Diagnostic tests for progestogen hypersensitivity.

Progesterone is an endogenous hormone, produced by the adrenal cortex, the gonads and in women, its source is the corpus luteum. Progesterone is produced in the late phase of the menstrual cycle, when implantation of the zygote does not occur, the corpus luteum involutes and the release of progesterone is suppressed, thus initiating menstruation. Progestogen Hypersensitivity were initially identified as hormone allergy and were related to endogenous reactions to hormones and alteration of ovarian function. Skin manifestations such as dermatitis or urticaria were initially reported and described as progesterone autoimmune dermatitis, although the immune-mediated mechanism was not clear. Currently there is no standardization for in vivo or in vitro tests for Progestogen Hypersensitivity diagnosis. In this review, we will address the different diagnostic methods of this disease.

[Autoimmunity in chronic urticaria. A historical and current perspective]. / Autoinmunidad en urticaria crónica. Perspectiva histórica y actual.

Chronic spontaneous urticaria is a condition that persists for more than six weeks, it occurs in the absence of an identifiable triggering factor and from the pathogenic activation of mast cells and basophils. The possibility of autoimmune etiology in up to 40 % of patients is presented, followed by subclinical infections and psychological factors. Two main mechanisms of the pathogenesis of chronic urticaria have been proposed: the former is the dysregulation of intracellular signaling pathways within mast cells and basophils, which leads to defects in the traffic or function of these cells. The latter is the development of autoantibodies against FcεRIα or IgE, in both mast cells and basophils. Numerous autoimmune diseases such as systemic lupus erythematosus, polymyositis, dermatomyositis, and rheumatoid arthritis have been associated with chronic urticaria; however, autoimmune thyroid disease deserves a special mention. A higher prevalence of antithyroid antibodies has been found, regardless of thyroid function (euthyroidism, hypo and hyperthyroidism) in patients with chronic spontaneous urticaria. Several infections have been linked to chronic urticaria. The best evidence is for Helicobacter pylori infection. Finally, stress is associated with the onset of the disease through the activation of the sympathetic and adrenomedullary system and the hypothalamic-pituitary- adrenal axis. Diagnosis may vary in different regions of the world, but the common feature is the completion of a thorough medical history.

La urticaria crónica espontánea es una afección que persiste durante más de seis semanas y ocurre en ausencia de un factor desencadenante identificable y resulta de la activación patógena de células cebadas y basófilos. Se plantea la posible etiología autoinmune hasta en 40 % de los pacientes, seguida de infecciones subclínicas y factores psicológicos. Se han propuesto dos mecanismos principales de la patogénesis de la urticaria crónica: la desregulación de las vías de señalización intracelular dentro de las células cebadas y basófilos que conduce a defectos en el tráfico o la función de estas células, así como el desarrollo de autoanticuerpos contra FcεRIα o IgE, tanto en células cebadas como en basófilos. Numerosas enfermedades autoinmunes como lupus eritematoso sistémico, polimiositis, dermatomiositis y artritis reumatoide se han asociado a urticaria crónica; sin embargo, la enfermedad tiroidea autoinmune merece una mención especial. Se ha encontrado una mayor prevalencia de anticuerpos antitiroideos, independientemente de la función tiroidea (eutiroidismo, hipo e hipertiroidismo), en pacientes con urticaria crónica espontánea. Varias infecciones se han relacionado a urticaria crónica. Existe la mejor evidencia de infección por Helicobacter pylori. Por último, el estrés está asociado al inicio de la enfermedad mediante la activación del sistema simpático y adrenomedular y el eje hipotálamo hipófisis suprarrenal. El diagnóstico puede variar en las diferentes regiones del mundo, pero el rasgo común es la realización de una historia clínica completa.

Erratum to "Partial and Transient Clinical Response to Omalizumab in IL-21-Induced Low STAT3-Phosphorylation on Hyper-IgE Syndrome".

[This corrects the article DOI: 10.1155/2019/6357256.].

The Effects of Alternate-Day Corticosteroids in Autoimmune Disease Patients.

INTRODUCTION: Several studiesdemonstrated that the use of alternate-day corticosteroid therapy maintains control of autoimmune diseases due to the prolongation of their therapeutic effect beyond their metabolic effect, with a significant decrease in side effects in patients. For this reason, the current recommendation for the use of these medications is in a short cycle to avoid adverse effects when used frequently and for prolonged periods of time. OBJECTIVES: To learn variations in serum levels of autoantibodies in autoimmune diseases treated with steroids on alternate days, as well as whether there are differences in the response to them depending on the type of disease. Study Design. A descriptive, retrospective, and cross-sectional study was conducted in which serum autoantibody levels were compared at the time of diagnosis and three months after alternate-day corticosteroid therapy. RESULTS: We included 106 patients from three autoimmune connective tissue diseases (systemic lupus erythematosus, Sjögren syndrome, and Hashimoto's thyroiditis) and observed a statistically significant decrease in serum autoantibody levels both in patients with lupus and those with Hashimoto's thyroiditis, regardless of the sex of the patients, as well as the type of steroids used. CONCLUSIONS: Treatment with alternate-day corticosteroids achieved a statistically significant decrease in serum autoantibody levels in patients with systemic lupus erythematosus and Hashimoto's thyroiditis.

