[Pruebas diagnósticas in vivo en alergia inmediata a penicilina: estudio piloto].

Background: The most commonly reported antibiotic allergy is penicillin. The false label of "allergy" to penicillin negatively affects the patient's quality of life and medical care. Objective: To determine the frequency of allergy to penicillin and amoxicillin by in vivo exposure tests in patients with a history of immediate reaction to this class of medicinal products. Methods: Observational, cross-sectional, descriptive and prolective study in patients between 12 and 60 years of age with a history of immediate reaction to penicillin and/or amoxicillin. Prick and intradermal skin tests were performed with benzylpenicilloyl polylysine (Pre-Pen), penicillin G and oral challenge test with amoxicillin. The frequency of positivity and negativity in these tests was calculated with a 95% CI. Results were analyzed in Epi info 7.2.5.0. Results: In total 13 patients (10 women) were included, with a mean age of 39 years (SD 12.14). In 84.6% the last adverse drug reaction occurred 10 years ago and in all manifested with urticaria. The 38.4% confirmed penicillin allergy and the most frequent adverse reaction after in vivo tests was pruritus. Conclusions: The clinical history alone is not sufficient, all patients with suspected penicillin allergy should be evaluated by in vivo exposure tests with major and minor determinants to corroborate or rule out allergy to this pharmacological class.

Antecedentes: La alergia a antibióticos notificada con más frecuencia es la penicilina. La falsa etiqueta de "alergia" a la penicilina afecta negativamente la calidad de vida del paciente y la atención médica. Objetivo: Determinar la frecuencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes con antecedente de reacción inmediata a esta clase de medicamentos. Métodos: Estudio observacional, transversal, descriptivo y prolectivo en pacientes entre 12 y 60 años con antecedente de reacción inmediata a penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, y prueba de reto oral con amoxicilina. La frecuencia de positividad y negatividad en estas pruebas fue calculado con un IC del 95%. Los resultados se analizaron en Epi info 7.2.5.0. Resultados: Se incluyeron 13 pacientes (10 mujeres), con una media de edad de 39 años (DE 12.14) y diagnóstico predominante de rinitis alérgica (61,5%). En 84,6% de casos la última reacción adversa a medicamentos ocurrió 10 años atrás y en todos se manifestó con urticaria. Sólo en cinco pacientes (38,4%) se corroboró alergia a penicilina y la reacción adversa más frecuente tras las pruebas in vivo fue prurito (23 %). Conclusiones: La historia clínica por sí sola no es suficiente, todos los pacientes con sospecha de alergia a penicilina deben ser evaluados mediante pruebas de exposición in vivo con los determinantes mayores y menores para corroborar o descartar alergia a esta clase farmacológica.

[Diagnóstico de alergia inmediata para penicilina: estudio piloto].

Objectives: To confirm the presence of allergy to penicillin and amoxicillin by in vivo exposure tests in patients with a history of immediate reaction to these drugs. Methods: Observational, cross-sectional, descriptive and prolective study. Patients between 12 and 60 years old with a history of immediate reaction after administration of penicillin and/or amoxicillin were included. Skin prick and intradermal tests were performed with benzylpenicilloyl polylysine and penicillin G, as well as oral challenge with amoxicillin. Results: Ten female and 3 male patients were included. The mean age was 39 years. In 84.6% of the cases the last adverse drug reaction occurred 10 years ago and in all cases it manifested with urticaria. Allergy to penicillin was corroborated in only 38.4% of cases. The most frequent adverse reaction after in vivo exposure tests was pruritus in 23%. Conclusions: Patients with suspected penicillin allergy should be evaluated by in vivo exposure testing with major and minor determinants to corroborate or rule out allergic reactions and improve treatment conditions.

Objetivos: Confirmar la presencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes que refieren antecedente de reacción inmediata con estos medicamentos. Métodos: Estudio observacional, transversal, descriptivo y prolectivo. Se incluyeron pacientes entre 12 y 60 años con antecedente de reacción inmediata tras administración de penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, así como desafío oral con amoxicilina. Resultados: Se incluyeron 10 pacientes femeninos y 3 masculinos. La edad promedio fue 39 años. En 84,6% de los casos la última reacción adversa a medica- mentos ocurrió 10 años atrás y en todos los casos se manifestó con urticaria. Sólo en el 38,4% se corroboró alergia a penicilina. La reacción adversa más frecuen- te, tras las pruebas de exposición in vivo fue prurito en el 23%. Conclusiones: Los pacientes con sospecha de alergia a penicilina se deben evaluar mediante pruebas de exposición in vivo con los determinantes mayores y menores, para corroborar o descartar reacciones alérgicas y mejorar las condiciones de tratamiento.

[Vitamin D and respiratory allergy: state of the art]. / Vitamina D y alergia respiratoria: estado del arte.

