Retinal phakomatosis and Von Hippel-Lindau peripheral capillary hemangioblastoma: proposal for staged surgery.

PURPOSE: Retinal capillary hemangioblastoma (RCH) is present in about half of the carriers of the VHL (von Hippel-Lindau) gene mutation and can lead to the evolution of blindness. Herewith is a proposal for surgical intraretinal feeder vessel ligature to induce ischemia the phakoma and to resolve the exudative secondary retinal detachment, with satisfying results at the 6 months follow-up end point. METHODS: The patient underwent a chandelier-assisted 23 G pars plana vitrectomy with valved trocars. A bimanual transretinal ligature of the hemangioblastoma's feeder vessel was performed, followed by localized endolaser to ablate the surrounding retina and capillaries, and a Polydimethylsiloxane 1000 (PDMS 1000) final tamponade. After 3 months, exchange PDMS/air/balanced salt solution (BSS), phacoemulsification, and in-the-bag intraocular lens (IOL) implantation were performed. RESULTS: At sixth month, fundus fluorescein angiography (FFA) showed a significant reduction of blood flow in the phakoma. Final best-corrected visual acuity (BCVA) was 6/6 (9 lines gain obtained compared to the baseline time). CONCLUSIONS: This surgical technique seems to be effective and promising for the treatment of VHL retinal capillary hemangioblastomas and their related retinal complications.

Living with food allergies: the experiences of adult patients and caregivers.

Background: Few studies have addressed how food allergy may impact differently on the daily lives of adults with food allergies and caregivers for food-allergic dependents. Objective: To explore similarities and differences in life experiences and unmet needs between individuals caring for a child with food allergy and adults with food allergy world-wide. Methods: Two multinational, virtual, interactive, moderated discussions of specific questions between respectively people with food allergies and caregivers for people with food allergies, with experienced clinicians participating. Results: Sixteen individuals living with food allergies and nine caregivers took part in the two roundtables. Food avoidance and antihistamines were the most common treatments for food-allergic reactions in both groups. Caregivers reported greater burden of disease on affected individuals and families than did adult patients. Adult panelists considered autoinjectors easy to use but caregivers reported additional emotional stress thinking about autoinjector use. Caregivers described an ever-present fear of inattention and of overlooking a risk factor for a severe reaction, whereas adult panelists showed a determination not to let their food allergies interfere with living their lives. Both groups had safety-conscious attitudes to treatments, but adult patients emphasized convenience while caregivers prioritized reduced severity of reactions and eliminated fear. Both groups confirmed the need for improved, trusted sources of information, and for resources and training programs for any new therapies. Conclusion: The interactive exchange provided insights into differences between adult patients and caregivers, notably in fear and confidence in daily life, severity of disease impact, and unmet needs for treatments.

Omalizumab in IgE-Mediated Food Allergy: A Systematic Review and Meta-Analysis.

BACKGROUND: A growing number of studies have shown encouraging results with omalizumab (OMA) as monotherapy and as an adjunct to oral immunotherapy (OMA+OIT) in patients with single/multiple food allergies. OBJECTIVES: To evaluate the efficacy and safety of OMA or OMA+OIT in patients with immunoglobulin E (IgE)-mediated food allergy. METHODS: An extensive literature search (inception to December 31, 2020) was performed to identify randomized, controlled, and observational studies that assessed OMA as monotherapy or OMA+OIT in patients with IgE-mediated food allergy. The outcomes were an increase in tolerated dose of foods, successful desensitization, sustained unresponsiveness, immunological biomarkers, severity of allergic reactions to food, quality of life (QoL), and safety. A P less than .05 was considered significant. RESULTS: In total, 36 studies were included. The OMA monotherapy (vs pre-OMA) significantly increased the tolerated dose of multiple foods; increased the threshold of tolerated dose for milk, egg, wheat, and baked milk; improved QoL; and reduced food-induced allergic reactions (all P < .01). The OMA+OIT significantly increased the tolerated dose of multiple foods (vs placebo and pre-OMA), desensitization (vs placebo+OIT and pre-OMA) (all P ≤ .01), and improved QoL (vs pre-OMA) and immunoglobulin G4 levels (both P < .01). No major safety concerns were identified. CONCLUSIONS: In IgE-mediated food allergy, OMA can help patients consume multiple foods and allow for food dose escalation. As an adjunct to OIT, OMA can also support high-dose desensitization and higher maintenance doses. Further studies are warranted to empirically evaluate the effect of OMA and confirm these findings.

