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The management of chronic urticaria (CU) has been controversial. Recently updated international guidelines propose evidence-based diagnosis and treatment. Nevertheless, dermatologists have heterogeneous approaches to managing CU. To estimate the percentage of dermatologists who have an optimal approach to CU according to the international guidelines, and to explore the variables associated with optimal management a cross-sectional study using a 17-question survey was delivered by email to dermatologists from Argentina. Optimal first, second, and third line treatment were considered when dermatologists chose a nonsedative antihistamine; increased the dosage of nonsedative antihistamines, and added omalizumab, respectively. Logistic regression was used to identify variables associated with optimal management. A total of 165 questionnaires were available for analysis. An optimal first, second, and third-line treatment approach was identified in 50%, 35%, and 15% of the dermatologists, respectively. The dermatologists' age being above 55 years old (OR: 0.12, 95% CI: 0.01-0.99, p .005) and having more than 5 years of expertise (OR: 0.4, 95% CI: 0.19-0.81, p .001) were significantly associated with a suboptimal approach in second-line treatment. We could not find variables associated with an optimal first or third-line treatment. The real-life management of CU in Argentina is partly suboptimal according to the international guidelines.
Assuntos
Urticária Crônica/terapia , Dermatologistas/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Argentina , Estudos Transversais , Relação Dose-Resposta a Droga , Pesquisas sobre Atenção à Saúde , Humanos , Pessoa de Meia-Idade , Guias de Prática Clínica como AssuntoRESUMO
PURPOSE OF REVIEW: Since omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017-February 2018. RECENT FINDINGS: Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6-8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse. Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).
Assuntos
Antialérgicos/administração & dosagem , Omalizumab/administração & dosagem , Urticária/tratamento farmacológico , Antialérgicos/efeitos adversos , Biomarcadores , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Omalizumab/efeitos adversos , Gravidez , Urticária/imunologiaRESUMO
Introduction. Chronic urticaria is an inflammatory skin condition characterized by the presence of evanescent wheals or angioedema that last for ≥ 6 weeks. Objective. To determine the prevalence of urticaria and describe its clinical characteristics in children and adolescents under 19 years of age in a general hospital. Population and methods. This was a cross-sectional study carried out between 2015 and 2020 in a population of children and adolescents seen at a private healthcare facility. Results. A total of 1567 medical records of patients with urticaria seen during the study period were reviewed. Thirty-six patients with chronic urticaria were identified; the prevalence was 0.16% (95% CI: 0.11-0.22). Conclusion. The prevalence of chronic urticaria in children and adolescents was 0.16%. A higher frequency was observed among girls and adolescents.
Introducción. La urticaria crónica es una afección inflamatoria de la piel caracterizada por presencia de habones evanescentes y/o angioedema, que ocurren durante un período ≥ 6 semanas. Objetivo. Determinar la prevalencia de esta enfermedad y describir características clínicas en niños y adolescentes menores de 19 años de un hospital general. Población y métodos. Estudio corte transversal, realizado entre el 2015 y el 2020, en una población de niños y adolescentes de un sistema de salud privado. Resultados. Se revisaron 1567 historias clínicas de pacientes con urticaria atendidos durante el período de estudio. Se identificaron 36 pacientes con urticaria crónica; se estableció una prevalencia del 0,16 % (IC95% 0,11-0,22). Conclusión. La prevalencia de urticaria crónica en niños y adolescentes fue del 0,16 %. Se observó mayor frecuencia en el sexo femenino y adolescentes.
Assuntos
Urticária Crônica , Hospitais Gerais , Humanos , Estudos Transversais , Feminino , Adolescente , Masculino , Criança , Prevalência , Urticária Crônica/epidemiologia , Pré-Escolar , Lactente , Urticária/epidemiologia , Estudos RetrospectivosRESUMO
Introduction. Allergic rhinitis (AR) is one of the most frequent chronic diseases in the pediatric population; it affects the quality of life of children and their families, has economic impact, and is frequently underdiagnosed and undertreated. Given the scarcity of local data, here we describe the prevalence of AR and the clinical characteristics of the study population. Population and methods. Observational, cross-sectional study in patients younger than 19 years. Results. A total of 250 patients were randomly included; their mean age was 9 years (SD: 5). AR was diagnosed in 14 of them. The prevalence of AR was 6%. Conclusions. The prevalence of AR in our setting was 6%. AR should be given the relevance it deserves so as to provide an adequate diagnosis and treatment.
