Trends (2007-2019) of major atopic diseases throughout the life span in a large Mexican population.

Background: Major atopic diseases such as atopic dermatitis (AD), allergic rhinitis (AR), and asthma share the same atopic background, but they often show differences in their epidemiological behavior. Objective: We aimed to report the profile of these atopic diseases in a large Mexican population, including their age-related incidences, male:female (M:F) ratios, recent time trends, and association with altitude. Methods: Registries from the largest, nationwide health institution in Mexico (more than 34 million insured subjects), were reviewed. New cases of AD, AR, and asthma diagnosed each year by family physicians from 2007 to 2019 were adjusted by the corresponding insured population to estimate incidence rates. Results: Incidences of the 3 atopic diseases were highest in the 0-4 years age-group and progressively decreased thereafter until adolescence. Asthma and AR, but not AD, were more frequent in males during childhood (M:F ratios of 1.5, 1.3, and 0.95, respectively), but predominated in females during adulthood (M:F ratios of 0.52, 0.68, and 0.73, respectively). Time trends showed an initial increasing trend of annual incidences, with a peak around 2009-2011, and a downward trend afterward. This decreasing trend was seen in all age-groups and was more evident for AD (∼50% drop) and asthma (∼40% drop) than for AR (∼20% drop). Geographical distribution suggested that incidences of asthma and AR, but not of AD, had an inverse association with altitude. Conclusion: Annual incidences of the 3 major atopic diseases have declined in recent years in almost all age groups, and their epidemiological profile during the life span showed contrasting differences according to age, sex, and ecological association with altitude, mainly regarding AD.

Asthma control and quality of life of asthmatic children and their caregivers. / Control del asma y calidad de vida en niños asmáticos y sus cuidadores.

BACKGROUND: Uncontrolled asthma impacts on quality of life of patients, but also in the one of caregivers; therefore, adequate asthma control is the main goal in the treatment of asthma. OBJECTIVE: To assess how the asthma control and other environmental factors are associated to the quality of life in asthmatic children and their caregivers. METHOD: The Asthma Control Test was administered to patients, and a questionnaire on quality of life was given to patients and their caregivers. Odds ratio prevalence (ORP) association of demographic and environmental factors, use of medications, among other factors, was estimated. RESULTS: 431 patients were included, with an average age of 10.55 years, and 65.2% were males. 93% of caregivers were women. Patients had a prevalence of poor quality of life of 57.3%, associated with inappropriate drugs use (ORP: 23.05; 95% confidence interval [95% CI]: 1.54-345.16), and uncontrolled asthma (ORP: 6.8; 95% CI: 3.48-13.5). There was poor quality of life in 73.3% of caregivers, associated with female gender and patient's poor quality of life. CONCLUSIONS: We observed poor quality of life in over half of the patients, mainly associated to an inadequate use of medications and uncontrolled asthma. In caregivers the poor quality of life was related to female gender and to patient's poor quality of life.

INTRODUCCIÓN: El asma no controlada impacta en la calidad de vida de los pacientes, pero también en la de los cuidadores; por ello, el control adecuado del asma es la meta principal del tratamiento. OBJETIVO: Evaluar cómo el control del asma de los niños asmáticos y otros factores ambientales influyen en la calidad de vida de los pacientes y de sus cuidadores. MÉTODO: Se aplicó el cuestionario Asthma Control Test a los pacientes y otro cuestionario sobre calidad de vida a los pacientes y a sus cuidadores. Se estimó la razón de momios de prevalencia (RMP) de factores sociodemográficos, ambientales, uso de medicamentos y otros factores. RESULTADOS: Se incluyeron 431 pacientes con asma, con una edad promedio de 10.55 años y el 65.2% de sexo masculino. Los cuidadores fueron mujeres en el 93% de los casos. Encontramos mala calidad de vida en el 57.3% de los pacientes, asociada principalmente con el uso inadecuado de medicamentos (RMP: 23.05; intervalo de confianza del 95% [IC95%]: 1.54-345.16) y el asma no controlada (RMP: 6.8; IC95%: 3.48-13.5). Hubo mala calidad de vida en el 73.3% de los cuidadores, asociada al sexo femenino y a la mala calidad de vida del paciente. CONCLUSIONES: Identificamos mala calidad de vida en la mitad de los pacientes, principalmente por el uso inadecuado de medicamentos y por el asma no controlada. La mala calidad de vida de los cuidadores se asoció al sexo femenino y a la mala calidad de vida del paciente.

