Relationship between exhaled nitric oxide and biomarkers of atopy in children and adolescents with allergic rhinitis.

INTRODUCTION: Measurement of the exhaled nitric oxide fraction (FeNO) has been proposed as an indirect and non-invasive method to detect eosinophilic airway inflammation. Allergic rhinitis (AR) is frequently associated with high levels of FeNO. Allergic sensitization can contribute to the recruitment of eosinophils in the airway and the consequent increase in FeNO. OBJECTIVE: To correlate FeNO values with inflammatory and atopic sensitization biomarkers in patients with AR. PATIENTS AND METHODS: Observational, analytical, cross-sectional study. Children and adolescents with AR without asthma were included. FeNO, blood eosinophil count, total serum IgE were determined and skin tests with aeroallergens were performed by calculating the scores for PPC1 (number of positive allergens), STS2 (sum of millimeters of positive papules) and the atopy index (ratio between STS2/STS1). Spearman's correlation test was used between FeNO and variables of inflammation and atopy. RESULTS: Twenty-eight patients between 6 and 17 years old were included. There was a significant positive correlation between FeNO and blood eosinophils (r=.38; p=.047) and between FeNO and the atopy index (r=.40; p=.03). No correlation was found between FeNO and total serum IgE (r=.24; p=.21), STS1 (r=.20; p=.32) and STS2 (r=.34; p=.08). CONCLUSION: In children and adolescents with AR, FeNO was correlated with the atopy index and the blood eosinophil count. These last biomarkers could be used as alternatives for FeNO as biomarkers of lower airway inflammation in patients with AR.

Relationship between exhaled nitric oxide and biomarkers of atopy in children and adolescents with allergic rhinitis

Introduction: Measurement of the exhaled nitric oxide fraction (FeNO) has been proposed as an indirect and non-invasive method to detect eosinophilic airway inflammation. Allergic rhinitis (AR) is frequently associated with high levels of FeNO. Allergic sensitization can contribute to the recruitment of eosinophils in the airway and the consequent increase in FeNO.ObjectiveTo correlate FeNO values with inflammatory and atopic sensitization biomarkers in patients with AR.Patients and methodsObservational, analytical, cross-sectional study. Children and adolescents with AR without asthma were included. FeNO, blood eosinophil count, total serum IgE were determined and skin tests with aeroallergens were performed by calculating the scores for PPC1 (number of positive allergens), STS2 (sum of millimeters of positive papules) and the atopy index (ratio between STS2/STS1). Spearman's correlation test was used between FeNO and variables of inflammation and atopy.ResultsTwenty-eight patients between 6 and 17 years old were included. There was a significant positive correlation between FeNO and blood eosinophils (r=.38; p=.047) and between FeNO and the atopy index (r=.40; p=.03). No correlation was found between FeNO and total serum IgE (r=.24; p=.21), STS1 (r=.20; p=.32) and STS2 (r=.34; p=.08).ConclusionIn children and adolescents with AR, FeNO was correlated with the atopy index and the blood eosinophil count. These last biomarkers could be used as alternatives for FeNO as biomarkers of lower airway inflammation in patients with AR. (AU)

Antecedentes: La determinación de la fracción exhalada de óxido nítrico (FeNO) ha sido propuesta como un método indirecto no invasivo para detectar la inflamación eosinofílica de la vía aérea. La rinitis alérgica (RA) se asocia frecuentemente con la FeNO elevada. La sensibilización a alérgenos puede contribuir al reclutamiento de eosinófilos en la vía aérea y el consiguiente incremento de la FeNO.ObjetivosCorrelacionar los valores de la FeNO con los biomarcadores inflamatorios y de sensibilización atópica en los pacientes con RA.Pacientes y métodosEstudio observacional, analítico y transversal. Se incluyeron niños y adolescentes con RA, sin asma. Se determinó la FeNO, el recuento de eosinófilos en sangre, la IgE sérica total, y se realizaron pruebas cutáneas con aeroalérgenos calificando los puntajes PPC1 (número de alérgenos positivos), PPC2 (suma de los milímetros de las pápulas positivas) y el índice de atopia (cociente entre milímetros de pápulas positivas/número de antígenos positivos). Se utilizó la prueba de correlación de Spearman entre la FeNO y las variables de inflamación y atopia.ResultadosSe incluyeron 28 pacientes entre 6 y 17 años. Se comprobó una correlación positiva significativa entre la FeNO y los eosinófilos en sangre (r=0,38; p=0,047), y el índice de atopia (r=0,40; p=0,03). No hubo correlación entre la FeNO con IgE sérica total (r=0,24; p=0,21) y con PPC1 (r=0,20; p=0,32) y PPC2 (r=0,34; p=0,08).ConclusionesEn niños y adolescentes con RA, la FeNO se correlacionó con el recuento de eosinófilos hemáticos y el índice de atopia. Estos últimos podrían utilizarse como sustitutos de la FeNO como biomarcadores de inflamación bronquial en pacientes con RA. (AU)