The rationale for development of ligelizumab in food allergy.

Food allergy (FA) is a growing healthcare problem worldwide and the rising prevalence in many countries can be attributed to lifestyle, environmental, and nutritional changes. Immunoglobulin E (IgE)-mediated FA is the most common form of FA affecting approximately 3%-10% of adults and 8% of children across the globe. Food allergen-induced immediate hypersensitivity reactions mediated by IgE and high-affinity IgE receptor (FcεRI) complexes on mast cells and basophils are a major hallmark of the disease. FA can affect several aspects of health-related quality of life and impose a substantial financial burden on patients and healthcare systems. Although currently there is one United States Food and Drug Administration (FDA) and European Medicines Agency (EMA)-approved treatment for peanut allergy (Palforzia), the main treatment approaches are based on allergen avoidance and symptom management. Thus, there is an urgent need for more effective and ideally disease-modifying strategies. Given the crucial role of IgE in FA, anti-IgE monoclonal antibodies are considered promising therapeutic agents. Talizumab was the first humanized anti-IgE antibody to demonstrate substantial protection against allergic reactions from accidental peanut exposure by substantially increasing the peanut reactivity threshold on oral food challenge. However, development of talizumab was discontinued and further trials were performed using omalizumab. In double-blind, Phase 2, placebo-controlled trials in patients with multi-FAs, sustained dosing with omalizumab, or omalizumab in combination with oral immunotherapy, enabled rapid desensitization to multiple trigger foods. In this review, we describe the development of ligelizumab (a derivative of talizumab), a next generation, humanized monoclonal anti-IgE antibody, its existing clinical evidence, and its potential in the management of FA. When compared with omalizumab, ligelizumab binds with ∼88-fold higher affinity for human IgE and recognizes a different epitope that substantially overlaps with the binding site of FcεRI. These properties translate into a high potency to block IgE/FcεRI signaling in both in vitro and in vivo studies. Given its efficient suppression of IgE levels, good safety and pharmacokinetic/pharmacodynamic profile, ligelizumab clearly warrants further studies for the potential management of FA.

Regulatory T cells and immunoglobulin E: A new therapeutic link for autoimmunity?

Autoimmune diseases have a prevalence of approximately 7 to 9% and are classified as either organ-specific diseases, including type I diabetes, multiple sclerosis, inflammatory bowel disease and myasthenia gravis, or systemic diseases, including systemic lupus erythematosus, rheumatoid arthritis and Sjögren's syndrome. While many advancements have been made in understanding of the mechanisms of autoimmune disease, including the nature of self-tolerance and its breakdown, there remain unmet needs in terms of effective and highly targeted treatments. T regulatory cells (Tregs) are key mediators of peripheral tolerance and are implicated in many autoimmune diseases, either as a result of reduced numbers or altered function. Tregs may be broadly divided into those generated in the thymus (tTregs) and those generated in the periphery (pTregs). Tregs target many different immune cell subsets and tissues to suppress excessive inflammation and to support tissue repair and homeostasis: there is a fine balance between Treg cell stability and the plasticity that is required to adjust Tregs' regulatory purposes to particular immune responses. The central role of immunoglobulin E (IgE) in allergic disease is well recognized, and it is becoming increasingly apparent that this immunoglobulin also has a wider role encompassing other diseases including autoimmune disease. Anti-IgE treatment restores the capacity of plasmacytoid dendritic cells (pDCs) impaired by IgE- high-affinity IgE receptor (FcεR1) cross-linking to induce Tregs in vitro in atopic patients. The finding that anti-IgE therapy restores Treg cell homeostasis, and that this mechanism is associated with clinical improvement in asthma and chronic spontaneous urticaria suggests that anti-IgE therapy may also have a potential role in the treatment of autoimmune diseases in which Tregs are involved.

Genetic Basis and Molecular Mechanisms of Uveal Melanoma Metastasis: A Focus on Prognosis.

