[Initial study of trap and identification of environmental pollens and fungi spores in Samborondon, Ecuador]. / Estudio inicial de captación e identificación de pólenes y hongos ambientales en Samborondón, Ecuador.

OBJETIVO: To identify and registry the most important aeroallergens trapped at the aerobiology station in the city of Samborondon, Ecuador. METHODS: Pollen grains and fungal spore counts were performed according to the standardized technique with a Hirst-type collection equipment, Burkard spore trap for seven days, following the recommendations of the National Allergy Bureau (NAB) of the American Academy of Allergy Asthma and Immunology (AAAAI). The equipment was installed on the roof of the Universidad de Especialidades Espiritu Santo (UEES), 25 m above ground level, coordinates: 2°07 ́57 ́ ́S 79°52 ́06 ́ ́W, in the city of Samborondon. The sampling period was performed from November 2022 to April 2023. RESULTS: We identified the following pollen families: Poaceae (258 grains/m3), Apocynaceae (Plumeria rubra pc) (214 grains/m3), Lamiaceae (180 grains/m3), Asteraceae Ambrosía spp.- (60 grains/m3), Chenopodiacea (27 grains/m3), Myrtaceae (17 grains/m3), Pinaceae (11 grains/m3), Betulaceae (7 grains/m3). Also identified fungical spores: Fuzariella spp./Leptosphaeria spp. (1899/m3), Cladosporium spp. (1407/m3), Nigrospora spp. (1183/m3), Dreschlera/Helmintosporum spp. (329/m3), Alternaria spp. (98/m3), Pithomyces spp. (79/m3), Curvularia spp. (48/m3), Stemphylium spp. (46/m3). CONCLUSIONS: We reported the first study of aerobiology (capture and identification of environmental pollens and fungi) in the city of Samborondon. The inhabitants of this area are exposed to different aeroallergens with a predominance of Poaceaes pollen and Fuzzariella spp./Leptosphaeria spp. spores. The identified allergens should be part of the usual allergy studies. The results of this first preliminary study should be compared with information from the forthcoming years, which will help to identify variations in the concentration of seasonal aeroallergens, annual fluctuations, and extend the traps to other parts of the city.

OBJETIVO: Identificar y registrar los aeroalérgenos más importantes captados en la estación de aerobiología en la ciudad de Samborondón, Ecuador. MÉTODOS: Los conteos de granos de polen y esporas de hongos se realizaron según la técnica estandarizada, con un equipo colector tipo Hirst, Burkard spore trap for seven days, siguiendo las recomendaciones de la National Allergy Bureau (NAB) de la American Academy Allergy Asthma and Immunology (AAAAI). El equipo se instaló en la azotea de la Universidad Espíritu Santo (UEES), en la ciudad de Samborondón, a 25 m de altura desde el nivel del suelo, 2°07´57´´S 79°52´06´´O. El periodo de captación se llevó a cabo entre noviembre de 2022 y abril de 2023. RESULTADOS: Identificamos las siguientes familias polínicas: Poaceae (258 granos/m3), Apocynaceae (Plumeria rubra pc) (214 granos/m3), Lamiaceae (180 granos/m3), Asteraceae Ambrosía spp.- (60 granos/m3), Chenopodiacea (27 granos/m3), Myrtaceae (17 granos/m3), Pinaceae (11 granos/m3), Betulaceae (7 granos/m3). Además esporas fúngicas: Fuzariella spp./Leptosphaeria spp. (1899/m3), Cladosporium spp. (1407/m3), Nigrospora spp. (1183/m3), Dreschlera/Helmintosporum spp. (329/m3), Alternaria spp. (98/m3), Pithomyces spp. (79/m3), Curvularia spp. (48/m3), Stemphylium spp. (46/m3). CONCLUSIONES: Se reporta el primer estudio de aerobiología (captación e identificación de pólenes y hongos ambientales), en la ciudad de Samborondón. Los habitantes de esta zona están expuestos a diferentes aeroalérgenos con predominancia al polen de Poaceaes y esporas de Fuzzariella spp./Leptosphaeria spp. Los alérgenos identificados deberían formar parte de los estudios alergológicos habituales. Los resultados de este primer estudio preliminar deberían ser comparados con información de los siguientes años para ayudar a identificar las variaciones de concentración de aeroalérgenos estacionales, las fluctuaciones anuales, y extender los captadores a otros puntos de la ciudad.

