[Frequency of Food-Sensitization by Prick-to-Prick Skin Tests and Atopy Patch Tests in Children with Allergic Diseases]. / Frecuencia de sensibilización a alimentos por pruebas cut·neas de prick-to-prick y de parche en niños con enfermedades alérgicas.

BACKGROUND: Food allergy is a health problem that has increased its prevalence in the last decade, and plays a role in the multiple symptoms of allergic diseases like asthma, atopic dermatitis and allergic rhinitis. It has become the new epidemic with significant implications. OBJETIVE: To describe the frequency of sensitization to food antigens by skin tests, prick-to-prick and atopy patch tests, in a group of allergic children in a pediatric hospital. METHODS: We retrospectively reviewed the results of skin tests with foods, prick-to-prick and atopy patch tests, in the clinical records of 170 and 140 children respectively, with a diagnosis of asthma, allergic rhinitis, atopic dermatitis, food allergy or eosinophilic gastroenteropathies, and analyzed the results with measures of central tendency and chi2 test. RESULTS: Immediate hypersensitivity tests with fresh foods (prick-to-prick) were positive in 135 cases. Cowís milk was positive in 28.8%, followed by egg white with 20.1% and banana in 19.4%. In the group of 1 to 5 years, cowís milk was positive in 26.9% (p <0.05). In children with a previous diagnosis of food allergy cowís milk was positive in 27.1% (p<0.05). In delayed hypersensitivity tests (patch tests) there were 105 positive results; soybean was positive in 53.3% of cases tested, followed by peanut and chocolate with 50.5%. In the group with atopic dermatitis soybean was positive in 55.6% (p <0.05). In the group of 1 to 5 years, soybean was positive in 52.1% (p <0.05). CONCLUSIONS: In children with various allergic diseases, with prick-to-prick skin tests, cowís milk was the food allergen with more frequent positive results. When we used atopy patch tests, soybean was the food with more positive results. We observe sensitization to different foods, according to the mechanism of injury, type I or IV, which is dependent on the type of skin tests used.

[Desensitization protocol to methotrexate. Clinical case]. / Protocolo de desensibilización a metotrexato. Caso clinico

Methotrexate (MTX) is a folic acid antagonist; its main effects are immunosuppressive and antineoplastic. It is used in the treatment of malignancies, lung and rheumatic diseases. There are few reports of immediate hypersensitivity and these include anaphylaxis, urticaria and angioedema. We present a 17 years old male, with a history of anaphylaxis to methotrexate during the induction therapy of ALL L2. It was decided that the drug was necessary for the patientís survival, thus diagnostic skin testing was performed, during which he presented anaphylaxis. The desensitization consisted of 5 days premedication and a 12-steps protocol of intravenous infusions of 8 hoursí duration, starting with a 1:1.000.000 dilution. The patient was successfully desensitized. He was maintained with IV MTX 50mg/m2 weekly for 1 year using the same protocol successfully. This protocol of 12 steps was successful and safe to desensitize a patient with anaphylaxis due to MTX. During such protocol intensive care supervision is critical, as all precautions should be taken to avoid endangering the life of the patient.

Carboplatin hypersensitivity and desensitization in an infant.

Although the reported incidence of carboplatin hypersensitivity is low, it is important to describe it because of its potentially fatal consequences. A 1-year-old Mexican girl weighing 10 kg who had optic nerve glioma was initially scheduled to receive 12 cycles of 600 mg/m2 carboplatin (CBP) as two 300-mg/m2 intravenous infusions administered over 1 hour on 2 different days and a 1-hour intravenous infusion of 1.5 mg/m2 vincristine every 4 weeks. The patient had no history of drug allergies or any type of adverse drug reaction, but she developed itchiness, maculopapular rash, sweating, respiratory distress, and anxiety during the seventh cycle of CBP. According to the algorithm developed by Naranjo et al, the adverse drug reaction was classified as definite secondary to CBP and confirmed by positive skin tests indicating hypersensitivity to the drug. After evaluating the clinical course of the adverse drug reaction and considering the need to continue cancer treatment, a decision was made to desensitize the patient to CBP. The desensitization procedure took 8 hours and was performed during each new chemotherapy cycle until the 12 cycles of chemotherapy were successfully completed. In summary, a case of CBP hypersensitivity in a 1-year-old girl who was successfully desensitized to CBP is reported.