Assessment of nasal obstruction by subjective methods and peak nasal inspiratory flow in children and adolescents with chronic rhinitis. / Evaluación de la obstrucción nasal por métodos subjetivos y pico flujo inspiratorio nasal en niños y adolescentes con rinitis crónica.

INTRODUCTION: Nasal obstruction (NO) is the most irritating symptom of chronic rhinitis (CR). The results of studies that correlated subjective and objective methods of NO in children and adults were contradictory. OBJECTIVES: To analyze the correlation between subjective NO scales and peak nasal inspiratory flow (PNIF) measurements and compare the subjective NO assessment and PNIF in children by age. POPULATION AND METHODS: Participants were patients with CR. The correlation between the subjective NO assessment using a visual analog scale (NO-VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) and nasal airflow measurement pre- and post-vasoconstrictor administration using the PNIF was estimated. The differences in the subjective NO assessment and PNIF between children aged 8-11 years and 12-15 years were analyzed. RESULTS: A total of 79 patients aged 8-15 years were included. No correlation was established between the NO-VAS and the PNIF before and after vasoconstrictor administration (r = -0.19; p = 0.11 and r = -0.18; p = 0.15 respectively) or between the NOSE and the baseline PNIF (r = -0.23; p = 0.07). Differences were observed in the PNIF between children aged 8-11 years and 12-15 years (p =<0.0001), but there were no differences in the subjective perception assessed with the NO-VAS (p = 0.7591). CONCLUSION: No correlation was demonstrated between the subjective NO score and the PNIF in children and adolescents with CR. Older children have a lower perception of NO than younger ones. Subjective NO scales cannot replace the PNIF measurement in patients with rhinitis.

Introducción. La obstrucción nasal (ON) es el síntoma más molesto de la rinitis crónica (RC). Los estudios que correlacionaron métodos subjetivos y objetivos de ON realizados en niños y adultos produjeron resultados contradictorios. Objetivos. Analizar la correlación entre escalas subjetivas de ON con determinaciones de pico flujo inspiratorio nasal (PFIN) y comparar la valoración subjetiva de la ON y el PFIN en niños según su edad. Población y métodos. Participaron pacientes con RC. Se estimó la correlación entre la evaluación subjetiva de la ON mediante una escala visual análoga (ON-EVA, por su sigla en inglés) y la Escala de evaluación de los síntomas de obstrucción nasal (NOSE, por su sigla en inglés) y medición del flujo aéreo nasal pre- y posvasoconstrictor, mediante PFIN. Se analizaron las diferencias entre los grupos de 8 a 11 años y los de 12 a 15 años para la valoración subjetiva de la ON y PFIN. Resultados. Se incluyeron 79 pacientes entre 8 y 15 años. No se comprobó correlación entre ON-EVA y PFIN antes y después del vasoconstrictor (r = -0,19; p = 0,11 y r = -0,18; p = 0,15 respectivamente) ni entre NOSE y PFIN basal (r = -0,23; p = 0,07). Hubo diferencias en el PFIN entre niños de 8-11 años y 12 a 15 años (p =<0,0001), pero no se demostraron diferencias en la percepción subjetiva por ONEVA (p = 0,7591). Conclusión. No se demostró correlación entre puntajes subjetivos de ON y PFIN en niños y adolescentes con RC. Los niños mayores perciben menos la ON que los de menor edad. Las escalas subjetivas de ON no reemplazan su medición con PFIN en pacientes con rinitis.