Introducción. La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes en la población pediátrica, afecta la calidad de vida del niño y la familia, tiene impacto económico y es frecuentemente subdiagnosticada y subtratada. Dada la escasez de datos locales, se describe su prevalencia y las características clínicas de la población en estudio. Población y métodos. Estudio observacional de corte transversal de pacientes menores de 19 años. Resultados. Se incluyeron 250 pacientes al azar, con una media de edad de 9 años (DE 5) Presentaron diagnóstico de RA 14 de ellos; se observó una prevalencia de RA del 6 %. Conclusiones. La prevalencia de RA en nuestro medio es del 6 %. Debemos darle la relevancia que amerita para brindar un diagnóstico y tratamiento adecuado.
Assuntos
Hospitais Gerais , Rinite Alérgica , Humanos , Estudos Transversais , Criança , Rinite Alérgica/epidemiologia , Rinite Alérgica/diagnóstico , Masculino , Feminino , Prevalência , Pré-Escolar , Adolescente , Departamentos Hospitalares/estatística & dados numéricos , PediatriaRESUMO
Latex allergy, or natural rubber latex allergy (NRLA), is a global health concern, even among the pediatric population, with symptoms varying in severity from mild to potentially life-threatening. Latex is derived from the Hevea Brasiliensis tree, producing twelve million tons annually for use in various everyday and medical products. Despite efforts to mitigate NRLA, its prevalence remains high, especially in at- risk groups such as children with spina bifida. Clinical manifestations include immediate and delayed symptoms, even anaphylactic reactions. Diagnosis involves a detailed medical history and specific tests. Prevention focuses on avoiding exposure, especially in medical and educational settings. Treatment, including immunotherapy, exhibits variable efficacy. NRLA has a strong negative impact on children's quality of life. The objective of this publication is to provide updated information and practical tools for the pediatrician's and allergist's practice.
La alergia al látex del caucho natural (ALCN) es un problema de salud global, incluso en población pediátrica, con síntomas de gravedad variable, desde leves hasta potencialmente mortales. El látex se obtiene del árbol Hevea brasiliensis; se producen doce millones de toneladas anuales que se utilizan en diversos productos cotidianos y médicos. A pesar de los esfuerzos para mitigar la ALCN, su prevalencia sigue siendo alta, especialmente en grupos de riesgo, como niños con espina bífida. Las manifestaciones clínicas incluyen síntomas inmediatos y retardados, hasta reacciones anafilácticas. El diagnóstico requiere una historia clínica detallada y pruebas específicas. La prevención se centra en evitar la exposición, especialmente en entornos médicos y escolares. El tratamiento, incluida la inmunoterapia, muestra eficacia variable. La ALCN tiene un fuerte impacto negativo en la calidad de vida. El objetivo de esta publicación es proveer información actualizada y herramientas prácticas para el consultorio del pediatra y el alergólogo.
