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7.
Allergol. immunopatol ; 45(3): 265-271, mayo-jun. 2017. graf
Artigo em Inglês | IBECS | ID: ibc-162389

RESUMO

Background. Respiratory allergy is characterised by an IgE-mediated reaction. The immune system functions, including IgE production, progressively decline over time, such as growing up and ageing. Molecular-based allergy diagnostic defines sensitisation profile. This study aimed to evaluate the impact of age on serum allergen-specific IgE to molecular component levels in a large sample of subjects. Methods. Serum IgE to: Phl p1, Bet v1, Ole e1, Cup a1, Par j2, Can f1, Der p2, and Fel d1 were assessed by ISAC method. Sera from 2788 patients, 1230 males (44.1%) and 1558 females (55.9%), median age 23 years (1st and 3rd quartiles: 9.7-49.7 years; age range: 1 month-103 years) were analysed. Results. The number of positive tests (i.e. sensitisation) tended to increase between birth and school-age till young adulthood and then decreased (p<0.0001) with the exception of Fel d 1 (p=0.14). A similar age-dependent trend was observed considering the levels of each allergen components: the levels of each allergen component, with the exception of Fel d 1, tended to increase till early adulthood and then to decrease reaching the lowest levels in the elderly. Conclusions. Allergen-specific IgE production to inhaled molecular components trend to reduce with ageing, but with differences between allergens. This phenomenon should be adequately evaluated managing allergic patients (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Imunoglobulina E/análise , Hipersensibilidade Imediata/diagnóstico , Doenças Respiratórias/diagnóstico , Técnicas Imunológicas , Alérgenos/análise , Estudos Retrospectivos , Análise Estatística , Análise de Variância
8.
J. investig. allergol. clin. immunol ; 27(supl.1): 1-35, 2017. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-167145

RESUMO

Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in pediatric and adult populations. A systematic search of MEDLINE, Cochrane, and Clinical Trials databases from 2000 to April of 2016 was carried out by a panel of experts from the Spanish Allergy and Clinical Immunology Scientific Society. Relevant studies prior to the year 2000 included in ulterior systematic reviews were also considered. More than 4000 articles were identified during the search and 241 were selected to retrieve available evidence on AIT, which was graded according to the Oxford classification. All the group members reviewed the resulting text until the final version reached the consensual agreement. A summary of recommendations on the more relevant topics are proposed. The role of AIT as a valuable therapeutic strategy for prevention of exacerbation and progressive decline in lung function is highlighted. Future research should include specific tools for asthma evaluation when assessing AIT effectiveness in asthmatic patients (AU)


El asma se asocia frecuentemente con alergia, entendida ésta como la producción de IgE específica frente a alérgenos ambientales. Actualmente, existen dos tipos de inmunoterapia específica con alérgenos (ITE) para la práctica clínica habitual: subcutánea y sublingual, ambas indicadas en el tratamiento de la rinitis y la conjuntivitis alérgicas. Sin embargo, su papel en el asma resulta todavía controvertido. Este documento pretende ofrecer al clínico una revisión de la evidencia del uso de ITE en asma, centrándose en aspectos más relevantes como su mecanismo de acción, eficacia, seguridad, tolerabilidad y coste-eficacia, tanto en población adulta como pediátrica. Un panel de expertos de la Sociedad Española de Alergología e Inmunología Clínica, llevó a cabo una búsqueda sistemática en las bases de datos MEDLINE, Cochrane y Clinica Trials, desde 2000 a abril de 2016. También se revisaron algunos estudios anteriores al 2000, incluidos en revisiones sistemáticas posteriores. Se identificaron más de 4000 artículos en la búsqueda y se seleccionaron 241 para documentar la evidencia disponible y graduarla según la clasificación Oxford. Todos los miembros del panel revisaron el texto resultante hasta la versión final, alcanzando un acuerdo de consenso y se propusieron recomendaciones para los aspectos más relevantes. Se señala específicamente que la ITE resulta potencialmente valorable en la prevención de las exacerbaciones y el declive progresivo de la función pulmonar, aunque se necesitan nuevos estudios que incluyan variables específicas de evaluación de asma para verificar la eficacia de la ITE en esta patología (AU)