Dialyzable Leukocyte Extract (Transferon™) Administration in Sepsis: Experience from a Single Referral Pediatric Intensive Care Unit.

Immunomodulatory agents have been proposed as therapeutic candidates to improve outcomes in sepsis. Transferon™, a dialyzable leukocyte extract (DLE), has been supported in Mexico as an immunomodulatory adjuvant in anti-infectious therapy. Here we present a retrospective study describing the experience of a referral pediatric intensive care unit (PICU) with Transferon™ in sepsis. We studied clinical and laboratory data from 123 patients with sepsis (15 in the DLE group and 108 in the control group) that were admitted to PICU during the period between January 2010 and December 2016. Transferon™ DLE use was associated with lower C reactive protein (CRP), increase in total lymphocyte counts (TLC), and decrease in total neutrophil count (TNC) 72 hours after Transferon™ DLE administration. The control group did not present any significant difference in CRP values and had lower TLC after 72 hours of admission. There was no difference in PICU length of stay between control and Transferon™ DLE group. Transferon™ DLE administration was associated with a higher survival rate at the end of PICU stay. This study shows a possible immunomodulatory effect of Transferon™ on pediatric sepsis patients.

Partial and Transient Clinical Response to Omalizumab in IL-21-Induced Low STAT3-Phosphorylation on Hyper-IgE Syndrome.

Hyper-IgE syndrome (HIES) is a rare primary immunodeficiency characterized by elevated levels of immunoglobulin E (IgE), eczematous dermatitis, cold abscesses, and recurrent infections of the lung and skin caused by Staphylococcus aureus. The dominant form is characterized by nonimmunologic features including skeletal, connective tissue, and pulmonary abnormalities in addition to recurrent infections and eczema. Omalizumab is a humanized recombinant monoclonal antibody against IgE. Several studies reported clinical improvement with omalizumab in patients with severe atopic eczema with high serum IgE level. We present the case of a 37-year-old male with HIES and cutaneous manifestations, treated with humanized recombinant monoclonal antibodies efalizumab and omalizumab. After therapy for 4 years, we observed diminished eczema and serum IgE levels.

[Good's syndrome. Report of case]. / Síndrome de Good. Reporte de un caso.

BACKGROUND: Good's syndrome is an association of thymoma and immunodeficiency. The symptoms are recurrent sinopulmonary infections in addition to the compressive side of thymoma. A laboratory finding is notable for the absence or decrease of B lymphocytes, hypogammaglobulinemia, inversion ratio CD4/CD8 and abnormal proliferative response to mitogens. CASE REPORT: Female, 49-year-old started five months earlier with lower limb edema, postprandial vomiting, dysphagia, chronic diarrhea and weight loss. A second endoscopy ruled gastric neoplasia. Chest radiography with mediastinal widening, Thoraco-abdominal CT with bilateral pleural effusion and a mass in the anterior mediastinum, histopathological report of the tumor: B1 thymoma. Laboratory findings: IgG 349 mg/dL, IgA 70.3 mg/dL, 37.1 IgM mg/dL, Ca125 631 UI/mL, leukocytes 7890 mm3, hemoglobin 13.2 g/dL, lymphocytes 2060 mm3, CD16+CD56+ 122 cells/µL, CD19 77 cells/µL, CD3 2052 cells/µL, CD4 977 cells/µL, CD8 998 cells/µL; ratio CD4/CD8 0.98, hepatitis C, B and HIV negative. They requested valuation to Clinical Immunology and Allergy due to hypogammaglobulinemia, the diagnosis of Good's syndrome was confirmed and initiated with intravenous gamma globulin replacement to immunomodulatory dose of 1 g/kg, she reached replacement goal in the third dose of immunoglobulin intravenous, with clinical improvement. She died four months later from cardiac complications. CONCLUSIONS: Despite the variability of presentation, Good's syndrome should be suspected as part of the paraneoplastic manifestations of thymoma.

Introducción: El síndrome de Good es una asociación de timoma e inmunodeficiencia. Los síntomas son infecciones sinopulmonares recurrentes, además de los provocados por la compresión del timoma. Los exámenes paraclínicos se caracterizan por ausencia o disminución de linfocitos B, hipogammaglobulinemia, inversión de la relación CD4/CD8 y respuesta proliferativa anormal a mitógenos. Caso clínico: Mujer de 49 años de edad con edema de miembros inferiores, vómito posprandial, disfagia, diarrea crónica y pérdida ponderal. Con una segunda endoscopia se descartó cáncer gástrico. En la placa de tórax se observó ensanchamiento de mediastino y en la tomografía toracoabdominal, derrame pleural bilateral y tumor en mediastino anterior. El reporte histopatológico fue timoma B1. Exámenes paraclínicos: IgG, IgA e IgM de 349, 70.3 y 37.1 mg/dL, respectivamente; Ca125 631 UI/mL, leucocitos 7890 mm3, hemoglobina 13.2 g/dL, linfocitos 2060 mm3; CD16+CD56+, CD19, CD3, CD4 y CD8 de 122, 77, 2052, 977 y 998 cel/µL, respectivamente; relación CD4/CD8 0.98; panel viral para hepatitis C, B y VIH negativo. La hipogammaglobulinemia confirmó síndrome de Good; se inició con 1 g/kg de gammaglobulina intravenosa, alcanzando meta de reemplazo a la tercera dosis, con mejoría clínica. La paciente falleció a los 4 meses por complicaciones cardiacas. Conclusiones: A pesar de la variabilidad de la presentación del síndrome de Good, debe sospecharse como parte de las manifestaciones paraneoplásicas del timoma.