Evaluación de la obstrucción nasal por métodos subjetivos y pico flujo inspiratorio nasal en niños y adolescentes con rinitis crónica / Assessment of nasal obstruction by subjective methods and peak nasal inspiratory flow in children and adolescents with chronic rhinitis

Introducción. La obstrucción nasal (ON) es el síntoma más molesto de la rinitis crónica (RC). Los estudios que correlacionaron métodos subjetivos y objetivos de ON realizados en niños y adultos produjeron resultados contradictorios. Objetivos. Analizar la correlación entre escalas subjetivas de ON con determinaciones de pico flujo inspiratorio nasal (PFIN) y comparar la valoración subjetiva de la ON y el PFIN en niños según su edad. Población y métodos. Participaron pacientes con RC. Se estimó la correlación entre la evaluación subjetiva de la ON mediante una escala visual análoga (ON-EVA, por su sigla en inglés) y la Escala de evaluación de los síntomas de obstrucción nasal (NOSE, por su sigla en inglés) y medición del flujo aéreo nasal pre- y posvasoconstrictor, mediante PFIN. Se analizaron las diferencias entre los grupos de 8 a 11 años y los de 12 a 15 años para la valoración subjetiva de la ON y PFIN. Resultados. Se incluyeron 79 pacientes entre 8 y 15 años. No se comprobó correlación entre ON-EVA y PFIN antes y después del vasoconstrictor (r = -0,19; p = 0,11 y r = -0,18; p = 0,15 respectivamente) ni entre NOSE y PFIN basal (r = -0,23; p = 0,07). Hubo diferencias en el PFIN entre niños de 8-11 años y 12 a 15 años (p = <0,0001), pero no se demostraron diferencias en la percepción subjetiva por ON-EVA (p = 0,7591). Conclusión. No se demostró correlación entre puntajes subjetivos de ON y PFIN en niños y adolescentes con RC. Los niños mayores perciben menos la ON que los de menor edad. Las escalas subjetivas de ON no reemplazan su medición con PFIN en pacientes con rinitis.

Introduction. Nasal obstruction (NO) is the most irritating symptom of chronic rhinitis (CR). The results of studies that correlated subjective and objective methods of NO in children and adults were contradictory. Objectives. To analyze the correlation between subjective NO scales and peak nasal inspiratory flow (PNIF) measurements and compare the subjective NO assessment and PNIF in children by age. Population and methods. Participants were patients with CR. The correlation between the subjective NO assessment using a visual analog scale (NO-VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) and nasal airflow measurement pre- and post-vasoconstrictor administration using the PNIF was estimated. The differences in the subjective NO assessment and PNIF between children aged 8-11 years and 12-15 years were analyzed. Results. A total of 79 patients aged 8-15 years were included. No correlation was established between the NO-VAS and the PNIF before and after vasoconstrictor administration (r = -0.19; p = 0.11 and r = -0.18; p = 0.15 respectively) or between the NOSE and the baseline PNIF (r = -0.23; p = 0.07). Differences were observed in the PNIF between children aged 8-11 years and 12-15 years (p = < 0.0001), but there were no differences in the subjective perception assessed with the NO-VAS (p = 0.7591). Conclusion. No correlation was demonstrated between the subjective NO score and the PNIF in children and adolescents with CR. Older children have a lower perception of NO than younger ones. Subjective NO scales cannot replace the PNIF measurement in patients with rhinitis

Estado actual del uso de medicamentos biológicos en asma grave / Biologic therapy for severe asthma: an update

Asma es una enfermedad heterogénea que se manifiesta con diferentes fenotipos y endotipos de fisiopatología compleja. El asma grave resistente al tratamiento con altas dosis de esteroides inhalatorios es una entidad infrecuente pero que plantea un gran desafío para el médico. Los progresos en los conocimientos de la fisiopatogenia del asma han permitido el desarrollo de nuevas terapias con inmunobiológicos que permiten una terapia más individualizada en el contexto de la medicina de precisión. La mayoría de estas nuevas terapias han sido desarrolladas para el asma T2 alta, principalmente eosinofílica, pero son menos los desarrollos para el asma T2 baja, cuyos mecanismos no están completamente dilucidados. Esta revisión intenta recopilar las más recientes evidencias acerca del uso de medicamentos biológicos en el asma grave, con especial énfasis en sus mecanismos de acción, indicaciones, eficacia clínica y posibles efectos adversos. (AU)