Assuntos
Humanos , Criança , Adulto , Asma/terapia , Dessensibilização Imunológica/métodos , Conferências de Consenso como Assunto , Técnicas Imunológicas/métodos , Alérgenos/imunologia , Hipersensibilidade/imunologia , Resultado do Tratamento , Análise Custo-Benefício/métodos , Imunoterapia/classificação , Alergia e Imunologia , Alergia e Imunologia/normas , Biomarcadores/análise , Administração Sublingual , Infusões Subcutâneas , Alérgenos/administração & dosagem , Asma/economia
9.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 34(3): 166-176, mar. 2016. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-150730

RESUMO

INTRODUCCIÓN: El análisis bibliométrico de la producción y repercusión de los documentos por áreas de conocimiento es un indicador cuantitativo y cualitativo de la actividad investigadora realizada en ese campo. El objetivo de este artículo es conocer la contribución de las instituciones españolas a la investigación en Enfermedades Infecciosas y en Microbiología en los últimos años. MATERIAL Y MÉTODOS: Se analizaron los documentos publicados en las revistas incluidas en las categorías «Infectious Diseases» y «Microbiology» de la Web of Science (Science Citation Index Expanded) de la ISI Web of Knowledge desde el año 2000 al 2013. RESULTADOS: En Enfermedades Infecciosas, España ocupó la cuarta posición a nivel mundial y contribuyó con el 5,7% de los 233.771 documentos publicados en esta especialidad. En Microbiología, España se situó en la sexta posición, con un porcentaje de producción del 5,8% de los 149.269 documentos de la categoría. La producción española aumentó a lo largo del período de estudio, tanto en Enfermedades Infecciosas como en Microbiología, pasando de 325 y 619 documentos en el año 2000 a 756 y 1.245 documentos en el año 2013, con una tasa de crecimiento del 131 y del 45,8%, respectivamente. La revista donde se publicó el mayor número de documentos fue Enfermedades Infecciosas y Microbiología Clínica. El 8,6 y el 8,2% de los documentos publicados en las categorías de Enfermedades Infecciosas y Microbiología, respectivamente, fueron el resultado de colaboraciones internacionales, especialmente con instituciones de Estados Unidos de América. El «índice h» fue de 116 en Enfermedades Infecciosas y de 139 en Microbiología, situando a España en la quinta posición en ambas categorías dentro de los países de la Unión Europea. CONCLUSIONES: En los últimos años la investigación española en Enfermedades Infecciosas y Microbiología ha alcanzado un buen nivel en producción y visibilidad internacional, alcanzando una posición de liderazgo mundial


INTRODUCTION: The bibliometric analysis of production and impact of documents by knowledge area is a quantitative and qualitative indicator of research activity in this field. The aim of this article is to determine the contribution of Spanish research institutions in Infectious Diseases and Microbiology in recent years. MATERIAL AND METHODS: Documents published in the journals included in the categories "Infectious Diseases" and "Microbiology" of the Web of Science (Science Citation Index Expanded) of the ISI Web of Knowledge from the year 2000-2013 were analysed. RESULTS: In Infectious Diseases, Spain ranked fourth worldwide, and contributed 5.7% of the 233,771 documents published in this specialty. In Microbiology, Spain was in sixth place with a production rate of 5.8% of the 149,269 documents of this category. The Spanish production increased over the study period, both in Infectious Diseases and Microbiology, from 325 and 619 documents in 2000 to 756 and 1245 documents in 2013, with a growth rate of 131% and 45.8%, respectively. The journal with the largest number of documents published was Enfermedades Infecciosas y Microbiología Clínica, with 8.6% and 8.2% of papers published in the categories of Infectious Diseases and Microbiology, respectively, and was the result of international collaborations, especially with institutions in the United States. The "index h" was 116 and 139 in Infectious Diseases and Microbiology, placing Spain in fifth place in both categories within countries of the European Union. CONCLUSIONS: In recent years, Spanish research in Infectious Diseases and Microbiology has reached a good level of production and international visibility, reaching a global leadership position