[Cancer as secondary immunodeficiency. Review]. / El cáncer como inmunodeficiencia secundaria. Revisión.

Secondary immunodeficiencys, previously presented in immunocompetent individuals. The lack of primary or secondary response to the presence of a foreign antigen, in the case of infections is a sentinel data in the diagnosis of immunodeficiency (can be primary or secondary), in the case of a self antigen may generate the presence of Cancer. Cancer has shown an increase in the prevalence and incidence globally. Most current medical treatments in cancer are focused primarily on immunomodulatory actions (immunosuppression / immune stimulation or both). Knowledge of key concepts from the perspective of innate and acquired immunity lead to cancer development, engaging immune surveillance and escape mechanisms of this that contribute to better understand the origin, behavior and treatment of neoplasm's. These treatments can cause immunological disorders such as allergy, anaphylaxis, lack of response immunogenicity care fields specialist in allergy and clinical immunology.

Las inmunodeficiencias secundarias aparecen en individuos previamente inmunocompetentes. La falta de respuesta primaria o secundaria a un antígeno extraño, en el caso de infecciones, es un dato centinela en el diagnóstico de inmunodeficiencia (puede ser primaria o secundaria); en el caso de un antígeno propio podría generar cáncer. Éste ha mostrado un aumento en la prevalencia e incidencia en forma global. La mayor parte de los tratamientos médicos actuales en cáncer se enfocan, fundamentalmente, a acciones inmunomoduladoras (inmunosupresióninmunoestimulación o ambos). El conocimiento de los conceptos clave, desde la perspectiva de la inmunidad innata y adquirida, conduce al desarrollo de cáncer, involucrándose a la vigilancia inmunológica y los mecanismos de escape de ésta, que contribuyen a comprender mejor el origen, comportamiento y tratamiento de las neoplasias. Los tratamientos pueden originar alteraciones inmunológicas como: alergia, anafilaxia, falta de respuesta por inmunogenicidad, campos de atención del especialista en Alergia e Inmunología clínica.

[Systemic lupus erythematous and CD24v]. / Lupus eritematoso sistémico y CD24v.

BACKGROUND: Systemic lupus erythematous is an autoimmune disease of multifactorial etiology with genetic predisposition. Its pathogenesis involved more than 100 genes. CD24 gene can mediate various functions such as their costimulatory activity in the clonal expansion of T cells. The single nucleotide polymorphism, resulting in a non-conservative replacement of alanine to valine (CD24v) precedes immediately GPI anchorage site (position ω-1), determines CD24 loss activity. CD24v has been associated with multiple sclerosis and systemic lupus erythematous in other populations. OBJECTIVE: To find the presence of CD24v in Mexican patients with systemic lupus erythematous. MATERIAL AND METHOD: A study of fenotyping of CD24v included 65 subjects, 32 cases (systemic lupus erythematous): 28 women and 4 men; and 32 controls: 9 women and 23 men; cases and controls from patients with systemic lupus erythematous in National Medical Center 20 de Noviembre ISSSTE, Mexico City, services of Clinical Immunology and Rheumatology. RESULTS: In cases, 19 patients had a wild homozygous genotype, 12 were heterozygous and only one patient showed homozygous polymorphism. In controls, 17 showed wild heterozygous genotypes; 14 were heterozygous and 1 was found to be polymorphic homozygote. With odds ratio: 0.84 and chi-squared of 0.17; therefore there was no statistically significant difference. CONCLUSIONS: Study population showed that there is no statistically significant difference between systemic lupus erythematous cases and controls with respect to the presence of CD24v.

Antecedentes: el lupus eritematoso sistémico es un padecimiento autoinmunitario, de origen multifactorial, con predisposición genética; más de 100 genes participan en su etiopatogenia. El gen de CD24 puede mediar varias funciones, como su actividad coestimuladora en la expansión clonal de las células T. El polimorfismo de un simple nucleótido de CD24, que resulta en un reemplazo no conservador de alanina a valina (CD24v), que precede inmediatamente al sitio de anclaje GPI (posición ω-1), condiciona la pérdida de actividad de CD24. Se ha descrito que CD24v está asociado con esclerosis múltiple y lupus eritematoso sistémico en otras poblaciones. Objetivo: encontrar la existencia de CD24v en pacientes mexicanos con lupus eritematoso sistémico. Material y método: estudio de genotipificación de CD24v en el que se incluyeron 64 sujetos, 32 casos con lupus eritematoso sistémico: 28 mujeres y 4 hombres; y 32 controles: 9 mujeres y 23 hombres; todos eran pacientes con lupus eritematoso sistémico del Centro Médico Nacional 20 de Noviembre, del ISSSTE, atendidos en los servicios de Inmunología Clínica y Reumatología. Resultados: de los casos, 19 pacientes tenían genotipo homocigoto silvestre, 12 con genotipo heterocigotos y sólo un paciente mostró el polimorfismo en estado homocigoto. De los controles, 17 sujetos mostraron genotipos heterocigotos silvestres, 14 eran heterocigotos y sólo en uno se encontró que era homocigoto polimórfico. Se obtuvo una razón de momios de 0.84 y chi cuadrada de 0.17, por lo que no hubo diferencia estadísticamente significativa. Conclusiones: se demostró que no hay diferencia estadísticamente significativa entre pacientes con lupus eritematoso sistémico y controles respecto a la existencia de CD24v.

