM1 data were collected. Infection-colonization of the airway was evaluated using sputum and throat swab cultures; the levels of anti-Pseudomonas aeruginosa antibodies (Anti-PaAb) were evaluated. RESULTS: Patients with CF and chronic colonization had anti-PaAb values of 11.6 ± 2.1 ELISA units (EU) and sCD40L in plasma of 1530.9 ±1162.3 pg/mL; those with intermittent infection had 5.7 ± 2.7 EU and 2243.6 ± 1475.9 pg/mL; and those who were never infected had 3.46 ± 1.8 EU (p≤0.001) and 1008.1 ± 746.8 pg/mL (p≤0.01), respectively. The cutoff value of sCD40L of 1255 pg/mL was associated with an area under the ROC (receiver operating characteristic curve) of 0.84 (95% CI, 0.71 to 0.97), reflecting P. aeruginosa infection with a sensitivity of 73% and a specificity of 89%. Lung damage was determined using the Brasfield Score, the Bhalla Score, and spirometry (FVC%, FEV1%) and found to be significantly different among the groups (p≤0.001). CONCLUSION: Circulating sCD40L levels are increased in patients with cystic fibrosis and P. aeruginosa infection. Soluble CD40L appears to reflect infection and provides a tool for monitoring the evolution of lung deterioration.

Do immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies have distinct implications in children with acute lymphoblastic leukemia? A cross-sectional study

Abstract Background l-Asparaginase is essential in the treatment of childhood acute lymphoblastic leukemia. If immunoglobulin G anti-l-asparaginase antibodies develop, they can lead to faster plasma clearance and reduced efficiency as well as to hypersensitivity reactions, in which immunoglobulin E can also participate. This study investigated the presence of immunoglobulin G and immunoglobulin E anti-l-asparaginase antibodies and their clinical associations. Methods Under 16-year-old patients at diagnosis of B-cell acute lymphoblastic leukemia confirmed by flow cytometry and treated with a uniform l-asparaginase and chemotherapy protocol were studied. Immunoglobulin G anti-l-asparaginase antibodies were measured using an enzyme-linked immunosorbent assay. Intradermal and prick skin testing was performed to establish the presence of specific immunoglobulin E anti-l-asparaginase antibodies in vivo. Statistical analysis was used to investigate associations of these antibodies with relevant clinical events and outcomes. Results Fifty-one children were studied with 42 (82.35%) having anti-l-asparaginase antibodies. In this group immunoglobulin G antibodies alone were documented in 10 (23.8%) compared to immunoglobulin E alone in 18 (42.8%) patients. Immunoglobulin G together with immunoglobulin E were simultaneously present in 14 patients. Children who produced exclusively immunoglobulin G or no antibodies had a lower event-free survival (p-value = 0.024). Eighteen children (35.3%) relapsed with five of nine of this group who had negative skin tests suffering additional relapses (range: 2-4), compared to none of the nine children who relapsed who had positive skin tests (p-value < 0.001). Conclusion Children with acute lymphoblastic leukemia and isolated immunoglobulin G anti-l-asparaginase antibodies had a higher relapse rate, whereas no additional relapses developed in children with immunoglobulin E anti-l-asparaginase antibodies after the first relapse.

Prevalence of eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease symptoms: A prospective study.