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BACKGROUND AND OBJECTIVE: Chronic spontaneous urticaria (CSU) is a distressing disease. We report real-world data from the global Chronic Urticaria Registry (CURE) about associations between various CSU states and sleep impairment, plus important health-related quality-of-life (HRQoL) outcomes and compared different methods to assess CSU states. METHODS: CURE data were collected at baseline and 6-monthly follow-ups (FU). Assessments included CSU states using the Urticaria Control Test (UCT), weekly Urticaria Activity Score (UAS7), and Physician Global Assessment (PhyGA) of treatment response. Complete response to treatment (CR, UAS7 = 0), complete control of disease (CC, UCT = 16), and PhyGA = CR were assessed, plus the Dermatology Life Quality Index and the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL) sleep domain. RESULTS: Overall, 2078 patients were included. At baseline, 9.8%, 17.9%, and 42.3% of patients had UCT = 16, UAS7 = 0, or PhyGA = CR, respectively, which increased at FU1 and FU2. Patients with higher UCT scores had better sleep and HRQoL. The presence of angioedema without wheals, episodic disease, omalizumab treatment, and male sex were associated with CC (P < .05). Among 469 patients who achieved CC or CR, 16.4% (n = 77) showed CC or CR with all 3 instruments. Agreement between UCT = 16 and UAS7 = 0 measurements was moderate (κ = 0.581), but poor between UCT = 16 and PhyGA = CR (κ = 0.208). CONCLUSIONS: Few patients had CR/CC of their CSU at baseline entry. Disease control strongly related to good sleep and better HRQoL; therefore, it is important to aim for CR in CSU treatment. Patient-reported UCT and UAS7 assessments demonstrated a more accurate measurement of CSU state versus physician assessments.
Assuntos
Angioedema , Antialérgicos , Urticária Crônica , Urticária , Humanos , Masculino , Antialérgicos/uso terapêutico , Urticária Crônica/tratamento farmacológico , Urticária/tratamento farmacológico , Urticária/induzido quimicamente , Omalizumab/uso terapêutico , Angioedema/induzido quimicamente , Doença CrônicaRESUMO
Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations.
La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.
Assuntos
Asma , Pediatria , Rinite Alérgica Perene , Rinite Alérgica , Rinite , Humanos , Criança , Qualidade de Vida , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica Perene/terapia , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Rinite Alérgica/epidemiologia , Asma/complicações , Rinite/complicaçõesRESUMO
Despite the efforts made to mitigate the consequences of this disease, natural rubber latex allergy (NRLA) continues to be a global health problem and is still considered one of the main worries in the working environment in many countries throughout the world. Due to thousands of products containing latex, it is not surprising that the current statistics suggest that prevalence remains high among healthcare workers and susceptible patients. In developed countries, reduction in the prevalence of IgE-mediated allergy to latex proteins from gloves may lead to lax attention by health care personnel. On the other hand, this situation is different in developing countries where there is a lack of epidemiological data associated with a deficit in education and awareness of this issue. The aim of this review is to provide an update of the current knowledge and practical recommendations regarding NRLA by allergologists from different parts of the world with experience in this field.
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OBJECTIVES: Hereditary angioedema (HAE) is a rare disease. During the last years, many studies and advances have been developed with the aim of better understanding the pathophysiology, as well as optimizing patient management. Several international working groups have attempted to clarify and standardize the care of HAE communicated as guidelines and consensus recommendations. We considered necessary to provide recommendations for the diagnosis and treatment of patients with HAE in Argentina. METHODS: A group of specialists of allergy and immunology from Argentina by using the online surveys methodology as well as face to face meetings developed the intended consensus. RESULTS: Recommendations were established based on published evidence and the expert opinion. The consensus focused on diagnosis, acute management of attacks, short and long-term prophylaxis, special situations (pediatrics and pregnancy) and disease management considering the health care system in Argentina. CONCLUSION: The recommendations established in this consensus guidelines will optimize the management of patients with HAE in Argentina.
Objetivos: El angioedema hereditario es una enfermedad poco frecuente. Durante los últimos años se han desarrollado muchas investigaciones y registrado avances con el objetivo de entender mejor la fisiopatología y optimizar la atención a los pacientes. Diversos grupos de trabajo internacionales han intentado clarificar y normalizar el cuidado de pacientes con angioedema hereditario, lo que se ha reflejado en guías y consensos. Consideramos necesario desarrollar un documento de consenso con recomendaciones para el diagnóstico y tratamiento del angioedema hereditario en Argentina. Metodología: Un grupo de expertos de Argentina, conformado por especialistas en Alergia e Inmunología mediante metodología de ronda de encuestas a distancia y reuniones presenciales llevó adelante la elaboración del consenso pretendido. Resultados: Se establecieron recomendaciones basadas en la evidencia publicada y en el criterio de los expertos participantes. Las recomendaciones se enfocaron en el diagnóstico, tratamiento y profilaxis de las crisis a corto y largo plazo, control de situaciones especiales y consideraciones del sistema de salud en Argentina. Conclusión: Las recomendaciones establecidas en este consenso permitirán optimizar la atención médica de los pacientes con angioedema hereditario en Argentina.
