Serum Vitamin D Is Inversely Associated with Blood Eosinophil Count Among Adults with Allergic Asthma.

OBJECTIVE: To evaluate the role that serum vitamin D concentration plays in the number of eosinophils in peripheral blood in adults with allergic asthma. MATERIAL AND METHODS: A total of 142 patients were categorized based on different cutoff points for eosinophils: ≥200, ≥300, ≥400, and ≥500 cells/mL. The vitamin D concentration was stratified into <20 and ≥20 ng/mL. The association between vitamin D (independent variable) and eosinophils (dependent variable) was explored using multivariate analysis. RESULTS: The average number of eosinophils in the included patients was 418 cells/mL, and 33.8% of the included patients had vita- min D concentrations ≥20 ng/mL. Asthmatic patients with vitamin D< 20 ng/mL had a higher mean concentration of eosinophils than did asthmatic patients with vitamin D ≥20 ng/mL (464 ± 377.7 eosinophils/mL vs. 327.8 ± 247.2 eosinophils/mL, P = .025). We also observed that vitamin D was inversely correlated with eosinophil count (rho = 0.244, P = .003). In the multivariate analysis, vitamin D <20 ng/mL showed a significant inverse association with each cutoff value for eosinophilia (odds ratio >1). CONCLUSION: Vitamin D concentrations <20 ng/mL are associated with a significant increase in the number of eosinophils in blood. Studies that analyze the use of vitamin D supplements as complementary therapy for the treatment of asthma are needed.

[Prevalence of cow´s milk allergy and lactose intolerance among Mexican late adolescents]. / Prevalencia de alergia a la leche de vaca e intolerancia a la lactosa en adolescentes tardíos mexicanos.

OBJECTIVE: To determine the prevalence of cow´s milk allergy and lactose intolerance in a sample of late adolescents. METHODS: Through a population-based study, data corresponding to students with aged 15 to 18 years were analyzed. RESULTS: A total of 1992 adolescents was analized. The prevalence of cow´s milk allergy was 1.4% (95% CI: 0.2% to 0.8%) and the prevalence of lactose intolerance was 0.5% (95% CI: 0.2% to 0.8%). Adolescents with cow´s milk allergy had fewer gastrointestinal symptoms (p = 0.036), but more skin (p < 0.001) and respiratory (p = 0.028) ailments than adolescents with lactose intolerance. CONCLUSIONS: The manifestations associated with cow's milk consumption in late adolescents seem to correspond mainly to cow´s milk allergy than to lactose intolerance.

OBJECTIVO: Determinar la prevalencia de alergia a la proteína de la leche de vaca e intolerancia a la lactosa en una muestra de adolescentes tardíos. MÉTODOS: Estudio transversal con base poblacional, en el que se analizaron los datos de pacientes adolescentes de 15 a 18 años. RESULTADOS: Se registraron 1992 estudiantes. La prevalencia de alergia a la proteína de la leche de vaca fue de 1.4% (IC95%: 0.9% a 2.0%) y de intolerancia a la lactosa de 0.5% (IC95%: 0.2% a 0.8%). Los adolescentes con alergia a la proteína de la leche de vaca tuvieron menos síntomas gastrointestinales (p = 0.036), pero más molestias cutáneas (p < 0.001) y respiratorias (p = 0.028) que los adolescentes con intolerancia a la lactosa. CONCLUSIONES: Las manifestaciones asociadas con el consumo de leche de vaca en adolescentes tardíos corresponden, principalmente, a la alergia de la proteína de la leche de vaca que a la intolerancia a la lactosa.

Beyond eosinophilia: inflammatory patterns in patients with asthma.

Background: Recently, inflammatory cell ratios have gained importance as useful indicators in the categorization of asthma.Objective: We compared the concentration of white blood cells in peripheral blood, as well as their respective inflammatory cell ratios, between patients with asthma and a healthy control group.Methods: We performed cross-sectional analyses of the data obtained from 53 adult patients with asthma and 109 adult controls. In our study, we estimated and compared the following inflammatory cell ratios: Neutrophil-Lymphocyte Ratio (NLR), Eosinophil-Lymphocyte Ratio (ELR), Eosinophil-Neutrophil Ratio (ENR), Eosinophil-Monocyte Ratio (EMR), and Platelet-Lymphocyte Ratio (PLR). The magnitude of association was quantified with the odds ratio.Results: In both groups, the average age was 33 years. In asthmatic patients, we obtained the following results: eosinophils ≥ 400 cells/µl, accounted for 37.7%; basophils ≥ 110 cells/µl, comprised 37.7%; and monocytes < 320 cells/µl, reached 11.3%. In the control group, the results were as follows: 4.6%, 9.2% and 0.9%, respectively. When compared to the control group, asthmatic patients had higher odds of eosinophils ≥ 400 cells/µl (OR = 12.61, p < 0.0001); higher odds of basophils ≥ 110 cells/µl (OR = 6.00, p < 0.0001); and increased odds of monocytes < 320 cells/µl (OR = 13.79, p = 0.017). NLR did not differ between our two groups; however, ELR, ENR, EMR and PLR were significantly higher in the asthma group.Conclusions: Overall, patients with asthma have a higher concentration of eosinophils and basophils, fewer monocytes in their blood, and higher ratios of increased chronic inflammation.