Assuntos
Humanos , Doenças Transmissíveis , Microbiologia/estatística & dados numéricos , Técnicas Imunológicas/estatística & dados numéricos , Indicadores Bibliométricos , Publicações Periódicas como Assunto/estatística & dados numéricos
11.
Allergol. immunopatol ; 44(1): 32-40, ene.-feb. 2016. tab
Artigo em Inglês | IBECS | ID: ibc-147481

RESUMO

Background: Allergy and autoimmunity are important immunological entities underlying chronic diseases in children. In some cases both entities develop simultaneously in the same patient. FOXP3 gene codes for a transcription factor involved in regulation of the immune system. Considering that regulatory T cells are involved in controlling immunological disease development, and the relevant role of FOXP3 in this kind of T cells, the objective of this study was to analyse the FOXP3gene in the most prevalent autoimmune diseases and/or allergies in childhood in a European population. Methods: A total of 255 Caucasian individuals, 95 controls and 160 patients diagnosed with allergic, autoimmune or both diseases were included in this study. The molecular analysis of FOXP3 was performed by DNA sequencing following the recommendations for quality of the European Molecular Genetics Quality Network. Genomic DNA was extracted from peripheral blood of all participants and was amplified using the polymerase chain reaction. After the visualisation of the amplified fragments by agarose gel-electrophoresis, they were sequenced. Results: Thirteen different polymorphisms in FOXP3 gene were found, seven of which had not been previously described. The mutated allele of SNP 7340C>T was observed more frequently in the group of male children suffering from both allergic and autoimmune diseases simultaneously (p = 0.004, OR = 16.2 [1.34-195.15]). Conclusions: In this study we identified for first time genetic variants of FOXP3 that are significantly more frequent in children who share allergic and autoimmune diseases. These variants mainly affect regulatory sequences that could alter the expression levels of FOXP3 modifying its function including its role in Treg cells (AU)


No disponible


Assuntos
Criança , Humanos , Fatores de Transcrição Forkhead , Fatores de Transcrição Forkhead/imunologia , Autoimunidade/imunologia , Asma/imunologia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Dessensibilização Imunológica/métodos , Técnicas Imunológicas/métodos , Polimorfismo Genético/imunologia , Estudos de Casos e Controles , Análise Citogenética/métodos
12.
J. investig. allergol. clin. immunol ; 26(1): 31-39, 2016. tab, ilus, graf
Artigo em Inglês | IBECS | ID: ibc-150187

RESUMO

Background: Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy. Objective: To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy. Methods: sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cor a 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges. Results: Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP-sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P<.05). Similar rates of Cor a 8 and Jug r 3 sensitization were detected by both techniques. Conclusions: The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved (AU)