Asthma is a heterogeneous disease with a complex pathophysiology that manifests with different phenotypes and endotypes. Severe asthma, resistant to treatment with high doses of inhaled steroids, is an uncommon entity but it implies a great medical challenge. Progress in the knowledge of the pathophysiology of asthma has allowed the development of new and more individualized therapy with biologics in the context of precision medicine. Most of these targeted biologic therapies for have been developed for asthma type-2 high, mainly eosinophilic, but there are fewer developments for non-T2 asthma, whose mechanisms are not completely elucidated. This review attempts to compile the most recent evidence about the use of biologic therapies in severe asthma, with special emphasis on its mechanisms of action, indications, clinical efficacy and possible adverse effects. (AU)

Número dedicado a la Educación Universitaria / Number dedicated to University Education

El volumen 5 número 1 de nuestra Revista Methodo Investigación Aplicada a las ciencias biológicas, la iniciamos proponiendo a la comunidad científica y educativa un análisis de diferentes factores que hacen a la Educación Universitaria, en especial de las carreras en ciencias de la salud. (AU)

[Environmental intervention in respiratory disease]. / Intervención ambiental en las enfermedades respiratorias.

In recent years there has been a significant increase in the prevalence of allergic diseases despite advances in the understanding of the pathogenesis, the dissemination of guidelines for its management and the emergence of new drugs. The reasons for this increase are not fully established, but it is suggested that multiple environmental factors may be involved. Inhaled air contains numerous harmful agents in addition to environmental allergens. The main immediate respiratory clinical expression after inhaling this contaminated air is asthma and rhinitis. The activity of human beings has altered the outdoor environment by the emission of multiple pollutants and has produced an increasing climate change. It also has a notable impact on the development of respiratory pathology and the modification of air quality. The bibliography on the subject of environmental control is very broad and sometimes difficult to interpret. In order to be able to make precise, valid and simple indications for patients to accomplish with, four scientific societies of the Argentine Republic that deal with this type of diseases, have elaborated a document that contains information of easy access to all medical personal involved in the treatment of patients with asthma and / or rhinitis, that provides practical measures for the patients and the different public health systems about unmet needs in this complex issue.

En los últimos años hubo un aumento significativo en la prevalencia de las enfermedades alérgicas pese a los avances en la comprensión de la patogénesis, la divulgación de guías para su control y tratamiento y la aparición de nuevos fármacos. La razón para este aumento no está totalmente establecida, pero se considera que múltiples factores ambientales podrían estar involucrados en ello. El aire inspirado contiene numerosos agentes nocivos además de alérgenos ambientales; el asma y la rinitis alérgica son las principales expresiones clínicas respiratorias inmediatas posteriores a su inhalación. En la antropósfera, el entorno de la superficie terrestre habitada por los humanos, se han alterado los equilibrios naturales por la emisión de múltiples sustancias y se ha producido un creciente cambio climático. Este fenómeno global influye en la calidad del aire y consecuentemente en el desarrollo de enfermedades respiratorias. Dado que la bibliografía sobre el tema del control ambiental es muy amplia, y en ocasiones difícil de interpretar para poder realizar indicaciones precisas, válidas y sencillas de cumplir por parte de los pacientes, cuatro sociedades científicas de la República Argentina, dedicadas a este tipo de enfermedades, elaboraron un documento con información de fácil acceso a todo profesional médico que trate asma y/o rinitis, que expone medidas prácticas para los enfermos y alerta a los distintos actores involucrados en la salud pública acerca de las necesidades insatisfechas en este tema tan complejo, a fin de poder elaborar una agenda para su posible resolución.