Physician practices and attitudes towards atopic dermatitis in Latin America: A cross-sectional study.

Background: The prevalence of atopic dermatitis (AD) is increasing in developing countries. Different worldwide guidelines have been proposed, but their applicability for AD specialists in Latin American (LA) countries is unknown. Objective: The objective of this study was to explore the medical approach to treating AD in LA countries. Methods: The study population comprised AD specialists (allergists and dermatologists). They completed an electronic survey containing questions about the health system, diagnostic criteria, and pharmacotherapy approach to treating AD. The survey was constructed and validated by the Atopic Dermatitis Committee of the Latin American Society of Allergy Asthma and Immunology (SLAAI) in Spanish and Portuguese. Each member was responsible for distributing the questionnaire through different networks in their respective countries. Results: A total of 284 AD specialists from 13 LA countries completed the questionnaire; among them, 67% were allergists and 33% were dermatologists. Less than 50% of the AD specialists strictly followed guideline recommendations. Among the AD specialists, the European and North American guidelines were more frequently used, and only 16% followed LA guidelines. Dermatologists used the local guidelines less frequently than allergists. Most physicians did not routinely use AD assessment tools (55%). The frequency of the diagnostic tests depends on symptom severity. The availability of some systemic treatments, such as biologics and Janus Kinase (JAK) inhibitors, is not universal in all LA countries. Conclusion: There were marked differences between the specialists, and these differences seemed to be affected by their specialty and each country's healthcare system. New AD education strategies that consider the particularities of the region could allow patients to be more accurately managed. AD assessment tools may provide a way to enhance AD treatment and allow for shared decision-making, patient empowerment, and standardized care.

Challenges in the Use of the Treat-to-Target Strategy in Atopic Dermatitis in Latin America: A Case Series Review.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, relapsing-remitting illness. In moderate-to-severe instances, recommendations urge patient-centered systemic therapy. Existing standards lack long-term treatment success requirements. A treat-to-target methodology was proposed for systemic therapy patients that requires global improvements to prompt decisions about treatment. METHODS: We conducted an observational study between May 2021 and June 2022 in three Ecuadorian patients with severe AD who were treated with dupilumab to assess the clinical evolution and behavior of the subdomains evaluated by clinimetric tools. RESULTS: Patients A and C satisfied disease-domain response criteria to dupilumab at 12 and 24 weeks, but B did not complete the algorithm objectives. Nonetheless, patient A improved AD severity, itching, bleeding, desquamation, sleep, daily activities, mood, emotions, sexual troubles, clothing, and sports subdomains. Patient B experienced reduced symptomatology, AD aggravation, daily activities impact, and work/study impairment. Patient C improved from severe to mild desquamation, itching, exudate, lichenification, and rough/dry skin. Sleep, shame, and study subdomains improved the most. CONCLUSION: We provide a new operational construct for analyzing current patient-reported outcome measures (PROMs) and clinician-reported outcome measures (CROMs) based on subdomains to widen our understanding of the state of disease activity and make clinical decisions when the treat-to-target strategy is not attained.

Persistence of airborne tree pollen from the Cupressaceae family during the last decade in the city of Bahia Blanca.

Airborne pollen is a major contributor to allergic respiratory diseases. However, the literature on patterns and seasonality of specific pollen types mainly comes from northern hemisphere and developed regions, limiting our ability to extrapolate these findings to other geographical locations. With this research letter, our aim is to contribute to the current knowledge of aerobiology by analyzing the decade-long patterns of airborne tree pollen in the city of Bahia Blanca, Argentina. In general, we found late winter to early spring as the period with the highest Cupressaceae pollen counts. In 2020, the average pollen count during July through September was 78.81 (SD 79.70), the highest recorded during the last 10 years. These months had varying pollen concentrations from moderate (15-89 grains/m3 of air) to high (90-1499 grains/m3 of air). Regardless of such variation, August had consistently been the month with the highest peak concentrations from 2010 to 2020 (61.2, SD 57.3), followed by September (27.1, SD 20.3). We did not find any month with very high (˃1500 grains/m3 of air) peak concentration. Further studies need to be done to expand our knowledge on aerobiology to characterize specific pollen sub-types and determine the exact allergenic potential of airborne pollen in different regions.