Introducción: La utilidad clínica del diagnóstico por componentes no ha sido evaluada en el estudio de la alergia a frutos secos (FS). Objetivo: Evaluar la capacidad diagnóstica de una micromatriz comercial de proteínas alergénicas en la alergia a cacahuete, avellana y nuez. Métodos: Se determinó la sIgE en pacientes alérgicos a FS mediante la micromatriz ISAC 112, e ImmunoCAP en los pacientes con sIgE negativa frente a los componentes de ISAC. Además, se realizó ImmunoCAP frente a Ara h 9, Cor a 8 y Jug r 3 en un subgrupo de pacientes sensibilizados a LTP. La sIgE detectada por ImmunoCAP fue comparada con los rangos de ISAC. Resultados: La mayoría de los alérgicos a cacahuete (66,7%), avellana (80,5%) y nuez (84%) estaba sensibilizados a su LTP. Sin embargo, no se detectó sIgE frente a los componentes de ISAC en el 33,3% de alérgicos a cacahuete, 13,9% de alérgicos a avellana y 13,6% de los alérgicos a nuez. El ImmunoCAP permitió detectar sIgE a Ara h 9 en 61,5%, Cor a 8 en 60% y Jug r 3 en 83,3% de los ISAC negativo. En el subgrupo LTP, ImmunoCAP (94,4%) fue superior a ISAC (72,2%) en la detección de sIgE a Ara h 9 (p<0,05). La sIgE frente a Cor a 8 y Jug r 3 fue detectada de forma similar por ambas técnicas. Conclusiones: La micromatriz ISAC es adecuada para el diagnóstico de alergia a avellana y nuez. La sensibilidad del componente Ara h 9 de ISAC debe ser mejorada (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Hipersensibilidade a Noz/imunologia , Arachis/imunologia , Hipersensibilidade a Amendoim/imunologia , Corylus/imunologia , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Testes Imunológicos/instrumentação , Testes Imunológicos/métodos , Testes Imunológicos , Técnicas Imunológicas/métodos , Testes Imunológicos/classificação , Testes Imunológicos/estatística & dados numéricos , Testes Imunológicos/normas , Técnicas Imunológicas/instrumentação , Técnicas Imunológicas/normas , Técnicas Imunológicas
16.
Allergol. immunopatol ; 43(3): 272-278, mayo-jun. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-136334

RESUMO

Background: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. Methods: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. Results: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. Conclusions: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dessensibilização Imunológica/métodos , Dessensibilização Imunológica/estatística & dados numéricos , Dessensibilização Imunológica , Síndromes de Imunodeficiência/epidemiologia , Síndromes de Imunodeficiência/imunologia , Síndromes de Imunodeficiência/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Alergia e Imunologia/educação , Alergia e Imunologia , Alergia e Imunologia/estatística & dados numéricos , Técnicas Imunológicas/métodos , Técnicas Imunológicas/normas , Técnicas Imunológicas
18.
J. investig. allergol. clin. immunol ; 25(5): 352-357, 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-144653

RESUMO

Background: Baker's asthma (BA) is the most prevalent occupational respiratory disease in developed countries. It is caused by inhalation of wheat dust in the working environment and affects 1%-10% of workers in the baking industry. Diagnosis of BA is based on bronchial challenge with wheat, a technique that carries a high risk for patients. The wheat lipid transfer protein Tri a 14 is a major allergen in BA. Objective: The aim of our study was to characterize Tri a 14 as a marker of BA in order to prevent patients from having to undergo bronchial challenge with wheat. Methods: The study population comprised 55 patients selected at the Rio Hortega Hospital, Valladolid, Spain. Patients with BA were diagnosed using a skin prick test (SPT) with wheat and Tri a 14 and bronchial challenge test (BCT) with wheat. Patients with food allergy had a clear clinical history of allergy to peach confirmed by positive SPT to peach extract and Pru p 3. Results: All patients in the BA group had a positive SPT result with wheat (100%), and most had positive results with Tri a 14 (95%). A positive BCT result with Tri a 14 was also observed in 22 of 27 of the patients with BA (82%). The response to Tri a 14 was specifically associated with BA. Conclusion: Tri a 14 is a good marker of BA and can be used in SPT and BCT as an alternative diagnostic method, thus avoiding bronchial challenge with wheat and reducing the risk associated with this technique (AU)