Intervención ambiental en las enfermedades respiratorias / Environmental intervention in respiratory disease

En los últimos años hubo un aumento significativo en la prevalencia de las enfermedades alérgicas pese a los avances en la comprensión de la patogénesis, la divulgación de guías para su control y tratamiento y la aparición de nuevos fármacos. La raz ón para este aumento no está totalmente estable cida, pero se considera que múltiples factores ambientales podrían estar involucrados en ello. El aire inspirado contiene numerosos agentes nocivos además de alérgenos ambientales; el asma y la rinitis alérgica son las principales expresiones clínicas respiratorias inmediatas posteriores a su inhalación. En la antropósfera, el entorno de la superficie terrestre habitada por los humanos, se han alterado los equilibrios naturales por la emisión de múltiples sustancias y se ha producido un creciente cambio climático. Este fenómeno global influye en la calidad del aire y consecuentemente en el desarrollo de enfermedades respiratorias. Dado que la bibliografía sobre el tema del control ambiental es muy amplia, y en ocasiones difícil de interpretar para poder realizar indicaciones precisas, válidas y sencillas de cumplir por parte de los pacientes, cuatro sociedades científicas de la República Argentina, dedicadas a este tipo de enfermedades, elaboraron un documento con información de fácil acceso a todo profesional médico que trate asma y/o rinitis, que expone medidas prácticas para los enfermos y alerta a los distintos actores involucrados en la salud pública acerca de las necesidades insatisfechas en este tema tan complejo, a fin de poder elaborar una agenda para su posible resolución.

In recent years there has been a significant increase in the prevalence of allergic diseases despite advances in the understanding of the pathogenesis, the dissemination of guidelines for its management and the emergence of new drugs. The reasons for this increase are not fully established, but it is suggested that multiple environmental factors may be involved. Inhaled air contains numerous harmful agents in addition to environmental allergens. The main immediate respiratory clinical expression after inhaling this contaminated air is asthma and rhinitis. The activity of human beings has altered the outdoor environment by the emission of multiple pollutants and has produced an increasing climate change. It also has a notable impact on the development of respiratory pathology and the modification of air quality. The bibliography on the subject of environmental control is very broad and sometimes difficult to interpret. In order to be able to make precise, valid and simple indications for patients to accomplish with, four scientific societies of the Argentine Republic that deal with this type of diseases, have elaborated a document that contains information of easy access to all medical personal involved in the treatment of patients with asthma and / or rhinitis, that provides practical measures for the patients and the different public health systems about unmet needs in this complex issue.

Diagnóstico de enfermedad granulomatosa crónica (EGC): perspectiva desde la resolución de un caso clínico / Diagnosis of chronic granulomatous disease (CGD): perspective from the resolution of a clinical case

La EGC es una patología de baja prevalencia incluida en el grupo de los defectos congénitos de los fagocitos. Existen dos formas de transmisión genética: ligada a X, la más frecuente y grave, y autosómica recesiva. Se debe a mutaciones de los genes que codifican para las proteínas que constituyen el complejo NADP oxidasa lo que induce incapacidad en fagocitos para realizar el estallido respiratorio. El diagnóstico se fundamenta en el fenotipo clínico y de laboratorio; la prueba de dihidrorodamina (DHR) con estímulo de PMA por citometría de flujo es el método diagnóstico de elección. El diagnóstico definitivo es la identificación de la mutación genética por secuenciación del ADN. La terapéutica curativa de esta patología es el trasplante de células madres hematopoyéticas (TCHP). (AU)

CGD is a low prevalence pathology included in the group of congenital phagocyte defects. There are two forms of genetic transmission: the X-linked, the most frequent and severe, and autosomal recessive. It is due to a mutation of the genes coding for proteins that constitute the NADP oxidase complex, which induces inability of phagocytes to perform respiratory burst. The initial diagnosis is based on the clinical and laboratory phenotype; the dihydrorhodamine (DHR) test with PMA stimulation by flow cytometry is a diagnostic method of choice. The demonstration of the genetic mutation by DNA sequencing is the definitive diagnosis. The haemopoietic stem-cell transplantation (HSCT) is the curative therapy of this pathology. (AU)

Tos crónica por hipersensibilidad refleja: un nuevo paradigma con implicancias diagnósticas y terapéuticas / Cough hypersensitivity syndrome: a new paradigm with diagnostic and therapeutic implications

La tos es un reflejo protector del aparato respiratorio que si se prolonga en el tiempo puede afectar seriamente la calidad de vida. Recientemente un nuevo paradigma califica a la tos por hipersensibilidad refleja consecuente a una exagerada sensibilidad de las terminaciones nerviosas periféricas a diversos estímulos y a alteraciones en los núcleos centrales integradores del reflejo. Este nuevo paradigma tiene implicancias terapéuticas, más allá del tratamiento de la causa de la tos. En este artículo se revisarán los nuevos mecanismos implicados en la tos por hipersensibilidad refleja y las nuevas drogas en investigación que modulan el reflejo tusígeno. A pesar de las nuevas investigaciones farmacológicas se necesitan evidencias más seguras para aconsejar un tratamiento "sintomático" de estos pacientes que contribuya al control de la hipersensibilidad central y periférica del reflejo de la tos.