Anxiety and depression in adult patients with asthma: the role of asthma control, obesity and allergic sensitization.

OBJECTIVE: To determine the frequency of anxiety and depression in adult patients with asthma and to identify factors associated with them. METHODS: This cross-sectional study included 164 consecutively recruited patients with asthma aged ≥ 18 years. Participants were clinically assessed and the mental state was analyzed through of the Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI-II); the Asthma Control Test (ACT) was measured, and allergic sensitization and respiratory function were also evaluated. Binary logistic regression models to identify the factors related to anxiety or depression were carried out. Complementary, 95% confidence intervals (CI) were estimated. RESULTS: Anxiety was present in 54.3% of patients (95% CI: 46.6%-61.7%) while depression was found in 50.6% (95% CI: 43.0%-58.2%). Depression increased the odds of anxiety in patients with asthma (OR: 26.00, p < 0.0001), whereas an ACT score ≥ 20 points and allergic asthma were associated with a lower odds than the reference group (OR: 0.29; p = 0.007 and OR: 0.29; p = 0.024, respectively). Depression was associated with anxiety and obesity (OR: 25.33, p < 0.0001 and OR: 3.66; p = 0.014, respectively). CONCLUSIONS: Overall, more than half of all asthmatic patients suffer from anxiety and depression. Well-controlled asthma and allergic sensitization decreased the likelihood of anxiety, while depression was associated with both obesity and anxiety.

[Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma 2020]. / Consenso mexicano en relación con la fracción exhalada de óxido nítrico (FeNO) en asma 2020.

The fractional exhaled nitric oxide (FeNO) is related to the level of eosinophilic inflammation in the airways and the levels of interleukin-13, as such it could be a diagnostic and monitoring tool in asthma. A working group was convened between pulmonologists, respiratory physiology experts, and allergists to establish criteria for the use of FeNO in asthma in Mexico. Through a simplified Delphi method and group discussion, seven key points regarding the use of FeNO were agreed upon. We agree that the measurement of FeNO serves for the diagnosis of asthma in specialized clinics, both in children and adults, as well as to determine the level of corticosteroid treatment. In severe asthma, we recommend FeNO for endotyping, for detecting poor therapeutic adherence, undertreatment, and the risk of crisis. We suggest FeNO can be used to determine the level of corticosteroid treatment and to identify patients at risk of loss of lung function. We also recommend it in adults to improve the selection of biological therapy and, in this context, we only suggest it in selected cases for children.

La fracción exhalada de óxido nítrico (FeNO) se relaciona con el nivel de inflamación eosinofílica en las vías aéreas y los niveles de interleucina-13, por lo que podría ser una herramienta diagnóstica y de seguimiento en el asma. Se convocó un grupo de trabajo integrado por neumólogos, expertos en fisiología de la respiración y alergólogos, con la finalidad de establecer criterios para el uso de la FeNO en asma en México. Mediante un método Delphi simplificado y discusión grupal, se consensaron varios puntos clave en relación con el uso de la FeNO. Sugerimos que la medición de la FeNO sirve para el diagnóstico de asma en clínicas especializadas, tanto en niños como adultos, así como para determinar el nivel de tratamiento con corticosteroides. En asma grave, recomendamos la FeNO para la endotipificación, detectar la mala adherencia terapéutica, el subtratamiento y el riesgo de crisis. Sugerimos su uso para determinar el nivel de tratamiento con corticosteroides e identificar pacientes con riesgo de tener una pérdida de la función pulmonar. También la recomendamos en el adulto para mejorar la elección de medicamentos biológicos y, en este contexto, solo la sugerimos en casos selectos en niños.

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines.

BACKGROUND: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. METHODS: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. RESULTS: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. CONCLUSIONS: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.

Peanut allergy among Mexican adults with allergic respiratory diseases: prevalence and clinical manifestations.