Diretriz Latino-americana sobre o Diagnóstico e Tratamento da Alergia Ocular ­ Em nome da Sociedade Latinoamericana de Alergia, Asma e Imunologia (SLAAI) / Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy ­ On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

A alergia ocular, também conhecida como conjuntivite alérgica (CA), é uma reação de hipersensibilidade mediada por imunoglobulina E (IgE) do olho desencadeada por aeroalérgenos, principalmente ácaros da poeira doméstica e pólen de gramíneas. Os sintomas geralmente consistem em prurido ocular ou periocular, lacrimejamento e olhos vermelhos que podem estar presentes durante todo o ano ou sazonalmente. A alergia ocular tem frequência elevada, é subdiagnosticada e pode ser debilitante para o paciente. É potencialmente danosa para a visão, nos casos em que ocasiona cicatrização corneana grave, e na maioria dos pacientes associa-se a outros quadros alérgicos, principalmente rinite, asma e dermatite atópica. É classificada em conjuntivite alérgica perene, conjuntivite alérgica sazonal, ceratoconjuntivite atópica e ceratoconjuntivite vernal. O diagnóstico procura evidenciar o agente etiológico e a confirmação se dá pela realização do teste de provocação conjuntival. O tratamento baseia-se em evitar o contato com os desencadeantes, lubrificação, anti-histamínicos tópicos, estabilizadores de mastócitos, imunossupressores e imunoterapia específica com o objetivo de obter o controle e prevenir as complicações da doença.

Ocular allergy, also known as allergic conjunctivitis, is an immunoglobulin E-mediated hypersensitivity reaction of the eye triggered by airborne allergens, primarily house dust mites and grass pollen. Symptoms usually consist of ocular or periocular itching, watery eyes, and red eyes that may be present year-round or seasonally. Ocular allergy has a high frequency, is underdiagnosed, and can be debilitating for the patient. It is potentially harmful to vision in cases of severe corneal scarring, and in most patients, it is associated with other allergic conditions, especially rhinitis, asthma, and atopic dermatitis. It is classified as perennial allergic conjunctivitis, seasonal allergic conjunctivitis, atopic keratoconjunctivitis, and vernal keratoconjunctivitis. Diagnosis seeks to identify the etiologic agent, and confirmation is given by conjunctival provocation testing. Treatment is based on avoiding contact with triggers, lubrication, topical antihistamines, mast cell stabilizers, immunosuppressants, and specific immunotherapy with the aim of achieving control and preventing disease complications.

Chronic urticaria patients are interested in apps to monitor their disease activity and control: A UCARE CURICT analysis.

BACKGROUND: Information/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self-evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study. METHODS: The methodology for CURICT has been reported. Briefly, a 23-item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria-related purposes. RESULTS: As previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only ∼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03-1.79]) and females versus males (OR [95% CI], 1.47 [1.17-1.85]) were more likely to be very to extremely interested in an app to assess disease control. CONCLUSIONS: Overall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well-designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research.

"Chronic urticaria and obstructive sleep apnea: Is there a significant association?"

BACKGROUND: Few studies have explored the association between obstructive sleep apnea (OSA) and chronic urticaria (CU). Our study aims to fill this gap by determining the frequency of the risk categories for OSA and how they might correlate with the specific CU patient reported outcome measures urticaria activity score (UAS7), urticaria control test (UCT) and CU quality of life questionnaire (CU-Q2oL). METHODS: We conducted a cross-sectional study involving a cohort of 171 Latin American CU patients. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables, while a chi-squared test for association between STOP-Bang OSA questionnaire categories and both UAS7 and UCT categories was performed to analyze how such variables interact. To further assess the strength of the correlation a Cramer's V coefficient was reported. Finally, a Kendall-Tau b correlation coefficient was performed to measure the correlation between the STOP-Bang score and other independent continuous variables. RESULTS: The average STOP-Bang score was 2.5, with 24% and 21% of patients falling into the intermediate and high-risk category for moderate-to-severe OSA, respectively. There was a strong statistically significant association (Cramer's V = 0.263; p = .000) between UAS-7 categories and STOP-Bang risk categories. A similar pattern of strong significant association (Cramer's V = .269; p = .002) was observed between UCT categories and STOP-Bang risk categories. A weak positive correlation between the STOP-Bang score and the CU-Q2oL average score (τb = 0.188, p = .001) was identified. Overall, 72.5% patients reported limitations with respect to sleep in a varied degree according to the CU-Q2oL. CONCLUSIONS: Our results suggest that a considerable proportion of patients with CU are at intermediate to high risk for OSA. Higher disease activity, poor CU control, and worse quality of life were all found to be associated with an increased risk. Additional studies are needed to determine the exact link between these conditions, and to determine whether screening and treatment for OSA might benefit patients with CU.