Cough is a protective reflex of the respiratory system that if persist over time can seriously affect the quality of life. Recently, a new paradigm qualifies cough as a consequence of a reflex hypersensitivity resulting from an exaggerated sensitivity of the peripheral nerve endings to various stimuli and central neural alterations in cough processing. This new paradigm has therapeutic implications, beyond the causal treatment of cough. In this article we will review the new mechanisms involved in cough due to reflex hypersensitivity and new therapeutic strategies under development that modulate the cough reflex. Despite the new pharmacological investigations, safer evidence is needed to advise a "symptomatic" treatment of these patients that contributes to the control of central and peripheral hypersensitivity of the cough reflex

Expression of FcRn receptor in placental tissue and its relationship with IgG levels in term and preterm newborns.

PROBLEM: IgG is the only antibody class, that is, actively transferred from the mother to the fetus across the placenta by an active, neonatal Fc receptor (FcRn) mediated process during pregnancy, conferring passive immunity and protection against infections to the newborn during the first months of life. Preterm infants may not receive sufficient titers of protective antibodies, as most of them are transferred only after the 34th week of gestation. Because of the great importance of this process, we investigated in a clinical setting the placental transmission of IgG antibodies in term and preterm newborns. METHOD OF STUDY: This work was conducted in 85 woman and their newborns, divided into four groups according to their clinical gestational age (≤37 weeks were considered as preterm). Blood samples were collected from the mothers and their newborns' umbilical cords to analyze total serum IgG concentrations, and a subgroup of 32 placentas was analyzed by immunohistochemistry to quantify the expression of the FcRn receptor. RESULTS: Total IgG levels in both mothers and neonates increased significantly through the third trimester of gestation. Regarding the newborns, in all groups, IgG levels exceeded their mother's values by a ~2.4%. A higher expression of FcRn was detected in placentas from newborns at week 36 of gestation onwards. CONCLUSION: Our results obtained from clinical samples, were in line with previous descriptions in model systems and confirmed that the IgG transfer from maternal serum to the fetus is positively correlated with FcRn expression in placental tissue throughout gestation.

[Analysis of nasal cytology in children and adolescents with rhinitis]. / Análisis de la citología nasal en niños y adolescentes con rinitis.

BACKGROUND: Nasal cytology in a easy-to apply method to differentiate rhinitis phenotypes from a physiopathogenic and diagnostic perspective. There are controversies about the relationship between clinical severity of rhinitis and inflammatory patterns expressed in the nasal cytology. OBJECTIVES: To study the characteristic of the eosinophil and neutrophil patterns in the nasal scraping for Allergic Rhinitis (AR) and Non Allergic Rhinitis (NAR) and its relationship with the clinical grades of rhinitis established by the Allergic Rhinitis and its Impact on Asthama Guideline (ARIA) Methods: In a observational, cross-sectional study we included patients aged 5 to 18 years presenting symptoms of either allergic (AR) or non- allergic rinitis (NAR) without asthma. Cytology was performed by analyzing nasal scraping obtained from the mucosal surface of the inferior turbinate and samples were stained using thr hematoxylin and eosin stain procedure. Inflammatory patterns between AR and NAR and between clinical grades of rhinitis classified by ARIA guide were compared. RESULTS: A total of 231 patients were included. Patients with AR exhibited higher percentage of eosinophils in nasal cytology than those with NAR (p = 0.0012) but no differences were observed in neutrophil count (p = 0.4011). No differences in the percentage of eosinophils and neutrophils between different grades of AR (p = 0.7342 and p = 0.0797 respectively) and NAR (p = 0.1010 and p = 0.1422 respectively) were observed. CONCLUSION: Eosinophil count in the nasal cytology was useful to differentiate rhinitis with a positive allergen skin test from rhinitis with negative skin test, but as neutrophils count, does not help to distinguish clinical grades of AR and NAR as classified by ARIA.

