European and Mexican vs US diagnostic extracts of Bermuda grass and cat in skin testing.

BACKGROUND: Laboratory testing of various diagnostic extracts has shown lower potencies for several European and Mexican extracts relative to the US Food and Drug Administration (FDA) reference (10,000 BAU/mL). Quantitative skin prick testing (QSPT) with Dermatophagoides pteronyssinus extracts have previously shown a similar picture. OBJECTIVE: To compare European and Mexican Bermuda grass (BG) and cat diagnostic extracts against an FDA-validated extract using QSPT. METHODS: Six diagnostic BG and cat extracts (1 reference FDA extract, 3 European extracts, 1 imported nonstandardized extract from the United States, and 1 Mexican extract) were tested with quadruplicate QSPT, as a concentrate and as 2 serial 2-fold dilutions, in cat and BG allergic individuals. RESULTS: BG showed good dose response in wheal size for the concentrate (1:2-1:4 dilutions; steep part of the curve). Cat showed poorer dose response. The Wilcoxon test for linked random samples was used to investigate whether the distribution of the reference differed from each of the test extracts to a statistically significant degree (2-sided asymptotic significance, α = .05). All BG and 2 cat extracts were statistically less potent than the 10,000 BAU/mL US reference. European BG extracts were 7,700, 4,100, and 1,600 BAU/mL, and cat extracts were 12,500, 4,400, and 5,100 BAU/mL. CONCLUSIONS: The potency of some diagnostic extracts of BG and cat used in Europe, Mexico, and the United States differs, with the US extracts being generally more potent. On the basis of provocation tests, optimal diagnostic concentrations should be determined. Similar comparisons using other manufacturers and therapeutic extracts might be interesting.

[Prevalence of reactions secundary to mosquito bites Aedes aegypti at en el Regional Center of Allergy and Clinical Immunology, University Hospital, de Monterrey, Nuevo Leon]. / Prevalencia de reacciones secundarias por picadura del mosquito aedes aegypti en el centro Regional de Alergia e Inmunología Clínica del Hospital Universitario, Monterrey, Nuevo León.

BACKGROUND: although systemic reactions resulting from hymenoptera stings have been studied extensively, the prevalence of allergic reactions to mosquitoes is unknown. OBJECTIVE: to investigate the prevalence of allergic reactions to Aedes aegypti bites in patients seeking treatment at the Allergy and Clinical Immunology Regional Center of Jose E Gonzalez University Hospital in Monterrey, Mexico. MATERIAL AND METHOD: we carried out a cross-sectional, descriptive study that included patients receiving skin tests for aeroallergens; skin sensitivity to mosquito bites was also tested. A questionnaire was used to obtain information about previous allergic reactions to mosquito bites. RESULTS: a total of 482 patients between 2 and 60 years of age were included; 53% were female, 407 (84.4%) had a history of local reactions to mosquito bites. Twelve patients (2.4%) stated a history of large local reaction; three (0.6%) of them with a positive skin prick test, one (0.2%) of those had systemic reaction history to mosquito. Eighty five (17.6%) patients had a positive mosquito skin test and 307 (63.6%) had a positive skin test for at least one aeroallergen. Seventy-eight (91.7%) of the 85 patients with a positive mosquito skin test had a history of local skin reactions to mosquito bite (odds ratio: 2.303 [confidence interval (CI) 1.037-5.10]. There was no statistically significance association between allergic diseases and mosquito allergy. CONCLUSIONS: adverse reactions and allergic reactions to mosquito bites occur frequently. However mosquito allergy is low. Further studies are required to determine the prevalence of mosquito allergy in the general population.

[Validation of a knowledge-questionnaire about asthma applied to teachers of elementary school of Monterrey, Mexico]. / Validación de un cuestionario de conocimientos acerca del asma aplicado a maestros de educación primaria de Monterrey, México.

BACKGROUND: asthma is one of the most common chronic childhood diseases; is increasing in prevalence and an important cause of school absenteeism. Previous studies have failed to evaluate knowledge about asthma among elementary school teachers worldwide because of the lack of validated questionnaires. OBJECTIVE: to validate a questionnaire about asthma knowledge for elementary school teachers in Monterrey, Nuevo Leon. MATERIAL AND METHODS: an observational, cross sectional, descriptive study, from February to December 2004, by applying a questionnaire to a group of elementary school teachers in Monterrey, Nuevo Leon. The questionnaire is a translation and adaptation to the questionnaire of 13 questions used to assess the knowledge about asthma among parents, according to the National Asthma Education Program of US. RESULTS: a total of 179 questionnaires were applied, in which 6 of the 13 questions were answered correctly by more than 90% of the teachers. The internal consistency reliability was adequate with a Cronbach a coefficient of 0.75. CONCLUSIONS: in order to obtain reliable data using questionnaires, these must undergo a validation process. Our questionnaire got validation because of the reliability shown according to the internal consistency analysis.