An increasing number of studies are analyzing the relationship between serum vitamin D levels and the development of sensitization and allergic diseases in genetically predisposed individuals, as well as the impact of vitamin D supplementation. This article reviews the literature on this subject. Clinical trials, meta-analyses and systematic reviews consulted in PubMed, EMBASE, Scopus, Ovid, Wiley Online Library, Springer, Cochrane and manual resources were included, with the keywords: vitamin D, 25 hydroxyvitamin D, cholecalciferol, asthma, rhinitis, allergy, 25-OH-D, 1,25 hydroxyvitamin D, supplementation. The results show a positive linear trend, however, differ. We should keep in mind that in the studies there is heterogeneity of population groups and associated factors, which may modify such studies. It is necessary to increase research to clarify this relationship and to have successful interventions from the patient's approach to the strengthening of pharmacological and immunological treatment of allergic patients with these diseases.

Cada vez son más los trabajos que analizan la relación de los niveles séricos de vitamina D y el desarrollo de sensibilizaciones y enfermedades alérgicas en los individuos con predisposición genética, así como el impacto de su suplementación. El presente artículo efectúa una revisión de la literatura acerca de este tema. Se incluyeron ensayos clínicos, metaanálisis y revisiones sistemáticas consultadas en PubMed, EMBASE, Scopus, Ovid, Wiley Online Library, Springer, Cochrane y recursos manuales, con las palabras clave: vitamina D, 25 hidroxivitamina D, colecalciferol, asma, rinitis, alergia, 25-OH-D, 1,25 hidroxivitamina D, suplementación. Los resultados muestran una tendencia lineal positiva; sin embargo, algunos difieren. Debemos tener en mente que en los estudios existe heterogeneidad de los grupos poblacionales y los factores asociados, lo que puede modificarlos. Es necesario incrementar las investigaciones para clarificar esta relación y tener intervenciones exitosas desde el abordaje del paciente hasta el fortalecimiento del tratamiento farmacológico e inmunológico de los pacientes alérgicos con estas enfermedades.

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort.

BACKGROUND: The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes. METHODS: The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. RESULTS: During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. CONCLUSION: Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines.

BACKGROUND: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. METHODS: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. RESULTS: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. CONCLUSIONS: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.

[The effectiveness and safety of subcutaneous immunotherapy for inhalable allergens in patients with respiratory allergies after one year of treatment]. / Eficacia y seguridad de la inmunoterapia subcutánea para alérgenos inhalables en pacientes con alergia respiratoria a un año de tratamiento.

BACKGROUND: Allergen-specific immunotherapy is an important therapeutic modality for the management of allergic rhinitis and allergic asthma. OBJECTIVE: To assess the effectiveness and safety of allergen-specific subcutaneous immunotherapy in patients with respiratory allergies at the University Hospital of Puebla after twelve months of treatment. METHODS: A longitudinal, sequential, analytic, quasi-experimental, prolective study. The study was carried out for twelve months with patients of both sexes, aged four to sixty-five years, diagnosed with asthma and/or rhinitis, and with sensitization to aeroallergens. The CARAT and Portnoy questionnaires were collected every two months in order to assess the effectiveness and safety respectively. RESULTS: 47 patients were included: 37 (78.7 %) of them were female. The average age was 29.8 years. 76.6 % of them were diagnosed with allergic rhinitis, and 23.4 % of them were diagnosed with both asthma and allergic rhinitis. The comparison of averages of the initial CARAT questionnaire against the final average by means of a student's t-test showed a t-value of -8.86 and a p-value of < 0.05. A total frequency of local adverse reactions of 19 % and systemic adverse reactions of 2.1 % was reported after 6 and 12 months of treatment. CONCLUSIONS: The assessed scheme of immunotherapy, derived from the Mexican clinical practice guidelines of immunotherapy 2011, is effective with a desirable safety profile.

Antecedentes: La inmunoterapia específica con alérgenos es una importante modalidad terapéutica para el manejo de la rinitis y asma alérgica. Objetivo: Evaluar la eficacia y seguridad de la inmunoterapia subcutánea con alérgenos en pacientes con alergia respiratoria del Hospital Universitario de Puebla posterior a 12 meses de tratamiento. Métodos: Estudio longitudinal, secuencial, analítico, cuasiexperimental, prolectivo. Durante 12 meses se incluyeron pacientes con asma o rinitis, sensibilizados a aeroalérgenos, de cuatro a 65 años y de ambos sexos; bimensualmente se recolectaron los cuestionarios CARAT y Portnoy para evaluar la eficacia y seguridad, respectivamente. Resultados: Se incluyeron 47 pacientes, 37 (78.7 %) mujeres. La edad promedio fue de 29.8 años. El 76.6 % tuvo diagnóstico de rinitis alérgica y 23.4 % de asma y rinitis alérgica. Al comparar el promedio del CARAT inicial contra el promedio final mediante prueba de t de Student se obtuvo un valor de ­8.86 y p < 0.05. Se reportó una frecuencia total de reacciones adversas locales de 19 % y de reacciones adversas sistémicas de 2.1 % a los seis y 12 meses del tratamiento. Conclusiones: El esquema de inmunoterapia evaluado, derivado de la Guía Mexicana de Práctica Clínica de Inmunoterapia 2011, es eficaz con un conveniente perfil de seguridad.