[Prevalence of intolerance to salicylates in patients with nasal polyposis]. / Prevalencia de intolerancia a salicilatos en pacientes con poliposis nasosinusal.

BACKGROUND: Salicylates intolerance is related to alteration in the metabolism of arachidonic acid leading to increased leukotrienes. The condition may be manifested with respiratory, skin or systemic symptoms or associated with sinonasal polyposis. Salicylates are present in anti-inflammatory drugs, cosmetics products and food. OBJECTIVE: To determine the prevalence of salicylates intolerance in patients with sinonasal polyposis presenting to Clinical Immunology and Allergy and Otolaryngology Service, CMN 20 Noviembre, Mexico City. MATERIAL AND METHOD: An observational, descriptive, cross sectional study included patients with sinonasal polyposis. The sample size was 49 patients, and variables were compared using STATISTICA 8.0. RESULTS: The prevalence of sinonasal polyposis was 4% of the study group, predominantly in females; only 24% of the population had an ideal weight, the salicylates intolerance prevalence was 53%, and the Samter triad was 31%. CONCLUSIONS: Sinonasal polyposis has an inflammatory disease pattern. Its pathophysiology is not yet fully established and in this study was related to obesity and persistent sinusitis. The most feared complication recurrence is associated with salicylates intolerance. The study found a slight increase of recurrence in the group of intolerance, with no statistically significant difference, possibly related to the sample size.

Antecedentes: la intolerancia a salicilatos se relaciona con la alteración en el metabolismo del ácido araquidónico, desencadenando incremento de cisteinil leucotrienos; puede manifestarse con síntomas respiratorios, cutáneos, sistémicos o asociado con poliposis nasosinusal. Los salicilatos están contenidos en antiinflamatorios, productos cosméticos y alimentos. Objetivo: determinar la prevalencia de la intolerancia a salicilatos en pacientes con poliposis nasosinusal que acuden al Servicio de Inmunología Clínica y Alergia y al servicio de Otorrinolaringología del Centro Médico Nacional 20 Noviembre, ISSSTE. Material y método: estudio observacional, descriptivo, transversal, en el que se incluyeron pacientes con poliposis nasosinusal. El tamaño de la muestra fue de 49 pacientes, las variables se compararon utilizando STATISTICA 8.0. Resultados: la prevalencia de poliposis nasosinusal fue de 4%, fue mayor en el género femenino; sólo 24% de la población se encontraba en un peso ideal, la prevalencia de intolerancia a salicilatos fue de 53%, la prevalencia de la tríada de Samter fue de 31%. Conclusiones: la poliposis nasosinusal es una enfermedad con patrón inflamatorio, su fisiopatología aún no se establece totalmente; en este estudio se encontró relacionada con obesidad y con la persistencia de sinusitis. La complicación más temida es la recurrencia, se ha relacionado con intolerancia a salicilatos; en este estudio se encontró leve incremento de la recurrencia en el grupo de intolerancia, sin diferencia estadísticamente significativa, posiblemente relacionado con el tamaño de la población.

[Infection due to Mycobacterium bovis in common variable immunodeficiency]. / Infección por Mycobacterium bovis en inmunodeficiencia común variable.

Common variable immunodeficiency (CVID) is an heterogeneous group of disorders characterized by impaired antibody production. It shows a wide spectrum of manifestations including severe and recurrent respiratory infections (Streptococcus pneumoniae, Haemophilus) and gastrointestinal (Campylobacter jejuni, rotavirus and Giardia lamblia). Viral infections caused by herpes zoster, cytomegalovirus (CMV) and hepatitis C are rare. The opportunistic agents such as CMV, Pneumocystis jirovecii, cryptococcus and atypical mycobacteria have been reported as isolated cases. This paper reports the case of a 38-year-old female patient, who began six years before with weight loss of 7 kg in six months, fatigue, weakness, sweating, fever and abdominal pain. Furthermore, patient had intestinal obstruction and abdominal CT showed mesenteric lymph growth. The mesenteric lymph node biopsy revealed positives Mycobacterium PCR, Ziehl-Neelsen staining and culture for M. bovis. In the laparotomy postoperative period was complicated with nosocomial pneumonia, requiring mechanical ventilation and tracheostomy. Two years later, she developed right renal abscess that required surgical drainage, once again with a positive culture for Mycobacterium bovis. She was referred to highly specialized hospital and we documented panhypogammaglobulinemia and lymphopenia. Secondary causes of hypogammaglobulinemia were ruled out and common variable immunodeficiency (CVID) was confirmed, we started IVIG replacement. Four years later she developed mixed cellularity Hodgkin's lymphoma. Until today she continues with IVIG and chemotherapy. This report of a patient with CVID and Mycobacterium bovis infection, a unusual association, shows the cellular immunity susceptibility in this immunodeficiency, additional to the humoral defect.