Uveal melanoma (UM) is the most frequently found primary intraocular tumor, although it accounts for only 5% of all melanomas. Despite novel systemic therapies, patient survival has remained poor. Indeed, almost half of UM patients develop metastases from micro-metastases which were undetectable at diagnosis. Genetic analysis is crucial for metastatic risk prediction, as well as for patient management and follow-up. Several prognostic parameters have been explored, including tumor location, basal dimension and thickness, histopathologic cell type, vascular mimicry patterns, and infiltrating lymphocytes. Herein, the Authors review the available literature concerning cytogenetic prognostic markers and biochemical pathways correlated to UM metastasis development.

Real-life Effectiveness of Omalizumab in Patients with Severe Allergic Asthma: RELIEF Study.

Introduction: Patients with severe allergic asthma (SAA) are at risk of severe exacerbations. Omalizumab is recommended as an add-on treatment for patients with uncontrolled SAA, despite high-dose inhaled corticosteroids and long acting ß2-agonist combination therapy (standard therapy).RELIEF was a prospective, open label, multicenter study conducted to assess the real-life effectiveness of omalizumab co-administered with standard therapy in patients with SAA for 24 months. Methods: A total of 347 patients aged ≥ 6 years with SAA were enrolled, 285 of whom (8 pediatrics and 277 adolescents and adults) completed this 24-month study. Compared with the 12 months prior to baseline, the mean number of exacerbations was reduced in the overall population at any time interval during the study. Proportion of patients with no exacerbations increased to 77.7% at 24 months from 32.6% at 12 months prior to baseline. A reduction in healthcare resource utilization was also observed. The mean number of specialist visits reduced from baseline (5.8 visits) to 2.4 visits at Month 24. Results: The mean asthma control test score was >19 at every time-point during the study. The rate of Global Evaluation of Treatment Effectiveness (GETE) for asthma response significantly increased at Months 18 and 24 (P <0.05) compared to baseline. Pulmonary function remained relatively stable for the overall study population. There were no new or unexpected safety findings in the study. Conclusion: RELIEF study showed that add-on therapy with omalizumab is effective in reducing exacerbations, healthcare utilization, and improving GETE score in patients with SAA uncontrolled by standard therapy.

Molecular Mechanisms Related to Oxidative Stress in Retinitis Pigmentosa.

Retinitis pigmentosa (RP) is an inherited retinopathy. Nevertheless, non-genetic biological factors play a central role in its pathogenesis and progression, including inflammation, autophagy and oxidative stress. The retina is particularly affected by oxidative stress due to its high metabolic rate and oxygen consumption as well as photosensitizer molecules inside the photoreceptors being constantly subjected to light/oxidative stress, which induces accumulation of ROS in RPE, caused by damaged photoreceptor's daily recycling. Oxidative DNA damage is a key regulator of microglial activation and photoreceptor degeneration in RP, as well as mutations in endogenous antioxidant pathways involved in DNA repair, oxidative stress protection and activation of antioxidant enzymes (MUTYH, CERKL and GLO1 genes, respectively). Moreover, exposure to oxidative stress alters the expression of micro-RNA (miRNAs) and of long non-codingRNA (lncRNAs), which might be implicated in RP etiopathogenesis and progression, modifying gene expression and cellular response to oxidative stress. The upregulation of the P2X7 receptor (P2X7R) also seems to be involved, causing pro-inflammatory cytokines and ROS release by macrophages and microglia, contributing to neuroinflammatory and neurodegenerative progression in RP. The multiple pathways analysed demonstrate that oxidative microglial activation may trigger the vicious cycle of non-resolved neuroinflammation and degeneration, suggesting that microglia may be a key therapy target of oxidative stress in RP.

Chronic urticaria treatment patterns and changes in quality of life: AWARE study 2-year results.