Factors related to changes in the asthma male: female ratio by age in 403 Mexican counties.

BACKGROUND: Asthma is more frequent in males during childhood and in females after adolescence, which has been attributed to changes in sexual hormones levels. OBJECTIVE: We explored changes of the asthma male: female ratio (AMFR) by age group in a large population (nationwide), and its ecological association (at county level) with some medical, geographical, or sociodemographic factors. METHODS: Registries of the largest medical institution in Mexico (∼37.5 million subjects assigned to a family physician) were analyzed and the AMFR calculated using asthma incidences. RESULTS: In boys, asthma incidence peaked at 0 to 4 years and progressively decreased, reaching a plateau in adulthood. In girls, asthma incidence showed a bimodal pattern, with maximal rates at 0 to 4 years old, and again at 50 to 54 years old. In the ecological analysis performed in more than 400 counties, the AMFR in adults (≥15 years old) inversely correlated with population density (r = -0.256) and altitude (r = -0.144), and directly correlated with acute respiratory tract infections (ARTI, r = 0.215), diabetes (r = 0.186), marginalization (r = 0.179), pneumonias (r = 0.166), and mean maximal temperature (r = 0.142), all with P < .01. In the multiple linear regression, only population density (P < .001) and ARTI (P = .006) remained statistically significant in the final model. CONCLUSION: Asthma incidence in males and females did not match the expected sexual hormones variations, and other factors such as population density and ARTI also influenced the AMFR. These findings challenge the traditional belief that sexual hormones are major determinants of the AMFR.

Altitude above 1500 m is a major determinant of asthma incidence. An ecological study.

BACKGROUND: Previous studies suggest an inverse correlation between asthma and altitude. In the present work, we performed an in-depth analysis of asthma incidence in the 758 Mexican counties covered by the largest medical institution in the country (∼37.5 million insured subjects), and evaluated its relationships with altitude and other factors. METHODS: Asthma incidence in each county was calculated from new cases diagnosed by family physicians. Other variables in the same counties, including selected diseases, geographical variables, and socioeconomic factors, were also obtained and their association with asthma was evaluated through bivariate and multivariate analyses. RESULTS: Median asthma incidence was 296.2 × 100,000 insured subjects, but tended to be higher in those counties located on or near the coast. When asthma incidence was plotted against altitude, a two-stage pattern was evident: asthma rates were relatively stable in counties located below an altitude of ∼1500 m, while these rates progressively decreased as altitude increased beyond this level (rS = -0.51, p < .001). Multivariate analysis showed that, once each variable was adjusted by the potential influence of the others, asthma incidence was inversely correlated with altitude (standardized ß coefficient, -0.577), helminthiasis (-0.173), pulmonary tuberculosis (-0.130), and latitude (-0.126), and was positively correlated with acute respiratory tract infection (0.382), pneumonia (0.289), type 2 diabetes (0.138), population (0.108), and pharyngotonsillitis (0.088), all with a p ≤ .001. CONCLUSION: Our study showed that altitude higher than ∼1500 m comprises a major factor in determining asthma incidence, with the risk of new-onset asthma decreasing as altitude increases. Other less influential conditions were also identified.

[IgG4-related disease: a case report]. / Enfermedad asociada a IgG4: reporte de un caso.

IgG4-related disease is an inflammatory condition characterized by high levels of IgG4. It affects salivary and lacrimal glands, pancreas, lymph nodes, lungs or kidney. The diagnosis is based on identifying a histological pattern with a dense lymphocyte and plasmacyte infiltration, focal fibrosis or phlebitis, finding more than 10 IgG4 positive cells per high power field and/or IgG4/IgG ratio in plasma higher than 40%. We present a patient with Mikulicz's disease who meets histological findings required for the diagnosis of IgG4 related disease.