Assuntos
Angioedemas Hereditários , Algoritmos , Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/terapia , Argentina , Criança , Feminino , Humanos , Gravidez , Inquéritos e QuestionáriosRESUMO
In recent years there has been a significant increase in the prevalence of allergic diseases despite advances in the understanding of the pathogenesis, the dissemination of guidelines for its management and the emergence of new drugs. The reasons for this increase are not fully established, but it is suggested that multiple environmental factors may be involved. Inhaled air contains numerous harmful agents in addition to environmental allergens. The main immediate respiratory clinical expression after inhaling this contaminated air is asthma and rhinitis. The activity of human beings has altered the outdoor environment by the emission of multiple pollutants and has produced an increasing climate change. It also has a notable impact on the development of respiratory pathology and the modification of air quality. The bibliography on the subject of environmental control is very broad and sometimes difficult to interpret. In order to be able to make precise, valid and simple indications for patients to accomplish with, four scientific societies of the Argentine Republic that deal with this type of diseases, have elaborated a document that contains information of easy access to all medical personal involved in the treatment of patients with asthma and / or rhinitis, that provides practical measures for the patients and the different public health systems about unmet needs in this complex issue.
En los últimos años hubo un aumento significativo en la prevalencia de las enfermedades alérgicas pese a los avances en la comprensión de la patogénesis, la divulgación de guías para su control y tratamiento y la aparición de nuevos fármacos. La razón para este aumento no está totalmente establecida, pero se considera que múltiples factores ambientales podrían estar involucrados en ello. El aire inspirado contiene numerosos agentes nocivos además de alérgenos ambientales; el asma y la rinitis alérgica son las principales expresiones clínicas respiratorias inmediatas posteriores a su inhalación. En la antropósfera, el entorno de la superficie terrestre habitada por los humanos, se han alterado los equilibrios naturales por la emisión de múltiples sustancias y se ha producido un creciente cambio climático. Este fenómeno global influye en la calidad del aire y consecuentemente en el desarrollo de enfermedades respiratorias. Dado que la bibliografía sobre el tema del control ambiental es muy amplia, y en ocasiones difícil de interpretar para poder realizar indicaciones precisas, válidas y sencillas de cumplir por parte de los pacientes, cuatro sociedades científicas de la República Argentina, dedicadas a este tipo de enfermedades, elaboraron un documento con información de fácil acceso a todo profesional médico que trate asma y/o rinitis, que expone medidas prácticas para los enfermos y alerta a los distintos actores involucrados en la salud pública acerca de las necesidades insatisfechas en este tema tan complejo, a fin de poder elaborar una agenda para su posible resolución.
Assuntos
Alérgenos/efeitos adversos , Exposição Ambiental/efeitos adversos , Doenças Respiratórias/etiologia , Poluentes Atmosféricos/efeitos adversos , Asma/etiologia , Mudança Climática , Humanos , Fatores de RiscoRESUMO
La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.
Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations
Assuntos
Humanos , Criança , Pediatria , Asma/complicações , Rinite/complicações , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/terapia , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Rinite Alérgica/epidemiologia , Qualidade de VidaRESUMO
La terapia de reemplazo enzimático disminuye la morbilidad y mejora la calidad de vida de los pacientes con mucopolisacaridosisii. Se han descrito reacciones de hipersensibilidad inmediata a este fármaco. La desensibilización es un tratamiento que induce la tolerancia temporaria a una droga y permite al paciente alérgico recibir la medicación.Se presenta el caso de un niño de 7 años con diagnóstico de síndrome de Hunter que, luego de 4 años de tratamiento con idursulfase, tuvo dos episodios de anafilaxia durante la infusión del fármaco. Se detectó inmunoglubulina E específica mediante pruebas cutáneas, y fue positiva la intradermorreacción con dilución 1/10 (0,2 mg/ml). Se realizó un protocolo de desensibilización de 12 pasos, sin presentar eventos adversos. La evaluación alergológica y la posibilidad de desensibilización constituyeron herramientas útiles en el manejo de nuestro paciente
Enzyme replacement therapy with idursulfase decreases morbidity and improves quality of life of patients with mucopolysaccharidosis ii. Immediate hypersensitivity reactions to this drug have been described. Desensitization is a treatment that induces temporary tolerance to a culprit drug, allowing the allergic patient to receive the medication.We present the case of a 7-year-old patient diagnosed with Hunter syndrome who presented, after 4 years of treatment, two episodes of anaphylaxis during the infusion of idursulfase. Detection of specific immunoglobulin E was carried out using skin tests, with intradermal reaction at a 1/10 dilution (0.2 mg/ml) being positive. A 12-step desensitization protocol was performed without presenting adverse events.The allergological evaluation and the possibility of desensitization were useful tools in the management of our patient.
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Humanos , Masculino , Criança , Dessensibilização Imunológica/métodos , Terapia de Reposição de Enzimas , Mucopolissacaridose II/tratamento farmacológico , Hipersensibilidade Imediata , Erros Inatos do MetabolismoRESUMO
INTRODUCTION: Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce. OBJECTIVE: To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors. POPULATION AND METHODS: Descriptive, cross-sectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact with latex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit. RESULTS: Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ± 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures. CONCLUSION: According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.
INTRODUCCIÓN: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. OBJETIVO: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. PACIENTES Y MÉTODOS: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. RESULTADOS: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. CONCLUSION: El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.
Assuntos
Hipersensibilidade ao Látex/epidemiologia , Meningomielocele/complicações , Adolescente , Criança , Estudos Transversais , Humanos , Imunoglobulina E/sangue , Látex/efeitos adversos , Hipersensibilidade ao Látex/diagnóstico , Masculino , Prevalência , Testes Cutâneos , Adulto JovemRESUMO
Introducción: Las alergias alimentarias afectan, mayoritariamente, a los niños en los primeros años de vida. Existen escasos datos epidemiológicos en nuestro país.Objetivos: Determinar los agentes causales, describir la prevalencia y características de los pacientes con alergia alimentaria en una población pediátrica argentina.Pacientes y métodos: Estudio retrospectivo observacional, de corte transversal, de pacientes menores de 18 años. Resultados: Se incluyeron 321 pacientes; se confirmó alergia alimentaria en un 64 % (207) de los casos. El 53 % (109) presentó mecanismo mediado por inmunoglobulina E; el 68 % (140), alergia a las proteínas de la leche de vaca; el 20 % (41), alergia al huevo, y el 12 % (24), anafilaxia como manifestación clínica. La prevalencia global de alergia alimentaria fue del 0,87 % (IC 95 %: 0,7-0,9).Conclusiones: La prevalencia global de alergia alimentaria fue del 0,87 %. La leche de vaca resultó el principal alérgeno incluso en adolescentes.