BACKGROUND: Peanut allergy among adults with respiratory diseases has seldom been studied within Mexico. OBJECTIVE: To establish the prevalence of peanut allergy among adults that have been diagnosed with either asthma or allergic rhinitis; we will also be describing the symptoms that are associated with peanut allergy. METHODS: We carried out a cross-sectional study through which we analyzed the corresponding data of 257 patients with allergic respiratory diseases, asthma or allergic rhinitis, all participants were 16 years of age or older, and were recruited in a consecutive manner. Peanut allergy was established by testing positive to a peanut skin-prick test; we also conducted a standard interview with each patient. RESULTS: From our sample of 257 patients, 18 tested positive to peanut sensitization, (7.0%; 95% CI = 3.9% to 10.1%); among these 18 participants, 7 were considered to be allergic to peanuts (2.7%; 95% IC: 0.7% to 4.7%). Predominant symptoms were oral, primarily affecting the pharynx and the palate, followed by swelling of the lips. When it came to respiratory discomfort, sneezing and rhinorrhea stood out, and lastly there were cutaneous symptoms. We did not detect any systemic reactions to the peanut. CONCLUSION: In our study, peanut allergy among adults with allergic respiratory diseases is not an uncommon occurrence.

Antecedentes: La alergia al cacahuate en adultos con enfermedades respiratorias alérgicas pocas veces ha sido estudiada en México. Objetivo: Establecer la prevalencia de alergia al cacahuate en un grupo de adultos con asma o rinitis alérgica; también se describen los síntomas asociados con la alergia al cacahuate. Métodos: Se realizó estudio transversal en el que analizaron los datos correspondientes a 257 pacientes con enfermedades respiratorias alérgicas, asma o rinitis alérgica, con edad igual o mayor a 16 años; los pacientes fueron reclutados consecutivamente. La alergia al cacahuate se determinó por una prueba cutánea positiva al cacahuate y a través de una entrevista estandarizada. Se estimaron intervalos de confianza (IC) a 95 % para proporciones. Resultados: De los pacientes incluidos, 18 estuvieron sensibilizados al cacahuate (7.0 %, IC 95 % = 4.4-10.9), siete de ellos fueron considerados alérgicos al cacahuate, para una prevalencia de 2.7% (IC 95%: 1.2% - 5.6%). En los pacientes con alergia al cacahuate, los síntomas predominantes fueron los orales, principalmente el prurito en la faringe y en el paladar, seguidos de edema de los labios; entre las molestias respiratorias sobresalieron los estornudos y la rinorrea y, al final, los síntomas cutáneos. No se documentaron reacciones sistémicas al cacahuate. Conclusión: En nuestro estudio, la alergia al cacahuate en adultos con enfermedades respiratorias alérgicas no fue infrecuente.

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]. / GUIMIT 2019, Guía Mexicana de Inmunoterapia. Guía de diagnóstico de alergia mediada por IgE e inmunoterapia aplicando el método ADAPTE.

BACKGROUND: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.

Antecedentes: En México, la inmunoterapia con alérgenos (ITA) y con veneno de himenópteros (VIT) se practica tradicionalmente combinando criterios de las escuelas europea y estadounidense; los dos tipos de extractos están comercialmente disponibles en México. Para una ITA adecuada es crucial un diagnóstico oportuno. Objetivo: Presentar GUIMIT 2019, Guía Mexicana de Inmunoterapia 2019, de base amplia, actualizada, que abarca temas de diagnóstico, indicaciones, dosificación, mecanismos, efectos adversos de la ITA y expectativas con esta modalidad de tratamiento. Método: Con la participación de múltiples grupos mexicanos de alergólogos, que incluían los centros formadores universitarios en alergia e inmunología, se desarrolló el documento de la guía según la metodología ADAPTE. Las guías de inmunoterapia de la European Academy of Allergy and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology, German Society for Allergology and Clinical Immunology y del American College of Allergy, Asthma, and Immunology se seleccionaron como guías fuente, ya que recibieron la puntuación AGREE-II más alta entre las guías internacionales disponibles; su evidencia conforma la base científica de GUIMIT 2019. Resultados: En GUIMIT 2019 se emiten recomendaciones fuertes o débiles (sugerencias) acerca de temas directamente relacionados con el diagnóstico in vivo o in vitro de las enfermedades alérgicas mediadas por IgE, la preparación y aplicación de ITA o VIT y sus efectos adversos; se incluye la revisión de las modalidades de ITA para el futuro. Todos los argumentos que se exponen fueron discutidos y votados con > 80 % de aprobación. Conclusión: Un grupo amplio y diverso de expertos en ITA y VIT emitió recomendaciones transculturizadas basadas en evidencia, que alcanzaron consenso; con ellas se pretende mejorar y homologar la práctica de la inmunoterapia en México.