BACKGROUND: A Worldwide Antihistamine-Refractory Chronic Urticaria (CU) patient Evaluation (AWARE) is a non-interventional, multicenter study including patients from Europe, Central and Latin America, Asia-Pacific, and the Middle East. AWARE describes real-world evidence for CU, including clinical characteristics, treatment patterns and the impact on quality of life. METHODS: Over the 2-year study, therapy changes, angioedema occurrence, and patient-reported outcomes (PROs) were recorded over 9 visits, including dermatology life quality index (DLQI) and 7-day urticaria activity score (UAS7). Data were stratified into subgroups: chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU), or CSU + CIndU. RESULTS: Out of 4838 patients analyzed, 9.9% were receiving no treatment for their CU symptoms at baseline, and 20.4% were receiving first-line non-sedating H1-antihistamine at approved doses. The predominant baseline therapy was up-dosed non-sedating H1-antihistamines (25.5%). By Visit 2, omalizumab was the overall most commonly used therapy (29.6%), increasing to 30.1% by the end of the study. Baseline DLQI scores for patients with CSU, CIndU and CSU + CIndU were 8.3, 7.6 and 9.1, respectively; scores decreased over the study for CSU and CSU + CIndU patients, but fluctuated for CIndU patients. Baseline angioedema occurrence was higher in CSU and CSU + CIndU patients, reported in 45.4% and 45.5% of patients, respectively, compared to 17.0% in CIndU patients. By the final visit, angioedema had decreased to 11.9% and 11.2% for CSU and CSU + CIndU, respectively, and 9.6% for CIndU. CONCLUSION: CU patients are undertreated at baseline; after entering the AWARE study, more patients received appropriate treatment. However, over two thirds are not escalated to third-line treatments.

Perfil genético hla en familias venezolanas: útil herramienta biomédica / Hla genetic profile in venezuelan families: biomedical useful tool

El sistema de antígenos leucocitarios Humano (Human Leukocyte Antigen, HLA) regula la respuesta inmune mediante su unión a moléculas como el receptor de células T, participando en la presentación de antígenos y el reconocimiento de lo propio en el organismo. La caracterización genética del sistema HLA en determinada población es de gran utilidad para la comprensión de mecanismos asociados a susceptibilidad o resistencia a enfermedades y en la selección de donantes/receptores en trasplantes de órganos. En este estudio se planteó determinar la frecuencia de los Haplotipos HLA de clase I presentes en individuos sanos, relacionados familiarmente y venezolanos de tercera generación y su correspondiente desequilibrio de ligamiento. Se incluyeron 765 individuos pertenecientes a 218 familias a los cuales se les realizó tipificación HLA A y HLA B por PCR-SSOP (polymerase chain reaction-sequence specific oligonucleotide probe) en baja resolución. Se identificaron 265 haplotipos de los cuales los más frecuentes fueron HLA A*24 B*35 (11,98 %), A*02 B*51 (9,7%) y A*02 B*35 (8,6 %).Para los cálculos de desequilibrio de ligamiento se consideraron las frecuencias mayores al 1% (28,7%) y no arrojaron valores estadísticamente significativos el 6,78% de estos haplotipos. Los resultados obtenidos corroboran la composición triétnica históricamente conocida de nuestra población, en la cual predominan genes caucásicos, amerindios y afrodescendientes; y su porcentaje marca la diferencia con otras poblaciones americanas estudiadas. Estos resultados representan una aproximación de la conformación genética establecida en Venezuela y aporta datos que podrán ser usados como referencia en programas de salud para la población.

The system of Human leukocyte antigens (HLA) is the most polymorphic in humans. Its function is performed by regulating the immune response by binding to molecules such as T-cell receptor, involved in antigen presentation and recognition of the same in the body. Genetic characterization of HLA system in a given population is useful for understanding the mechanisms associated with susceptibility or resistance to various diseases and selection of donors and recipients in organ transplants, among others. The objective of the present study is to determine the frequency of HLA Class I Haplotypes present in healthy individuals, family relationships and third-generation Venezuelan and their corresponding linkage disequilibrium. We included 765 individuals belonging to 218 families who underwent HLA typing HLA A and B by PCR-SSOP (polymerase chain reaction-sequence specific oligonucleotide probe) in low resolution. 265 haplotypes were identified of which the most frequent were HLA A * 24 B * 35 (11.98%), A * 02 B * 51 (9.7%) and A * 02 B * 35 (8.6%). Calculations of linkage disequilibrium were considered frequencies above 1% (28.7%) and did not show statistically significant the 6.78% of these haplotypes. The results support the historically known tri-ethnic composition of our population, in which genes predominantly Caucasian, Mongoloid and Negroid, and make a difference with other American populations studied. These data can be used as reference to applications of benefit to this population.