La inmunodeficiencia común variable forma un grupo heterogéneo de trastornos que se distinguen por falla en la producción de anticuerpos. Tiene un amplio espectro de manifestaciones, que incluyen infecciones severas y recurrentes respiratorias (Streptococcus pneumoniae, Haemophilus) y gastrointestinales (Campylobacter jejuni, rotavirus y Giardia lamblia). Las infecciones virales ocasionadas por herpes zoster, citomegalovirus y hepatitis C son poco frecuentes. Los agentes oportunistas como citomegalovirus, Pneumocystis jirovecii, micobacterias atípicas y criptococo se han reportado como casos aislados. Se comunica el caso de una paciente de 38 años de edad, que inició su padecimiento seis años previos con pérdida ponderal de 7 kg en seis meses, astenia, adinamia, diaforesis, fiebre y dolor abdominal. Además, la paciente tenía obstrucción intestinal, la tomografía abdominal mostró crecimiento de ganglios mesentéricos. Se sometió a laparoscopia con toma de biopsia ganglionar; el reporte de PCR para complejo Mycobacterium, la tinción de Ziehl-Neelsen y el cultivo para M. bovis fueron positivos. El periodo posquirúrgico se complicó con neumonía intrahospitalaria que requirió ventilación mecánica y traqueostomía. Dos años después la paciente padeció absceso renal derecho que ameritó drenaje quirúrgico, nuevamente con cultivo positivo para Mycobaterium bovis. Fue referida a un hospital de alta especialidad, donde se encontró panhipogammaglobulinemia y linfopenia. Se descartaron causas secundarias y se inició reemplazo con inmunoglobulina intravenosa (IgIV) al confirmar el diagnóstico de inmunodeficiencia común variable. Cuatro años después se diagnosticó linfoma de Hodgkin variedad celularidad mixta, actualmente la paciente recibe IgIV y quimioterapia. El caso que comunicamos de una paciente con inmunodeficiencia común variable (IDCV) e infección por Mycobacterium bovis, poco frecuente en este tipo de inmunodeficiencias, expone el múltiple espectro de infecciones de la IDCV, lo que refleja no sólo afectación humoral, sino también celular.

[Pulmonary age-chronological age relation as indicator of improvement and severity of patients with bronchial asthma]. / Relación edad pulmonar-edad cronológica como indicador de mejoría y gravedad de los pacientes con asma bronquial.

BACKGROUND: Spirometry is a very useful clinical test to evaluate pulmonary function in asthmatic patients. However, pulmonary function could be affected by the sex, time of clinical evolution, lung age (LA) and chronological age (CA). OBJECTIVE: To evaluate LA/CA as index of clinical improvement or severity in asthmatic patients. MATERIAL AND METHOD: A prospective study was done where asthma severity was evaluated according to GINA classification. Spirometry was performed at the beginning of this study, at 46, 96, 192 days and after 10 months. Statistical analysis was performed using t test, two-way ANOVA test, correlation and multiple regression models as well as ROC curves were also performed, a p<0.05 was considered significant. RESULTS: Seventy asthmatic patients were included (22 male and 48 female), mean CA was 35-years; mean LA was 48-years with a LA/CA index=1.4, time of clinical evolution was 13 years. A LA/CA index=1 (range 0.5 to 0.9) was observed in asymptomatic patients. LA/CA index over 1 were related with airway inflammation, and a LA/CA index higher than 2 correlated with GINA step 3. Interestingly when we analyzed CA and LA, we observed in female group a higher than 10 years difference between CA and LA (GINA step 2 and 3); while in male we observed (GINA step 1, step 2 and step 3). LA/CA index less than or equal to 1 was considered normal. CONCLUSIONS: LA/CA index could be used as clinical indicator of clinical improvement or severity in asthma patients in both, male and female, with excellent correlation of pulmonary function and age.