Antecedentes: El asma del panadero (BA) es la enfermedad respiratoria ocupacional más frecuente en los países occidentales. Está causada por la inhalación diaria de harina de trigo en el entorno de trabajo, afectando entre 1-10% de los trabajadores de la industria panadera. El diagnóstico de BA se basa en la provocación bronquial con trigo, una técnica de alto riesgo para los pacientes. La proteína de transferencia de lípidos de trigo (LTP) Tri a 14 ha sido descrita como alérgeno principal en esta patología. Objetivo: El objetivo de nuestro estudio ha sido caracterizar Tri a 14 como marcador de BA, y así evitar la provocación bronquial con trigo en estos pacientes. Métodos: Para ello, se seleccionaron cincuenta y cinco pacientes en el Hospital Río Hortega de Valladolid, España. Resultados: Los pacientes diagnosticados con BA mostraron prueba cutánea (SPT) positiva a trigo (100%) y la mayoría también a Tri a 14 (95%). Todos ellos, fueron sometidos a provocación bronquial con Tri a 14, observándose un resultado positivo en 22/27 de los sujetos evaluados (82%). Conclusiones: En base a esto, se puede concluir que Tri a 14 es un buen marcador de BA, y podría ser utilizado en SPT y provocación bronquial como método diagnóstico, reduciendo el uso de la provocación bronquial con trigo y el riesgo asociado a esta técnica (AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Asma/diagnóstico , Hipersensibilidade a Trigo/diagnóstico , Testes de Provocação Brônquica/métodos , Testes Cutâneos , Alérgenos , Dessensibilização Imunológica/métodos , Alergia e Imunologia , Hipersensibilidade/diagnóstico , Técnicas Imunológicas/métodos , Triticum/efeitos adversos , Saúde do Trabalhador/normas , Testes Cutâneos/instrumentação , Testes Cutâneos/métodos , Técnicas Imunológicas/normas , Técnicas Imunológicas
19.
J. investig. allergol. clin. immunol ; 25(4): 283-287, 2015. tab
Artigo em Inglês | IBECS | ID: ibc-138424

RESUMO

Objetivo: Comparar las pruebas cutáneas prick (PC) con técnicas in vitro (fluoro enzimoinmunoensayo –FEIA- en detección única y múltiple) para detectar sensibilización a profilina y a LTP. Métodos: Se estudiaron retrospectivamente 181 pacientes con alergia a polen y a alimentos vegetales y 61 controles. Se realizaron PC frente a profilina de palmera (Pho d 2) y LTP de melocotón (Pru p 3) y se analizó la IgE específica a Phl p 12 y Pru p 3 por FEIA y por micromatriz de proteínas alergénicas. Resultados: Quince de los 201 sujetos con PC negativa a LTP mostraron ensibilización a este alérgeno mediante IgE específica sérica y en 18 de 41 con PC positivas a LTP no se observó esta sensibilización por otras técnicas. Diecisiete de los 186 sujetos con PC negativa a profilina detectaron IgE específica sérica frente a Phl p 12 y en 30 de los 56 con PC positiva a profilina no se objetivó sensibilización a Phl p 12 en suero. Se observó un acuerdo moderado entre las tres técnicas estudiadas. Conclusiones: La PC frente e a LTP y profilina es un método sensible detectando estas sensibilizaciones y muestra un acuerdo aceptable con las técnicas in vitro, especialmente en los pacientes con negatividad de la PC frente a LTP y a profilina (AU)


Objective: To compare the skin prick test (SPT) with in vitro techniques (single and multiplex fluorescence enzyme-immunoassay [FEIA]) for detecting sensitization to profilin and lipid transfer protein (LTP). Methods: We retrospectively studied 181 patients with pollen and/or plant food allergy and 61 controls. SPT was performed with date palm profilin (Pho d 2) and peach LTP (Pru p 3), and specific IgE (sIgE) to Phl p 12 and Pru p 3 was analyzed using single FEIA and microarray. Results: Fifteen of 201 patients with negative results for LTP in the SPT were sensitized to this allergen in the in vitro tests, and 18 of 41 patients with positive results for LTP in the SPT were not sensitized according to the in vitro tests. Seventeen of 186 patients with negative results for profilin in the SPT were sensitized to Phl p 12 by serum sIgE, and 30 out of 56 patients with positive results for profilin in SPT were not sensitized to Phl p 12 according to the other tests. Moderate agreement was observed between the 3 techniques studied. Conclusions: SPT is a sensitive technique for detecting sensitization to LTP and profilin. Its results are similar to those of in vitro techniques, especially in patients with negative SPT results for peach LTP and palm tree profiling (AU)