Asociación del polimorfismo del gen ICOS (c.1564 t/c) con hepatitis autoinmune tipo 1 en población mestiza venezolana / Association of icos (c.1564 T/C) gene poymorphims with autoimmune hepatitis type 1 in Venezuelan mestizo population)

Introducción: Un evento inmunopatológico característico en la hepatitis autoinmune (HAI) es la activación prolongada de la respuesta Th1. Diferentes promotores genéticos pueden predisponer a esta activación provocando ruptura de la inmunotolerancia. Uno de estos promotores es ICOS perteneciente a la familia de CD28, moléculas involucradas en funciones que regulan las respuestas Th1 y Th2 previniendo la activación prolongada de la respuesta Th1. Objetivo: Determinar el polimorfismo del gen ICOS (c.1564 T/C) en pacientes mestizos venezolanos con HAI tipo 1 y su posible asociación con la expresión clínica. Materiales y Métodos: Se investigaron 70 pacientes con HAI tipo 1 y 121 individuos sanos, ambos grupos venezolanos de tercera generación. La determinación del polimorfismo se realizó mediante reacción en cadena de la polimerasa (PCR) seguida por polimorfismos en la longitud de los fragmentos de restricción (RFLP). Resultados: El alelo silvestre T fue el más frecuente tanto en pacientes como en controles siendo mayor en el segundo grupo (60,7% vs 70,4%; p=0,05; pc=ns OR 1,45 p<0,05). El alelo mutado C se observó más en los pacientes con respecto al grupo control (39,3% vs 29,6%; p=0,05; pc=ns OR 1,45 (p<0,05). En las frecuencias genotípicas, se demostraron los genotipos heterocigotos (T/C) y homocigotos para el alelo mutado (C/C) más prevalentes en el grupo de pacientes que en controles y el genotipo silvestre T/T más frecuente en controles que en pacientes siendo estas diferencias significativas al 10% (χ2=5,31;2GL;p=0,07); OR 2,08 (p<0,05). Los pacientes con el genotipo heterocigoto demostraron niveles más elevados de globulinas, de IgG y mayor presencia de anticuerpos anti-mitocondriales que los observados en el genotipo T/T con diferencia estadística significativa al 10%. Además, se observa menor presencia de anticuerpos antinucleares en el genotipo T/C vs. T/T (p<0,10; pc=ns). Conclusiones: En el estudio del polimorfismo del gen ICOS (c.1564 T/C) los genotipos heterocigoto T/C y homocigoto mutado C/C son más frecuentes en pacientes mestizos venezolanos con HAI tipo 1 que en controles con riesgo significativo. Este polimorfismo se asocia a ciertas variables inmunodiagnósticas.

Introduction: A characteristic immunopathological event in autoinmune hepatitis (AIH) type 1 is the prolonged activation of Th1 response. Different promoters might predispose to this activation inducing immunotolerance breaking. ICOS is one of these promoters which belong to CD28 family, molecules involved in Th1 and Th2 regulating functions to prevent Th1 longer activation. Objective: To determine gen ICOS (c.1564 T/C) polymorphism in Venezuelan mestizo patients with AIH type 1 and its possible association with clinical expression. Materials and Methods: Seventy patients with AIH type 1 and 121 healthy individuals, both third generation Venezuelan groups, were investigated. Polymorphism determination was performed by polymerase chain reaction (PCR) following by restriction fragments longitudinal polymorphisms (RFLP). Results: The most frequent allele was wild T either in patients and controls, being higher in the second group (60,7% vs. 70,4%; p=0,05; pc=ns OR 1,45 p<0,05). The mutant C allele was observed more in patients than controls (39,3% vs. 29,6%; p=0,05; pc=ns OR 1,45 (p<0,05). In the genotypes frequencies, heterozygote genotypes (T/C) and homozygote mutant allele (C/C) were prevalent in the patient’s group while in the control´s group the wild genotype T/T was the most frequent being these differences significantly to 10% (χ2=5,31;2GL;p=0,07); OR 2,08 (p<0,05). Compared to the T/T genotype group, patients with heterozygote genotype shown higher levels of globulins, IgG and presence of anti-mithocondrial antibodies with a significant difference to 10%. Moreover, presence of antinuclear antibodies was less frequent in the T/C genotype vs. T/T (p<0,10; pc=ns). Conclusion: Heterozygote genotype T/C and homozygote mutant genotype C/C of gen ICOS (c.1564 T/C) with a significantly risk are more frequent in Venezuelan mestizo patients with AIH type 1 than in controls with a significantly risk. This polymorphism is associated with certain immunodiagnostic variables.