[The effectiveness and safety of subcutaneous immunotherapy for inhalable allergens in patients with respiratory allergies]. / Eficacia y seguridad de la inmunoterapia subcutánea para alérgenos inhalables en pacientes con alergia respiratoria.

BACKGROUND: Specific immunotherapy is a treatment aimed at modifying the course of the allergic disease, with which important immunological and clinical changes are achieved. OBJECTIVE: To assess the effectiveness and safety of subcutaneous immunotherapy in patients diagnosed with respiratory allergies in the University Hospital of Puebla, Mexico. METHODS: A longitudinal, analytic, quasi-experimental study. The study was carried out with patients aged four to sixty-five years, diagnosed with allergic rhinitis or asthma, with sensitization to aeroallergens, in whom immunotherapy was started. For the effectiveness assessment, the Control of Allergic Rhinitis and Asthma Test (CARAT) was used. Safety was assessed through Portnoy's Questionnaire Survey of Adverse Reactions. RESULTS: 59 patients were included: 72.9% were female; 23.7% of them were diagnosed with allergic rhinitis and asthma, and 76.3% were diagnosed with allergic rhinitis. The comparison of averages of the CARAT questionnaire at the beginning of the treatment and after four months of follow up showed a statistically significant positive development. An incidence of adverse local reactions of 9.03% was found; no adverse systemic reactions were reported. CONCLUSIONS: The assessed scheme of subcutaneous immunotherapy got to significantly decrease the asthma symptoms and AR symptoms, with a desirable safety profile.

Antecedentes: La inmunoterapia específica es un tratamiento orientado a modificar el curso de la enfermedad alérgica y con la que se han logrado importantes cambios inmunológicos y clínicos. Objetivo: Evaluar eficacia y seguridad de la inmunoterapia subcutánea en pacientes con diagnóstico de alergia respiratoria en el Hospital Universitario de Puebla, México. Métodos: Estudio longitudinal, analítico, cuasiexperimental. Se incluyeron pacientes de cuatro a 65 años con diagnóstico de asma o rinitis alérgica, con sensibilización a aeroalérgenos, que iniciaron tratamiento con inmunoterapia. Para la valoración de la eficacia se utilizó el cuestionario Control of Allergic Rhinitis and Asthma Test (CARAT). La seguridad se evaluó mediante el cuestionario de reacciones adversas de Portnoy. Resultados: Se incluyeron 59 pacientes, 72.9 % fueron mujeres; 23.7 % con diagnóstico de rinitis alérgica y asma y 76.3 % con diagnóstico de rinitis alérgica. La comparación de promedios del cuestionario CARAT al inicio del tratamiento y a los cuatro meses de seguimiento mostró evolución favorable estadísticamente significativa. Se encontró una incidencia de reacciones adversas locales de 9.03 %; no se reportaron reacciones adversas sistémicas. Conclusiones: El esquema de inmunoterapia subcutánea evaluado logra disminuir significativamente los síntomas del asma y la rinitis alérgica, con un conveniente perfil de seguridad.

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]. / GUIMIT 2019, Guía Mexicana de Inmunoterapia. Guía de diagnóstico de alergia mediada por IgE e inmunoterapia aplicando el método ADAPTE.

BACKGROUND: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.

Antecedentes: En México, la inmunoterapia con alérgenos (ITA) y con veneno de himenópteros (VIT) se practica tradicionalmente combinando criterios de las escuelas europea y estadounidense; los dos tipos de extractos están comercialmente disponibles en México. Para una ITA adecuada es crucial un diagnóstico oportuno. Objetivo: Presentar GUIMIT 2019, Guía Mexicana de Inmunoterapia 2019, de base amplia, actualizada, que abarca temas de diagnóstico, indicaciones, dosificación, mecanismos, efectos adversos de la ITA y expectativas con esta modalidad de tratamiento. Método: Con la participación de múltiples grupos mexicanos de alergólogos, que incluían los centros formadores universitarios en alergia e inmunología, se desarrolló el documento de la guía según la metodología ADAPTE. Las guías de inmunoterapia de la European Academy of Allergy and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology, German Society for Allergology and Clinical Immunology y del American College of Allergy, Asthma, and Immunology se seleccionaron como guías fuente, ya que recibieron la puntuación AGREE-II más alta entre las guías internacionales disponibles; su evidencia conforma la base científica de GUIMIT 2019. Resultados: En GUIMIT 2019 se emiten recomendaciones fuertes o débiles (sugerencias) acerca de temas directamente relacionados con el diagnóstico in vivo o in vitro de las enfermedades alérgicas mediadas por IgE, la preparación y aplicación de ITA o VIT y sus efectos adversos; se incluye la revisión de las modalidades de ITA para el futuro. Todos los argumentos que se exponen fueron discutidos y votados con > 80 % de aprobación. Conclusión: Un grupo amplio y diverso de expertos en ITA y VIT emitió recomendaciones transculturizadas basadas en evidencia, que alcanzaron consenso; con ellas se pretende mejorar y homologar la práctica de la inmunoterapia en México.