La enfermedad relacionada con IgG4 es una condición fibroinflamatoria en la que existe elevación de IgG4, afección a nivel de glándulas salivares, lacrimales, páncreas, ganglios linfáticos y pulmón. Para su diagnóstico se requiere la identificación de un patrón histológico sugestivo que muestre infiltrado linfoplasmocitario denso, fibrosis focal o flebitis a nivel de una glándula, más de 10 células positivas para IgG4 por campo de gran aumento y relación de IgG4/IgG arriba de 40% en plasma. Describimos el caso de una paciente que presentó enfermedad de Mikulicz y cumplió con los datos histológicos para diagnóstico de enfermedad relacionada con IgG4.

Prevalence and Characteristics of Exercise-Induced Bronchoconstriction in High School and College Athletes at 2,240 m Altitude.

BACKGROUND: Athletes practicing strenuous physical activities may develop exercise-induced bronchoconstriction (EIB). We aimed to determine the prevalence and features of this condition in Mexico City (altitude, 2,240 m). METHODS: In the present study, 208 high school and college athletes performed a standardized EIB test on a treadmill. RESULTS: Responses to exercise had large between-subject variability in all physiological parameters (forced expiratory volume in one second [FEV1], heart rate, blood oxygen saturation level [SpO2], blood pressure), with nearly similar proportions of subjects in whom FEV1 increased or decreased. According to the recommended cut-off value of 10% FEV1 decrease, only 15 (7.2%) athletes had a positive EIB test. Weight lifters were more prone to develop EIB (three out of seven athletes; p = 0.01). Subjects with a positive EIB test already had a lower baseline forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio (96.4 vs. 103.2% of predicted, respectively; p = 0.047), and developed more respiratory symptoms after exercise than subjects with a negative test. There were no differences with respect to age, gender, body mass index, history of asthma or atopic diseases, smoking habit, and exposure to potential indoor allergens. CONCLUSIONS: The relatively low prevalence of EIB in athletes from Mexico City raises the possibility that high altitude constitutes a protective factor for EIB. In contrast, weight lifters were especially prone to develop EIB, which suggests that repetitive Valsalva maneuvers could be a novel risk factor for EIB. There was a large between-subject variability of all physiological responses to exercise.

[Aerobiological study of anemophilous pollens in the city of Toluca, Mexico]. / Estudio aerobiológico de pólenes anemófilos en la ciudad de Toluca, México.

BACKGROUND: Due to the high incidence of allergic diseases in Mexico, caused by exposure to pollens, there have been several studies of plants and atmospheric pollens in various regions in the last decades. In the city of Toluca there have been two previous pollen samplings using gravimetric methodology, for which it is necessary to obtain new samplings with a standardized volumetric technique, in order to have updated and confident results of a region with considerable environmental changes in the last years. OBJECTIVE: To determine the different types of pollens, seasonal variations and behavior in the four seasons of the year. MATERIAL AND METHOD: A descriptive study, related to the identification of pollens by the suction and trapping of particles with the volumetric sampler type Hirst (Burkard) performed in the city of Toluca, Mexico, from October 1, 2004 to September 30, 2005. RESULTS: Twenty-nine different airborne pollen types were identified, which amounted a total of 13,542 pollen grains. During winter we found the largest number of pollens. The months with the highest and lowest amount of pollens were January and August, respectively. Pollens from trees predominated, mainly from the Cupressaceae (44%) and Pinaceae (13.8%) families, which were present in the atmosphere throughout the year. CONCLUSIONS: We identified a larger amount of pollens from trees in winter, mainly from the Cupressaceae family, and it is closely related to the number of trees planted of this species in the city.