Assuntos
Feminino , Humanos , Masculino , Testes Cutâneos , Técnicas In Vitro/métodos , Técnicas In Vitro , Hipersensibilidade/diagnóstico , Profilinas/análise , Hipersensibilidade Respiratória/epidemiologia , Hipersensibilidade Alimentar/imunologia , Proteínas Ligadas a Lipídeos/imunologia , Estudos Retrospectivos , Imunoensaio/métodos , Alérgenos , Técnicas Imunológicas/métodos , Grupos Controle , Hipersensibilidade Imediata/imunologia
20.
J. investig. allergol. clin. immunol ; 25(4): 288-294, 2015. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-138425

RESUMO

Objectives: To contrast the initial suspected etiology of anaphylaxis with the postworkup diagnosis in patients attended at the emergency department (ED) of a tertiary-level hospital in Spain and to investigate the incidence, causes, and management of anaphylaxis. Methods: We performed an observational study of patients aged more than 15 years who came to the ED with anaphylaxis between 2009 and 2010. All clinical records from the ED were reviewed. We recorded data on clinical management, the etiology proposed by the attending emergency physician, and the cause reported by the patient. The findings were compared with the diagnosis reached after the allergy workup. Results: The incidence of anaphylaxis was 0.08%. The most common manifestation was skin-mucosal symptoms (98.3%). Anaphylaxis was diagnosed in the ED in only 44% of the cases, regardless of severity. Only 39.7% received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity. A total of 60 patients were subsequently seen at the allergy department. The final etiology differed from the initial suspicion in the ED in 45% of cases. The frequency of anaphylaxis of uncertain origin decreased from 33.3% to 13.3%. After the allergy workup, drugs (41.7%) were considered the main cause of anaphylaxis, followed by food (25%). Conclusions: The incidence of anaphylaxis (0.08%) was double that estimated in the ED. Anaphylaxis is underdiagnosed. A correct diagnosis conditions the administration of epinephrine, regardless of the severity of symptoms. The real etiology of anaphylaxis should only be proposed after an allergy workup, which is recommended in all cases, as the real cause can differ considerably from the initial impression in the ED (AU)


Objetivos: Contrastar la etiología sospechada de la anafilaxia con el diagnóstico tras el estudio alergológico en la población atendida en el Servicio de Urgencias (SU) de un hospital español de tercer nivel, y determinar incidencia, causas y manejo de la anafilaxia. Métodos: Se realizó un estudio observacional con pacientes mayores de 15 años de edad del SU con anafilaxia, entre 2009 y 2010. Se revisaron las historias clínicas del SU. Se recogieron manejo clínico, impresión etiológica del médico de Urgencias y paciente. Éstos se compararon con el diagnóstico final tras el estudio alergológico. Resultados: La incidencia de anafilaxia fue 0,08%. La manifestación más frecuente fue la cutáneo-mucosa (98,3%). Sólo se diagnosticó de anafilaxia al 44% de los casos, independientemente de la gravedad. El 39,7% recibió adrenalina, más frecuentemente si se diagnosticaban de anafilaxia, independientemente de la gravedad. Un total de 60 pacientes se atendieron posteriormente en Alergología. La etiología final cambió en un 45% del sospechado en el SU. El origen incierto se redujo de un 33.3% a un 13.3%. Tras el estudio alergológico, la causa más frecuente fueron los fármacos (41,7%), seguidos de los alimentos (25%). Conclusiones: La incidencia de anafilaxia, 0,08%, dobló la estimada en el SU. La anafilaxia está infradiagnosticada, mientras que el diagnóstico correcto condiciona la administración de adrenalina, independientemente de la gravedad. La verdadera etiología de la anafilaxia debería considerarse tras el estudio alergológico, que se debería recomendar a todos los pacientes, ya que puede ser diferente de la impresión en el SU (AU)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Anafilaxia/diagnóstico , Emergências/epidemiologia , Técnicas In Vitro , Hipersensibilidade/diagnóstico , Imunização , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade Alimentar , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade Alimentar , Alergia e Imunologia/tendências , Técnicas Imunológicas/métodos
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