Maintenance of skills, competencies, and performance in allergy and clinical immunology: time to lay the foundation for a universal approach.

Allergist/clinical immunologist maintenance of certification and training program reaccreditation are mandatory in some countries. The World Allergy Organization conducted surveys in 2009 and 2011 to assess where such programs were available and to promote the establishment of such programs on a global level. This was done with the presumption that after such an "inventory," World Allergy Organization could offer guidance to its Member Societies on the promotion of such programs to assure the highest standards of practice in the field of allergy and clinical immunology. This review draws on the experience of countries where successful programs are in place and makes recommendations for those wishing to implement such programs for the specialty.

Sensibilización al maní en pacientes venezolanos con enfermedades atópicas y/o urticaria / Sensitization to peanut in Venezuelan patients with atopic diseases and / or uticaria

La sensibilización y las manifestaciones alérgicas al maní se han incrementado últimamente a nivel mundial, constituyendo el mismo la causa principal de anafilaxia por alimentos. Como la prevalencia de alergia al maní varía de acuerdo a las regiones nos propusimos evaluar, en una etapa preliminar, la sensibilización al maní por pruebas cutáneas (“skin prick test”) en pacientes venezolanos atópicos y/o con urticarias que acudieron a la Consulta ambulatoria de Alergía del Instituto de Inmunología. El 5,4 % de los pacientes manifestó algún tipo de manifestación cutánea o respiratoria al ingerir maní. Se demostró sensibilización al maní por pruebas cutánea en el 6,5 % de los pacientes. Sin embargo, un porcentaje pequeño (2 %) de ellos mostró, en conjunto, pruebas cutáneas positivas y síntomas a la ingesta del maní. Ningún paciente refirió síntomas severos tras la ingestión de maní. La mayoría de los pacientes con pruebas positivas al maní, también mostraron pruebas positivas a otros alimentos. Estos resultados concuerdan con la percepción de los médicos venezolanos de una baja frecuencia de reacciones adversas, especialmente graves, a la ingesta de maní en nuestro país

Peanut allergy and sensitization incidence has increased world wide to become the first cause of food anaphylaxis. Since the prevalence of peanut allergy changes according to geographical areas, the aim of the study was to assess, in a preliminary report, peanut allergy incidence by skin prick test in atopic Venezuelan patients with atopy and or urticaria from the outpatient allergy clinic of the Institute of Immunology. Cutaneous or respiratory manifestations after peanut ingestion was observed in 5.4 % of the patients studied. Cutaneous test was positive in 6.5 % of patients. In the other hand, a small group (2 %), showed positive skin test along with symptoms after peanut ingestion. None of the patients had severe reactions. Most of the patients with peanut positive skin test were positive to other food allergens. These results are in accordance with the general clinical perception of small frequency of adverse reaction, specially the most serious ones, to peanut ingestion in our country

Allele and haplotype frequencies at human leukocyte antigen class I and II genes in Venezuela's population.