Antecedentes: debido a la alta prevalencia de enfermedades alérgicas en México causadas por exposición a polen, en las últimas décadas se han hecho estudios de plantas y pólenes atmosféricos en varias regiones. En la ciudad de Toluca se hicieron dos muestreos polínicos, mediante metodología gravimétrica, por lo que es necesario hacer un estudio con metodología volumétrica estandarizada para obtener resultados actualizados y confiables de una región con cambios ambientales considerables en los últimos años. Objetivo: determinar los diferentes tipos polínicos, las variaciones estacionales y su comportamiento en las cuatro estaciones del año. Material y método: estudio descriptivo de la identificación de pólenes, mediante el método de succión y captura de partículas con el muestreador volumétrico tipo Hirst (Burkard), efectuado en la ciudad de Toluca, México, del 1 de octubre de 2004 al 30 de septiembre de 2005. Resultados: se identificaron 29 diferentes tipos polínicos, con un conteo total de 13,542 granos de polen. Durante el invierno se encontró la mayor cantidad de pólenes. Los meses con mayor y menor cantidad de pólenes fueron enero y agosto, respectivamente. Predominaron los árboles, principalmente de la familia Cupressaceae (44%) y polen de Pinaceae (13.8%); estos dos grupos polínicos estuvieron presentes durante todo el año. Conclusiones: identificamos una mayor cantidad de pólenes de árboles durante el invierno, principalmente de la familia Cupressaceae, lo que se relaciona estrechamente con la cantidad de árboles sembrados de esta especie en la ciudad.

[Fraudulent publication in medical journals]. / Publicación fraudulenta en revistas médicas.

Fraud can be present in some scientific medical publications; however, the magnitude of this situation is unknown. One of the associated factors for this transgression of the good practice of investigation is the need to publish and obtain recognition and benefits, regardless of the means. The deliberate fabrication and falsification of data, plagiarism and duplication of publications are some of the scientific misconducts. Many cases of fraud in publications are known, and they have reached public opinion and have been a matter of legal sanctions (the names of Woo Suk Hwang, Jon Sudbo, Joachim Blodt, Robert Slutsky, and William Summerlin reminds us a few known cases). In the last decades, national and international regulatory organisms have been created in order to intervene against this scientific misconduct. Currently, we can rely on several effective software programs, whose function is to detect plagiarism and falsification of data. The prevention of scientific misconduct through information and education of the investigators could lead to the decrease of the presence of this problem, which damages scientific credibility and put at risk the patient's safety.

El fraude suele estar presente en algunas publicaciones científicas médicas; sin embargo, se desconoce la magnitud de esta situación. Uno de los factores asociados a esta transgresión de las buenas prácticas de investigación es la necesidad de publicar y obtener reconocimiento y beneficios, sin importar los medios. La fabricación y falsificación de datos, el plagio y la duplicación de publicaciones, de manera intencionada, son algunas de las formas de conducta inapropiada o fraudulenta. Se conocen muchos casos de fraude en publicaciones que han trascendido a la opinión pública y han sido objeto de sanciones legales (como ejemplos están los sonados casos de Woo Suk Hwang, Jon Sudbo, Joachim Blodt y William Summerlin). En las últimas décadas surgieron organismos reguladores, nacionales e internacionales, cuyo fin era intervenir en contra de la conducta fraudulenta en la investigación científica. Actualmente se dispone de software que ayuda en la detección del plagio y de la falsificación de datos. La prevención de conductas fraudulentas, mediante información y educación a los investigadores, podría ayudar a disminuir este fenómeno que lesiona la credibilidad científica y atenta contra la seguridad de los pacientes.

[Standardizaron of the biological potency of allergenic extracts from Dermatophagoides pteronyssinus for immunotherapy]. / Estandarización de la potencia biológica de extractos alergénicos de Dermatophagoides pteronyssinus para inmunoterapia.

BACKGROUND: Allergic rhinitis and asthma are the more frequent allergic diseases. Dermatophagoides pteronyssinus is one of the more clinically relevant causes of allergic diseases. OBJECTIVE: To standardize the biological potency Allergenic Bioequivalent Units (BAU) of Dermatophagoides pteronyssinus allergen extracts of three national laboratories. METHODS: This experimental, prospective, transversal, quantitative study included patients allergic to house dust mites. According to the FDA protocol, allergenic extracts of Dermatophagoides pteronyssinus from three Mexican manufacturers, were injected intradermally in threefold dilutions, until get an midpoint orthogonal diameters 50 mm erythema sum. Statistical analysis was done using logistic regression, one-way analysis of variance and Bonferroni test. RESULTS: We included 20 adult patients, 11 women and 9 men, aged between 16 and 45 years. Four patients had allergic asthma and rhinitis and 16 only had allergic rhinitis. There were no systemic anaphylactic reactions. Correlation coefficients of linear regression of the dose/response were to Allerstand r=0.55, Allergomex r=0.54 and Allerquim r=0.57(p=0.001). Dilutions calculated for 100,000 BAU/ml for each extract were Allerstand 1:26295, Allergomex 1:26341 and Allerquim 1:73993. The protein concentration (mcg/mL) was: Allergomex: 63, Allerquim 65, Allerstand 154. CONCLUSIONS: It was established the biological potency for each tested extract. We have found significant differences in the biological equivalence among the extracts from the three manufacturers. The procedure showed an adequate safety profile.