[Sensitivity and specificity of the modified epicutaneous patch test in the diagnosis of respiratory allergy to Dermatophagoides pteronyssinus]. / Sensibilidad y especificidad de la prueba epicutánea modificada en el diagnóstico de alergia respiratoria a Dermatophagoides pteronyssinus.

BACKGROUND: The skin prick test is recognized as the gold standard for the specific diagnosis of allergy. OBJECTIVE: To determine the sensitivity and specificity of the epicutaneous patch test that has been modified for the diagnosis of respiratory allergy to Dermatophagoides pteronyssinus. METHODS: An observational, interpretative, prolective, and transversal study. The included patients were between 6 and 49 years old, with symptoms of a respiratory allergy, and a skin test was performed on them by using the European standardized prick test and a modified epicutaneous patch test with the variable of the scarification that occurred before the antigen was applied, and its homogenization with a wooden applicator, which occurred after the antigen was applied. The levels of sensitivity, specificity, and prevalence influence and positive and negative predictive values were calculated. RESULTS: 104 patients were included, of which 72 (69.2%) were women. The age category of the patients was 24 ± 11.3 years of age. 78.9% of the patients were diagnosed with allergic rhinitis, 1.9% were diagnosed with asthma, and 19.2% were diagnosed with both rhinitis and asthma. The prevalence of the respiratory allergy to Dermatophagoides pteronyssinus was of 62.5%; 94.23% with a correct diagnosis. The sensitivity and specificity of the test was of 93.85% and 94.87%; the positive and negative predictive values were of 96.83% and 90.24%, and the positive and negative likelihood ratios were of 18.30 and 0.06. CONCLUSIONS: The modified epicutaneous patch test was highly sensitive and specific; it decreased the risk of allergen carryover and it lowered the cost of the material that was used.

Antecedentes: La prueba por punción cutánea es el estándar de oro en el diagnóstico específico de alergia. Objetivo: Determinar sensibilidad y especificidad de la prueba epicutánea modificada para el diagnóstico de alergia respiratoria a Dermatophagoides pteronyssinus. Métodos: Estudio observacional, interpretativo, prolectivo y transversal. Se incluyeron pacientes de seis a 49 años de edad, con cuadro clínico de alergia respiratoria, en quienes se realizó punción cutánea con técnica europea y prueba epicutánea con la variante de escarificación previa a la aplicación del antígeno y posterior homogenización del mismo con aplicador de madera. Se calculó sensibilidad, especificidad, influencia de la prevalencia, valores predictivos positivo y negativo. Resultados: Se incluyeron 104 pacientes, 72 (69.2 %) del sexo femenino. La edad fue de 24 ± 11.3 años, 78.9 % tuvo diagnóstico de rinitis alérgica, 1.9 % de asma y 19.2 % de rinitis y asma. La prevalencia de alergia respiratoria a Dermatophagoides pteronyssinus fue de 62.5 %; 94.23 % estaba correctamente diagnosticado. La sensibilidad y especificidad de la prueba fue de 93.85 y 94.87 %, los valores predictivos positivo y negativo de 96.83 y 90.24 % y los cocientes de probabilidades positivo y negativo de 18.30 y 0.91. Conclusiones: La prueba epicutánea modificada fue altamente sensible y específica, disminuyó el riesgo de contaminación por arrastre de alérgenos y los costos en el material utilizado.

[Frequency of skin reactivity to food allergens in allergic patients]. / Frecuencia de reactividad cutánea hacia alérgenos alimentarios en pacientes alérgicos.

BACKGROUND: Food allergy is deemed to have a worldwide prevalence ranging from 2 to 10 %. OBJECTIVE: To determine the frequency of skin reactivity to food allergens by age groups. METHODS: Cross-sectional, descriptive, prolective, observational study. Patients aged from 2 to 64 years with symptoms consistent with allergic disease were included. Skin prick tests were carried out with food allergens. Frequencies and percentages were estimated. RESULTS: One-hundred and ninety-one patients were included, out of which 63.4% were females. Mean age was 22.5 years; 19.3 % showed positive skin reactivity to at least one food. Distribution by age group was as follows: preschool children 13.5 %, schoolchildren 24.3 %, adolescents 2.7 % and adults 59.5 %. Diagnoses included allergic rhinitis in 84.3 %, asthma in 19.4 %, urticaria in 14.1 % and atopic dermatitis in 8.4 %. Positive skin reactivity frequency distribution in descending order was: soybeans with 5.2 %, peach with 4.7 %, grapes, orange and apple with 3.6 %, nuts with 3.1 %, pineapple, avocado, tomato and tuna with 2.6 %. CONCLUSION: The frequency of skin reactivity to food allergens was similar to that reported in the national and Latin American literature, but sensitization to each specific allergen varied for each age group.