[Allergic bronchopulmonary aspergillosis. A report of a case and literature review]. / Aspergilosis broncopulmonar alérgica. Comunicación de un caso y revisión de la bibliografía.

Allergic bronchopulmonary aspergillosis is a world rare disease with a prevalence between 1 and 2%. It presents in moderate-severe asthma and cistic fibrosis patients. The diagnosis is made in the basis of Rossenberg and Greenberg criteria that can be essential or non essential. We present the case of a 3-year-old boy with allergic bronchopulmonary aspergillosis without bronchiectasies and with a good response to corticosteroids. His mother complained of two years of nasal obstruction, purulent rinorrea, nasal pruritus, sneezing, chronic cough and recurrent wheezing, twice to thrice a month. He also occasionally had vomits and diarrhea in relation with strawberries, banana, cow's milk and chocolate. We made the diagnosis of asthma, allergic rhinitis, sinusitis, and probably food allergy. We treated him with step approach of ICS according to GINA 2006, albuterol PRN, and elimination diet, with bad response. Laboratory exams: Blood white cells with eosinophilia (6%), total serum IgE: 1684 ng/L, aspergillus skin prick test: 4mm, serum IgG-Aspergillus fumigatus: 2.3 mcg/mL, serum IgE-Aspergillus fumigatus: negative, chest roentgenographic parahiliar and apical infiltrates, and chest computed tomography without bronchiectasies. We added prednisone to the treatment for four months, and we observed a very good response; he is now in treatment as mild persistent asthma with ICS low doses. ABPA must be suspected in patients with moderate-severe persistent asthma and a skin prick test positive to Aspergillus fumigatus regardless the age. The treatment with oral corticosteroids is the mainstream of management, and most of the patients have a good response, as we observed with this patient.

[Uncommon manifestations of atopic dermatitis]. / Manifestaciones poco frecuentes de dermatitis atópica.

Atopic dermatitis is an inflammatory process characterized by a series of cutaneous alterations of typical morphology and distribution, with intense pruritus of nocturnal predominance, of chronic evolution, stational appearance, and with personal and family history of atopy. On genetically predisposed skin, dry and hypersensitive, the immune factors and other types are implicated in determining the abnormal reactions to multiple endogenous and environmental factors. The diagnosis is clinical, generally obtained by a group of signs and symptoms known as the Hanifin and Rajka criteria. The patients with atopic dermatitis can present with clinical typical manifestations, or minimized and localized variations as well, considered a stigma of atopic constituent. In some patients there can be observed clinical and morphological variations with special localizations denominated atypical variations of atopic dermatitis. The identification of these atypical presentations of atopic dermatitis leads to the differential diagnosis, with an early establishment of the disease's diagnosis and the appropriate and early treatment.

[Allergic conjunctivitis in children]. / Conjuntivitis alérgica en la infancia.

Allergic conjunctivitis is a group of diseases that are frequent in childhood, associated to several allergic diseases affecting the ocular surface. It is related to type 1 hypersensitivity reactions. Two acute disorders: seasonal allergic conjunctivitis and perennial allergic conjunctivitis, exist, as do three chronic diseases: vernal keratoconjunctivitis, atopic keratoconjunctivitis and giant papillary conjunctivitis. The ocular surface inflammation causes itching, tearing, lid and conjunctival edema-redness, and photophobia during the acute phase and can lead to a classic late-phase response (associated to eosinophilia and neutrophilia) in a subset of individuals. As in the case of several chronic allergic diseases, it can remodel the ocular surface tissue. This allergic disease is very frequent. Vernal keratoconjunctivitis could produce corneal lesions and visual illness; however, atopic keratoconjunctivitis does not permanently affect the vision. The aim of this review is to provide a current overview for a better understanding of the symptoms associated to this disease, to describe its classification, recent advances in its physiopathology and its treatment.

Asthma prevalence in children living in north Mexico City and a comparison with other Latin American cities and world regions.