BACKGROUND: Eosinophilic esophagitis (EoE) is not routinely considered in the differential diagnosis of refractory gastroesophageal reflux disease (GERD). AIMS: To prospectively evaluate the prevalence of EoE and describe the clinical features and predictors of EoE in patients with refractory symptoms of GERD. METHODS: Esophageal biopsies were obtained in patients with symptoms of GERD refractory to 8 weeks of conventional antisecretory therapy. Diagnosis of EoE was defined as at least 20 eosinophils × high power field and clinical unresponsiveness to proton pump inhibitors. Clinical and manometric features were compared. Independent risk factors predicting EoE were identified. RESULTS: Six out of 150 included patients (4%) met the diagnostic criteria for EoE. Patients with EoE were significantly younger, had significantly more dysphagia, atopy, ineffective esophageal peristalsis, esophageal rings and esophageal strictures than patients without EoE. Independent predictors of EoE were: age under 45 years (OR 4.8, 95% CI 2.4-8.6), dysphagia (OR 12.2, 95% CI 4.3-19.4), and atopy (OR 3.4, 95% CI 1.5-7.4). CONCLUSIONS: EoE is an uncommon condition (4%) in patients with refractory symptoms of GERD. Age under 45 years, atopy or dysphagia may warrant suspicion of EoE in this subset of patients.

[Prevalence of hymenoptera sting allergy in veterinary medicine students from Monterey, Nuevo Leon, Mexico]. / Prevalencia de la alergia a la picadura de himenópteros en estudiantes de medicina veterinaria de la ciudad de Monterrey, Nuevo león, México.

BACKGROUND: The reported prevalence of allergic systemic reactions to hymenoptera venom occur in up to 3.3% and large local reactions occur in 17% in the general population. OBJECTIVE: To investigate the prevalence of hymenoptera sting allergy in a group of veterinary medicine students from Monterrey, Nuevo Leon, Mexico. PARTICIPANTS AND METHODS: A transverse and observational study was done with 64 students of veterinary medicine. We conducted a questionnaire about the students' history of insect allergy and atopy. Skin test with allergenic extracts of bee and ant were practiced to all subjects. We performed aeroallergen skin prick test to the subjets with suspected atopy. RESULTS: Students age ranged from 17 to 25 years (mean 20.2) and 37 were males. Twenty students (31.3%) had clinical history of atopy and positive skin tests to aeroallergens. On the other hand, 5 students (7.8%), including 2 atopic, had suffered large local reactions, but none of them had suffered systemic reactions. Bee and ant skin tests were positive in 15.6% and 31.3% of the students respectively. There was no difference in the prevalence of hymenoptera allergy between atopic and non atopic subjects (p < 0.05). Further, the frequency of atopy in subjects with positive skin tests for bee and ant was 50%. CONCLUSION: The prevalence of large local reactions and hymenoptera sensitization found in this group was similar to that found in other epidemiologic studies.

[Costs due to asthma medical care in a group of children from northeastern Mexico]. / Costos derivados de la atención médica del asma en un grupo de niños del Noreste de México.

BACKGROUND: In 1998 the economic burden of asthma in the United States was estimated in 12.7 billion dollars. In Mexico the annual direct costs for asthma could be approximately from 32 to 35 million dollars. OBJECTIVE: To estimate the healthcare costs in asthmatic children in the Northeast of Mexico. MATERIAL AND METHODS: A descriptive cross-sectional study was performed. We applied a questionnaire to the parents of 60 asthmatic children. They attended to a conference about asthma and allergy illnesses. In this questionnaire the parents answered some questions that provided us information about expenditures because of the treatment of their children with asthma during the last year. RESULTS: Fifty-six questionnaires were answered correctly. The mean age of children was 10.8 +/- 2.5 years and 64.3% of them were males. The annual costs reported by patient were < or = 225 USD for medical consultation (76.8%) and < or = 134 USD for immunotherapy (81.6%). On the other hand, the costs for emergency department visits and hospitalization were < or = 45 USD and < or = 180 USD by each event respectively. CONCLUSIONS: The costs of asthma treatment in children are considerable and cause a huge impact in the family economy. It is necessary further research in bigger groups and doing comparative studies among different groups will help clarify the extent of the economic burden of asthma in Mexico.

[Prevalence of allergy to drugs in a group of asthmatic children and adolescents of northeast of Mexico]. / Prevalencia de alergia a medicamentos en un grupo de niños y adolescentes asmáticos del noreste de México.