Antecedentes: Se considera que la alergia alimentaria tiene una prevalencia mundial de 2 a 10 %. Objetivo: Determinar la frecuencia de reactividad cutánea hacia alérgenos alimentarios por grupos de edad. Métodos: Estudio observacional, descriptivo, transversal y prolectivo. Se incluyeron pacientes de 2 a 64 años de edad con cuadro compatible de enfermedad alérgica. Se efectuaron pruebas por punción cutánea con alérgenos alimentarios. Se estimaron frecuencias y porcentajes. Resultados: Se incluyeron 191 pacientes, 63.4 % fue del sexo femenino. La edad promedio fue 22.5 años; 19.3 % mostró reactividad cutánea positiva al menos a un alimento. La distribución por grupo etario fue la siguiente: preescolares 13.5 %, escolares 24.3 %, adolescentes 2.7 % y adultos 59.5 %. Los diagnósticos fueron rinitis alérgica 84.3 %, asma 19.4 %, urticaria 14.1 % y dermatitis atópica 8.4 %. La distribución de la frecuencia de reactividad cutánea positiva en orden descendente fue 5.2 % a soya, 4.7 % a durazno, 3.6 % a uva, naranja y manzana, 3.1 % a nuez y 2.6 % a piña, aguacate, tomate y atún. Conclusión: La frecuencia de reactividad cutánea para alérgenos alimentarios fue similar a la informada en la literatura nacional y latinoamericana, pero la sensibilización para cada alérgeno específico varió en cada grupo etario.

[Skin reactivity frequency to aeroallergens in patients with clinical symptoms of allergic disease]. / Frecuencia de reactividad cutánea hacia antígenos inhalables en pacientes con cuadro clínico de enfermedad alérgica.

BACKGROUND: Allergic diseases diagnosis must be based on adequate allergological anamnesis and an immunological sensitization test; the most sensitive and specific is the skin prick test. OBJECTIVE: To determine the frequency of skin reactivity to aeroallergens, by age groups, in patients of the Department of Allergy and Clinical Immunology of the Hospital Universitario de Puebla, in Mexico. METHODS: A cross-sectional study was conducted that included patients aged 2 to 64 years with symptoms suggestive of allergic disease, in which skin prick tests with aeroallergens were performed; the diagnostic criteria were those of international guidelines. Frequencies, percentages and dispersion measures were calculated. RESULTS: Of 173 patients, 63 % were females. Mean age was 22.3 years. The frequency of skin reactivity for Quercus sp. was 12.72 %, for Periplaneta americana, 9.83 %, for Dermatophagoides farinae, 9.25 %, for Cynodon dactylon, 8.09 %, for Blatella germanica, 8.09 %, for Holcus halepensis, 6.94 %, for Dermatophagoides pteronyssinus, 6.36 %, for Schinus molle, 5.78 %, for Fraxinus uhdei, 5.20 %, for Lolium perenne, 5.20 %, for Ambrosia eliator, 5.20 % and for Artemisa tridentata, 4.62 %. CONCLUSION: Although Dermatophagoides are the most frequently reported aeroallergens, the most common aeroallergen in this study was pollen, probably owing to geographical and environmental factors, although this was not observed in the analysis by age groups.

Antecedentes: El diagnóstico de las enfermedades alérgicas debe basarse en la historia clínica alergológica adecuada y en una prueba inmunológica de sensibilización; la de mayor sensibilidad y especificidad es la prueba cutánea por punción. Objetivo: Determinar la frecuencia de la reactividad cutánea hacia aeroalérgenos, por grupos etarios, en pacientes del Servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla, México. Métodos: Se realizó estudio transversal que incluyó a pacientes de 2 a 64 años de edad, con síntomas sugestivos de enfermedad alérgica, en quienes se realizaron pruebas cutáneas con aeroalérgenos; los criterios diagnósticos fueron los de las guías internacionales. Se calcularon frecuencias, porcentajes y medidas de dispersión. Resultados: De 173 pacientes, 63 % fue del sexo femenino. La edad media fue de 22.3 años. La frecuencia de la reactividad cutánea para Quercus sp. fue 12.72 %, Periplaneta americana 9.83 %, Dermatophagoides farinae 9.25 %, Cynodon dactylon 8.09 %, Blatella germanica 8.09 %, Holcus halepensis 6.94 %, Dermatophagoides pteronyssinus 6.36 %, Schinus molle 5.78 %, Fraxinus uhdei 5.20 %, Lolium perenne 5.20 %, Ambrosia eliator 5.20 % y Artemisa tridentata 4.62 %. Conclusión: Los Dermatophagoides son los aeroalérgenos más identificados, pero en el presente estudio fue más común un polen, probablemente debido a factores geográficos-medioambientales, aunque no fue así en el análisis por grupos etarios.

The international survey on the management of allergic rhinitis by physicians and patients (ISMAR).