How are patients with chronic urticaria interested in using information and communication technologies to guide their healthcare? A UCARE study.

BACKGROUND: Patients with chronic urticaria (CU) are increasingly using information and communication technologies (ICTs) to manage their health. What CU patients expect from ICTs and which ICTs they prefer remains unknown. We assessed why CU patients use ICTs, which ones they prefer, and what drives their expectations and choices. METHODS: In this cross-sectional study, 1841 patients across 17 countries were recruited at UCAREs (Urticaria Centers of Reference and Excellence). Patients with CU who were >12 years old completed a 23-item questionnaire. RESULTS: Most patients were interested in receiving disease information (87.3%), asking physicians about CU (84.1%), and communicating with other patients through ICTs (65.6%). For receiving disease information, patients preferred one-to-one and one-to-many ICTs, especially web browsers. One-to-one ICTs were also the ICTs of choice for asking physicians about urticaria and for communicating with other patients, and e-mail and WhatsApp were the preferred ICTs, respectively. Many-to-many ICTs such as Facebook, Instagram, LinkedIn, and Twitter were least preferred for all 3 purposes. Living in rural areas and higher education were linked to higher odds of being interested in receiving disease information, asking physicians, and communicating with patients through ICTs. CONCLUSIONS: Most patients and especially patients with higher education who live in rural areas are interested in using ICTs for their healthcare, but prefer different ICTs for different purposes, ie, web browsers for obtaining information, e-mail for asking physicians, and WhatsApp for communicating with other patients. Our findings may help to improve ICTs for CU.

Contaminación atmosférica en América Latina: impacto en la salud Y regulación actual - reporte del grupo del Comité de Aerobiología de la Sociedad Latinoamericana de Asma, Alergia e Inmunología / Atmospheric pollution in Latin America: impact on health and current regulation - report of the Aerobiology Committee of the Latin American Society of Asthma, Allergy and Immunology

La contaminación ambiental, en todas sus vertientes, tiene un efecto de enormes dimensiones no sólo sobre la existencia del planeta, sino también sobre la salud de la humanidad. América Latina es una región privilegiada ambientalmente, debido a su gran acervo de patrimonio natural, biodiversidad y posibilidades de provisión de servicios ambientales. Pero, a su vez, es una de las regiones más urbanizadas del orbe, con las afectaciones y presión al medio ambiente que esto implica, principalmente en la calidad del aire que se respira, derivadas de antiguos patrones productivos y de ocupación territorial, que se han agudizado como consecuencia del modelo de desarrollo predominante. Los efectos sobre la salud humana de diversas sustancias contaminantes están relacionados a procesos inflamatorios sobre mucosas y al aumento de la morbimortalidad en personas con enfermedades preexistentes, principalmente de los sistemas neurológico, cardiaco y respiratorio, en particular las enfermedades alérgicas respiratorias. La región latinoamericana enfrenta importantes problemas ambientales, determinados por los patrones de uso de sus recursos naturales, los sistemas de producción, los hábitos de consumo de las poblaciones humanas y la regulación gubernamental ambiental, que en muchos casos es laxa o pobremente implementada por los gobiernos en turno.

Air quality, in all its dimensions, has a major effect not only on the existence of the planet, but also on human health. Latin America is an environmentally privileged region, due to its great wealth of natural heritage, biodiversity and possibilities of provision of environmental services. But, at the same time, it is one of the most urbanized regions in the world, with the effects and pressure on the environment that this implies, mainly in the air quality, due to patterns of production and of territorial occupation, which they have exacerbated as a result of the predominant development model. The effects of diverse pollutant substances on the human health are related to inflammatory processes on mucous membranes and to increased morbidity and mortality in people with pre-existing diseases, especially of the neurological, cardiac and respiratory systems, in particular respiratory allergic illnesses. The Latin American region faces important environmental problems determined by the patterns of use of its natural resources, systems of production, habits of consumption of the human populations, and environmental governmental regulation, which is often lax or poorly implemented by the local authorities.