Introduction: Food allergies affect mostly children in their first years of life. Epidemiological data obtained in Argentina are scarce. Objectives: To determine offending foods and describe the prevalence and characteristics of patients with food allergy in an Argentine pediatric population. Patients and methods: Observational, retrospective, cross-sectional study on patients younger than 18 years. Results:A total of 321 patients were included; food allergy was confirmed in 64 % (207) of cases. An immunoglobulin E-mediated mechanism was observed in 53 % (109); cow's milk protein allergy, in 68 % (140); egg allergy, in 20 % (41); and anaphylaxis as clinical manifestation, in 12 % (24). The overall prevalence of food allergy was 0.87 % (95 % confidence interval: 0.7-0.9). Conclusions: The overall prevalence of food allergy was 0.87 %. Cow's milk was the main allergen, even among adolescents
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Hipersensibilidade Alimentar/diagnóstico , Imunoglobulina E/imunologia , Estudos Epidemiológicos , Estudos Transversais , Estudos Retrospectivos , Hipersensibilidade a LeiteRESUMO
En los últimos años hubo un aumento significativo en la prevalencia de las enfermedades alérgicas pese a los avances en la comprensión de la patogénesis, la divulgación de guías para su control y tratamiento y la aparición de nuevos fármacos. La raz ón para este aumento no está totalmente estable cida, pero se considera que múltiples factores ambientales podrían estar involucrados en ello. El aire inspirado contiene numerosos agentes nocivos además de alérgenos ambientales; el asma y la rinitis alérgica son las principales expresiones clínicas respiratorias inmediatas posteriores a su inhalación. En la antropósfera, el entorno de la superficie terrestre habitada por los humanos, se han alterado los equilibrios naturales por la emisión de múltiples sustancias y se ha producido un creciente cambio climático. Este fenómeno global influye en la calidad del aire y consecuentemente en el desarrollo de enfermedades respiratorias. Dado que la bibliografía sobre el tema del control ambiental es muy amplia, y en ocasiones difícil de interpretar para poder realizar indicaciones precisas, válidas y sencillas de cumplir por parte de los pacientes, cuatro sociedades científicas de la República Argentina, dedicadas a este tipo de enfermedades, elaboraron un documento con información de fácil acceso a todo profesional médico que trate asma y/o rinitis, que expone medidas prácticas para los enfermos y alerta a los distintos actores involucrados en la salud pública acerca de las necesidades insatisfechas en este tema tan complejo, a fin de poder elaborar una agenda para su posible resolución.
In recent years there has been a significant increase in the prevalence of allergic diseases despite advances in the understanding of the pathogenesis, the dissemination of guidelines for its management and the emergence of new drugs. The reasons for this increase are not fully established, but it is suggested that multiple environmental factors may be involved. Inhaled air contains numerous harmful agents in addition to environmental allergens. The main immediate respiratory clinical expression after inhaling this contaminated air is asthma and rhinitis. The activity of human beings has altered the outdoor environment by the emission of multiple pollutants and has produced an increasing climate change. It also has a notable impact on the development of respiratory pathology and the modification of air quality. The bibliography on the subject of environmental control is very broad and sometimes difficult to interpret. In order to be able to make precise, valid and simple indications for patients to accomplish with, four scientific societies of the Argentine Republic that deal with this type of diseases, have elaborated a document that contains information of easy access to all medical personal involved in the treatment of patients with asthma and / or rhinitis, that provides practical measures for the patients and the different public health systems about unmet needs in this complex issue.
Assuntos
Humanos , Doenças Respiratórias/etiologia , Alérgenos/efeitos adversos , Exposição Ambiental/efeitos adversos , Asma/etiologia , Mudança Climática , Fatores de Risco , Poluentes Atmosféricos/efeitos adversosRESUMO
La alergia a la proteína de la leche de vaca (APLV) es la alergia alimentaria más frecuente en pediatría. Existen pocos estudios que han evaluado la prevalencia de esta enfermedad en Argentina. Objetivos. Estimar la prevalencia de la APLV y describir su variación durante un período de 11 años. Pacientes y métodos. Se realizó un estudio de cohorte retrospectivo en recién nacidos vivos pertenecientes al programa de atención médica de un hospital universitario de comunidad. Resultados. Se identificaron 116 casos de niños con APLV. La prevalencia acumulada fue de 0,8% (intervalo de confianza -le- 95%: 0,65-0,95). Se observó un incremento porcentual de casos por año, de 0,4% en 2004 a 1,2% en 2014. Conclusión. La prevalencia de APLV fue del 1,2% en 2014, tres veces superior a la prevalencia en 2004.