Antecedentes: la espirometría es una prueba clínica que se utiliza para evaluar la función pulmonar en asmáticos. La función pulmonar puede estar afectada por el género, tiempo de evolución clínica, edad pulmonar y edad cronológica. Objetivo: evaluar la relación edad pulmonar-edad cronológica (EP/EC) como indicador de gravedad en pacientes asmáticos. Material y método: estudio prospectivo en el que se evaluó la gravedad del asma mediante la clasificación GINA. La espirometría se realizó al inicio del estudio y a los días 46, 96 y 192, durante 10 meses de seguimiento. Se usaron la prueba t Student, ANOVA de dos vías, modelos de correlación y regresión múltiple y curvas ROC; un valor p<0.05 se consideró significativo. Resultados: se incluyeron 70 pacientes asmáticos (22 hombres y 48 mujeres); la media de la edad cronológica (EC) fue de 35 años, la media de la edad pulmonar (EP) fue de 48 años, con valor del indicador EP-EC=1.4 y la evolución clínica de la enfermedad fue de 13 años. El valor del indicador EP-EC=1 (intervalo de 0.5 a 0.9) se observó en pacientes asintomáticos. El indicador EP-EC mayor a 1 se relacionó con obstrucción de la vía aérea y el indicador EP-EC mayor a 2 se correlacionó con grado 3 de GINA. El análisis de la edad cronológica y pulmonar en las mujeres demostró diferencia de más de 10 años entre ambas edades (GINA grados 2 y 3); mientras que en los hombres se observaron (GINA grados 1, 2 y 3). El valor del indicador EP-EC menor o igual que 1 se consideró normal. Conclusiones: la relación edad pulmonar-edad cronológica puede usarse como indicador clínico de la gravedad y mejoría clínica de pacientes asmáticos, con buena correlación entre la función pulmonar y la edad cronológica.

Eosinophilic gastroenteritis / Gastroenteritis eosinofílica

The eosinophilic gastroenteritis is a disease of unknown etiopathogenesis and rare presentation, with several clinical symptoms, ranging from mild episodes until nonspecific abdominal acute episodes of intestinal obstruction, which some times make it necessary urgent surgical treatment. This wide symptomatic range seems to be conditioned by the degree of eosinophilic infiltration of the intestinal wall and the number of layers involved. This paper reports the case of a patient who, due to the diagnosis difficulties, illustrates in a single patient the intestinal and respiratory anatomo-clinical diversity and the evolution of the eosinophilia both intestinal and peripheral. Patient was sent to our service with diagnoses of bronchial asthma, chronic allergic rhinitis and chronic anemia.

La gastroenteritis eosinofílica es una enfermedad de etiopatogenia no aclarada y manifestación poco frecuente, con síntomas clínicos diversos, abarca desde cuadros leves abdominales inespecíficos hasta episodios agudos de obstrucción intestinal que en ocasiones hacen preciso el tratamiento quirúrgico urgente. Este amplio abanico sintomático parece estar condicionado por el grado de infiltración eosinofílica de la pared intestinal y el número de capas afectadas. Comunicamos un caso que por la dificultad diagnóstica ilustra, en un solo paciente, la diversidad anatomoclínica del cuadro intestinal y respiratorio y la evolución de la eosinofilia intestinal y periférica. La paciente fue enviada a nuestro servicio con los diagnósticos de asma bronquial, rinitis crónica alérgica y anemia crónica persistente.

[Levels of CD4+ and FOXP3+ lymphocytes in patients with allergic rhinitis]. / Concentraciones de linfocitos T CD4+ y FOXP3+ en pacientes con rinitis alérgica.

BACKGROUND: Allergic rinitis is the more common allergic disease, affecting to 25% of general population. Otitis media, sinusitis and other complications result from not controlled allergic rinitis. It has been reported that a low expression of FOXP3 marker on lymphocytes is associated with allergic diseases, and that allergen immunotherapy increases its synthesis. OBJECTIVE: To compare CD4+ FOXP3+ T cell levels in patients with allergic rhinitis, with and without allergen immunotherapy. METHODS: In this cross-sectional, observational and comparative study were included adult patients with allergic rinitis in two groups: one group with 29 patients under allergen immunotherapy for six months, and other group with 30 patients without immunotherapy. Lymphocyte markers CD3, CD4, CD8 y FOXP3 were determined in both groups, as well as serum immunoglobulins. RESULTS: In the group treated with immunotherapy the mean age was 36.4 years, and 72% of them were women. In the other group the age average was 40.4 years and 63% were women. There were no significant differences in immunoglobulin levels among both groups; IgG4 had higher levels, but not significant, in the immunotherapy group (82.1 vs 72.4 mg/dL, p=0.67). Patients from the group without immunotherapy had higher number of FOXP3+ lymphocytes, but not significant (8.2 vs 7.9, p=0.57). CONCLUSIONS: Patients treated with allergen immunotherapy had lower FOXP3+ lymphocytes number than those not treated. More studies are needed for considering FOXP3+ lymphocyte molecule as a useful marker in the follow-up of patients under immunotherapy.

[Allergic asthma and interleukins 2, 4, 5, 6 and 12 and gamma interferon levels]. / Asma alérgica y concentraciones de interleucinas 2, 4, 5, 6 y 12 e interferón gamma.