Reports of previous studies done without following the international guidelines in different cities of Mexico showed a decrease in asthma prevalence. The aim of this study was to determine the prevalence and severity of asthma symptoms in children and teenagers living in north Mexico City and compare them with those of other Latin American cities and world regions. The cross-sectional survey followed the protocol of the International Study of Asthma and Allergies in Childhood IIIb phase survey. The study population included children 6-7 years old and teenagers 13-14 years old from randomly selected primary and secondary schools. There were 1629 boys and 1582 girls in the group of 6- to 7-year-old children and 2039 boys and 1860 girls in the 13- to 14-year-old group. "Wheezing or whistling in the chest at any time in the past" was present in 19.2% (95% confidence interval [CI], 17.9, 20.6) of the children and in 17.0% (95% CI, 15.8, 18.1) of the teenagers; "wheezing or whistling in the chest in the last 12 months" was reported in 6.8% (95% CI, 5.9, 7.6) of the children and 9.9% (95% CI, 9.0, 10.8) of the teenagers; "asthma ever" was claimed in 4.5% (95% CI, 3.8, 5.2) of the children and 8.0% (95% CI, 7.1, 8.8) of the teenagers. These prevalences were low compared with other ISAAC Latin American surveys and intermediate in comparison with worldwide regional prevalences reported by ISAAC surveys. The prevalence of asthma is low in Mexico City in comparison with other surveyed locations, but the number of patients with asthma makes it an important issue for Mexican public health programs.

Co-administration of salbutamol and fluticasone for emergency treatment of children with moderate acute asthma.

This study aimed to compare the efficacy of nebulized therapy with salbutamol alone or in combination with fluticasone. In a randomized, double-blind clinical trial, 150 children with moderate acute asthma were randomly assigned to receive by nebulizations either (i) three doses of salbutamol 30 microl/kg per dose, each dose administered every 15 min, (ii) three doses of salbutamol plus two doses of fluticasone 500 microg/dose at 15 and 30 min after first dose of salbutamol, or (iii) three doses of salbutamol/fluticasone 500 microg/dose, each combined dose administered every 15 min. Pulse oxymetry (SaO2), peak expiratory flow (PEF) and Wood et al. (Am J Dis Child, 123, 1972, 123) clinical scale were evaluated at baseline, 15, 30, 45, 60, 90 and 120 min after the first nebulization. Patients in the three groups significantly improved since 15 min after the first nebulization. We did not observe differences in the recovery of SaO2 and PEF among the three groups of treatment (p > 0.10). In group 3, children showed better clinical response at 120 min than the other two groups (p < 0.05). No significant adverse effects were observed with any treatment. To summarize, in children with acute moderate asthma, nebulized salbutamol at an accumulated dose of 90 mul/kg plus fluticasone at an accumulated dose of 1500 microg produced better clinical relief after 2 h. However, similar PEF and SaO2 responses were observed with salbutamol alone or in combination with different doses of fluticasone.

Tipos y características de los inhaladores para el manejo de asma / Types and characteristics of devices for the treatment of asthma

El tratamiento del asma requiere del uso de medicamentos durante períodos largos para lograr el control de la enfermedad y la vía inhalada es la forma más adecuada para administrarlos. En las últimas 2 décadas se han desarrollado nuevos y mejores dispositivos para la entrega del medicamento, con marcadas diferencias respecto a su diseño, construcción, características de salida y tamaño de las partículas. El médico debe conocer los puntos tecnológicos más destacados de cada aparato para que pueda aprovechar sus ventajas y haga recomendaciones muy precisas. Existen varios dispositivos para administrar medicamentos inhalados: los más viejos y de uso cotidiano en hospitales son los nebulizadores y de manera más reciente se introdujeron los inhaladores de dosis medida presurizados o los inhaladores de polvo seco, que son más usados para el paciente ambulatorio. La condición particular de cada uno de estos dispositivos debe conocerse y aplicarse para ofrecer el máximo beneficio al paciente asmático.

Asthma management requires the use of many drugs for long time with the purpose of achieving control. Inhalator delivery of asthma medications is the best way. In the previous 2 decades, technology has improved delivery devices, changes in design, materials and outsize particles. Physicians should know all the technical points in order to take advantage of these new devises to be able to make appropriate recommendations for their use. There is a large quantity of options for the delivery of asthma medications: nebulizers, metered dose inhaler and dry powder inhalers. Particular characteristics of delivery devices should be known and applied in particular patients.The aim of this review article is assist physicians to choose the best device option.

Cyclophosphamide hypersensitivity in a leukemic child.