The characterization of asthma with blood eosinophilia in adults in Latin America.

Objective: To identify and characterize asthma with blood eosinophilia in adults. Methods: This cross-sectional study consisted of 164 asthma patients, aged 18 years or older. Multivariate analyses by logistic regression were performed to identify clinical characteristics and biomarkers associated with asthma with blood eosinophilia (defined as asthma and a peripheral blood eosinophil count ≥400 cells/mm3). To evaluate the diagnostic accuracy of these biomarkers, the sensitivity, specificity and predictive values were calculated. Additionally, the area under the receiver operating characteristic (ROC) curve (AUC) was estimated for each biomarker. Results: Overall, 37.8% (95%CI: 30.7-45.4%) of asthma patients had blood eosinophilia. The following factors were associated with this characteristic: patient age <50 years (OR 3.25; 95% CI: 1.33-7.94), a serum level of IgE ≥300 UI/mL (OR 2.32; 95%CI: 1.14-4.75), and an Asthma Control Test (ACT) score <20 points (OR 3.10; 95%CI: 1.35-4.75); asthma with blood eosinophilia was also associated with a baseline FEV1/FVC <70% (OR 2.68; 95%CI: 1.28-5.59). On the other hand, age <50 years and ACT score <20 showed the highest sensitivity (above 80% each). Serum IgE level ≥300 UI/mL had the highest specificity (almost 68%). Finally, those with an ACT score <20 had the highest AUC (68%). Conclusions: In our study population, one-third of asthmatic adults had asthma with blood eosinophilia. Furthermore, the prevalence was greater in those ≤50 years of age; these patients experienced more severe, more poorly controlled asthma and had higher total serum IgE levels.

[High prevalence of food sensitization among adults with allergic diseases who live in the Guadalajara metropolitan area]. / Alta prevalencia de sensibilización a alimentos en adultos con enfermedades alérgicas residentes en la zona metropolitana de Guadalajara.

BACKGROUND: The prevalence of food sensitization in adults shows differences owing to geographic, regional and cultural circumstances. OBJECTIVE: To identify the prevalence and factors associated with food sensitization in adults with allergic diseases. METHODS: Cross-sectional study, where medical records of adult patients with any allergic disease and who tested positive to airborne allergens on at least one skin test were reviewed. Age, sex, underlying allergic disease and skin test result were recorded. Statistical analyses included food sensitization prevalence with the corresponding 95 % confidence intervals (CI), as well as a multivariate analysis to determine associated factors. RESULTS: We included 258 patients with a mean of 36 years of age; 75 % were of the female sex. The most common underlying condition was allergic rhinitis (59 %). The prevalence of food sensitization was 37 % (95 % CI, 31.5-43.3) and it did not vary significantly according to sex or allergic disease in question. The most sensitizing food was soybeans (44.8 %), and associated factors were sensitization to cat dander (OR = 1.8; 95 % CI, 1.03-3.2) and 5 or more positive skin tests (OR = 4.3, 95 % CI 2.3-8.1). CONCLUSION: The prevalence of food sensitization in people with allergic disease was 40 %. Further studies are required to determine its prevalence in the general population.

Antecedentes: La prevalencia de sensibilización a alimentos en adultos presenta diferencias debido a las condiciones geográficas, regionales y culturales. Objetivo: Identificar la prevalencia y los factores asociados a la sensibilización a alimentos en adultos con alguna enfermedad alérgica. Métodos: Estudio transversal en el que se revisaron los expedientes clínicos de adultos con alguna enfermedad alérgica que presentaron al menos una prueba cutánea positiva a aeroalérgenos. Se registró edad, sexo, enfermedad alérgica de base y resultado de la prueba cutánea. El análisis es-tadístico incluyó prevalencia de sensibilización a alimentos e intervalos de confianza (IC) de 95 %, así como análisis multivariado para determinar los factores asociados. Resultados: Se incluyeron 258 pacientes con edad media de 36 años; 75 % fue del sexo femenino. La enfermedad de base más frecuente fue la rinitis alérgica (59 %). La prevalencia de sensibilización a alimentos fue de 37 % (IC 95 %, 31.5-43.3) y no varió significativamente según sexo o enfermedad alérgica. El alimento más sensibilizante fue la soya (44.8 %) y los factores asociados, la sensibil-ización al epitelio de gato (OR = 1.8; IC 95 %, 1.03-3.2) y 5 o más pruebas cutáneas positivas (OR = 4.3; IC95 %, 2.3-8.1). Conclusiones: La prevalencia de sensibilización a alimentos en personas con enfermedad alérgica fue de 40 %; para determinarla en la población general se requieren estudios adicionales.