[Risk factors for allergy to honey-bee venom in Mexican beekeepers]. / Factores de riesgo de alergia al veneno de abeja en apicultores mexicanos.

BACKGROUND: Allergy to Hymenoptera venom has a low prevalence in the general population, but in beekeepers could be as high as 42%. The exposure to bee sting confers an occupational allergic risk to beekeepers, causing them sensitization during the first years, which if continues for a long time may induce immune tolerance. OBJECTIVE: To know some risk factors of allergic reactions to honey-bee stings in a sample of beekeepers through a self-applied questionnaire. METHODS: A self-applied questionnaire was performed by beekeepers from the whole country, with questions about age, sex, time of beekeeping activities, average number of stings per month and types of post-sting reactions. The relative risk and the odds ratio were calculated for some risk factors. RESULTS: A total of 1541 questionnaires were completed. The average age was 37 years. There were 1289 (84%) men and 252 women. The average time of exposure to honey-bee sting was 7.2 years, and the number of stings per month averaged 33. There was atopic family history in 14.5% of the beekeepers, and 20% of them had personal atopy. In 125 (8%) beekeepers there were local allergic reactions and in 32 (2%) there were systemic allergic reactions. The relative risk for allergy to honey-bee venom in whom had atopic family history was 3.9 (CI 1.7-9.2), in those with less than 4 stings per month was 3.2 (CI 1.12-9.33), in those with more than 20 years exposure was 0.97 (CI 0.95-0.98) and for those over 50 years of age was 0.32 (CI 0.1-0.8). Beekeepers with less than 10 years of exposure had OR of 4.33 (CI 0.5-33.9). CONCLUSIONS: The risk factors observed for hypersentivity to honey-bee venom in beekeepers were: atopic family history, less than 10 years of exposure and less than 4 stings per month. As probable protective factors we found the exposure for over 20 years and persons older than 50 years of age.

[Association between obesity and asthma severity in children]. / Asociación entre obesidad y gravedad del asma en niños.

BACKGROUND: The association of prevalence of obesity and asthma has increased significantly, this phenomenon seems multifactorial. Obesity is considered a risk factor for asthma. It has been reported positive association between obesity and allergic asthma. In Mexico there is no conclusive data about this issue. METHODS: The study was conducted in patients from 4 to 14 years of age, with allergic asthma. A history and physical examination and BMI estimation were performed, as well as the classification of asthma severity. RESULTS: We included 244 patients diagnosed with childhood allergic asthma, Fifty two patients (21.31%, OR 3.6) showed some degree of obesity (above the 85 percentile), 15.1% were male and 6% were female. Morbid obesity was found in 40 patients (16.3%). CONCLUSIONS: Our study found an increased prevalence of obesity in children with asthma, with a predominance in male gender, and showed a high association between the severity of asthma and increased BMI.

[Mortality related to honey-bee stings in Mexico from 1988 to 2009]. / Mortalidad en México relacionada con picaduras de abeja de 1988 a 2009.