Although hypersensitivity reactions to chemotherapeutic drugs have rarely been reported, they may occur with any of these agents. A Mexican native 44-kg 13-year-old boy suffering from acute lymphoblastic leukemia (ALL) received chemotherapy for 7 years. Three years later, a recurrence of ALL was detected in his right testicle. The patient was scheduled to receive 12 weekly cycles of 50 mg/kg of cyclophosphamide (CPM) as a 1-hour intravenous infusion. The patient did not have any history of drug allergies or any other type of ADR. Immediately after the fourth cycle of CPM, the patient developed itchy, maculopapular rash, sweating, respiratory distress, and anxiety. According to the algorithm developed by Naranjo et al, the ADR was classified as probably secondary to CPM. Skin tests were negative to hypersensitivity to CPM, and a new cycle of CPM was administered. However, the patient developed a similar hypersensitivity reaction to CPM. After an analysis of the clinical course of the ADR and the need to continue the chemotherapeutic treatment with CPM, we decided to desensitize the patient to this drug. Total duration of the procedure was 5 hours and was performed on only 1 occasion. The program of 12 cycles of chemotherapy was successfully completed without any sign or symptom of hypersensitivity to CPM. In conclusion, we have reported a case of hypersensitivity to CPM who was successfully desensitized to CPM.

[Eosinophilic colitis. A report of two cases with non conventional treatment]. / Colitis eosinofílica. Comunicación de dos casos con tratamiento no convencional.

Eosinophilic colitis is a rare entity of unknown etiology characterized by diarrhea, abdominal pain, and gastrointestinal bleeding. Diagnosis includes histopathological infiltration of more than 20 eosinophils in colon. It is frequently associated with milk hypersensitivity and, less usual, with other foods and increased IgE. Histopthological appearance of eosinophil mediators has been observed in the gut. It is sometimes related to the degree of infiltration of eosinophils in the gut as well as to the disease severity. There is not an established treatment for this entity, although systemic steroids have been used with certain efficacy. However, there is a recurrence of the symptoms when the therapy stops, besides the well known side effects of the long-term use of steroids. Cromolyn inhibits mast cell degranulation and prevents liberation of mediators. It is successful in certain cases, specially the severe ones. However, it is not available for its use in our country. Ketotifen, as last resource in our patients with bad response to habitual treatment and restriction diet, was used. Although its use is controversial, we consider that stabilizing mast cell membrane with subsequent inhibition of degranulation and recruitment of eosinophils to sites of inflammation, would also restrain histamine liberation and blockage of H1 receptors, which would diminish local damage induced by eosinophils. Nonetheless ketotifen mechanism of action is unknown, our patients improved after treatment with this drug.

[Quality of life in children with allergic rhinitis before and after being treated with specific immunotherapy (cases and controls)]. / Calidad de vida en niños con rinitis alérgica antes y después de ser tratados con inmunoterapia específica (casos y controles).

BACKGROUND: Rhinitis is the most frequent allergic disease in children. Symptoms may affect importantly life quality. Measures to avoid allergens when possible and the use of drugs are an important part of the treatment; however, specific immunotherapy is the only treatment altering the natural course of the disease. OBJECTIVE: To assess if specific immunotherapy improves life quality in children with allergic rhinitis. MATERIAL AND METHODS: Patients who attended to the allergy department during August and September 2002, and who fulfilled the inclusion criteria, were included. Two groups of treatment were formed: group A received specific immunotherapy with standardized allergenic extracts, from IPI ASAC Mexico. They started with a concentration of 0.07 bioequivalent units (BEU), with twice-a-week-application with increases of 10 (0.7, 7 and 80 BEU) each seven weeks up to maintenance dose of 700 BEU at six months. Group B only was given pharmacological treatment. Paediatric Rhinoconjunctivitis Quality of Life Questionnaires, specific to children with allergic rhinoconjunctivitis, validated for its use in Spanish in Mexican children by the department of Clinical Epidemiology and Biostatistics of Mc Master University, were applied to all patients. RESULTS: Twenty-seven patients were included in each group, 14 males, adjusted for age with a correlation coefficient (r2) = 0.9799. In both groups, mean age was of 11 years 6 months (group A: 7 to 16 years, group B: 7 to 17 years). Eighteen (44.4%) and fifteen patients (33.3%), of groups A and B respectively, had persistent mild rhinitis, and 9 (55.6%) and 12 cases (66.7%) of groups A and B, respectively, had moderate persistent rhinitis. All of them were sensitized to domiciliary allergens. As to life quality a high odds ratio (OR) was found when assessing patients six months after treatment, especially in nasal symptoms such as pruritus (OR = 6.8) and obstruction (OR = 5.9). Also for practical symptoms the OR was high: carving eyes and nose (OR = 7), blowing the nose (OR = 4.8) and carrying disposable tissues (OR = 4.7). OR for other symptoms was as follows: thirst and throatitch, OR = 4; irritability, OR = 6.2, and ocular pruritus, OR = 3.1. Patients without immunotherapy were likely to use more drugs (OR = 6.4) than those receiving immunotherapy. CONCLUSION: We did not find controlled studies on life quality with the use of immunotherapy in children. In this study, specific immunotherapy was found to improve life quality in children with allergic rhinoconjunctivitis, especially in nasal symptoms, such as pruritus and obstruction, as well as in practical symptoms. These results are similar to those by Fell, who found that 92% patients referred an improvement of nasal symptoms, a better labor performance and a lesser use of drugs after four months of using immunotherapy.