Influence of alexithymia on the management of Latin American patients with asthma: A cross-sectional study.

OBJECTIVES: In asthmatic patients, studies suggest that alexithymia leads to negative consequences and emotions that can affect physical, psychological, and social aspects of life. We designed this study to determine the frequency of alexithymia in Latin American patients with asthma, as well as to understand how this personality trait and each of its components interact with asthma severity and demographic variables, and their implications on treatment adherence and disease control under such setting. METHODS: We conducted a cross-sectional study, involving 265 Latin American patients with asthma. Patient demographics and clinical characteristics were reported. The presence of alexithymia, asthma severity, and control, as well as treatment adherence, was analyzed. To assess the presence of alexithymia, the 20-item Toronto Alexithymia Scale was used. For the statistical analyses, we performed Kendall's tau-b correlation coefficient, chi-square tests for association, and one-way analysis of variance. RESULTS: A total of 265 patients participated in the study with a gender distribution of 69.4% female and an average age of 54.7 years. In total, 30.2% of individuals presented alexithymia. There was a statistically significant correlation between educational level and 20-item Toronto Alexithymia Scale categories (p < .001), as well as a higher proportion of severe (35.1%, p = .001) and uncontrolled (50.0%, p = .185) asthma in patients with alexithymia. A higher proportion of patients with some level of non-adherence was seen on those with uncontrolled asthma (68.5%, p = .008). CONCLUSION: Our results suggest that in our sample, 3 in 10 Latin American asthma patients have alexithymia, and such mental condition is more common in those individuals with lower educational levels. Individuals with alexithymia present with severe asthma more frequently than do patients with possible or no alexithymia and are also more likely to have their disease uncontrolled.

Sensitization to subtropical grass pollens in patients with seasonal allergic rhinitis from Bahia Blanca, Argentina.

BACKGROUND: Grass pollinosis is an important contributor to allergic diseases, with varying patterns and frequency of allergens according to the geographical location studied. Our study aims to provide a better understanding of subtropical grass pollinosis in Argentinian patients with seasonal allergic rhinitis. METHODS: We conducted a retrospective cross-sectional study involving 894 patients with seasonal allergic rhinitis from Bahía Blanca, Argentina. Skin prick tests were performed to selected pollen species belonging to three subfamilies of the Poaceae genera. Frequency of sensitization to specific grass pollen extracts, cross-reactivity of allergens assessed by skin prick test, and possible associations between allergen extracts and asthma or allergic conjunctivitis were analyzed. RESULTS: Sensitization to the Pooideae subfamily was the most frequent, encompassing 86.8% (CI: 84.4%-88.9%) of the studied population. Positive reactions to allergen extracts from the Chloridoideae and the Panicoideae subfamilies showed smaller papule size than allergen extracts from the Pooideae subfamily (χ2(5) = 83.75, p < 0.001). Patients with a positive skin prick test (SPT) to a specific extract were more likely to present some degree of cross-reactivity to the remaining pollens when compared to patients with negative SPT to the same specific extract. Even though the proportion of patients presenting with asthma (46.9%) was higher than those with conjunctivitis (22.6%), there was only a statistically significant association between sensitization to Festuca arundinacea (φ = 0.089, p = .009), Phalaris arundinacea (φ = 0.074, p = .032) and Paspalum notatum (φ = 0.070, p = .038) and the presence of conjunctivitis. CONCLUSIONS: Our results suggest a high frequency of sensitization to grass pollen extracts from the Poaceae family among patients with seasonal allergic rhinitis. Overall, sensitization to the Pooidae subfamily was the most common, where Phalaris arundinacea presented the highest frequency.

Learnings from real-life experience of using omalizumab for chronic urticaria in Latin America.

