Monthly variation of Dermatophagoides allergens and its influence on respiratory allergy in a high altitude environment (Quito, 2800 m a.s.l. in Andean Ecuador).

BACKGROUND: Seasonal variation of Dermatophagoides allergens and its influence in allergic respiratory airway diseases has not been investigated in Andean cities. The objective of this study was to evaluate those parameters in a city located in the Andean mountains. METHODS: Der p1 and Der f1 were measured in dust samples from mattresses in 13 houses in Quito (2800 m above sea level). Samples were collected monthly from August 2004 to July 2005. Patients presenting to a local outpatient allergy clinic with asthma and rhinitis and isolated allergy to Dermatophagoides were analysed to determine if a correlation existed between seasonal Der allergen levels and the number of patients presenting with allergies. RESULTS: High levels of dust mites and humidity were observed throughout the year. The highest geometrical mean values of allergens were detected in April (Der p1, 10.15 µg/g) and May (Der f1, 13.03 µg/g), whilst the lowest levels were detected in August (Der p1, 4.26 µg/g), and September (Der f1, 1.4 µg/g). Of the 361 patients examined, 182 were allergic to Dermatophagoides, (45.6% asthmatics, 97.8% rhinitics, and 43.4% with both diseases). Patient presentation spiked in August, and from February to May. However, there was not a significant correlation between mite allergen concentrations and humidity or the number of patients presenting with allergies. CONCLUSIONS: Dust samples from mattresses in Quito revealed high concentrations of Der p1 and Der f1. We observed a trend towards increased presentation of asthmatic and rhinitic patients in the months with highest levels of allergens.

[Sociodemographic risk factors of hantavirus cardiopulmonary syndrome]. / Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus.

BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. AIM: To evaluate sociodemographic factors as risk factors in severity of HCPS. PATIENTS AND METHODS: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. RESULTS: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. CONCLUSION: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Asthma and its relation with Dermatophagoides pteronyssinus and Dermatophagoides farinae in Andean altitudes (Quito, Ecuador).

Previous investigations in alpine altitudes suggest a very low etiopathogenic relation between house-dust mites and bronchial asthma in these geographical zones. Our purpose was to analyze the relationship between asthma and sensitization to the house-dust mites D. pteronyssinus and D. farinae in Andean altitudes. We studied 587 asthmatic patients, residents in Quito, Ecuador, (2800 m above sea level), ranging in age from 8 months to 84 years. The patients were divided into five age groups. We investigated the prevalence of house-dust mite sensitization by skin prick tests in each group. Fifty asymptomatic students with ages between 6 to 20 years old were studied as a control group. Three hundred and thirty asthmatic patients (56.2%) were sensitized to house-dust mites while only 15 (30%) of the 50 asymptomatic students were sensitized (p < 0.01). The percentage of asthmatics sensitized followed an age-dependent curve that began with the children under 6 years old (45.1%), reached its maximum between 12 and 19 years old (79.0%) and decreased to 25.8% in asthmatics older than 40 years. The differences among these groups were statistically significant (p < 0.01). Also, we observed a significant prevalence in sensitization (p < 0.01) in males versus females. The mean size of the skin reaction obtained with D. pteronyssinus and D. farinae was larger (p < 0.001) in the 12-19 year olds than in the group of asthmatics over 40 years old. It was also greater in the asthmatics with chronic rhinitis than in the group of asthmatics without nasal symptoms (p < 0.01). We suggest that the house-dust mites D. pteronyssinus and D. farinae are an important source of allergens in the pathogenesis of bronchial asthma in patients who live in the high Andes.

Dust mites but not grass pollen are important sensitizers in asthmatic children in the Ecuadorian Andes.

Grass pollen is an important cause of asthma and rhinoconjunctivitis in Europe and the United States. In the high Andes however, the role this pollen plays in respiratory allergies is unknown. In this study, we tested the prevalence of grass pollen sensitization in comparison to other aeroallergens on 433 asthmatic children living in Quito, Ecuador (the Andes mountain range, 2,800 m above sea level). The skin prick test technique was used. We found that the least sensitizing allergens of all were grass pollen (12.2%) and molds (7.4%) with p < 0.0001. A clear predominance of sensitization to the house dust mite Dermatophagoides pteronyssinus (77.8%) and Dermatophagoides farinae (76.9%), in comparison to the other aeroallergens tested, in terms of sensitization (p = 0.00000) and papule size (p < 0.0002), was observed. The most highly sensitized group consisted of asthmatics between 5 and 15 years of age (D. pteronyssinus 90.7%, D. farinae 87.5%, dog hair 37.4%, cat hair 43%, grass pollen 15.9% and molds 9.9%). In the total study group, males were only more sensitive than females to D. pteronyssinus (82.1% vs. 71.6%, p = 0.0009). We concluded that in the group of asthmatic children studied, grass pollen showed a low capacity of sensitization, even though it is widely found all over our city. The most sensitizing allergens were D. pteronyssinus and D. farinae, followed by cat and dog hair.

Pseudo-allergic reactions to corticosteroids: diagnosis and alternatives.