Cow's milk protein allergy (CMPA) is the most common food allergy in pediatrics. In Argentina, the prevalence of this dis-ease has been evaluated in a few trials.Objectives. To estimate the prevalence of CMPA and describe its variation throughout a period of 11 years.Population and methods. A retrospective cohort study was carried out in live newborn infants enrolled in a health care program of a university community hospital.Results. One hundred and sixteen cases of children with CMPA were identified. Cumulative prevalence was 0.8% (95% confi-dence interval [CI]: 0.65-0.95). A percent increase of 0.4% in 2004 to 1.2% in 2014 was observed in the number of cases per year.Conclusion. In 2014, CMPA prevalence was 1.2%, i.e. three times that of 2004.
Assuntos
Humanos , Recém-Nascido , Recém-Nascido , Prevalência , Substitutos do Leite Humano , Hipersensibilidade Alimentar , Proteínas do Leite/efeitos adversosRESUMO
Introducción. La alergia a la proteína de la leche de vaca es la alergia alimentaria más frecuente en pediatría. El subtipo de las mediadas por inmunoglobulina E (IgE) presenta mayor riesgo de vida y peor pronóstico. Objetivos. Describir la evolución de la alergia a la proteína de la leche de vaca mediada por IgE y los factores de riesgo asociados a la persistencia de la enfermedad. Pacientes y método. Estudio descriptivo, retrospectivo en pacientes que consultaron a la sección de Alergia Pediátrica del Hospital Italiano entre junio de 2006 y junio de 2012 con diagnóstico de alergia a la leche de vaca mediada por IgE. Resultados: Se hallaron 72 pacientes con alergia a la leche de vaca mediada por IgE, 39 (54%) de sexo masculino. La edad promedio al momento del diagnóstico fue de 5,19 ± 3,7 meses; los síntomas de presentación más frecuentes fueron urticaria y vómitos. La rinitis y el asma fueron las enfermedades atópicas concomitantes más frecuentemente observadas. En el período de estudio, el 54,5% adquirieron tolerancia a la edad promedio de 32 meses. La presencia de pápulas mayores de 8mm en el prick test y de sensibilización a la caseína se asoció con la persistencia de la enfermedad. Conclusión. El 54,5% de los pacientes desarrolló tolerancia a los 32 meses de vida. Se encontró una asociación significativa entre el tamaño de la pápula al momento del diagnóstico y la sensibilización a la caseína con la persistencia de la enfermedad.
Introduction. Cow's milk protein allergy is the most common allergy in pediatrics. Immunoglobulin E (IgE)-mediated cow's milk allergy poses a higher risk for life and a worse prognosis. Objectives. To describe the course of IgE-mediated cow's milk protein allergy and risk factors associated with disease persistence. Patients and methods. This was a descriptive, retrospective study conducted in patients seen at the Division of Pediatric Allergy of Hospital Italiano between June 2006 and June 2012 who had been diagnosed with IgE-mediated cow's milk allergy. Results. Out of the 72 patients with IgE-mediated cow's milk allergy, 39 (54%) were boys. Patients' average age at the time of diagnosis was 5.19 ± 3.7 months old; the most common symptoms were urticaria and vomiting. Rhinitis and asthma were the most commonly observed concomitant atopic diseases. In the study period, 54.5% of patients developed tolerance at an average age of 32 months old. An 8-mm papule in the skin prick test and casein sensitization were associated with disease persistence. Conclusion. Overall, 54.5% of patients developed tolerance at 32 months old. A significant association was observed between papule size at the time of diagnosis and casein sensitization and disease persistence.
Assuntos
Humanos , Masculino , Feminino , Lactente , Imunoglobulina E/imunologia , Hipersensibilidade a Leite/imunologia , Argentina , Estudos Retrospectivos , Fatores de Risco , Tolerância ImunológicaRESUMO
Introducción: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. Objetivo: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. Pacientes y métodos: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. Resultados: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. Conclusión: El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.
Introduction: Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce. Objective: To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors. Population and Methods: Descriptive, crosssectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact withlatex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit. Results: Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ? 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures. Conclusion: According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.