[Calisthenics as a preventive measure against the decrease in maximum expiratory flow in asthmatic patients before and after a soccer game]. / Calistenia como medida preventiva de la caída del flujo espiratorio máximo en pacientes asmáticos antes y después de un juego de futbol.

BACKGROUND: Exercise-induced asthma is a syndrome characterized by dyspnea, thoracic pain, cough, sibilant rales and diminished physical performance. It appears into the first 30 minutes after the beginning of physical activity. OBJECTIVE: To evaluate calisthenic effect on maximal expiratory flow rate in asthmatic patients. MATERIAL AND METHODS: A prospective, observational and descriptive study was done through a soccer game. Male and female asthmatic patients from 6 to 16 years old with intermittent and mild asthma were included. Maximal expiratory flow rate was measured before the beginning of soccer game, and then, at the end of the first and second sets. Statistical analysis was made through the media values comparison and t Student test. RESULTS: 60 patients were included. They were 11.3 +/- 2.4 mean aged. 45% had diagnosis of mild asthma, 36.6% mild asthma and allergic rhinitis and 6.6% persistent asthma. Average of basal maximal expiratory flow rate was 275 +/- 90 L/s, and no significant changes were observed in 52 patients: mean maximal expiratory flow rate at the end of first and second sets was 275 +/- 86 L/s and 273 +/- 96 L/s, respectively. Maximal expiratory flow rate diminished at 77 +/- 3.8% and 83 +/- 9.5% in the other eight patients at the end of the first and second sets, respectively. CONCLUSIONS: Calisthenic made before physical activity prevents maximal expiratory flow rate diminishment.

[The response to PPD and its relation to allergic diseases in children vaccinated at birth with BCG]. / La respuesta al PPD y su relación con las enfermedades alérgicas en los niños vacunados al nacimiento con BCG.

BACKGROUND: The increase of the atopical disorders can be partially explained by two factors, the infectious disease in developed and developing countries, and the changes in immunization programs, infections such as measles, whooping cough or tuberculosis can modify the immune response. Recent studies have demonstrated that an inverse relation could exist between the response to late cutaneus hypersensitivity to Mycobacterium tuberculosis and atopic condition. Also, a strong positive response has been associated with low levels of IgE and Th1 cytokines. However some authors have not found positivity between low prevalence in allergic diseases and PPD. OBJECTIVE: To determine the reaction to PPD in children vaccinated with BCG at birth and its disorders. MATERIAL AND METHOD: The study sample included male and female children from 2 to 7 years old, vaccinated with BCG at birth, this fact was corroborated with the post vaccination scar. They had all been diagnosed with allergic disease with clinical compatible data, positive Prick test, elevated serum IgE, and absence of any associated immune deficiency. RESULTS: A total of 50 patients, with a mean age of 4.7 years (2.0 to 7.7 years) were studied. 72% (36) were males and 28% (14) females. Twenty-two percent had diagnosis of asthma, 8% allergic rhinitis, and 62% both diagnosis. The average diameter of tuberculin induration was of 5 mm; 5 patients (10%) had positive reaction (+10 mm); 23 patients (46%) were between 5-9 mm; 8 patients (16%) between 1-4 mm, and 14 of the patients (28%) without reactivity. CONCLUSION: We demonstrated that the vaccination with BCG do not protect against the development of allergy, and the negative tuberculin response may mean a reduced cell response. So, it is necessary to assess the cell immunity and revaccination with BCG, with determination of immunological markers, before and after, such as IL 4, IL 2, INF and allergy symptoms.