Associated Markers for Adult-onset Allergic Asthma.

The clinical behavior of asthma varies with age at onset. This study was undertaken to identify associated markers of adult-onset allergic asthma (age ≥20 years).This cross-sectional study compared two groups: 58 patients with asthma onset at ≥20 years and 66 with onset at ≥20 years. They were compared depending on results of clinical history, and body mass index (BMI), aeroallergen sensitization, total serum IgE, eosinophil count, asthma control test, and asthma severity level.Ages at first asthma episode were 10.0 ± 6.6 and 33.4 ± 10.5 (p<0.001) in the <20 and ≥20 group, respectively. BMI was higher in adult asthmatic subjects (29.8 versus 27.1, P=0.017), but BMI ≥30 kg/m(2) was not associated with asthma onset in ≥20 years (odds ratio [OR] = 1.56, 95% confidence interval [CI] 0.759 to 3.211; p= 0.227). After multivariate analysis, allergic rhinitis and IgE ≥150 IU/mL were negatively correlated with asthma onset in ≥20 years old (OR adjusted [ORa] = 0.255, 95% CI 0.078 to 0.837, P= 0.024, and ORa =0.385, 95% CI 0.175 to 0.849, p= 0.018, respectively).Adult-onset allergic asthma was not different from early-onset asthma.

[Frequency of sensitization to pollens of the subclass Rosidae in patients with respiratory allergy]. / Frecuencia de sensibilización a pólenes de la subclase Rosidae en pacientes con alergia respiratoria.

BACKGROUND: Studies related to the patterns of sensitization to rare species of aeroallergens are uncommon. OBJECTIVE: To determine the frequency of sensitization to pollens clinically relevant in Allergology, corresponding to subclass Rosidae in patients with respiratory allergy. PATIENTS AND METHOD: A cross-sectional study was done with patients included in a group with allergic rhinitis or asthma, respectively. We studied the clinical history, physical examination and reactivity to a panel of allergens, including the species Prosopis, Schinus, Acacia and Eucalyptus. Frequency of sensitization and confidence intervals at 95% (95%CI) were calculated. RESULTS: A total of 104 allergic rhinitis patients and 99 patients with asthma diagnosis were included. In both groups, the mean age corresponded to fourth decade of life. Women had greater frequency. In patients with allergic rhinitis, frequencies of sensitization were: mesquite tree 26.2% (95%CI: 17.7% to 34.6%), American pepper tree 11.5% (95%CI: 5.4% to 17.6%), eucalypt tree 6.7% (95%CI: 1.9% to 11.5%) and acacia tree 3% (95%CI: 0.3% to 6.3%). In subjects with asthma the results were as follows: mesquite tree 13.1% (95%CI: 6.5% to 19.7%), American pepper tree 7.1% (95%CI: 2% to 12.2%), eucalypt tree 4% (95%CI: 0.1% to 7.9%) and acacia tree 3% (95%CI: 0.4% to 6.4%). Both groups had a high frequency of sensitization to ash tree and oak tree followed by eucalypt, pine and acacia tree. CONCLUSIONS: Studied capacity of sensitization to tree pollens for this population is low, except for mesquite tree.

Antecedentes: los estudios relacionados con los patrones de sensibilización a especies de aeroalergenos poco comunes son infrecuentes. Objetivo: determinar la frecuencia de sensibilización a pólenes de relevancia alergológica provenientes de la subclase Rosidae en pacientes con alergia respiratoria. Pacientes y método: estudio descriptivo y transversal en el que se incluyeron pacientes de manera consecutiva a un grupo con rinitis alérgica y a otro con asma. Se estudiaron mediante historia clínica, exploración física y reactividad cutánea a un panel de alergenos, que incluyó a las especies Prosopis, Schinus, Acacia y Eucalyptus. Se determinaron las frecuencias de sensibilización y sus intervalos de confianza a 95% (IC 95%) respectivos. Resultados: se estudiaron 104 pacientes con rinitis alérgica y 99 con asma; en ambos grupos la media de edad se ubicó en la cuarta década de la vida y hubo predomino de mujeres. En los pacientes con rinitis alérgica se observó la siguiente frecuencia de sensibilización: mezquite 26.2% (IC 95%: 17.7 a 34.6%), pirul 11.5% (IC 95%: 5.4 a 17.6%), eucalipto 6.7% (IC 95%: 1.9 a 11.5%) y acacia 3% (IC 95%: 0.3 a 6.3%). En los sujetos con asma la conducta fue la siguiente: mezquite 13.1% (IC 95%: 6.5 a 19.7%), pirul 7.1% (IC 95%: 2 a 12.2%), eucalipto 4 (IC 95%: 0.1 a 7.9%) y acacia 3% (IC 95%: 0.4 a 6.4%). Los dos grupos manifestaron un predominio de sensibilización por los fresnos y encinos; al final se encontraron eucalipto, pino y acacia. Conclusión: la capacidad de sensibilización de los árboles analizados, con excepción del mezquite, es menor.