BACKGROUND: Honeybee stings can cause toxic and allergic reactions that may lead to severe symptoms, and sometimes to death. Mexico is the third worldës honey country exporter and sixth producer. Due to the arrival of Africanized bees into Mexico in 1986, the National Program for Control of Africanized Bee (NPCAB) was created, in order to reduce the socioeconomic and sanitary impact from the new bee species. OBJECTIVE: To report deaths related to honey-bee sting in Mexico, from 1988 to 2009. METHODS: Reports gathered from offices of the National Program for the Control of Africanized Honey-Bee throughout the country, were used to show the number of deaths related to honey-bee stings which occurred in Mexico from 1988 to 2009. RESULTS: People suffering from multiple honey-bee stings were reported in all the states of the country. Between 1988 and 1998 there were 360 honey-bee related accidents, involving over 5000 people. From 1988 to 2009 there were 480 demised persons with an annual average of 21.8. Regarding age, people over 50 years were the most affected ones. The largest number of fatal cases, 340, occurred from 1990 to 1999, with an annual average of 34, and between 2000 and 2009, the number of cases decreased to 118. CONCLUSIONS: There was an average of 21 annual death cases related to honey-bee stings from 1988 to 2009. Toxic reactions caused by multiple stings are the most likely cause of death in the majority of cases. Fatal cases occurred mainly in people older than 50 years. There was a decrease in the mortality rate associated to honey-bee stings in the last decade.

Passive smoking induces leukotriene production in children: influence of asthma.

BACKGROUND: Passive smoking is associated with poor asthma control in children, but the mechanism is unknown. Leukotrienes are involved in the asthma pathogenesis and their synthesis is increased in adult subjects who actively smoke. OBJECTIVE: To evaluate whether passive smoking, as assessed by urinary cotinine levels, increases leukotriene production in children with or without asthma. METHODS: This was a prospective, cross-sectional study in which children with stable intermittent asthma (without exacerbation) and healthy control children were studied through spirometry and urinary concentrations of cotinine and leukotriene E(4) (LTE(4)). Both groups were balanced to include children with and without passive smoking. RESULTS: Ninety children (49 with asthma and 41 controls, 54.4% females) aged 9 years (range, 5-13 years) were studied. Urinary LTE(4) concentrations were progressively higher as cotinine levels increased (r(S) = 0.23, p = .03). LTE(4) also correlated with body mass index (BMI) (r(S) = 0.30, p = .004), and multiple regression analysis revealed that BMI was even more influential than cotinine for determining LTE(4) levels. LTE(4) concentrations were unrelated with gender, age, or spirometry. In turn, cotinine inversely correlated with forced expiratory volume in one second (FEV(1)) (r(S) = -0.22, p = .04) and forced vital capacity (FVC) (r(S) = -0.25, p = .02), but when analyzed by groups, these relationships were statistically significant only in children with asthma. CONCLUSIONS: Exposure to environmental tobacco smoke, as assessed by urinary cotinine levels, was associated with an increased urinary concentration of LTE(4), although BMI exerted more influence in determining its concentration. Urinary cotinine was associated with decreased lung function, mainly in children with asthma.

[Assessment of hypersensitivity to honey-bee venom in beekeepers by skin tests]. / Valoración mediante pruebas cutáneas de la hipersensibilidad al veneno de abeja en apicultores.

BACKGROUND: Beekeepers are exposed to frequent honey-bee stings, and have the risk to develop hypersensitivity to bee venom, but long-term exposure can induce immune tolerance in them. Up to 30% of beekeepers show positive skin tests with honey-bee venom. The prevalence of systemic reactions to bee stings in beekeepers is from 14% to 42%. OBJECTIVE: To know the prevalence of hypersensitivity to honeybee venom in Mexican beekeepers and non-beekeepers by the use of skin tests. MATERIAL AND METHODS: A group of 139 beekeepers and a group of 60 non-beekeeper volunteers had a history and physical related to age, sex, family and personal atopic history and time of exposure to bee stings. Both groups received intradermal skin tests with honey-bee venom, 0.1 mcg/mL and 1 mcg/mL, and histamine sulphate 0.1 mg/mL and Evans solution as controls. The skin tests results of both groups were compared by chi-squared test. RESULTS: Of the group of beekeepers, 116 were men (83%) and 23 women, average age was 39.3 years, had atopic family history 28% and personal atopy 13%, average time of exposure to bee stings was 10.9 years, skin tests with honey-bee venom were positive in 16.5% and 11% at 1 mcg/mL and 0.1 mcg/mL, respectively. In the non-beekeepers group venom skin tests were positive in 13.3% and 6.7% at 1 mcg/mL and 0.1 mcg/mL. We did not find significant differences between the two venom concentrations tested in both groups, neither in the number of positive skin tests between the two groups. CONCLUSIONS: We found hypersensivity to honey-bee venom slightly higher in the beekeepers than in the group apparently not exposed. Both honey-bee venom concentrations used did not show difference in the results of the skin tests. The similarity of skin tests positivity between both groups could be explained by immune tolerance due to continued exposure of beekeepers.