Epidemiologic studies suggest that the prevalence of allergic rhinitis (AR) is rising worldwide. Several reports, in fact, indicate increasing trends in the prevalence of AR especially in developing countries, likely related to the environment and climate changes and the adoption of an urbanized Western lifestyle. The primary objective of the present study was to collect information about management in real-life settings, including a characterization of typical patients' profile referring to physicians, the disease features, the common approaches to diagnostic assessments and therapeutic decisions. This was an international, multicenter, cross-sectional study conducted in adults or children (≥6 years) suffering from rhinitis confirmed by physician's diagnosis for at least one year. The 234 physicians who participated in the study included a total of 2778 patients in Egypt, Mexico, Brazil, Colombia, Guatemala, Iran, Venezuela, Argentina, Israel, Kuwait and United Arab Emirates. It was found that clinical history was the selected tool to diagnose and categorize AR patients (97.1%), with less than half of patients undergoing allergy testing, may be explaining the scarce use of immunotherapy on management of disease. Out of 2776 patients, 93.4% had somehow received a recommendation to avoid allergens and irritant agent exposure. Notably, 91.4% were receiving at least one treatment at the time of the survey, mostly oral antihistamines (79.7%) and intranasal corticosteroids (66.3%). Oral antihistamines, intranasal steroids and decongestants were considered both safe and effective by patients and physicians, preferring oral and nasal route of administration. The ISMAR registry was designed according to the most accepted epidemiological recommendations, and provides interesting information regarding the management of rhinitis from a patient and physician points of view, with many similarities between the participating countries. Further efforts are required to better manage AR and its comorbidities.

[Correlation between the magnitude of skin prick test reactivity and pollen-specific serum IgE levels in patients with respiratory allergy]. / Correlación entre la magnitud de la reactividad cutánea por punción y las concentraciones de IgE sérica específica a pólenes en pacientes con alergia respiratoria.

BACKGROUND: For the etiological diagnosis of allergic respiratory diseases skin tests or specific serum IgE determination are used. OBJECTIVE: To determine the correlation between the extent of reactivity to cutaneous prick tests and the levels of pollen specific serum IgE in patients with respiratory allergy. PATIENTS AND METHODS: A prolective, descriptive and transversal study was done with patients of both genders, aged 2 to 60 years, who attended for the first time at the service of Allergy and Clinical Immunology of University Hospital of Puebla, Mexico, with presumptive diagnosis of respiratory allergy. All patients underwent clinical history, skin prick tests with standardized allergenic extracts and quantification of pollen specific serum IgE by chemiluminescence method. We estimated the correlation index r using the statistical method Pearson product-moment correlation coefficient; a value r equal to or higher than 0.70 was considered a significant relationship or a high correlation. RESULTS: Nine-one patients were included, of whom 58.2% were female. The diagnoses were: allergic rhinitis (79.1%), asthma and allergic rhinitis (16.5%) and only asthma (4.4%). Only significant correlation was found in patients with allergic rhinitis for Rumex crispus (r = 0.702) and in patients with asthma and rhinitis for Ambrosia trifida (r = 1). CONCLUSION: Only for Rumex crispus and Ambrosia trifida, the skin prick tests or the determination of specific serum IgE levels are comparable diagnostic methods of allergic respiratory diseases.

ANTECEDENTES: para el diagnóstico etiológico de las enfermedades alérgicas respiratorias se realizan pruebas cutáneas o determinación de IgE sérica específica. OBJETIVO: determinar la correlación entre la magnitud de la reactividad a las pruebas cutáneas por punción y las concentraciones de IgE séricaespecífica para pólenes en pacientes con alergia respiratoria. PACIENTES Y MÉTODOS: estudio prolectivo, descriptivo y transversal efectuado en pacientes de uno y otro sexo, con edades de 2 a 60 años, que acudieron por primera vez al servicio de Alergia e Inmunología Clínica del Hospital Universitario de Puebla con diagnóstico presuntivo de alergia respiratoria. A todos los pacientes se les realizó historia clínica, pruebas cutáneas por punción con extractos alergénicos estandarizados y cuantificación de IgE sérica específica para pólenes por método de quimioluminiscencia. Se estimó el índice de correlación r con el método estadístico coeficiente de correlación producto-momento de Pearson, un valor de r igual o mayor de 0.70 se consideró una relación notable o una correlación elevada. RESULTADOS: se incluyeron 91 pacientes, 58.2% eran mujeres. Los diagnósticos fueron: rinitis alérgica (79.1%), asma y rinitis (16.5%) y únicamente asma (4.4%). Sólo se encontró una correlación significativa en pacientes con rinitis alérgica para Rumex crispus (r = 0.702) y en pacientes con asma y rinitis para Ambrosia trifida (r = 1). CONCLUSIÓN: sólo para Rumex crispus y Ambrosia trifida, las pruebas epicutáneas o la determinación de las concentraciones de IgE sérica específica son métodos equiparables en el diagnóstico etiológico de la alérgica respiratoria.

[Prevalence of Cutaneous Reactivity to an Allergenic Extract of Mus musculus in Patients with Allergic Rhinitis and Asthma]. / Prevalencia de reactividad cutánea a un extracto alergénico de Mus musculus en pacientes con rinitis alérgica y asma.