In the (sub)tropics allergic rhinitis and its impact on asthma classification of allergic rhinitis is more useful than perennial-seasonal classification.

BACKGROUND: Two different allergic rhinitis (AR) symptom phenotype classifications exist. Treatment recommendations are based on intermittent-persistent (INT-PER) cataloging, but clinical trials still use the former seasonal AR-perennial AR (SAR-PAR) classification. This study was designed to describe how INT-PER, mild-moderate/severe and SAR-PAR of patients seen by allergists are distributed over the different climate zones in a (sub)tropical country and how these phenotypes relate to allergen sensitization patterns. METHODS: Six climate zones throughout Mexico were determined, based on National Geographic Institute (Instituto Nacional de Estadística y Geografía) data. Subsequent AR patients (2-68 years old) underwent a blinded, standardized skin-prick test and filled out a validated questionnaire phenotyping AR. RESULTS: Five hundred twenty-nine subjects participated in this study. In the tropical zone with 87% house-dust mite sensitization, INT (80.9%; p < 0.001) and PAR (91%; p = 0.04) were more frequent than in the subtropics. In the central high-pollen areas, there was less moderate/severe AR (65.5%; p < 0.005). Frequency of comorbid asthma showed a clear north-south gradient, from 25% in the dry north to 59% in the tropics (p < 0.005). No differences exist in AR cataloging among patients with different sensitization patterns, with two minor exceptions (more PER in tree sensitized and more PAR in mold positives; p < 0.05). CONCLUSION: In a (sub)tropical country the SAR-PAR classification seems of limited value and bears poor relation with the INT-PER classification. INT is more frequent in the tropical zone. Because PER has been shown to relate to AR severity, clinical trials should select patients based on INT-PER combined with the severity cataloging because these make for a better treatment guide than SAR-PAR.

Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub)tropics.

BACKGROUND: Allergen exposure leads to allergen sensitization in susceptible individuals and this might influence allergic rhinitis (AR) phenotype expression. We investigated whether sensitization patterns vary in a country with subtropical and tropical regions and if sensitization patterns relate to AR phenotypes or age. METHODS: In a national, cross-sectional study AR patients (2-70 y) seen by allergists underwent blinded skin prick testing with a panel of 18 allergens and completed a validated questionnaire on AR phenotypes. RESULTS: 628 patients were recruited. The major sensitizing allergen was house dust mite (HDM) (56%), followed by Bermuda grass (26%), ash (24%), oak (23%) and mesquite (21%) pollen, cat (22%) and cockroach (21%). Patients living in the tropical region were almost exclusively sensitized to HDM (87%). In the central agricultural zones sensitization is primarily to grass and tree pollen. Nationwide, most study subjects had perennial (82.2%), intermittent (56.5%) and moderate-severe (84.7%) AR. Sensitization was not related to the intermittent-persistent AR classification or to AR severity; seasonal AR was associated with tree (p < 0.05) and grass pollen sensitization (p < 0.01). HDM sensitization was more frequent in children (0-11 y) and adolescents (12-17 y) (subtropical region: p < 0.0005; tropical region p < 0.05), but pollen sensitization becomes more important in the adult patients visiting allergists (Adults vs children + adolescents for tree pollen: p < 0.0001, weeds: p < 0.0005). CONCLUSIONS: In a country with (sub)tropical climate zones SPT sensitization patterns varied according to climatological zones; they were different from those found in Europe, HDM sensitization far outweighing pollen allergies and Bermuda grass and Ash pollen being the main grass and tree allergens, respectively. Pollen sensitization was related to SAR, but no relation between sensitization and intermittent-persistent AR or AR severity could be detected. Sensitization patterns vary with age (child HDM, adult pollen). Clinical implications of our findings are dual: only a few allergens -some region specific- cover the majority of sensitizations in (sub)tropical climate zones. This is of major importance for allergen manufacturers and immunotherapy planning. Secondly, patient selection in clinical trials should be based on the intermittent-persistent and severity classifications, rather than on the seasonal-perennial AR subtypes, especially when conducted in (sub)tropical countries.