[Changes in lung function after a bronchial provocation test with cockroach antigens]. / Cambios en la función pulmonar después de una prueba de reto bronquial con antígenos de cucaracha.

BACKGROUND: Cockroach allergens sensitized patients at a very young age and can predispose to severe asthma on atopic children. OBJECTIVE: To evaluate the FEV, changes induced after bronchoprovocation with Blatella germanica (Bg) or placebo on allergic respiratory children. MATERIAL AND METHODS: A prospective transversal study was performed in 25 children from 8 to 16 yr with allergic rhinitis and/or asthma diagnosis with sensibility only to Bg (Bayer Corp allergens) by Prick skin test, with a 1:20 weight/volume dilution. After previous training on spirometry, they assisted for a double blind bronchial challenge with 10, 25, 50, 75, 100, 150, 200, 300, 400, 500 until 750 proteic nitrogen units of Bg or 0.9% NaCl solution in a nebulized open circuit, with a 5 litter flow for 3 min. A week after, they returned for the crossover double blind bronchial challenge. At the beginning of the study a basal spirometry was performed and subsequent spirometrics at 1.5 and 3 min after each challenge with a 10 min rest between the challenges. The test was interrupted if cough, dyspnea, wheezing and/or a 15% or more FEV1 fall appeared. RESULTS: Twelve patients showed a FEV1 fall with the antigen challenge, all with specific lgE for Bg. All they had positive skin test to Bg, 9 had asthma and rhinitis and 3 only asthma. When placebo was used 6 patients showed a FEV1 fall. When comparing the average basal and final FEV1 values after the challenges, the fall was statistical significant in both groups with a p = 0.0015 when Bg was used, and p = 0.046 with placebo. CONCLUSION: These results show that two times fold number of patients challenged with Bg had a FEV1 fall than placebo, and the t Student test showed that antigen challenge was more significant than placebo. We demonstrated that respiratory allergic patients sensitised with Bg after a bronchial challenge with these allergens show a FEV1 fall. This suggests that cockroach allergen sensitisation can be on account of children's asthma.

[Hypersensitivity detected by skin tests to food in allergic patients in the Hospital Infantil de México Federico Gómez]. / Hipersensibilidad por prueba cutánea a alimentos en pacientes alérgicos en el Hospital Infantil de México Federico Gómez.

BACKGROUND: The prevalence of food allergy depends on the feeding practices of different parts of the world. Peanuts and nuts cause a great part of allergies in the United States; in Spain and Portugal are commonly due to fish, milk; in Italy seafood and mustard in France. In Mexico we don't know the frequency of food allergy and involved groups of age or specific foods. OBJECTIVE: To determine the frequency of immediate hypersensitivity for foods in allergic children from Hospital Infantil de México Federico Gómez. MATERIAL AND METHODS: A retrospective study was performed between January 1995 to December 1999. The skin prick test (SPT) to food was reviewed according to Aas classification. Male and female from 12 months to 18 years old were reviewed. RESULTS: We documented 1,419 patients with allergy. Of them 442 (31%) had positive skin prick test (SPT) to some of the 33 tested foods. The average age of the study group was of 12.8 years. The most affected was from 4 to 7 years (49%); the second group from 1 to 3 years with 23.7%, and the third was from 12 to 17 years with 13.5%. Fish, milky, seafood, soy, beans, orange, onion, tomato, chicken, nut, lettuce and strawberry, were responsible for 58% of the total of allergic reactions. Of those fish, milk, seafood, soy and orange (39%) had the highest frequency. Hypersensitivity to several foods is low, finding just one allergen in 50% of the cases, two allergens in 25%, three allergens in 9%, four in 7%, five in 5% and more than 6 only in 3% of cases. CONCLUSION: We concluded that almost any kind of food reaction seen in our study was due to alimentary habits of different populations, socioeconomic status, and availability of foods. This indicates the diversity of costumes in Mexican people due to the wide geographical area and cultural background of our country. Results could be increased because of only 33 allergens were tested.