BACKGROUND: Asthma is an inflammatory chronic illness, in which mastocyt cells, basophils, T lymphocytes, eosinophils and cytokines play a role. Its association with the production of TH2 cytokines is not well known, but it is considered an aberrant immune response, yielding the activation and recruitment of a number of effector cells (mastocyts/eosinophils) and the appearance of clinical symptoms. OBJECTIVE: To determine the serum values of the interleukins 2, 4, 5, 6 and 12 and gamma interferon in relation to the severity degree of asthma and the time of immunotherapy in patients with stable chronic allergic bronchial asthma. MATERIAL AND METHODS: Clinical records of allergic asthmatic patients from the external consultation at Servicio de Alergia e Immunología Clínica were reviewed in a period of 12 months (1st January 2002 to 1st January 2003) and those of healthy volunteers, forming three groups: Group 1, allergic asthmatics with immunotherapy less than 24 months; Group 2, allergic asthmatics with more than 24 months of immunotherapy, and Group 3, healthy volunteers (control group). Previous informed consent, a serum sample was taken of all subjects. RESULTS: Ninety-two subjects were included: 41 (45%) allergic asthmatics and 51 (55%) healthy volunteers. Significant differences were found in interleukins 2, 4, 5, 6 and 12 levels between healthy volunteers and asthmatics without relating the immunotherapy time. In the total group gamma interferon levels were not found. A relation of interleukins Th2 levels with the severity degree of asthma was not found. Differences of serum interleukins Th1 and Th2 in allergic patients related to immunotherapy time were not significant; even though, irrespective of immunotherapy time, IgG levels were always high. CONCLUSIONS: Patients with allergic asthma have a predominance of serum interleukins Th2 and, despite of the immunotherapy, in the maintaining phase, these continue high, which may be due to an immune system dysregulation maybe including other factors. Immunotherapy continues being one of the most useful specific treatments in allergic diseases, demonstrated by its satisfactory clinical response, reduced drugs' use and modification in severity and evolution of the disease.

[Quality of life evaluation in the patient with allergic rhinits]. / Evaluación de la calidad de vida del paciente con rinitis alérgica.

BACKGROUND: The introduction of the evaluation tools, such as the quality of life-questionnaires, allows to assess how functional alterations due to an illness affect the patient's life. OBJECTIVE: To know the emotional, social and occupational state of allergic rhinitis patients. MATERIAL AND METHODS: Quality of life questionnaires were applied once to a group of 50 patients with allergic rhinitis diagnosis from the clinic immunology and allergy service, from May to August 2002. RESULTS: Female sex was the predominant (64%), with ages from 8 to 74 years (average of 36.9 years). In women severe rhinitis was observed in 37.5%, and in men mild rhinitis was found in 61%. The main occupations were: student (20%), administrative (20%) and teacher (18%). Nasal symptoms appeared when doing the following activities: housework in 18 cases (36%), reading in 10 cases (20%) and house maintenance in 5 cases (10%). In the analysis done to know the usefulness of the questionnaire a sensitivity of 90% and a specificity of 85% were found. CONCLUSIONS: The quality of life was found to be altered, affected and closely related to the presentation of nasal symptoms when doing different daily-life activities, which produces dissatisfaction in patients.

[Presence of anti-Helicobacter pylori, antithyroid, and high-affinity IgE receptor antibodies in patients with chronic urticaria]. / Presencia de anticuerpos anti-Helicobacter pylori, antitiroideos y antirreceptor de alta afinidad de la inmunoglobulina E en pacientes con urticaria crónica.

BACKGROUND: Chronic urticaria is characterized by erythematous wheals during more than 6 weeks. In 47% of the patients it is associated to Helicobacter pylori infection; in 50%, to antibodies (Abs) against the high affinity receptor of the IgE, and in 12 to 20% to antithyroid's antibodies (antithyroglobuline, mychrosomals) and, from these, 25% have alterations of the thyroid function. OBJECTIVE: To determine the presence of the anti-Helicobacter pylori and anttihyroids antibodies and the high affinity anti-receptor of the IgE in healthy subjects and patients with chronic urticaria. MATERIAL AND METHODS: Eighty subjects were included: 40 healthy subjects and 40 patients whit diagnosis of chronic urticaria. In all of them a blood sample was extracted to the determination of the antibodies and skin test applications with autologous serum to determine the antibody of the high affinity anti-receptor of IgE. For the analysis of the results descriptive statistics was used (central tendency measures, frequencies, means, averages and percentages), as well as multiple correlations and inferential analyses. RESULTS: Anti-Helicobacter pylori, antithyroid (antithyroglobulin, microsomal) antibodies and the skin test with autologous serum (antibody of the high affinity anti-receptor of IgE) were negative in the healthy group (mean age: 41 years, 36 women, 90%). Of the 40 patients with chronic urticaria (mean age: 42 years, 36 women, 90%), the frequency of the antibody of high affinity anti-receptor of the IgE was: 5 patients with negative skin test (12.5%), 1 (2.5%)+, 7 (17.5%)++, 9 (22.5%)+++, 18 (45%)++++. The anti-Helicobacter pylori antibodies were positive in 30 (75%) patients and negative in 10 (25%). The antithyroid's antibodies were as follows: antithyroglobulin: 4 (10%) positive, microsomal: 4 (10%) positive. The concomitant diseases found were: hypothyroidism (3, 7.5%) mixed rhinitis (2.5%) and autoimmunity 2 (5%). CONCLUSION: The test skin with autologous serum to determine the IgG antibody against the high affinity receptor of IgE is a simple and low-cost procedure leading to determine the cause of the idiopathic chronic urticaria in a high percentage of patients. As reported in literature, the Helicobacter pylori infection documented by the detection of the IgM antibodies against Helicobacter pylori is frequent in patients with chronic urticaria, which is important due to it could be implied in the diagnosis and treatment.