Population studies represent an integral part and link in understanding the complex chain of host-pathogen interactions, disease pathogenesis, and MHC gene polymorphisms. Genes of Mongoloid, Caucasoid, and Negroid populations have created a distinctive HLA genetic profile in the Venezuelan population. Our objective was to determine the predominant HLA class I and II alleles and haplotype frequencies in the hybrid population of Venezuela. The study population consisted of 486 healthy unrelated native Venezuelans and 180 families. We examined the frequency of HLA A-B-C, HLA-DQ and HLA-DR genes by polymerase chain reaction and subsequent hybridization with sequence-specific oligonucleotide probes. Phenotypic, allelic and haplotype frequencies were estimated by direct counting and using the maximum-likelihood method. The predominant HLA class I alleles were A*02, A*24, A*68, B*35, B*44, B*51, B*07, B*15 and Cw*07. Regarding HLA class II, the most frequent alleles were DQB1*03 and DRB1*04, DRB1*15, DRB1*13, DRB1*07. The prevailing haplotype was HLA-A*02B*35 DQB1*03 DRB1*04. Some of these alleles and haplotype frequencies were predominantly present in Amerindians (A*02, A*24, B*35, Cw*07, DRB1*04, A*24 B*35). Previous reports have shown high incidence of A*02, B*44, B*51, DRB1*15, DRB1*13, DRB1*07 alleles in several European populations and A*68, B*07, B*15 alleles in African Americans, which could have contributed to the ethnic admixture of the Venezuelan population. We conclude that our results provide strong evidence that Venezuela's population represents an admixture of the primitive Mongoloid Aborigines, Caucasoid Europeans and Western African Negroid migrants.

Diagnosis and treatment of urticaria and angioedema: a worldwide perspective.

: Urticaria and angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to urticaria and angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of urticaria and angioedema in medical practice and will become a useful source of information for optimum patient management worldwide.

Asociación del polimorfismo del gen PTPN22 (C1858T) con hepatitis autoinmune tipo 1 en la población mestiza venezolana / Association of polymorphism of PTPN22 gene (C1858T) with type 1 autoimmune hepatitis in the Venezuelan mestizo population

Introducción: La Hepatitis Autoinmune (HAI) tipo 1 es una enfermedad hepática progresiva en la cual se demuestra susceptibilidad genética asociada a determinantes compartidos de moléculas HLA clase II. Sin embargo, 30 a 50% de estos pacientes, no asocian alelos HLA de susceptibilidad por lo que otros promotores genéticos que pudiesen predisponer a la ruptura de inmunotolerancia están siendo investigados. La Proteína Linfoide Tirosina Fosfatasa (LYP) codificada por el gen PTPN22, ejerce una potente inhibición en el linfocito T activado. El polimorfismo de este gen en la posición 1858 (sustitución de citosina (C) por una timina (T)) se describe asociada a múltiples patologías autoinmunes pero aún no se ha reportado en HAI tipo 1. Objetivo: Determinar la posible asociación del polimorfismo del gen PTPN22 en mestizos venezolanos con HAI tipo 1. Material y Métodos: Nuestra población consistió de 62 pacientes con HAI tipo 1 y 107 individuos sanos, ambos grupos venezolanos de tercera generación. La determinación del polimorfismo se realizó mediante la amplificación de la región en estudio (posición 1850 del codón 620) con la técnica de PCR estandarizada seguida por digestión de enzimas de restricción (Xcm I). Resultados: El genotipo más frecuente fue el genotipo homocigoto silvestre (C/C) tanto en pacientes (90.3%) como en controles (98.1%,) sin diferencia significativa. El polimorfismo C1858T (genotipo C/T) del gen PTP22 se identificó con mas frecuencia en los pacientes con diferencia estadísti-camente signifi cativa al relacionarlo con el grupo control (p= 0.029, OR=5,6). El genotipo homocigoto TT no se observó en ninguno de los individuos estudiados. Conclusión: El polimorfismo del gen PTPN22 a nivel C1858T descrito en otras enfermedades de origen au-toinmune también se detecta en HAI tipo 1, probable-mente confiriendo susceptibilidad a esta enfermedad en la población mestiza venezolana.