BACKGROUND: Updated urticaria guidelines recommend that patients should be assessed for disease activity, severity, control, and quality of life at baseline and follow up. Regarding treatment, guidelines consider second generation antihistamines as the cornerstone in therapy for chronic urticaria (CU), while other drugs, such as omalizumab, are conceived as second-line alternatives. In regards to omalizumab, despite advances in the management of CU, there are still open questions about timing, dosing, and objective measures for clinical response. This study was designed to portray the use of patient-reported outcomes (PROs) in chronic urticaria management, as well as the effectiveness and treatment patterns of omalizumab in CU, as seen in a real-life setting in Latin America. METHODS: This is a retrospective observational study, involving 72 Latin American patients with chronic urticaria treated with omalizumab. Patient reported outcomes and treatment patterns, response, quality of life improvement and discontinuation were analyzed. RESULTS: From the 72 patients, 91.7% (n = 66) were assessed through PROs, where urticaria control test (UCT) was the most used (79.2%; n = 57). Overall, 80.0% (n = 44) responded to omalizumab at some point of the treatment. Omalizumab 300 mg was associated with earlier response compared to lower doses. Regardless of dosage, most patients assessed with CU-Q2oL improved quality of life (80.8%; n = 21). With respect to omalizumab discontinuation, 20.8% (n = 15) patients interrupted omalizumab before the 3rd month of treatment (p = .000). CONCLUSIONS: The present study highlights how the use of PROs and omalizumab in Latin America differ from guidelines' recommendations and clinical trials. Even though most patients were initiated under omalizumab 300 mg, most of them finished with lower doses. Regardless of dosage, most patients responded to omalizumab and improved quality of life at some point during treatment. However, such features were seen earlier with omalizumab 300 mg. Regarding treatment discontinuation, one-fifth of patients interrupted omalizumab before the third month.

[Does Ecuadorians with asthma has preferences in the use of information and communication technologies? Pilot study]. / ¿Los ecuatorianos con asma tienen preferencias en el uso de tecnologías de la información y comunicación? Estudio piloto.

BACKGROUND: Inadequate communication between asthmatic patients and their physicians may interfere directly with asthma control. In the last years, the use of information and communication technologies (ICTs) it has increased in Latin-America. This technology seems to be a good tool to improve communication and management of the asthmatic patient. OBJECTIVE: We evaluated the frequency and preference patterns of communication and information technologies in Ecuadorian patients with bronchial asthma. METHODS: We conducted a pilot cross-sectional study to identify the frequency and preferences of ICT in patients with asthma. The Spanish version of the Michigan questionnaire was used. Age and educational level were categorized into 3 groups. We used logistic regression between these groups regarding the frequency of use, interest in seeking and receiving information related to their asthma for the age and educational level of the patients. RESULTS: A total of 222 patients participated in our study. The mean age was 45.6 years (SD 17.4), the most common sex was female with 89.25 %. Almost all patients had a cell phone (87.5 %) and internet access (62.7 %). The three ICTs most likely to be used to search for or receive information about their illness were WhatsApp, Facebook and email (p <0.05). CONCLUSION: Information and communication technologies improve the care of asthmatic patients. In our pilot study email and text messages are the most preferred ICT among patients however WhatsApp and Facebook may be appropriate for certain ages especially young asthmatic. Knowledge of preferences can help the development of ICT in a personalized way and improve the outcomes in patients with asthma.

Antecedentes: La comunicación inadecuada entre los pacientes y sus médicos puede interferir directamente con el control del asma. En los últimos años, el uso de tecnologías de la información y comunicación se ha incrementado en Latinoamérica y parece ser un recurso útil para mejorar la comunicación, adherencia y control del paciente con asma. Objetivo: evaluar la frecuencia y patrones de preferencia de las tecnologías de comunicación e información en pacientes ecuatorianos con asma bronquial. Métodos: estudio transversal en el que se utilizó la versión en español del cuestionario Michigan. La edad y el nivel educacional fueron categorizados en tres grupos. Se utilizó regresión logística entre los grupos respecto a la frecuencia de uso e interés en buscar y recibir información relacionada con el asma, según la edad y nivel educativo. Resultados: en nuestro estudio participaron 222 pacientes. La edad media fue de 45.6 ± 17.4 años y el sexo más común fue el femenino, con 89.25 %. Casi todos los pacientes tenían teléfono celular (87.5 %) y acceso a internet (62.7 %). Las tres tecnologías de la información y comunicación con mayor probabilidad de ser usadas con fines de buscar o recibir información acerca de la enfermedad fueron WhatsApp, Facebook y correo electrónico (p < 0.05). Conclusión: el correo electrónico y los mensajes de texto fueron preferidos por los pacientes, sin embargo, WhatsApp y Facebook pueden ser apropiados para ciertos grupos, especialmente para los jóvenes. La selección de TIC adecuadas para la comunicación médico-paciente podría mejorar la adherencia y el control de los pacientes con asma.