ANTECEDENTES: los apicultores están expuestos frecuentemente a picaduras de abejas y tienen el riesgo de volverse hipersensibles al veneno de abejas, pero la exposición a largo plazo puede inducir tolerancia inmunológica. Hasta 30% de los apicultores tienen pruebas cutáneas positivas con veneno de abeja. La prevalencia de reacciones sistémicas por picaduras de abejas en los apicultores es de 14 a 42%. OBJETIVO: conocer la prevalencia de hipersensibilidad al veneno de abeja en apicultores mexicanos y no apicultores, mediante la aplicación de pruebas cutáneas. MATERIAL Y MÉTODOS: estudio transversal que se incluyeron 139 apicultores y 60 voluntarios no apicultores se les elaboró su historia clínica con referencia a la edad, sexo, antecedentes familiares y personales atópicos y tiempo de exposición a picaduras de abejas. A los dos grupos se les aplicaron pruebas cutáneas intradérmicas con veneno de abeja con 0.1 y 1 mcg/mL, y como testigos sulfato de histamina 0.1 mg/mL y solución de Evans. Los resultados de las pruebas cutáneas se compararon entre los dos grupos mediante chi cuadrada. RESULTADOS: del grupo de apicultores 116 fueron hombres (83%) y 23 mujeres, la edad promedio fue de 39.3 años; refirieron atopia familiar 28% y atopia personal 13%; el tiempo de exposición promedio a picaduras de abejas fue de 10.9 años; las pruebas cutáneas con veneno de abeja fueron positivas en 16.5 y 11% a concentraciones de 1 y 0.1 mcg/mL, respectivamente. En el grupo de no apicultores las pruebas cutáneas con veneno resultaron positivas en 13.3 y 6.7% a concentraciones de 1 y 0.1 mcg/mL, respectivamente. No se observaron diferencias significativas entre las dos concentraciones de veneno probadas en ambos grupos, ni en el número de pruebas cutáneas positivas entre los dos grupos. CONCLUSIONES: se encontró hipersensibilidad al veneno de abeja ligeramente mayor en los apicultores que en el grupo aparentemente no expuesto. Las dos concentraciones de veneno de abeja probadas no mostraron diferencia en los resultados de las pruebas cutáneas.

[Hypersensitivity reactions to insulin]. / Reacciones de hipersensibilidad a la insulina.

BACKGROUND: Hypersensitivity reactions to insulin are infrequent, yet of clinical importance. The mechanisms of hypersensitivity involved can be of three types: I, III and IV. OBJECTIVE: To describe the pathophysiology of hypersensitivity to insulin, its clinical features and diagnostic and therapeutic approach, that help identify the cases of allergy to insulin and begin a treatment, or if necessary, to refer patients to a specialists or appropriate medical attention. METHODS: An electronic search of papers related to insulin hypersensitivity was performed in PubMed and the articles selected were those considered the most relevant for this review. RESULTS: Thirty eight papers about pathophysiology, mechanisms of injury and the different types of insulin involved in hypersensitivity reactions were included. Likewise, information for the diagnosis of insulin hypersensitivity and some options of treatment for first contact physicians or the referral of patients to specialists in endocrinology and allergy were included. CONCLUSIONS: Insulin hypersensitivity has a low prevalence and diverse clinical manifestations. The different types of insulin suitable allow the majority of cases of hypersensitivity to continue the treatment in a efficient and flexible manner.

[Mexican clinical practice guidelines of immunotherapy 2011]. / Guía Mexicana de Práctica Clínica de Inmunoterapia 2011.

BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. OBJECTIVES: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. METHODS: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE. RESULTS: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions. CONCLUSIONS: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence. KEYWORDS: Allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, skin testing, allergy diagnosis, rhinitis, asthma, atopic dermatitis, house dust mite, pollens, anaphylaxis, adrenaline, Mexico.