Immediate and nonimmediate reactions induced by contrast media: incidence, severity and risk factors.

BACKGROUND: The pattern of the contrast media-induced adverse reactions has not been investigated extensively in Mexico. OBJECTIVE: To estimate the incidence and the degree of severity of the adverse reactions to contrast media, administered for the first time, in hospitalized subjects. METHODS: We studied 99 patients longitudinally on whom computed tomography with contrast media (iopamidol) was carried out. The adverse reactions were identified by clinical examination; subsequently, they were classified as mild, moderate and severe, following the Manual on Contrast Media version 9 guides, and as immediate and nonimmediate. In addition, the vital functions, oxygen saturation, serum creatinine levels and the total number of eosinophils were measured before and after the procedure. RESULTS: The incidence of immediate and nonimmediate adverse reactions was of 26.3% and 10.1%, respectively. The mild immediate reactions were 18 (69.2%), the most common being the sensation of warmth, nausea and pruritus; among the more delayed reactions, nephrotoxicity stood out (5.1%). The serum creatinine median showed no difference either before or after the intravenous injection of contrast media (p = 0.13); in contrast, there was a significant difference in the total number of eosinophils (p ≤ 0.001). The values of high baseline systolic blood pressure and the diminished baseline amounts in pulse oximetry were significantly related with any type of the adverse reactions to contrast media. CONCLUSION: The incidence of the adverse reactions to contrast media was greater with respect to previous reports; the majority of these reactions were of the immediate type and of a mild nature. The risk factors that have mostly been implicated in the adverse reactions to contrast media could not be identified in our cohort.

[Prevalence of Sensitization to the Most Common allergens in Elderly Patients from the Western of Mexico]. / Prevalencias de sensibilizaciÛn a alÈrgenos m·s comunes en adultos mayores del occidente de México.

BACKGROUND: Allergic diseases affect a great proportion of seniors. OBJECTIVE: To determine the prevalence of allergen sensitization in this age group in the western of Mexico. METHODS: A retrolective study related to skin prick tests with a common allergen panel was performed on the first consultation in elderly patients during a period of three years in Guadalajara, Mexico. RESULTS: We included 60 subjects, with an average of 67.7 years old; 83.3% were women. Diagnosis of allergic rhinitis was present in 60%, allergic rhinitis plus asthma in 30%, and asthma alone in 10%. Non atopic comorbidities were present in 56.7% of the cases. Median serum IgE was 124.95 UI/ml, the average of positive skin prick tests was 4 (1 to 21); 13.3% were sensitized to just 1 aeroallergen, and 55% were to more than three aeroallergens. Sensitization to pollens was predominant, even more to tree pollens. One by one, house dust mite, Fraxinus sp and Amaranthus palmeri were the most commonly found. Diabetes was associated to a lower positive prick test (p = 0.021). CONCLUSIONS: The most common sensitizing allergens are similar for other age groups from the same area. Elderly patients with diabetes had lower positive allergen skin tests. Itís recommended to identify the allergen sensitization in seniors with allergic disease symptoms, as part of their clinical evaluation.

[Allergen sensitization in Mexican adults with asthma: Experience at a teaching hospital]. / Sensibilización a alergenos en adultos mexicanos con asma; la experiencia en un hospital escuela.

INTRODUCTION: Cutaneous test practice to identify atopy is recommended in persons who suffer persistent asthma. OBJECTIVE: To estimate the prevalence of allergen sensitization in a group of adult asthma patients; plus, to investigate about the differences that exist between atopic and non-atopic asthmatic persons. METHODS: Consecutive asthmatic outpatients were evaluated for the first time in an Allergology Service. They were analyzed through clinical history, physical examination, and allergic cutaneous reactivity to any of 38- allergen panel. IgE serum levels were quantified too. RESULTS: One hundred eighty one asthmatic patients were included. Mean age was 40 years; 75.1% were women; in 59.9%, asthma was accompanied by allergic rhinitis; 81.2% fulfilled the atopy criteria. On average, each patient had 7.2 positive skin tests, corresponding to house-dust mite the highest frequency, followed by cockroach. Subjects age correlated negatively with the amount of positive cutaneous test and IgE serum levels, and positively with severity of asthma. IgE serum level higher than 100UI/ml was identified as a predictive factor for atopic asthma (OR = 3.1, p = 0.03). CONCLUSIONS: A substancial amount of asthmatic patients were atopic. The most highly sensitizing allergens were house-dust mite and cockroach. Differences between atopic and non-atopic asthmatics depended on their age and IgE serum levels.