Information and communication technology use in asthmatic patients: a cross-sectional study in Latin America.

Rapid diffusion, low cost and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, communication and interventions in asthma. There is little information in Latin America about usage frequency of ICTs in asthmatic patients. The analysis undertaken consisted of an observational, cross-sectional study that aimed to identify the frequency and type of ICTs most often used by asthmatics. The Spanish version of the Michigan questionnaire was employed in five Latin American countries. Age and educational level was categorised. Logistic regression was performed among these groups concerning the frequency of ICT usage and the level of interest shown in seeking and receiving information about asthma. In total, 673 asthma patients were surveyed. The mean age was 43.44 years. Over two-thirds of the participants were female (68.4%). The most used ICT was the short message service (SMS) (69.9%). SMS and E-mail are useful tools for communicating (i.e. receiving and seeking information) with all asthma patients, irrespective of their age. WhatsApp (61.5%) and Facebook (32.0%) were rated as being the most interesting channels of communication for receiving information. Regression analysis showed that younger asthmatics and asthmatics with higher educational levels were most likely to use almost all forms of ICTs. ICTs are generally an attractive platform for managing care, communication and interventions to improve asthma care. SMS and E-mail were found to be the preferred ICT forms among users. However, social media forms such as WhatsApp and Facebook may also be appropriate for certain types of patient.

Anaphylaxis in a 4-year-old male caused by contact with grasses: a case report.

BACKGROUND: Acute urticaria is the presence of urticaria for <6 weeks, and it is the most common type of urticaria in children. Sometimes, it may be associated with anaphylaxis, a life-threatening condition. Urticaria must be differentiated from anaphylaxis because the latter may require emergency treatment. We describe a child with anaphylaxis exposed to grasses on two occasions. CASE PRESENTATION: We described a 4-year-old male child with anaphylaxis exposed to grasses. Patient also suffered mild neurologic/respiratory symptoms but it is unlikely that he had anaphylaxis. Skin-prick tests were positive to Cynodon dactylis, Phalaris arundinacea and Festuca elatior. Little is known about the importance of pollens as a cause of urticaria in young children. CONCLUSIONS: The case reported here is particularly interesting because, to the best of our knowledge, anaphylaxis due to pollen exposure in children aged <4 years has not been reported before. We strongly encourage all physicians searching for the cause of acute urticaria (allergists, dermatologists, primary-care physicians) to consider the possibility of pollen allergy, and to screen these patients for pollen sensitization.

Prevalencia de alergia al veneno de abeja entre los apicultores del sudoeste de la provincia de Buenos Aires / Prevalence of venom bee allergy in beekeepers of the Southwest of the Provincia de Buenos Aires

Objetivos. Relevar la prevalencia de racciones alérgicas (RA) por picaduras de abejas (Apis mellifera), así como el grado de conocimiento entre los apicultores y salas médicas en cuanto a los tratamientos y medidas de prevención. Materiales y métodos. Preguntas ak hoc en una encuesta realizada a apicultores, en 18 partidos del sudoeste bonaerense (proyecto financiado por el Consejo Federal de Inversiones). Resultados. De los 1.335 encuestados, el 97% alguna vez fue picado por una abeja, el 23% manifestó RA de diferente grado, el resto tuvo reacciones normales. Las RA son más frecuentes entre los 5 a 30 minutos posteriores a la picadura. En 8% de los que tuvieron RA necesitó ser medicado. El 94% de éstos fue medicado con algún tipo de corticoide. El 98% conoce el peligro de la picadura de abeja, y sólo el 71% respondió qué tratamiento aplicar en ese caso. Entre ellos, el 90% usaría algún tipo de corticoide (7% adrenalina y 2% antihistamínicos). Sólo el 6,6% sabe que tienen que usar adrenalina en caso de shock anafiláctico. El 1,6% de los apicultores sabe qué tratamiento se les aplicó. También representa un 1,1% del total de apicultores que debieron ser medicados en un hospital o sala. Conclusión. La actividad supone un riesgo alto de picaduras y la mayoría de los apicultores no cuentan con información suficiente para afrontar esta tarea con los conocimientos sobre prevención o tratamiento adecuados. Hay poco conocimiento en las salas asistenciales sobre el tratamiento de urgencia en un shock anafiláctico y su prevención.