Two patients treated with parenteral paramethasone (Triniol) and dexamethasone (Sedionbel) are described. A few minutes after administration of the drugs, they presented urticaria (patients 1 and 2) and conjunctivitis (patient 1). The purpose of our study was to determine the cause of the patients' reactions, the immunological mechanisms involved and whether these patients would be able to tolerate any kind of corticoid. Clinical examinations and skin, oral and parenteral challenges with different corticosteroids and ELISA tests were performed. In the two patients, skin and ELISA tests with paramethasone were negative, as was the prick test with each of its excipients. A single-blind parenteral challenge with Triniol was positive in both patients after the administration of 1 ml of the drug, and negative with its excipients. We also carried out oral and parenteral challenges with other corticosteroids and found intolerance to some of them. These results suggest that paramethasone caused pseudoallergic reactions in our patients. Corticosteroids different from paramethasone also produced hypersensitivity reactions in these patients; however, a few of them were tolerated. The basic mechanisms of those reactions are not yet fully understood. To our knowledge, this is the first report of a pseudo-allergy caused by paramethasone.

Severe allergic conjunctivitis and chemosis caused by disodium cromoglycate.

A 63-year-old man with chronic, nonallergic rhinoconjunctivitis presented immediate adverse reactions, such as intense itching, burning, redness and severe swelling of both conjunctivae after using disodium cromoglycate eye drops. Skin prick tests and conjunctival provocation tests were positive with pure disodium cromoglycate. Circulating IgE-specific antibodies to disodium cromoglycate in serum were demonstrated by RAST. We suggest that the acute ocular reaction was caused by disodium cromoglycate and that the underlying mechanism was probably an IgE-mediated immunological reaction.

[Diagnostic difficulties in the narcolepsy-catalepsy syndrome: with reference to our series of cases]. / Dificultades diagnósticas en el síndrome narcolepsia-cataplejía: a propósito de nuestra casuística.

The narcolepsy-cataplexy syndrome is a disorder of unknown aetiology, characterized by excessive daytime sleepiness associated with cataplexy and other REM sleep phenomena. Diagnosis is based on the clinical findings, although this may be difficult especially with respect to confirming the cataplexy. Objective tests, such as typing for HLA, DR2DQ1 (DRw15DQw6, WHO90) and above all TMLS (average latency < 5 mn and two or more onsets of sleep in the phases REM and SOREMP's) is of great help. However, the exact diagnostic significance of some aspects of these tests and their parameters is still under discussion. In this paper we review our series of cases consisting of fourteen patients who fulfil the clinical diagnostic criteria required in the ICSD-1990. TMLS and HLA typing was done for all. Of the HLA types, DQ1 was present in all our patients, unlike DR2 which was not found in two patients. Regarding TMLS, the average latency < 5 mn is a parameter met by all cases, although one did not have SOREMP's. The findings of the objective tests done on our patients are in agreement with those described by other authors. They underline the significance of the support they lend to the diagnosis. However, they are not the definite answer to the problem.

[Periodical EEG pattern modifications in herpetic encephalitis treated with acyclovir]. / Modificaciones del patrón EEG periódico en las encefalitis herpéticas tratadas con aciclovir.

The presence of PLED or localized or lateralized periodic activity in encephalitis strongly suggests that the encephalitis is due to the herpes simplex virus. Nevertheless, there has been controversy over its clinical significance. In addition, since the introduction of antiviral drugs in the treatment of herpes encephalitis in its initial stages, the prognosis of the disease has improved. We studied nine patients all diagnosed as having herpes encephalitis and treated with acyclovir. The presence or absence of periodic activity and its characteristics were analyzed. It was seen that either there was no such activity, or if there was, it was not exactly as classically described.

Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus / Sociodemographic risk factors of hantavirus cardiopulmonary syndrome

Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.

Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Embarazo triple monocorial triamniótico: experiencia de dos casos y revisión de la literatura / Triamniótico triple monochorionic pregnancy: experience of two cases and literature review

Los embarazos múltiples se consideran una entidad de alto riesgo obstétrico. Su incidencia ha ido en aumento debido a la utilización de técnicas de reproducción asistida y el aumento de la edad materna. Se presentan 2 casos de embarazos triples monocoriales triamnióticos, de sexo femenino y masculino. En ambos embarazos se manifestaron complicaciones, principalmente fetales y neonatales, atribuidas a embarazos múltiples descritas en la literatura.

Multiple pregnancies are considered a high-risk obstetric entity. Their incidence has been increasing due to the use of assisted reproductive techniques and increased maternal age. Here, we describe two cases of triamniotic monochorionic triplet pregnancies, female and male respectively. Both pregnancies demonstrated complications, mainly fetal and neonatal, attributed to multiple pregnancies reported in the literature.

U.S. Hispanics: challenging issues for the 1990s.