[Practice patterns in Mexican allergologists about skin tests with allergens during 2005-2006]. / Patrones de práctica de alergólogos mexicanos en cuanto a pruebas cutáneas con alergenos durante 2005-2006.

BACKGROUND: Immunotherapy has been practiced since over a hundred years. The exact composition of the immunotherapy concentrate, with which the patient is treated, depends partly on the results of the skin prick tests applied to the allergic patient. As such, the effectiveness of the immunotherapy depends heavily on the quality of the skin prick test. The detailed recommendations for the realization of the skin prick tests have evolved and changed over the years, leading to multiple variations in its application in Mexico. OBJECTIVE: We tried to get a picture of the daily practice patterns of the members of CMICA and CoMPedIA concerning the application of skin prick tests. MATERIALS AND METHODS: Aquestionnaire was sent in various occasions to all members of the Colegio Mexicano de Inmunologia Clinica y Alergia (CMICA) and of the Colegio Mexicano de Pediatras, Especialistas en Inmunologia y Alergia (CoMPedIA). The results are presented descriptively and by calculation of the frequency/percentages of intervals of replies, in the case of numerical responses. RESULTS: A response rate of 61 (17%) was obtained of the College members, showing consistency in some replies but a wide variation in others, for example in the time certain medication has to be suspended before the execution of the skin prick test. Comparing the replies obtained with recent recommendations in international publications, some discrepancy can be detected. CONCLUSIONS: In some aspects of the survey there is coincidence of the skin test practices among the participants; however, in other items there is an important variation.

[Frequency of exercise-induced asthma in a group of children and adolescents with mild asthma attending a summer camp]. / Frecuencia de asma inducida por ejercicio en un grupo de niños y adolescentes con asma leve que acudieron a un campamento de verano.

BACKGROUND: Exercise-induced asthma is a transitory bronchospasm, which occurs after 6 to 8 minutes of continuous exercise. Diagnosis is done by a suggestive clinical history and by 15 to 20% post-challenge fall in FEV1. It happens in about 6 to 13% of general population, 90% of asthmatic individuals and 40% of individuals with allergic rhinitis. OBJECTIVE: To know the frequency of asthma induced by exercise in a group of asthmatic children and teenagers who went to a summer camp. MATERIAL AND METHODS: A cross-sectional, descriptive and observational study, which included 33 patients suffering from intermittent mild asthma, was based on espirometric measurements made before and after 8 minutes of continuous exercise (running). None of them had previous diagnosis of exercise-induced asthma. FEV1 greater than or equal to 15% was considered exercise-induced asthma. The test was performed at a room temperature of 73F and humidity of 40%. All patients were asymptomatic before the study and were given short-acting inhaled beta2-agonists as rescue medication, which was not administered during the 12 previous hours to the test. Data analysis was made by means of descriptive statistic. RESULTS: Thirty-three children aged 8-16 years with diagnosis of asthma were studied, with an average age of 12.5 years; 42.4% were female and 57.5% male. Of the 33 patients, 6 had (18.2%) a 15% fall in FEV1 after exercise; 50% of these patients showed exercise-induced mild asthma, 33% moderate and 17% severe. At the end of the test, in six patients (100%) FEV1 increased by 15%, five minutes after the administration of a beta2-agonist. CONCLUSIONS: Exercise-induced asthma is frequent among asthmatic pediatric patients, occurring in 18.8% of this study. Likelihood of having exercise-induced asthma must be deliberately investigated in all asthmatic patients, in order to establish an opportune diagnosis of this condition and provide recommendations of preventing therapy.

[Assessment of an educational course on asthma for primary care physicians]. / Evaluación de un curso de educación en asma para médicos del primer nivel de atención.

BACKGROUND: The Global Initiative for Asthma (GINA) is a collaborative effort to disseminate updated guidelines about the diagnosis and management of patients that suffer from asthma. Implementation of these guidelines by the primary care practitioners reduces the morbidity of these patients. OBJECTIVE: To evaluate the efficacy of a training course of asthma on the knowledge of the primary care physicians. PATIENTS AND METHODS: Sixty physicians were evaluated before and after a lecture-based educational intervention on asthma. The overall score and per-topic subscores were compared. Likewise, differences among physicians from distinct specialties were assessed. The correlation between perceived and actual usefulness was calculated. RESULTS: The mean score before the training course was of 65.76 (SD = 11.95) points, and after the course of 84.87 (SD = 9.27) points; p < 0.0001. The mean improvement percentage was of 34.48% for the overall score, 41.47% for general knowledge, 47.57% for diagnosis and 28.4% for treatment. Improvement had no relation with physician's specialty. The correlation between perceived and actual usefulness was of -0.005 (p > 0.05) for the absolute score change and 0.025 (p>0.05) for the percentage change. CONCLUSIONS: A short lecture-based training course of asthma increases the knowledge of bronchial asthma and GINA guidelines among primary health care physicians. Differences among physicians of distinct specialties were not significant.