BACKGROUND: A high prevalence of sensitization to antigen Mus musculus (mouse) in patients with allergic respiratory diseases has been reported worldwide. OBJETIVE: To determine the prevalence of skin reactivity to the Mus musculus antigen in patients with asthma and allergic rhinitis in the Department of Allergy and Clinical Immunology, Hospital Universitario de Puebla. METHODS: We conducted a cross-sectional, observational, prospective and descriptive study in patients of both genders, from 2 to 58 years old. All patients were attending the hospital for the first time, in a period of 6 months with the diagnoses of asthma, allergic rhinitis, or both. Each patient underwent skin prick test with epithelial antigen Mus musculus. Data were analyzed with SPSS-Statistics software, version 18. RESULTS: We included 110 patients, 50% were women, mean age was 24.1 years (SD 16.2); 92.7% were from urban areas and the rest from rural areas. The overall prevalence of skin reactivity to the antigen tested was 1.8%; corresponding to patients with allergic rhinitis 2.4% and the remaining subgroups showed no reactivity. One of the three patients with positive skin tests worked in an animal laboratory, exposed to Mus musculus. CONCLUSIONS: We found a low prevalence of positive skin tests with mouse antigen. However, in patients with respiratory allergy symptoms and a strong exposure to mice or rodents we suggest to perform skin tests with mice allergen extracts.

[Correlation of cutaneous reactivity between allergenic extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae with Blomis tropicalis in patients with allergic rinitis and asthma]. / Correlación de reactividad cutánea entre extractos alergénicos de Dermatophagoides pteronyssinus y Dermatophagoides farinae, con Blomia tropicalis en pacientes con rinitis alérgica y asma.

BACKGROUND: There are documented molecular homologies between mites from the same group, but intergroup characteristics are not. Although mites share the same taxonomic order, there are species antigenically distinct. At the present we dont know clearly the differences in cutaneous reactivity among several house dust mites species. OBJETIVE: to estimate the correlation of skin reactivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae antigens with that of Blomia tropicalis in patients with allergic rhinitis and asthma. METHODS: a cross sectional, observational, prolective and interpretive study was performed in patients of both genders, aged 2 to 58 with allergic rhinitis and asthma. All patients underwent skin prick tests with allergenic extracts. RESULTS: One hundred and ten patients were included, with an age average of 24.1 years; 50% were males. There were positive skin tests with mites in 59% of the patients, 24.5% for Blomia t; 10% for D. pteronyssinus plus Blomia t. and 7.29% for D. farinae plus Blomia t. The correlation of the skin reactivity between Dermatophagoides pteronyssinus and Blomia tropicalis (r= 0.36) and between Dermatophagoides farinae and Blomia tropicalis (r= 0.27), was not significant in both cases. CONCLUSIONS: We found that most patients with allergic rhinitis and asthma showed positive skin tests with the mite extracts tested. There is a weak correlation between both species of Dermatophagoides and Blomia tropicalis.

[Impact of the integral allergological treatment on quality of life of patients with allergic rhinitis at the University Hospital of Puebla]. / Impacto del tratamiento alergológico integral en la calidad de vida de los pacientes con rinitis alérgica del Hospital Universitario de Puebla.

BACKGROUND: In order to determine the impact of allergic rhinitis on the quality of life of the patients, standardized and validated questionnaires have been developed. The quality of life is the perception of the patient of the functional effects of his illness and its therapeutics consequences. OBJECTIVE: To determine the modification of index the quality of life on the patients with allergic rhinitis attended at the external consultation of the service of allergy and clinical immunology of the Hospital Universitario de Puebla when they were submitted to integral allergologic treatment. PATIENTS AND METHODS: It was carried out a longitudinal, prospective, experimental and prolective study in patients of both sexes, older than 18 years with diagnosis of allergic rhinitis, a validated and standardized questionnaire was applied to assess the quality of life index every 14 days during 6 months. It was measured severity degree at the beginning and the end of the study. It was assessed the sample size considering a reasonable size of the effect 1 and a variability of 0.8 for usual techniques. The severity degree was compared with RIDIT analysis and the mean with variance, a value of p smaller than 0.05 was considered significant. RESULTS: Sixteen patients were included, 75% were women. The average age was 34.2 years old. When the severity degrees were compared it was an average RIDIT of 0.014 with a "z" of -5.0 that implicated a value of p < 0.001. The comparison among the initial quality of life and the subsequently visits mean was significantly different since third visit. CONCLUSION: The integral allergologic treatment modifies the quality of life and the severity degree in the patients with allergic rhinitis.

[Prevalence of seropositividad to antibodies IgG and IgM against Helicobacter pylori in the medical residents of the University Hospital of Puebla]. / Prevalencia de seropositividad a anticuerpos IgG e IgM contra Helicobacter pylori en el personal médico residente del Hospital Universitario de Puebla.

BACKGROUND: Helicobacter pylori is a gram-negative, curved, microaerophilic, oxidase, catalase and urease positive bacillus. It lives in the gastric mucosa, and is the main etiological agent of peptic ulcer, and of atrophic and multifocal gastritis. It is associated with extraintestinal, vascular, autoimmune and cutaneous diseases. The infection by this bacteria causes a chronic inflammatory process related with the sensibilization of mast cells, which increases the incidence of allergic diseases. OBJECTIVE: To estimate the seropositivity prevalence of IgG and IgM antibodies against Helicobacter pylori in medical resident personnel. PATIENTS AND METHOD: A transversal, descriptive and observational study was carried out in medical residents of the Hospital Universitario de Puebla. Serum levels of IgG and IgM antibodies against Helicobacter pylori were determined by chemiluminescence. Data were analyzed applying descriptive statistics, such as: frequency, central tendency and dispersion measures. RESULTS: 57 residents were included, 54.4% were men. The mean age was 28.4 (SD 2.9). Seropositivity prevalence of IgG and IgM antibodies was 24.6 and 33.3%, respectively. Combined seropositivity prevalence of IgG and IgM was of 43.9%. CONCLUSION: Seropositivity prevalence of IgG and IgM antibodies against Helicobacter pylori in the medical resident personnel of the Hospital Universitario de Puebla was similar to the reported in the general population. This estimation might be considered a reference to other epidemiological and clinical studies such as those pretending to evaluate and demonstrate the relationship between infection by Helicobacter pylori and other entities, even allergies.