[Recommendations for the management of the child with allergic diseases at school]. / Recomendaciones para el manejo del niño con enfermedades alérgicas en la escuela.

Allergic diseases cause great impact on the health related quality of life in children and adolescents, resulting in increased school absenteeism and deficiencies in school performance. Although the bibliographic framework on allergic diseases is wide, in our country, there are no guidelines for proper management of the allergic child at school. It is necessary to establish guidelines for coordinated action among the educational community, the families, the pediatrician, the health team and governmental and non-governmental authorities. This position paper aims to provide information about the impact of allergic diseases on school activities, establish standards of competence of the various stakeholders at school and consider the legal framework for the intervention of the school staff about the child with allergies at school.

Clinical comparison between patients with selective immunoglobulin A deficiency and other primary immunodeficiencies.

Primary immunodeficiencies (PID) are low-prevalence diseases. There are warning signs that may raise clinical suspicion. The objectives of this study were to describe the clinical characteristics and warning signs of patients with PID and to compare the clinical differences between selective immunoglobulin A (IgA) deficiency and other PIDs. Eighty-nine patients were studied; their median age at the time of diagnosis was 6 years old (4.08-11.67). Fifty-three (59.5%) patients were male. Fifty-four (60.7%) patients had selective IgA deficiency, and 35 (39.3%) had other PIDs. The main clinical manifestations were rhinopharyngitis in 65 (73.03%) patients and atopy in 39 (43.82%). Twenty- four (26.97%) patients showed warning signs, and none had selective IgA deficiency. Patients with other PIDs had a higher incidence of lower respiratory tract infection, sepsis, skin infections, mucocutaneous candidiasis, dental alterations, cardiovascular malformations, angioedema, hospitalizations and death. Ten (28.57%) patients received intravenous gammaglobulin, 15 (42.85%) antibiotic prophylaxis, and 2 (2.24%) antifungal prophylaxis.

[Update on anaphylactic shock treatment recommendations: what's new in the use of epinephrine?]. / Actualización en las recomendaciones del tratamiento del choque anafiláctico: novedades sobre el uso de adrenalina.

In 1998, the Sociedad Argentina de Pediatría issued the recommendation of the treatment of anaphylactic shock. While this recommendation suggested the use of subcutaneous epinephrine, currently the intramuscular via is considered the most appropriate one. Pharmacological aspects determine this preference. For outpatient treatment, the correct use of autoinjectors can control anaphylaxis quickly and effectively. The use of other medications in the proposed 1998 recommendation remains unchanged.

Actualización en las recomendaciones del tratamiento del choque anafiláctico: novedades sobre el uso de adrenalina / Update on anaphylactic shock treatment recommendations: What's new in the use of epinephrine?

En 1998, la Sociedad Argentina de Pediatría publicó la recomendación del tratamiento del choque anafiláctico. Mientras en dicha recomendación se sugería el uso de adrenalina por vía subcutánea, actualmente se considera la vía intramuscular como la más adecuada. Aspectos farmacodinámicos determinan esta preferencia. Para el tratamiento extrahospitalario, el uso de autoinyectores de manera correcta puede colaborar en el control rápido y eficaz de la afección. El uso del resto de las medicaciones propuestas en la recomendación de 1998 se mantiene sin cambios.

In 1998, the Sociedad Argentina de Pediatría issued the recommendation of the treatment of anaphylactic shock. While this recommendation suggested the use of subcutaneous epinephrine, currently the intramuscular via is considered the most appropriate one. Pharmacological aspects determine this preference. For outpatient treatment, the correct use of autoinjectors can control anaphylaxis quickly and effectively. The use of other medications in the proposed 1998 recommendation remains unchanged.

Actualización en las recomendaciones del tratamiento del choque anafiláctico: novedades sobre el uso de adrenalina. / [Update on anaphylactic shock treatment recommendations: whats new in the use of epinephrine?].

In 1998, the Sociedad Argentina de Pediatría issued the recommendation of the treatment of anaphylactic shock. While this recommendation suggested the use of subcutaneous epinephrine, currently the intramuscular via is considered the most appropriate one. Pharmacological aspects determine this preference. For outpatient treatment, the correct use of autoinjectors can control anaphylaxis quickly and effectively. The use of other medications in the proposed 1998 recommendation remains unchanged.