[Allergen sensitization and asthma in children from 1 to 3 years of age]. / Sensibilización con alergenos y asma en niños de uno a tres años de edad.

BACKGROUND: Asthma is a multifactorial disease. Children with atopy history could be sensitized with indoor and food allergens from early stages of the life and this predispose to develop asthma. Controversy exists about the factors that increase or decrease the risk of disease, such as breast feeding, early weaning, smoking exposition, immunizations. OBJECTIVE: To determine if these risk factors and inhaled and food allergen sensitization predispose to asthma development. METHODS: A case-control study was performed. Cases (1 to 3 year-old 74 children) with asthma and control (74 healthy age-matched children) were included, r2 = 0.90. Skin-prick test (SPT) was performed by using indoor and food allergens. Test was considered positive if skin reaction was equal or higher than 3 mm. The results were compared by means of the x2 test. A logistic regression analysis was performed for obtaining odds ratio (OR) (95% confidence interval for each factor). RESULTS: Out of the SPT carried out with aero-allergens, 23 (31%) were positive in the two groups. Regarding the food, 27 cases (36.4%) and 15 controls (20.2%) were positive (x2 = 4.7); p < 0.05, OR = 2.2, IC 95% (1.6-3.1). Atopy was positive in 50 (67.5%) cases and 39 (52.7%) of the controls (x2 = 3.4); p < 0.05, OR 1.8 (1.3 to 2.5). The weaning before the first three months of life was positive in 44 (59.4%) of the cases against 15 (20.2%) of the controls (x2 = 23.7) p < 0.05 with a OR 5.7 (4.9 at 6.6). CONCLUSIONS: We found a probability 2.2 times higher for developing asthma when children were sensitive to at least one food. We also reported that 100% of our sensitized cases with food had received breast feeding during the first four months of life, which is similar to results of other authors where the breast feeding during an intermediate time (one to six months) does not protect against allergic disease. Early introduction of solid food (before the three months of age) was the main factor increasing probability for developing asthma. In our study, atopy almost duplicated this probability.

Síndrome de hiper IgE y deficiencia de IgG1 e IgM / Hyper-IgE syndrome associated with IgG1 and IgM deficiency

Introducción. El síndrome de hiperinmunoglobulina E (hiper IgE) es una inmunodeficiencia congénita autosómica dominante con penetrancia incompleta, caracterizada por dermatitis crónica grave, infecciones frecuentes, formación de abscesos, valores séricos de IgE elevados (>2000 UI/mL) y eosinofilia periférica. Se puede asociar con múltiples alteraciones de la respuesta inmune. Se presenta el caso de un paciente con la rara asociación no reportada de hiper IgE y deficiencia de IgG1. Caso clínico. Masculino de 6 años de edad con dermatosis crónica, infecciones de vías aéreas de repetición, presencia de abscesos fríos en miembros inferiores, con mala respuesta a antihistamínicos, queratolíticos y lubricantes. Por mala evolución clínica y sospecha de inmunodeficiencia fue enviado al Hospital Infantil de México Federico Gómez. A su ingreso presentaba dermatosis generalizada activa y sinusitis maxilar bilateral, manejándose con cefaclor, antihistamínicos, y cuidados de piel. Un mes después se complicó con varicela por lo que se hospitalizó, quedando con cicatrices queloides. Se le diagnosticó hiper IgE por evolución clínica y niveles de IgE de 11 000 UI/mL, asociado con deficiencia de IgG1 y niveles persistentemente subnormales de IgM. Se le inició tratamiento con trimetoprim y sulfametoxazol a 5 mg/kg/día durante 3 meses con buena respuesta clínica; posteriormente presentó remisión de su enfermedad. Conclusión. Se encontró el síndrome de hiper IgE asociado a una deficiencia de IgG1 que lo hace más susceptible a infecciones por diferentes patógenos y niveles subnormales de IgM.