Background: Autoimmune hepatitis (AIH) type 1 is a progressive inflammatory disorder of the liver with genetic association to human leukocyte antigens. How-ever, the genetic background of AIH type 1 is considered to be polygenic. Lymphoid tyrosine phosphatase, encoded by the PTPN22 gene, exerts an important down regulatory effect on T cell activation in immune response. The single nucleotide polymorphism C1858T within the PTPN22 gene has been associated with in-creased susceptibility to a number of autoimmune dis-orders. Objective: The aim of this study was to assess the association of the single nucleotide polymorphism C1858T of the PTPN22 gene in Venezuelan Mestizos patients with AIH type 1. Materials and Methods: 62 Venezuelan Mestizos patients with AIH type 1 and 107 healthy volunteers were investigated. Cases and controls were genotyped for C1858T polymorphism by restriction fragment length polymorphism analysis of PCR products. Results: The wild-type C/C homozygous genotype was the most common variant in both patients (90.3 %) and controls (98.1 %). The heterozygous genotype C/T was significantly found in AIH patients compared to controls (OR = 5.6, P = 0.029). The T/T homozygous mutant genotype was not observed in either population. Conclusions: These results suggest that the PTPN22 1858C/T genotype could confer differential susceptibility to AIH type 1 in Venezuelan Mestizos patients. In addition, these findings provide strong evidence that lymphoid tyrosine phosphatase could be a critical player in multiple autoimmune disorders.

Desloratadine therapy improves allergic rhinitis symptoms in latin american children aged 6 to 12 years.

OBJECTIVE: : To determine the effectiveness of desloratadine syrup in relieving symptoms of allergic rhinitis (AR) among children in Latin America. METHODS: : In an open-label trial conducted in 5 Latin American countries, 455 children aged 6 to 12 years with seasonal or perennial AR were treated with desloratadine syrup 2.5 mg/d for 6 weeks. Thirty percent of subjects were concomitantly taking corticosteroids, and 21.3% had a history of asthma. Efficacy was measured by improvement in the Total Symptom Severity 4 questionnaire and decrease in severity of individual nasal symptoms of congestion, rhinorrhea, pruritus, and sneezing. Physicians and subjects' caregivers rated symptom improvement in a separate assessment at final visit. RESULTS: : Treatment with desloratadine led to a significant decrease in mean Total Symptom Severity 4 score, from 7.54 at baseline to 1.96 at study end (P < 0.0001), and in individual symptom scores, including congestion (P < 0.0001 for all). Similar improvements were found in groups receiving desloratadine monotherapy and desloratadine plus corticosteroids. Allergic rhinitis symptoms were rated "better" or "much better" by 94% of caregivers. Incidence of adverse events was 6%. CONCLUSIONS: : Desloratadine, with or without concomitant corticosteroids, was efficacious and safe in the treatment of AR in this group of Latin American children.

Genetic contribution of major histocompatibility complex class II region to type 1 autoimmune hepatitis susceptibility in Venezuela.

AIMS: Autoimmune hepatitis (AIH) is a progressive liver disease characterized by the presence of circulating autoantibodies, hypergammaglobulinaemia and a favourable response to immunosuppressive treatment. Although the pathogenesis of type 1 AIH is unknown, disease susceptibility is partially determined by genes linked to the class II region of the major histocompatibility complex. Type 1 AIH has been associated with DRB1*03, DRB1*04 and DRB3 alleles in European and North American Caucasians, with DRB1*0405 in Japanese, with DRB1*0404 in Mexican, and with DRB1*1301 in Argentinean populations. METHODS: To analyse the molecular basis of these associations in Venezuela (mestizo population), we examined the frequency of human leucocyte antigens (HLA)-A -B -C, HLA-DQ and HLA-DR genes by low- and high-resolution oligonucleotide typing in a population of 41 type 1 AIH patients and 111 ethnic- and aged-matched healthy subjects. RESULTS: The frequencies of both DRB1(*)1301 (P<0.0001) and DRB1*0301 (P<0.005) were significantly higher in patients than in controls. In addition, patients showed a strong association with the DRB3 allele (P<0.01). In contrast, the DQB1*04 allele was significantly decreased in the patient group (P<0.01). The frequencies of haplotypes A*01-B*08-DQB1*02-DRB1*03-DRB3, DQB1*05-DRB1*1301, DQB1*06-DRB1*1301 and A*02-DRB1*1301, B*45-DRB3 were significantly increased in type 1 AIH patients compared with the controls (P<0.01). CONCLUSIONS: In conclusion, our data indicate that type 1 AIH predisposition in a Venezuelan mestizo population of different ethnic backgrounds is associated with DRB1*1301 and DRB1*0301 alleles. In addition, our findings suggest that protection against disease might be conferred by the DQB1*04 allele, with distinct ethnic differences from other populations.