Angioedema y urticaria asociadas con infección activa del virus de Epstein-Barr en un adulto / Angioedema and urticaria associated with active Epstein-Barr virus infection in an adult patient

Un paciente de 43 años de edad consultó por una historia de dos años con episodios recurrentes de urticaria en miembros y tronco, y edema de labios y párpados. Se le realizaron varios estudios de diagnóstico, incluyendo mediciones del C1 inhibidor y análisis de marcadores para infecciones virales, entre otras cosas. Los resultados fueron dentro de los parámetros normales salvo los títulos de IgG anti-EBV que resultaron positivos en dilucione de 1/80. Se efectuó la técnica de transcripción reversa y PCR (RT-PCR) para determinar la presencia de EBV en forma replicativa, y se determinó la presencia de ARN con secuencias del gen BLLF1. El paciente recibió un tratamiento durante 40 días con acyclovir 200 mg 4 veces al día. Al final de dicho período, los síntomas (urticaria y angioedema) desaparecieron por completo, y la técnica de RT-PCR resultó negativa para el gen BLLF1 del virus de Epstein-Barr. Sobre las bases del seguimiento clínico y los resultados de la técnica de RT-PCR, concluimos que la infección activa por el EBV puede jugar un rol en la expresión de urticaria y angioedema en pacientes susceptibles

Angioedema y urticaria asociadas con infección activa del virus de Epstein-Barr en un adulto / Angioedema and urticaria associated with active Epstein-Barr virus infection in an adult patient

Un paciente de 43 años de edad consultó por una historia de dos años con episodios recurrentes de urticaria en miembros y tronco, y edema de labios y párpados. Se le realizaron varios estudios de diagnóstico, incluyendo mediciones del C1 inhibidor y análisis de marcadores para infecciones virales, entre otras cosas. Los resultados fueron dentro de los parámetros normales salvo los títulos de IgG anti-EBV que resultaron positivos en dilucione de 1/80. Se efectuó la técnica de transcripción reversa y PCR (RT-PCR) para determinar la presencia de EBV en forma replicativa, y se determinó la presencia de ARN con secuencias del gen BLLF1. El paciente recibió un tratamiento durante 40 días con acyclovir 200 mg 4 veces al día. Al final de dicho período, los síntomas (urticaria y angioedema) desaparecieron por completo, y la técnica de RT-PCR resultó negativa para el gen BLLF1 del virus de Epstein-Barr. Sobre las bases del seguimiento clínico y los resultados de la técnica de RT-PCR, concluimos que la infección activa por el EBV puede jugar un rol en la expresión de urticaria y angioedema en pacientes susceptibles (AU)

Valor del prick test con alimentos en pacientes con urticaria / Value of the prick test with food in patients with urticaria

Con el objetivo de determinar el valor de los prick test con alérgenos alimentarios, para el diagnóstico de la urticaria estudiamos a 28 pacientes junto con otros parámetros de laboratorio. Se dosaron complejos inmunes circulantes (CIC), IgE sérica total, IgM, IgG e IgA séricas totales. Se correlacionaron los hallazgos para determinar si había diferencias significativas entre ellos y además se los comparó con un grupo de control de 15 personas sin urticaria ni antecedentes personales o familiares de atopia, a quienes se realizó el mismo prick test con alérgenos alimentarios. Los resultados no demostraron diferencias significativas cuando se compararon prick test positivos en el grupo de pacientes y en el grupo de control, tampoco cuando se compararon los pacientes con prick test positivo y valores altos de IgE con los pacientes con prick test positivo y valores normales de IgE. Lo mismo sucedió cuando se quisieron correlacionar los valores de IgE sérica elevados con los valores de CIC que excedían los normales. Nuestras conclusiones fueron negativas con respecto al uso de los prick test con alérgenos alimentarios para el diagnóstico etiológico de la urticaria. Estos resultados podrían ser revisados en los siguientes puntos: 1. Variar los criterios de inclusión de los pacientes con urticaria y el número de pacientes; 2. Trabajar con alérgenos estandarizados y utilizar una lista de alérgenos con frecuencia ya determinada para la alergia alimentaria en la ciudad de Córdoba