PIP: Hispanics are the largest minority in the US after blacks and, as a poor and disadvantaged minority, face many problems and challenges with which they must deal in the future. There has been a 34% increase in the US Hispanic population from 1980-1988 due to heavy immigration and high birth rates, resulting in a young age structure for Latinos with a median age of 25.5 years vs. the US median of 32.2 years. US Latinos are a very diverse group which includes Mexicans (62%), Puerto Ricans (13%), Cubans (5%), and Central and South Americans (12%), although they tend to be clustered in very few states. Discrimination has plagued this population because of illegal immigration concerns and illegal drug flow problems. Hispanics continue to suffer from poor educational achievement, language barriers, low-paying jobs, and poverty. Cubans have made the most progress so far in all of these areas. Poverty will likely persist into the 1990's. Bilingualism is and will be prevalent as long as immigration continues, but future generations will begin to use English as their 1st language. 17 states, however, have adopted "official English" laws in order to decrease the use of funds for Spanish language services. Using Spanish in school is a very divided issue--some favor bilingual education, some favor the shot-gun English approach. As Hispanics grow into work force age, lack of education will prevent entry into skilled labor. Corporations, however, are taking a bigger interest in bilingual workers. Nationally, Hispanics are beginning to matter as an electorate. The number of Latino elected officials has doubled from 1974 to 1988. The 1990 census may show us that we have been underestimating the number of Hispanics in the US. A higher percentage of future Latin immigrants will be better educated. Policymakers should recognize Hispanic problems and help to promote solutions, in the interest of the American people as a whole.^ieng

Bronchial asthma caused by Lathyrus sativus flour.

A 10-year-old child with asthmatic attacks related to Lathyrus sativus flour inhalation was studied in our department. Skin test and specific bronchial provocation challenge were positive. Specific IgE antibodies to Lathyrus sativus flour was demonstrated by indirect enzyme immunoassay. We suggest that our patient's allergic symptoms were due to the development of Type I allergic reactivity to L. sativus antigens.

Farm animal feeders: another group affected by cereal flour asthma.

Asthma induced by cereal flour is a long recognized entity. We present studies of three patients affected by asthma related to exposure to cereal flour contained in animal formula feeds. Skin prick test performed with the formula feed components showed positive reactions to cereal flours (wheat, rye and barley) and negative to the other substances in these formulas. Specific anti-wheat, rye and barley flour IgE antibodies were found by RAST. Bronchial provocation tests (BPT) with wheat flour (patients 1 and 2) and barley flour (patient 3) all showed immediate responses. These findings suggest that our patients' symptoms were caused by an IgE-mediated hypersensitivity to cereal flours from animal formula feeds. We call attention to the importance of cereal flours in animal formula feeds as a cause of occupational asthma in farm and animal feeders.

Specific bronchial challenge in cockroach asthma.

Clinical characteristics of allergic asthma due to inhalation of cockroach antigens have been reported sporadically in the literature. To assess the patterns of bronchial response in cockroach asthma we performed bronchial provocation tests (BPT) with cockroach extract in 25 asthmatic patients who had positive skin test with this extract. Of 25 patients, 23 had cockroach-specific-IgE-antibodies. Seventeen subjects presented only immediate asthmatic reaction, five patients had dual response (immediate + late), and one patient developed only late asthmatic response. BPT were negative in two patients who did not have cockroach-specific-IgE-antibodies. These results indicate that BPT with cockroach antigen is a very specific test for cockroach asthma. It shows immediate, dual and late responses, and correlates well with the presence of specific IgE antibodies against this allergen.

Hereditary angioedema: a study of three families.

Familial angioedema is an autosomal dominant hereditary disease whose pathogenesis is attributed to a C1 inhibitor (C1 INH) deficit. Two genetic forms have been recognized related to the C1 inhibitor deficiency or its dysfunction. Antifibrinolytics as well as androgenic derivatives have proved to be effective in the prevention and treatment of this pathology. In this paper we present the studies carried out in three families affected by C1 inh. deficit and the treatment employed. Some of the members of these families showed symptoms related with this deficit. A satisfactory explanation has not been formulated to justify the reason why only some of the members in our study showed symptomatology, given that there were no differences between the C1 inh. levels in these patients and those who were not affected. The absence of family history connected with this disease does not necessarily suggest that a genetic mutation has been produced. This deficit could have been present in earlier generations but without clinical manifestations. Stanozolol proved effective in the control of symptoms in the two patients to whom this treatment was applied. However, the rise of C1 inh. levels was significative only in one of them. The lack of connection between the clinical improvement and the normalization of the C1 inh. levels led us to think that the main goal of the therapy should not be directed to the normalization of these levels but to keep the patient asymptomatic with the lowest possible doses of the selected medication.

Distribution of IgG subclass antibodies anti-ENA (extractable nuclear antigens) in systemic rheumatic diseases.

The subclass distribution of anti-ENA antibodies was investigated in the serum of patients with systemic rheumatic diseases, using an ELISA technique. All the sera studied were previously detected positive for anti-ENA antibodies by other technique (gel precipitation). The patients were classified according to the enzymatic sensitivity of the antigen against the antibodies. There was no subclass restriction for antibodies against Ribonuclease-sensitive ENA antigen or other ENA antigens. Progressive studies showed that a single pattern of subclass distribution for each serum was maintained.