BACKGROUND: Drug adverse reactions are a common cause of morbidity and they constitute an important challenge in medical practice. The allergic reactions represent only a small proportion of all the drug adverse reactions and although their real prevalence is unknown, some estimated numbers have been suggested. It seems that atopia is not a risk factor for the development of this kind of reactions. PATIENTS AND METHODS: A cross-sectional descriptive study was performed to assess the prevalence of drug allergy in asthmatic children of the northeast of Mexico that attend summer camps. We investigated the history of drug adverse reactions and their clinical features in 90 atopic asthmatic patients from 5 to 15 years old which were evaluated trough a questionnaire that was completed by their parents. RESULTS: Eight of the 90 evaluated patients (8.8%) had history of adverse reactions to some drug. The drugs involved in that reactions were: penicillin in four patients (50%), aspirin in 2 (25%), trimethoprim and sulfamethoxazole in one (12.5%) and metamizole sodium in one (12.5%). The most common administration route was oral. In all of the cases the diagnosis was made on clinical basis. One of the patients had suffered from anaphylaxis, but in the other seven, urticaria was the unique clinical manifestation of the reaction. In all of the affected patients, the reactions were totally resolved in less than 48 hours. CONCLUSIONS: The prevalence of drug allergy in this group was similar to that reported in general population. Penicillin was the most common involved drug and urticaria was the most frequent clinical manifestation.

[Bronchial foreign body as a differential diagnosis for asthma. Report of a case and review of the literature]. / Cuerpo extraño bronquial como diagnóstico diferencial de asma. Reporte de un caso y revisión de la literatura.

The aspiration of foreign bodies into the airway is a common problem in childhood, mainly in children younger than 10-years old. Foreign bodies located in the tracheobronchial tree can cause episodic cough, dyspnea and wheezing, and generate a misdiagnosed of asthma if physicians do not consider the possibility of a bronchial foreign body as a differential diagnosis of this disease. In these cases, chest X-ray films are very important because those can show the most of foreign bodies or indirect radiographic signs of a bronchial foreign body. Nowadays, bronchoscopy is the method of choice for removal foreign bodies from the tracheobronchial tree. If there are not complications, most of patients may recover and become non-symptomatic in a short-term after the foreign body extraction. We show the case of a nine years old boy who suffered the aspiration of a tack, which stayed in a bronchi during several years, and was misdiagnosed as asthmatic.

IGE, eosinófilos y parasitosis: un estudio piloto / IGE, eosinophils and parasitosis: a pilot study

En el presente estudio se trata de demostrar si hay correlación entre elevación de IgE, eosinofilia y parasitosis, ya que la cuantificación de la IgE es difícil y costosa, mientras que el estudio de eosinófilos es simple y económico. Los resultados muestran en forma estadística, moderada correlación entre los valores de IgE y eosinófilos. Además se encontró que en la población económicamente baja la IgE y los eosinófilos son más elevados que los de la población de estrato medio, esto pudiera explicarse por la presencia de parasitosis intestinal

Rinosinusitis crónica, síntomas predominantes en menores de 14 años que acudieron al centro regional para la prevención y el tratamiento de las enfermedades alérgicas / Chronic rhinosinusitis in population younger 14 years main symptoms

La rinosinusitis crónica afecta al 5 por ciento de la población que sufre infecciones de las vías respiratorias. El objetivo del presente estudio es conocer los sintomas predominantes en la población menor de 14 años con diagnóstico de rinosinusitis crónica, conocer su distribución etaria, por sexo y tiempo de evolución. Se incluyeron 100 pacientes con este diagnóstico a quienes se les realizaron: historia clínica, examen físico, citología nasal, pruebas cutáneas y serie de senos paranasales. Los sintomas predominantes fueron: tos, halitosis, descarga retronasal purulenta, fiebre, cefalea, odinofagia, dolor facial, y edema periorbitario, de predominio en el sexo masculino y con un tiempo promedio de evolución de 1-2 años