[Treatment for living with food allergy]. / Tratamiento en pacientes con alergia alimentaria.

The treatment of food allergy involves completely removing the allergenic food from the diet, careful label reading, and ingredient awareness. Family education is crucial, understanding alternative names for the allergen. An emergency action plan provided by the doctor, with clear instructions for epinephrine application and when to seek medical attention, is essential. For mild to moderate symptoms, oral antihistamines may be prescribed. Psychological support is necessary due to emotional repercussions. Collaboration with an allergy specialist is crucial for personalized treatment. Natural tolerance to the food may be achieved, especially in non-IgE-mediated allergies. However, some allergic manifestations persist, requiring treatment alternatives. Avoidance of the allergen and epinephrine application are key measures. Immunotherapy aims to desensitize immune cells, but its effectiveness varies. Bioterapeutic agents, such as monoclonal antibodies, are under investigation, although their clinical use still requires more studies.

El tratamiento de la alergia alimentaria implica la completa eliminación del alimento alergénico de la dieta, lectura minuciosa de etiquetas y conciencia sobre ingredientes. La educación familiar es crucial, comprendiendo los nombres alternativos del alérgeno. Se debe contar con un plan de acción de urgencia proporcionado por el médico, con instrucciones claras para la aplicación de epinefrina y cuándo buscar atención médica. Para síntomas leves a moderados, se pueden recetar antihistamínicos. El apoyo psicológico es esencial debido a las repercusiones emocionales. La colaboración con un especialista en alergias es crucial para un tratamiento personalizado. La tolerancia natural al alimento puede lograrse, especialmente en alergias no mediadas por IgE. Sin embargo, algunas manifestaciones alérgicas persisten, requiriendo alternativas de tratamiento. La evitación del alergeno y la aplicación de epinefrina son medidas clave. La inmunoterapia busca desensibilizar las células inmunológicas, pero su efectividad varía. Los agentes bioterapéuticos, como anticuerpos monoclonales, se investigan, aunque su uso clínico aún requiere más estudios.

[Clinical-epidemiological profile of patients with suspicion of alimentary allergy in Mexico. Mexipreval Study]. / Perfil clínico-epidemiológico de pacientes con sospecha de alergia alimentaria en México. Estudio Mexipreval.

BACKGROUND: Adverse reaction to food has increased around the world in last years. Prevalence of food allergy raises between 2-4% in adults, and 6-8% in children. The clinical presentation is heterogeneous and varies from mild symptoms to anaphylactic reactions. Even the clinical history focused in the food is important; demonstration of allergen sensitization is mandatory. OBJECTIVE: To describe the profile of the patients with suspicion of food allergy and the regular clinical practice followed in Mexico. MATERIAL AND METHOD: An observational, descriptive, cross-sectional study was carried out from March 2013 to March 2014 using a convenience sample of allergic patients who were treated in the office, both private and public, of those physicians who seen food allergy patients. RESULTS: Clinical, epidemiological, diagnostic and therapeutic data were collected from 1,971 suspicious food allergic patients presenting for the first time in the departments of the researchers involved in the study. No difference was found in relation to gender. In relation to age, a bimodal distribution, with peaks at 2 and 35 years old, was found. A history of respiratory allergy was present in 75% of cases; 80% of patients had had any previous symptoms before seeking consultation and the most frequent clinical manifestations were cutaneous, 5% reported anaphylaxis. CONCLUSION: The foods involved in reactions change with age. The clinical presentation changes with the food, although the skin is the most frequently affected organ. Even if the suspicious were high, the confirmation with specific diagnostic tools is strongly recommended.

Antecedentes: las enfermedades alérgicas asociadas con alimentos se incrementan anualmente. Tienen una prevalencia de 2 a 4% en adultos y de 6 a 8% en niños. El cuadro clínico varía de síntomas leves hasta reacciones anafilácticas. El diagnóstico se basa en la historia clínica, pero debe demostrarse evidencia de sensibilización específica para el alergeno. Objetivo: conocer el perfil clínico-epidemiológico de los pacientes con sospecha de alergia alimentaria vistos en consultorios médicos (alergólogos y no alergólogos), así como la conducta diagnóstica y tratamiento habitual. Material y método: estudio observacional, transversal y descriptivo, efectuado en consultorios de médicos que atienden pacientes con alergia alimentaria en la República Mexicana durante un año natural de abril de 2013 a marzo de 2014, mediante un muestreo por conveniencia. Resultados: se realizaron 1,971 encuestas. No se encontró diferencia en relación con el género. En relación con la edad, se reportó una distribución bimodal, con picos a los 2 y 35 años de edad. Había antecedente de alergia respiratoria en 75% de los casos. El 80% de los pacientes tuvo algún síntoma antes de buscar atención y las manifestaciones clínicas más frecuentes afectaron la piel (57.1%). El 5% refirió haber padecido al menos un evento de anafilaxia. Conclusión: el tipo de alimento implicado cambia con la edad. La forma de manifestación clínica más frecuente fue la cutánea, pero varía con el tipo de alimento. Aun cuando la sospecha clínica sea alta, deben utilizarse métodos específicos que confirmen el diagnóstico.

[Guía latinoamericana para el diagnóstico y tratamiento de alergia a las proteínas de la leche de vaca (GL-APLV)].

Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.

[Mexican clinical practice guidelines of immunotherapy 2011]. / Guía Mexicana de Práctica Clínica de Inmunoterapia 2011.

BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. OBJECTIVES: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. METHODS: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE. RESULTS: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions. CONCLUSIONS: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence. KEYWORDS: Allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, skin testing, allergy diagnosis, rhinitis, asthma, atopic dermatitis, house dust mite, pollens, anaphylaxis, adrenaline, Mexico.