Desensibilización a insulina DNA recombinante humana en una adolescente con diabetes mellitus insulinodependiente / Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus

Antecedentes: las reacciones adversas a fármacos se han incrementado durante los últimos años, en cerca del 15 por ciento de esos efectos quizá haya una participación inmunológica de acuerdo con el mecanismo de daño involucrado de la clasificación de Gell y Coombs, que pueden ser tipo I (inmediatas), tipo II (citotóxica), tipo III (influidas por complejos inmunitarios), y tipo IV (retardada). La alergia a la insulina se define como una respuesta inmunológica tipo I y, en menor frecuencia, tipo II o III a las preparaciones de insulina exógena y ocurre del 0.1 al 0.2 por ciento de los pacientes. Pacientes: se comunica el caso de una paciente de 13 años de edad, con antecedentes de diabetes mellitus dependiente de insulina, con manifestaciones de hipersensibilidad a la insulina recombinante humana (exantema urticariforme y prurito generalizado) sin respuesta favorable a la terapia previa a la medicación e imposibilidad para utilizar un tratamiento alternativo para su control metabólico. Por esta razón se procedió a la desensibilización con insulina. Métodos: la prueba cutánea con insulina rápida fue positiva a una dilución 1:10, los anticuerpos específicos IgE para insulina resultaron negativos y la IgE total fue normal. La desensibilización se inició con insulina rápida, a una dilución de 1:1000 por vía intradérmica, posteriormente subcutánea hasta alcanzar la dosis acumulada necesaria para la paciente durante el día. En el transcurso del proceso apareció un exantema maculopapular y prurito generalizado que remitió con antihistamínicos intravenosos. Resultados: la paciente toleró la desensibilización muy bien. Los últimos 14 meses ha sido tratada con insulina recombinante humana administrada por vía subcutánea sin problemas. Discusión: la desensibilización a fármacos no es un procedimiento frecuente y sólo se debe utilizar cuando es imposible sustituir la terapéutica. Nuestra paciente quizá tuvo una reacción de hipersensibilidad tipo I a insulina; sin embargo, no se puede descartar una reacción citotóxica influida por anticuerpos IgG o IgM o por complejos inmunitarios. La desensibilización fue bien tolerada y 14 meses después la paciente ha tolerado en forma adecuada su dosis diaria de insulina recombinante humana.

Efecto temprano y tardío de la prueba cutánea con Blatella germanica (Bg) y/o Periplaneta americana (Pa) sobre el volumen espiratorio forzado y el flujo espiratorio máximo en niños con alergia respiratoria / Early and late effect of the skin prick test with cockroach (Blatella germanica and/or periplaneta american) on the forced expiratory volume and peak expiration flow in children with respiratory allergy

Introducción. Se ha demostrado que los alergenos de cucaracha sensibilizan a los niños atópicos y frecuentemente predisponen al desarrollo de asma grave a temprana edad. Objetivo: evaluar los cambios tempranos como tardíos sobre el volumen espiratorio forzado (VEF1) y flujo espiratorio máximo (FEM) en niños con alergia respiratoria y prueba cutánea (PC) positiva a antígeno de cucaracha.Material y métodos. Estudio prospectivo longitudinal cruzado doble ciego controlado en niños de 6 a 16 años de edad con un VEF1 y FEM basal mayor de 80 por ciento de su predicho y PC positiva exclusivamente a Blattella germanica (Bg) y/o Periplaneta americana (Pa). En diferentes momentos se midió el VEF1 y FEM antes de la PC con Ba y/o Pa, o con placebo (solución glicerinada) y se realizaron espirometrías y flujimetrías a los 15 min 2, 4, 6, 8, 12, 24 y 48 horas. Análisis estadístico: se utilizó t de Student para muestras pareadas.Resultados. Se estudiaron 30 pacientes con PC positiva a alergeno de cucaracha: 21 hombres y 9 mujeres; 20 presentaron PC positiva a Bg y Pa, 8 a Bg y 2 a Pa. Catorce de 30 pacientes presentaron caída del VEF1 a los 15 min, 13 de ellos la presentaron también a las 6, 12 y 24 horas después de la PC con antígeno. Sólo 3 pacientes presentaron esa caída a los 15 min de la prueba con placebo. En todas las mediciones del grupo estudiado con alergeno de cucaracha se encontró caída del VEF1 mayor de 15 por ciento (P=0.02). En el FEM no se encontró diferencia estadística significativa en ninguno de los grupos (P=0.5).Conclusiones. La medición del VEF1 fue más eficaz para detectar caídas, tanto tempranas como tardías. Por el contrario el FEM no fue sensible para detectar cambios en la función pulmonar después de reto cutáneo con alergenos de cucaracha.