[Frequency of Helicobacter pylori infection in patients with chronic urticaria of Puebla University Hospital]. / Frecuencia de infección por Helicobacter pylori en pacientes con urticaria crónica del Hospital Universitario de Puebla.

BACKGROUND: Chronic urticaria may be continuous or recurrent according to its form of appearance. Within the diseases associated to chronic urticaria there are mycosis, parasitism and bacterial infections where Helicobacter pylori stands out. This has been related to the allergic diseases promoting a Th2 response. OBJECTIVE: To determine the frequency of infection caused by Helicobacter pylori in patients with chronic urticaria of the allergic and clinical immunology service of the Puebla University Hospital. PATIENTS AND METHODS: A descriptive, cross-sectional, prolective and observational study was made in adult patients, between 18 and 60 years old, with diagnosis of chronic urticaria. Inhalated and food skin prick test were made to all the patients. The infection by Helicobacter pylori was documented by serology, fecal antigen, endoscopy with fast test of urease and histological study. Descriptive statistics was implemented such as frequency, percentage, central tendency and dispersion measures. RESULTS: 30 patients were included; 83.3% were women. The average age was 37.8 years (SD 13.2). The most frequent type of chronic urticaria was the persistent one, representing 56.7%. The frequency of positivism of IgG antibodies against Helicobacter pylori represented the 60.0%, for IgM 33.3% and for fecal antigen 60.0%, the combined IgG, IgM, fecal antigen, fast test of ureasa and histological study was of 83%. CONCLUSION: The high frequency of infection caused by Helicobacter pylori in the patient with chronic urticaria suggests a possible role in its etiopathogeny, extending the therapeutic possibilities.

[Impact of integrated asthma treatment on the patients' quality of life]. / Impacto del tratamiento integral del asma sobre la calidad de vida de los pacientes.

BACKGROUND: Patient's perception about the effect of disease's manifestations on daily activities is called health-related quality of life, and it is used to evaluate the individual response to treatment. At present, there are some questionnaires designed to evaluate it. OBJECTIVE: To evaluate the effect of integral treatment dosage on quality of life in asthmatic adults. MATERIAL AND METHODS: A prospective, longitudinal and experimental study was made. We included male and female adult patients, with allergic asthma. A standardized questionnaire of quality of life was applied to all of them in every visit, for eight times. The integral treatment was based on Global Initiative for Asthma judgments. RESULTS: Ten patients were included, 70% of them were women. The media age was 37.4 +/- 15.73 years old. The asthma was diagnosed as intermittent in 10% cases, mild persistent in 20%, moderate persistent in 20% and severe persistent in 50% patients. The group of age most frequently affected was that of 20 to 30 years old. The media index of quality of life was 2.43 +/- 0.91 at the first visit and it was 5.73 +/- 1.11 at eighth visit. It was found a significant difference. CONCLUSION: Integral treatment improves quality of life in asthmatic adults.

[Impact of integral allergic treatment in the quality life of patients with allergic rhinitis]. / Impacto del tratamiento alergológico integral en la calidad de vida de pacientes con rinitis alérgica.

BACKGROUND: The quality of life is the perception of a patient about functional effects of his illness and therapy. Recently, appropriate instruments were devised to evaluate the health related with the quality of life, as the standardized and validated questionnaires for rhino-conjunctivitis. OBJECTIVE: To determine the impact of integral allergological treatment upon the quality of life of patients with allergic rhinitis that were attended as outpatients at the Service of Allergy and Clinical Immunology of Hospital Universitario de Puebla. MATERIAL AND METHODS: It was carried out a longitudinal, prospective, experimental and prolective study in patients of both sexes, older than 18 years old, with diagnosis of allergic rhinitis; life quality was evaluated by means of the application of a validated and standardized questionnaire every 15 days during 4 months. After being included in the study, patients received the integral allergological treatment conformed by educational measures, environmental control, pharmacotherapy and specific immunotherapy. We determined frequency for qualitative variables and average for quantitative variables. The averages were compared by means of variance analysis. The significance value was established down in 0.05. RESULTS: Thirteen patients were included, 61.5% of them were male. The average age was 33.2 (SD 17.0). There was a significative difference in quality of life index when patient was included in comparison with the indexes in subsequent visits. The most frequent allergic rhinitis was the moderate-severe persistent type, with a 76.9% rate. CONCLUSION: Integral allergological treatment improves quality of life of patients with allergic rhinitis.