[Spontaneus pneumomediastinum associated with exacerbation of asthma during the epidemic of influenza A H1N1: Inform of four cases]. / Neumomediastino espontáneo asociado a exacerbación del asma durante la epidemia de influenza A H1N1; informe de cuatro casos.

Spontaneus pneumomediastinum (SP) is an infrequent but usually benign pathology. Its main clinical manifestations are thoracic pain, dyspnea and subcutaneous emphysema. We describe the clinical findings of 4 SP patients, identified in the context of an A H1N1 influenza virus epidemic. All the patients were young and all of them required initial medical attention for asthma exacerbation. The most frequent symptoms and signs to detect SP were cervical pain and subcutaneous emphysema; chest radiography helped to confirm the diagnosis. Concomitant A H1N1 influenza virus infection was documented in two patients. The treatment was focused in the basic pathology; two patients were placed on oseltamivir, whereas the two others just had expectant management.

[Sensitization to aeroallergens in subjects with allergic rhinitis who live in the metropolitan zone of Guadalajara, Jalisco]. / Sensibilización a aeroalergenos en sujetos con rinitis alérgica que viven en la zona metropolitana de guadalajara, México.

BACKGROUND: allergic rhinitis is the most common allergic disease worldwide. Aeroallergens are compromise in its presentation and its prevalence varies in different parts of the world. Aeroallergen sensitization in the Guadalajara metropolitan area is not yet documented. OBJECTIVE: to determine by means of skin prick test the sensitization prevalence to aeroallergens in patients with allergic rhinitis. PATIENTS AND METHODS: We retrospective evaluated the results of skin prick test to different aeroallergens and their prevalence by age group in patients with allergic rhinitis referred to our allergy department. RESULTS: the complete data of 965 subjects were available, 78% of these had positive skin prick tests, the age range of the patients was 16 to 78 years, 74.9% of which were women; 9% were sensitized to one allergen and 11.5% had more than 15 positive skin prick test. The most frequent interior allergens were house dust mites and outdoor allergens Quercus sp and Fraxinus sp. Males showed the highest reaction frequency to aeroallergens. The age range from 21 to 40 years presented the highest frequency of positive skin prick test. CONCLUSION: our data demonstrate that house dust mites followed by tree pollens are the most frequent aeroallergens in patient with allergic rhinitis. Positive skin prick test frequency was age associated.

[Assessment of the clinical efficacy and safety of epinastine plus pseudoephedrine vs loratadine plus pseudoephedrine in perennial allergic rhinitis]. / Evaluación de la eficacia y seguridad clínica de epinastina más pseudoefedrina vs loratadina más pseudoefedrina en rinitis alérgica perenne.

BACKGROUND: Several drugs for the treatment of perennial allergic rhinitis and its symptoms have been investigated since some years ago. These drugs are: steroidal-type immunoregulators, immunotherapy and antihistamines. Because of first generation of the last ones originated several side effects, pharmacological research was oriented to the search of formulas with the same of higher efficacy, but with fewer effects on central nervous system. OBJECTIVE: To compare the efficacy and safety of epinastine 10 mg plus pseudoephedrine 120 mg vs loratadine 5 mg plus pseudoephedrine 120 mg, twice a day, in the treatment of perennial allergic rhinitis. MATERIAL AND METHODS: A comparative, random, open, prospective, longitudinal and multicenter study was made in 62 patients with an average age of 26.17 +/- 9.75 years (13-56 years) with diagnosis of perennial allergic rhinitis, who attended to external consultation of the different departments of allergy of the participant institutions. All patients were submitted to: complete clinical history, physical exploration, measurement of vital signs, nasal exploration, qualification of allergic symptoms and record of daily symptoms. Moreover, washout during a week and pharmacological treatment was given during two weeks. Symptoms referred by patient and findings of physical exploration during the different visits, as well as rhinoscopic findings, were assessed by a scale of five parameters of rhinitis. Tolerance grade of drugs was assessed based on frequency and severity of side effects. RESULTS: According to the basal clinical assessment symptoms qualification of patients of groups of epinastine and loratadine was of 9.12 +/- 2.78 and 7.90 +/- 2.7, respectively. Seven side effects appeared: three cases of somnolence, one of sickness and one of anxiety in patients of group of loratadine and one case of somnolence and one of dysmenorrhea in the subjects of group of epinestine. Although it did not have statistically significant difference, it is clinically important for patients. Frequency of side effects was higher in the loratadine group. CONCLUSION: Both drugs are efficient for the treatment of perennial allergic rhinitis.