[Failure of allergen-based immunotherapy in adults with allergic asthma]. / Fracaso de la inmunoterapia con alergenos en pacientes adultos con asma alérgica.

BACKGROUND: The allergic asthma is the reversible chronic inflammatory process at the airways, secondary to exaggerate reply to the allergens exposition, its treatment includes: avoiding the exposure to allergens, pharmacology therapy and the specific immunotherapy with allergens (ITA), which is based on the growing dosages of the extract allergenic; the objectives are to modify the immune response and to improve the allergic disease. The ITA can fail due to causes attributable to the patient, vaccine-inherent causes and/or factors related to the allergic disease. OBJECTIVE: To determine the main causes of specific immunotherapy with allergens' failure in our hospital. MATERIAL AND METHODS: In the present study 126 records of patients with allergic asthma treated in the extern consultation service of the clinical immunology and allergy department of the CMN 20 de Noviembre, ISSSTE, were reviewed from January 1996 to December 2001. RESULTS: It was found that specific immunotherapy with allergens, failed in 32 (23%) patients. Main causes of failure were: 1) withdrawal in the vaccine application in 19 (59%) patients; 2) high serum levels of IgE. The co-morbidities that contribute to poor responses to the treatment were: obesity, gastroesofageal reflux and chronic rhynosinusitis. CONCLUSIONS: Specific immunotherapy with allergens is an alternative method of allergic asthma's treatment which has been approved by national and international medical consensus. Main causes of failure in our hospital are the abandon of treatment and high serum levels of IgE, as well as the existence of other conditions.

[Prevalence of latex-fruit syndrome in health workers with latex allergy]. / Prevalencia del síndrome de látex-fruta en trabajadores de la salud con alergia al látex.

BACKGROUND: Prevalence of latex allergy in the general population is lesser than 1%. These patients have clinical and immunochemical cross-reactivity between latex and fruits; sometimes this has been referred to as the "latex-fruit-syndrome" (LFS); atopy was found to be a risk factor to sensitization to fruits. OBJECTIVE: To investigate the prevalence of LFS, in a group of health care workers with latex-allergy. METHODS: Hospital employees were initially screened for latex allergy with a questionnaire; these patients were divided into the following two groups: 1) health care workers with latex-allergy, classified into two subgroups: a) with a familial history of atopy; b) without a familial history of atopy, and 2) health care workers with familial history of atopy but without latex-allergy. Skin prick tests with latex and fruits extracts (kiwi, avocado, banana and chestnut) were done. RESULTS: Based in clinical history and with confirmation by skin testing, three patients of the health care workers' group with latex allergy have LFS (prevalence of 12.5%). Sensitivity and specificity for skin prick test in health care workers with latex-fruit syndrome were: latex, kiwi and chestnut sensitivity: 100%; latex and avocado specificity: 90%; chestnut and kiwi specificity: 100%. CONCLUSION: A low prevalence of latex-fruit syndrome was detected in our population. We found a higher prevalence in females with a history of atopy. Our findings were consistent with other literature reports.

Estudio comparativo entre el tratamiento de la uveítis autoinmune con prednisona y con ciclofosfamida y azatioprina / Conparative study between the treatment of the autoimune uveitis with prednisona and with ciclofosfamida and azatioprina

Antecedentes: la uveítis es una enfermedad autoinmune que compromete cualquier estructura interna del globo ocular; su característica principal es la inflamación intraocular. Objetivo: determinar cuál es la opción terapéutica más efectiva en contra de la uveítis autoinmune: ciclofosfamida, azatioprina o prednisona. Material y métodos: pacientes de uno y otro sexo entre 16 y 65 años de edad con diagnóstico de uveítis autoinmune (anterior, intermedia y posterior), a quienes se les realizó historia clínica, exploración física y estudios clínicos. Se les solicitó su consentimiento informado por escrito y se asignaron al azar a tres grupos de tratamiento: grupo 1 (azatioprina) 14 (42.4 por ciento) pacientes; grupo 2 (prednisona) 15 (45.5 por ciento) pacientes, y grupo 3 (ciclofosfamida) 4 (12.1 por ciento) pacientes. Se realizaron observaciones doble ciego y valoraciones al día 0 y a las semanas 1, 2, 4 y 6 de tratamiento. Resultados: de 33 pacientes estudiados 13 (39.4 por ciento) fueron hombres y 20 (60.6 por ciento) mujeres, el diagnóstico más frecuente fue uveítis por toxoplasmosis. Se observó un control mejor y más rápido de la inflamación a las 6.2 semanas en la cámara anterior con 100 mg/día de azatioprina con p < 0.0001, para prednisona: p = .000 y para ciclofosfamida: p = 135. En la cámara posterior no se observaron cambios inflamatorios significativos para los tres grupos con p =.353. Los efectos adversos observados con más frecuencia ocurrieron en el grupo de prednisona con p < 0.05 en 24.2 por ciento, caracterizados por neutropenia e infección de las vías urinarias. Conclusiones: la azatioprina, a dosis de 100 mg/día oral durante seis semanas, se considera el medicamento más eficaz, ya que demostró disminución significativa del proceso inflamatorio en menor tiempo, con menos efectos colaterales y con conservación de la agudeza visual.